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Acupuncture

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Acupuncture is a component of traditional Chinese medicine that has been used for the treatment of pain for thousands of years and is based on the premise that illness arises from the imbalance of energy flow (Qi) through the body (Dyson-Hudson et al. 2001). Needle acupuncture involves inserting fine needles into specific points to correct these imbalances (Dyson-Hudson et al. 2001; NIH Consensus Conference 1998; Pomeran 1998; Wong & Rapson 1999). Acupuncture has been shown to activate type II and type III muscle afferent nerves or A delta fibers, blocking the pain gate by stimulating large sensory neurons as well as releasing endogenous opioids, neurotransmitters and neurohormones (Dyson-Hudson et al. 2001; Pomeran 1998; Wong & Rapson 1999).

Table 8: Acupuncture in Post-SCI Pain

Evidence from the studies above suggests acupuncture results in significant decrease in pain intensity over time (Dyson-Hudson et al. 2007; Dyson-Hudson 2001; Nayak 2001; Norrbrink 2011). However, no group differences were found between acupuncture and sham treatment (Dyson-Hudson 2007) or Tager Psychophysical Integration (Dyson-Hudson 2001). True acupoint was significantly more effective in reducing pain intensity compared to sham or no acupoint (Yeh et al. 2010). Electroacupunture was also shown to improve symmetric bilateral burning pain post intervention (Rapson et al. 2003). Norrbrink et al. (2011) found that acupuncture improved worst pain intensity but not average pain intensity when compared to a massage intervention.

Conclusion

There is level 1a evidence (from two randomized controlled trials; Dyson-Hudson et al. 2001, 2007) that in general acupuncture is no more effective than Trager therapy or sham acupuncture in reducing nociceptive musculoskeletal shoulder pain post SCI.

There is level 1b evidence (from one randomized controlled trial; Yeh et al. 2010) that acupuncture and electroacupuncture reduces neuropathic pain of patients with SCI.

  • Acupuncture may reduce post-SCI neuropathic and musculoskeletal pain.

    Electrostimulation acupuncture is effective in improving neuropathic pain in SCI pain.