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).
Dyson-Hudson and colleagues conducted two RCTs (2001; 2007) examining the effect of a 10 treatment, 5 week program of manually stimulated acupuncture on shoulder pain compared to two different control interventions. In the first study, Dyson-Hudson et al. (2001),compared acupuncture treatment to Trager Psychosocial Integration performed by a certified Trager practitioner. Trager therapy is a form of bodywork and movement re-education designed to induce relaxation and encourage the patient to identify and correct painful patterns. It was hypothesized that chronically contracted muscles shortened by stress led to pain (Dyson-Hudson et al. 2001). There was a significant effect over time for both treatments in reducing shoulder pain but there was no difference between the two groups. The second RCT, (Dyson-Hudson et al. 2007) examined acupuncture against sham acupuncture (i.e. minimal depth needle insertion at nonspecific anatomic sites). The results suggested that acupuncture was no more effective than sham acupuncture for the treatment of shoulder pain post SCI and/or that there may be a significant placebo effect associated with these interventions.
An RCT by Yeh et al. (2010) found that patients that received acupoint electrical stimulation showed significant improvement in pain intensity and average pain compared to those that received sham acupoint electrical stimulation treatment or no treatment (p<0.01). Improvement in impact of pain on sleep was also reported in the acupoint electrical stimulation group compared to the other two groups (p<0.05).
In a prospective controlled trial, participants in the acupuncture group reported significant reduction in worst pain intensity and pain unpleasantness compared to those in the massage group at 2 month follow-up. No significant difference was seen between the two groups on pain intensity based on the VAS scale (Norrbrink & Lundeberg 2011).
Nayak et al. (2001)administered 15 acupuncture treatments over a 7.5-week period of time. Pain intensity decreased from pre-treatment to post-treatment with post-treatment decline in pain intensity being maintained at 3 month follow-up. Despite these results, 54.5% of those treated reported a worsening of pain after treatment.Those that reported pain below their injury did not respond to treatment (p<0.05). Those who reported pain relief at 3 month follow-up reported only moderate levels of pain intensity at the beginning of the study compared to those who did not report pain relief at follow-up (p<0.01). With the overall reduction in pain intensity there were also a decrease in pain interference with ADLs and an improvement in overall well-being. The authors felt that 50% of patients demonstrated improvement in their pain with acupuncture.
Rapson et al. (2003)asked patients to rate their pain intensity according to a visual analogue scale after electroacupuncture treatments. Sixty-seven percent (24/36) of patients reported improvement, with improvement best for those with bilateral symmetric constant burning pain.
Banerjee (1974) reported on five patients who developed burning, distressing pain below the level of SCI and who responded to transcutaneous electrical nerve stimulation (TENS) strong enough to lead to muscle contraction below the level of injury. The exact mechanism of action for this analgesic response was not delineated.
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.