London: National Institute for Health and Care Excellence (UK); 2021 Apr.
Acupuncture is one of the treatment modalities many pain sufferers seek or get in contact with whilst living with pain and seeing a variety of healthcare professionals in both publicly funded and private settings. Reasons for getting in contact with an acupuncture therapist may include the quest for alternative formulations and treatment strategies for chronic pain, the desire to have temporary or even persistent relief from pain, being dissatisfied with what has already been tried or the lack of treatments that have not been tried before.
There are wide variations in what people associate with the term “acupuncture”. From a simplistic sense, all acupuncture treatments have in common the placement of needles in various parts of the body. The depth of needle penetration ranges from just touching the skin to penetration of deeper body layers, such as bones and deep muscle tissues. In the majority of cases the needles are placed in muscle tissue close to nerve endplates. The placement of needles depends on the theoretical framework therapists apply. Therapists trained in traditional Chinese medicine operate under the assumption of optimising the flow of the vital energy “Qi” in the body. Western approaches in contrast locate their strategy in a neurobiological paradigm and have somatosensory stimulation as the concept underpinning their therapeutic strategies.
Dry needling is a concept aimed at the treatment of painful areas in striated muscle, myofascial trigger points. In this concept therapists aim to needle “as close to where it hurts without making it worse”. In contrast protagonists of traditional Chinese medicine (TCM) choose distant points in their attempts to harmonise the perceived misbalance of body functions and emotions.
Recent research demonstrated that contextual factors, such as therapeutic setting, interpersonal skills of the therapist or even the therapist themselves (“practitioner-effect”) have a significant influence on the outcome of the intervention. In the context of chronic pain, acupuncture treatments are often delivered in sequences of several sittings over time, which can facilitate building a therapeutic relationship. Acupuncture treatments offer the opportunity to treat several painful places and affected body functions at one time, which makes it an attractive option for people with many ailments and emotional components to their predicament. Acupuncture is often delivered in individually tailored one-to-one-settings, but some service providers have moved to deliver acupuncture therapy in group settings.
This review intends to determine the effectiveness of acupuncture and electroacupuncture in people with chronic pain.