Page 319 Guide to Pain Management in Low-Resource Settings

Chapter 41

Th e Role of Acupuncture in Pain Management

Natalia Samoilova and Andreas Kopf

Case report Basic concepts

Mansur, aged 37, with acute back pain radiating to the Why has acupuncture become
left leg, has come to you for medical advice. He has an so popular for pain management?
acute radicular pain syndrome, without evidence of Acupuncture, as an alternative treatment for pain
any major neurological defi cit (bladder/ bowel incon- management, is becoming popular. Th e main reason
tinence, loss of sensitivity, or muscle paralysis). You ex- is growing evidence on the eff ectiveness of acupunc-
plain to Mansur that currently there is no indication ture, even though studies on effi cacy (e.g., specifi city
for surgery as long as sensation and muscle function of standard acupuncture points compared to needling
are not impaired. A conservative treatment is planned. sham points) have shown contradictory results. A low
Because of the etiology of the pain, epidural steroids rate of adverse events and a high degree of patient sat-
and systemic anticonvulsants would be the fi rst thera- isfaction are other main arguments for the growing use
peutic option, but there is no anesthesiologist trained of acupuncture in Western countries. Another reason
in epidurals, and anticonvulsants are not available. could be that the framework of traditional Chinese
Simple analgesics like diclofenac and tramadol are medicine (TCM) regards the human body as “whole,”
tried, initially, but they do not relieve the pain, and rather than a complex of individual symptoms. Th ere
Mansur comes back complaining about inability to is a strong tendency toward the biopsychosocial model
walk and sit for longer periods of time. You decide to of pain management, an idea that has become an inte-
try acupuncture. Certain acupuncture points have to gral part of modern pain management. Another reason
be chosen according to the symptoms and the underly- is that in small remote hospitals with a limited supply
ing disease: of drugs, acupuncture sometimes remains one of the
First, acupuncture points at the site of pain are few possible methods of treatment to provide pain
treated: B40 and B60, then Du-mai 26. relief. Also, acupuncture maybe a reasonable alterna-
After that painful points are chosen: B2, B24, tive in patients with contraindications to various drugs
B52, B54, B36, GB30, and GB34. Th e needles are left in or who are intolerant of side eff ects, or in situations
place for 10–20 minutes every day for a week, then ev- where drugs are not aff ordable. When used in a ratio-
ery other day for 2 weeks. Luckily, over the 3 weeks of nal way and as part of a comprehensive pain manage-
treatment, the symptoms decline, allowing Mansur al- ment program, acupuncture can be eff ective, especially
most complete range of motion and mobility. if the patient is receptive toward it. Another advantage

Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. Patel. IASP, Seattle, © 2010. No responsibility is assumed by IASP 307
for any injury and/or damage to persons or property as a matter of product liability, negligence, or from any use of any methods, products, instruction, or
ideas contained in the material herein. Because of the rapid advances in the medical sciences, the publisher recommends that there should be independent
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