Even four years after her car accident, 60-year-old Fran Zierler lived with devastating shoulder and neck pain.
"It felt like an ice pick was pounding in my arm 100 times a day," she recalled. "I had very little use of my left arm for anything. I couldn't carry [anything]."
She had tried physical therapy, chiropractic medicine, and usual pain management, including multiple shots of steroids into her spine -- none of which provided relief. She was even scheduled to have spine surgery to improve her pain, but three days before her surgery, her insurance pulled coverage, and her operation was cancelled.
Little did she know that this may have been a blessing in disguise.
In January 2009 she was referred to Dr. Jun Mao, a licensed physician and acupuncturist at the University of Pennsylvania.
"The only thing I had not tried was acupuncture," Zierler said.
Now, a new review of research suggests that this ancient technique may truly hold benefits for those suffering from certain forms of chronic pain.
In a review of 29 previous well-designed studies, which together looked at almost 18,000 patients, researchers at Memorial Sloan-Kettering Cancer Center found that acupuncture does, indeed, work for treating four chronic pain conditions: back and neck pain, osteoarthritis, chronic headache and shoulder pain.
Even "placebo" acupuncture, where the practitioner only pretends to place the needle or places the needle in a random site, is effective at relieving pain, though true acupuncture works better.
The review was published Monday in the Archives of Internal Medicine.
In the analysis, the researchers determined that 50 percent of true acupuncture patients experienced pain relief -- in other words, pain levels that were cut in half. Only 42 percent of sham acupuncture patients and 30 percent of patients who had no acupuncture at all experienced similar pain relief.
The researchers said it is better and more precise than previous reviews because of the high quality standard that was required by the study authors.
"In general, we were interested in acupuncture because clearly it's very controversial," said Dr. Andrew Vickers, the primary author of the study. "It comes from and involves ideas that aren't found in conventional books of anatomy and physiology."
Complementary and alternative medicine, including acupuncture, has long been a controversial topic in medicine. About 3 million Americans undergo acupuncture, mostly for chronic pain. Even so, given the lack of good evidence, many patients were not referred for acupuncture.
"There is now a solid evidence base for referring patients for acupuncture," Vickers added.
And Mao, who treated Zierler with the technique, said that aside from therapeutic gains, the technique can be empowering for some as well.
"I think [acupuncture] can help patients regain some sense of control in managing their own illness, help them relax and shift focus away from their pain," Mao said.
Critics maintain, however, that the clinical relevance of this study is unclear and that most of acupuncture may very well be just a "placebo" effect.
They also note that acupuncture can be very painful and can have serious risks, such as infection or puncturing a lung -- though these occur rarely.
"The problem with acupuncture is that it doesn't last very long; it's like taking a pill," said Dr. Joshua Prager, a board-certified pain specialist at UCLA. "I do see it as something worth trying, but it only works in a small percentage of my patients."
Dr. Doris Cope, director of pain medicine at University of Pittsburgh Medical Center, agrees that "by itself it rarely, in my patients, is 100 percent effective or long-lasting, requires multiple visits and time commitment and often patients find lack of insurance coverage as a practical barrier."
Additionally, Medicaid and Medicare often do not cover therapies such as acupuncture, so patients may end up having to pay out-of-pocket.
"Overall, [this review] is still far from being the final word," said Dr. Brent Bauer from the Mayo Clinic.
Still, the researchers do not advocate for replacing mainstream pain management with acupuncture, but instead stress that it should be used in conjunction with other therapies.
And for some like Fran Zierler, whose unbearable pain lasted for years before she started acupuncture, adding this therapy might make a big difference.
"[It was] a miracle," Zierler said. "An absolute miracle."
- Alternative Medicine
- chronic pain