acupuncture and postoperative pain

Medical Research - Pain
A new highly reliable instrument for the assessment of pre- and postoperative gynecological pain.
Stener-Victorin E, Kowalski J, Lundeberg T.
Department of Obstetrics and Gynecology, Goteborg University, SE-413 45 Goteborg, Sweden.

In this study, we evaluated the reliability of a newly developed method for pain assessment, which is based on perceptual matching by Pain Matcher, Cefar Medical AB, Lund, Sweden, during minor gynecological surgery. In addition, the responsiveness to two different anesthetic methods-electro-acupuncture or a fast-acting opiate, alfentanil, both in combination with a paracervical block-was estimated by using Pain Matcher and visual analog scale (VAS) assessments before and 2 h after surgery. Two hundred-twenty-three women (aged 22-38 yr) participated.

The results show that Pain Matcher is a reliable method for pain assessments, with lack of random individual disagreement and with no statistical evidence of systematic disagreement in position or in concentration. The augmented rank-order coefficient (r(a)) values were excellent (0.95-1.00). When scales were used to detect true changes over time, there was no clear indication of responsiveness, mostly because of statistically significant random individual changes. However, the individual changes were much smaller for magnitude matching than for VAS.

In conclusion, we would recommend the use of perceptual matching by Pain Matcher for pain assessment, because in this study it was a reliable and powerful in test-retest situations and had smaller individual changes than VAS after intervention. The Pain Matcher procedure was well accepted by the patients, and the results suggest that it may be useful when evaluating acute pre- and postoperative pain.

IMPLICATIONS: We evaluated a new instrument for pain assessment. Our results show that this method is highly reliable, is well tolerated by the patients, is reported to be easy to use, and may be useful when evaluating acute pre- and postoperative pain.



Acupuncture for patients with chronic neck pain.
Witt CM, Jena S, Brinkhaus B, Liecker B, Wegscheider K, Willich SN.
Institute of Social Medicine, Epidemiology, and Health Economics, Charite University Medical Center, Berlin, Germany.

Acupuncture is widely used by patients with neck pain, but there is a lack of information about its effectiveness in routine medical care. To investigate the effectiveness of acupuncture in addition to routine care in patients with chronic neck pain compared to treatment with routine care alone. Randomized controlled multicentre trial plus non-randomized cohort.

General Practices in Germany. 14,161 patients with chronic neck pain (duration >6 months). Patients were randomly allocated to an acupuncture group or a control group receiving no acupuncture. Patients in the acupuncture group received up to 15 acupuncture sessions over three months. Patients who did not consent to randomization received acupuncture treatment. All subjects were allowed to receive usual medical care in addition to study treatment.

Neck pain and disability (NPAD Scale by Wheeler) after three months. Of 14,161 patients (mean age 50.9+/-13.1 years, 68% female) 1880 were randomized to acupuncture and 1886 to control, and 10,395 included into the non-randomized acupuncture group. At three months, neck pain and disability improved by 16.2 (SE: 0.4) to 38.3 (SE: 0.4); and by 3.9 (SE: 0.4) to 50.5 (SE: 0.4), difference 12.3 (p<0.001) in the acupuncture and control group, respectively. Treatment success was essentially maintained through six months. Non-randomized patients had more severe symptoms at baseline and showed higher neck pain and disability improvement compared to randomized patients. Treatment with acupuncture added to routine care in patients with chronic neck pain was associated with improvements in neck pain and disability compared to treatment with routine care alone.



Adolescent endometriosis-related pelvic pain treated with acupuncture: two case reports.
Highfield ES, Laufer MR, Schnyer RN, Kerr CE, Thomas P, Wayne PM.
Integrative Therapies Team, Center for Families, Children's Hospital, Boston, MA 02215, USA.

BACKGROUND: Chronic pelvic pain in adolescents accounts for 10% of outpatient gynecology visits, and 70% of adolescent patients whose pelvic pain is unresponsive to initial therapy have endometriosis. To date, there has been no published research investigating the use of acupuncture for adolescents with chronic pelvic pain and/or endometriosis.

METHODS: This paper presents two case reports describing the impact of a course of acupuncture on adolescent girls with endometriosis-related chronic pelvic pain of more than 1 year.

RESULTS: Both patients, undergoing between 9 and 15 treatments over a 7- to 12-week period, experienced modest improvement in pain as measured by oral self-reports of pain on a scale from 1 to 10, as well as self or family-reported improvement in headaches, nausea and fatigue. No adverse effects were reported.

CONCLUSIONS: These case reports provide preliminary evidence that acupuncture may be an acceptable and safe adjunct treatment therapy for some adolescents with endometriosis-related pelvic pain refractory to standard antiendometriosis therapies. These observations suggest that a prospective, randomized controlled trial of the safety and efficacy of acupuncture for this population may be warranted.



Performance of acupuncture as labor analgesia in the clinical setting.
Nesheim BI, Kinge R.
Department of Obstetrics, Ullevaal University Hospital, University of Oslo, Norway.

BACKGROUND: Three randomized controlled trials have shown that acupuncture during labor can reduce the use of epidural analgesia and meperidine. To supplement these trials, we have designed an observational study to answer the research question: "Do laboring women in a normal hospital setting who receive acupuncture require less epidural analgesia than those who do not receive acupuncture?"

METHODS: Setting: Delivery ward of a tertiary care University hospital in Norway. Subjects: All attempted vaginal labors during the period 01.12.99-31.12.03 (n = 17,741). Statistical analysis: Multivariate logistic regression analysis.

RESULTS: The dependent variable in the regression analysis was use of epidural analgesia. The independent variables were: use of acupuncture, use of nitrous oxide, use of meperidine, parity, ethnicity, age, duration of pregnancy, type of labor (induced or not), and duration of first stage of labor. In the multivariate analysis the odds ratio for having an epidural was 0.6 (95% CI 0.5-0.7) for the patients having acupuncture compared to those not having acupuncture.

CONCLUSIONS: Women having acupuncture as labor analgesia in the clinical setting have a reduced use of epidural analgesia.

Decrease of pregnant women's pelvic pain after acupuncture: a randomized controlled single-blind study.
Lund I, Lundeberg T, Lonnberg L, Svensson E.
Department of Physiology and Pharmacology, Karolinska Institutet, SE-171 77 Stockholm, Sweden.

BACKGROUND: The efficacy of acupuncture on low-back and/or pelvic pain in late pregnancy is reviewed in few reports. Our aim was to evaluate the effects of two different acupuncture stimulation modes on pelvic pain intensity and some emotional symptoms due to the pain condition.

METHODS: In a prospective randomized controlled single-blind study, pregnant women with pelvic pain, median gestational age 26 weeks (range 18-35), were given 10 acupuncture treatments. Needles were inserted subcutaneously over acupuncture points without further stimulation (superficial, n=22), or intramuscular and stimulated repeatedly until a perceived sensation of numbness, de qi, (deep, n=25). Self-reported pain intensity at rest and during daily activities was assessed on a visual analog scale. The variables pain, emotional reactions, and loss of energy were assessed according to the Nottingham Health Profile questionnaire. Changes in assessed variables were analyzed with a nonparametric statistical method allowing for analysis of systematic group changes separated from additional individual changes.

RESULTS: After acupuncture stimulation, significant systematic group changes towards lower levels of pain intensity at rest and in daily activities as well as in rated emotional reaction and loss of energy were seen. The results also showed additional individual changes in most variables. In this study, no differences between the effects induced by the superficial and deep acupuncture stimulation modes were observed.

CONCLUSION: Acupuncture stimulation that is individually designed may be a valuable treatment to ameliorate suffering in the condition of pelvic pain in late pregnancy.