Chronic Pain FAQ

By far, lower back pain is the most common chronic pain condition in the U.S., and it is the single leading cause of disability worldwide according to the WHO. By far, the most common diagnosis for this condition is “non-specific lower back pain,” representing 90% of all cases. Non-specific means that doctors cannot identify a specific disease or structural problem to explain the pain. Without a known cause, most doctors have limited treatment options to manage the pain.

A 2022 review of studies evaluated the effectiveness of acupuncture in combination with standard treatments to treat non-specific lower back pain. In this analysis, it was shown that patients who received acupuncture treatment along with standard care, reported both significantly lower levels of pain and improved ability to physically function compared to standard care alone.

The evidence that acupuncture can be an effective treatment for chronic lower back pain is so widely accepted now, that in January 2020, the Centers for Medicare and Medicaid Services changed course and began covering acupuncture as an accepted treatment option for chronic lower back pain that lasts longer than 12 weeks. This is a first for CMS and will likely herald the coverage of acupuncture for a wider range of chronic health conditions based on both clinical- and cost-effectiveness.

Neck and upper back pain is common, second only to lower back pain as reported by U.S. adults. It can have many causes including muscle strain due to poor posture (think of hunching over your computer or smartphone), arthritis, disc degeneration, nerve compression, and whiplash injuries.

One study, reported by the Academy of American Family Physicians, examined acupuncture compared to massage in the treatment of chronic neck pain. In the study, it was reported that patients who recieved acupuncture treatment had the greatest reduction in pain at the end of the study and that acupuncture also produced improvements in range of motion and quality of life. It was also shown that these effects were greatest in patients suffering pain for more than 5 years.

Osteoarthritis is the most common form of arthritis, affecting millions of people in the U.S. It occurs when the protective cartilage that covers the ends of the bones wears over time. Although it can affect any joint, it is mostly common in the hands, knees, hips, and spine. Unfortunately the damage to the joints cannot be reversed, but it is possible to manage the condition and reduce pain.

A 2022 review of studies concluded that acupuncture had significant effect in reducing pain due to knee osteoarthritis and improve patients ability to perform both work and daily activities. It was concluded that acupuncture can be recommended as a beneficial therapy for patients that suffer from chronic pain due to osteoarthritis and could help them increase their quality of life.

A migraine is more than just a bad headache. It is a common neurological disease that involves changes to the vascular system that affect the brain’s neurological centers. Characterized by severe throbbing pain, it is also common to have other neurological symptoms such as visual disturbances, numbness or tingling in the face, ringing in the ears, dizziness, or changes to smell or taste.

Typically, migraines happen in 4 phases:

1. Prodrome—This happens before the onset of pain and may include:
   • Poor concentration
   • Emotional changes
   • Nausea
   • Fatigue
   • Sensitivity to light and sound
   • Increased urination
   • Muscle pain

2. Aura—This is the increase of sensory neurological symptoms:
   • Visual disturbances
   • Numbness or tingling
   • Ringing in the ears
   • Dizziness
   • Changes in smell or taste

3. Headache—The pain may last for 4 hours up to 3 days or more:
   • Painful sensitivity to light, sound, or odors
   • Nausea/Vomiting
   • Feeling hot or cold
   • Fatigue
   • Dizziness
   • Loss of vision
   • Diarrhea

4. Postdrome—Often called migraine hangover:
   • Unable to concentrate
   • Depression
   • Fatigue
   • Confusion

In a 2020 review of studies examining the effect of acupuncture compared to commonly used medications showed that acupuncture was more effective in reducing the frequency of migraine attacks, pain scores, had fewer adverse reactions, and improved intracranial blood flow significantly better than medications.

Fibromyalgia is a chronic disorder with widespread musculoskeletal pain that often occurs with fatigue, sleep, memory, and mood issues. Although the cause is currently unknown, new research points to the way the brain processes pain and non-pain signals, becoming overly sensitized to these signals.

Women are much more likely to develop fibromyalgia than men, and the risk factors including family history and other chronic pain conditions such as osteoarthritis, rheumatoid arthritis, or lupus.

The primary symptoms of fibromyalgia include:
• Widespread pain—Constant dull achy pain that has lasted for at least three months and occurs on both sides of the body.
• Fatigue—Sleep is often disturbed by pain leaving people feeling fatigued even after a full night’s sleep.
• Cognitive difficulties—Impairment in the ability to focus, pay attention, or concentrate mentally.

Fibromyalgia can be a complex syndrome that often presents with other conditions such as:
• Irritable bowel syndrome
• Migraine headaches
• Bladder infections
• Jaw pain
• Anxiety and Depression

Fibromyalgia is a difficult condition to treat and requires a multidisciplinary approach to achieve the best results for patients. In a 2013 systematic review of studies, published by Cochrane Reviews, it was concluded that while there was evidence of acupuncture in improving pain and physical functioning in people with fibromyalgia, the best results were obtained when electroacupuncture was used in conjunction with exercise and medication.

After surgery, the body forms scar tissue at the incision site as a natural response to the damage. To close the surgical wound, the body lays down dense collagen fibers in a single direction rather than in the multidirectional pattern of healthy tissues. While this single direction pattern is stronger to hold the wound closed, it makes scar tissue less elastic than the surrounding healthy tissues. This may may cause feelings of tightness or restrict normal range of motion.

Scar tissue can cause pain for a few different reasons.

1. Loss of Elasticity—Restrictions in the tissue’s elasticity can cause these tissues to be over-stretched with normal movements, causing sharp, tearing pain. This pain can limit normal activities such as exercise or physical work, adversely affecting a person’s quality of life.

2. Nerve Damage—Sometimes nerves are damaged at the incision site, which can cause long-term pain or localized numbness.

3. Fibrosis—This occurs when the body produces too much scar tissue, causing adhesions between muscles, tendons, nerves, and joints. These adhesion can lead to chronic pain, inflammation, and loss of function of the tissue or joint.

Your spine is made of many stacked bones called vertebrae and the spinal cord run through a canal in the center of these bones. Between every vertebrae, a pair of nerves split from the cord and travel to areas of the body to transmit commands from the brain and receive signals from the tissues. When these nerves exit the spine, they pass through small openings in the bones, called foramen. It is here that the nerves may become compressed, causing inflammation and pain. The compression may be due to narrowing of the bony passageway, called stenosis, bone spurs, disc herniation, or disc degeneration.

Symptoms of nerve root compression, called radiculopathy, can include localized sharp, stabbing pain, electrical or shooting sensations, numbness and tingling into the legs, feet, arms, and hands, or muscular weakness and atrophy. Depending on the cause of the compression, most of the time, the pain, numbness, and weakness will not resolve on their own without medical intervention.

Acupuncture has been shown to be very effective in reducing pain from nerve root compression. In a 2022 review of studies, published by Journal of Orthopedic Surgery and Research, it was noted that often physical therapy was not sufficient to improve chronic pain and disability from nerve compression and the risks of addiction from long-term opioid use warranted the investigation of additional therapies. In a review of 44 random control trials of the effectiveness of acupuncture, it was shown that acupuncture demonstrated significant reduction in pain scores, so much so, that the authors of the review supported new guidelines which recommend acupuncture as a first-line, non-pharmacological management for lower back pain.

In some instances, the pain from nerve root compression cannot be relieved with non-invasive treatments and surgical intervention is necessary to relieve the compression to reduce pain and regain normal function. In a review of studies published in the journal, Medicine, in 2022, it was shown that acupuncture was significantly better than both narcotic pain medications and rehabilitation exercises in reducing post-operative pain. It was noted that acupuncture reduced local inflammatory mediators that cause pain and inhibited pain receptors in the brain to produce pain-relieving effects. In addition, acupuncture can improve blood circulation and oxygen supply at the site of the nerve damage, promoting recovery.

Peripheral neuropathy is an umbrella term for nerve diseases that affect the nerves running from the spinal cord to the body’s tissues. Because it can affect any of the nerves of the body, there are a wide range of symptoms:

• Motor symptoms—muscle weakness and atrophy, paralysis, spasms
• Sensory symptoms—Pain, tingling, numbness, imbalance, and clumsiness
• Autonomic symptoms—Blood pressure issues, sweating, bowel and bladder issues, and sexual dysfunction

There are many different conditions that can cause peripheral neuropathy, some of the most common are:

• Diabetes
• Autoimmune Diseases—Lupus, rheumatoid arthritis, Guillain-Barre
• Chemotherapy
• Infections—Lyme disease, shingles, HIV
• Vascular disorders

Peripheral neuropathy can be a difficult condition to treat, with most treatment plans consisting of a range of modalities. Acupuncture is a safe and effective part of an overall treatment plan. In a 2023 review of random controlled trials, published in Frontiers, demonstrated that acupuncture reduced pain intensity scores for participants with neuropathic pain in 16 studies.

Endometriosis is a condition where tissue similar to the uterine lining grows outside of the uterus, which is often very painful. It can affect the ovaries, fallopian tubes, and tissues lining the pelvis. Endometriosis tissue acts just like the lining of the uterus—it thickens, breaks down, and bleeds with each menstrual cycle. Because it grows deep in the abdomen and cannot leave the body, it can lead to the formation of cysts, scar tissue, and fibrous adhesions, causing the pelvic organs to stick together. This causes pain and may lead to fertility problems.

The symptoms of endometriosis include:

• Painful periods
• Pain with sex
• Pain with bowel movements or urination
• Excessive bleeding—Heavy periods or bleeding between periods
• Infertility
• Other symptoms—Fatigue, diarrhea, constipation, and nausea that are more common during menstruation

For many people who see their doctor because of the pain, endometriosis may be confused for other conditions that cause pelvic pain—like pelvic inflammatory disease, ovarian cysts, or irritable bowel syndrome. For some, the pain may be ignored and attributed to normal menstrual cramping.

Acupuncture and Chinese Medicine has a long history of considering the special nature women’s health and has developed many effective treatment protocols. In a 2023 review of studies, published in Integrative Medicine Research, acupuncture demonstrated a greater reduction in pelvic pain when compared both to no treatment and to standard care offered by conventional medicine. The authors of the study went on to recommend acupuncture as a treatment intervention for endometriosis.

Period pain, called dysmenorrhea, happens when the uterus contracts to shed its lining. For many, the pain begins just before the start of the period and may last for a few days. Primary dysmenorrhea refers to cramping pain with no known cause, while secondary dysmenorrhea is the result of known conditions, such as endometriosis.

Symptoms include:

• Cramping pain—felt in lower abdomen, lower back, or legs
• Abdominal distention and pressure
• Nausea
• Fatigue
• Diarrhea
• Anxiety and Depression—some people, when faced with chronic pain will begin to experience anxiety and depression when they cannot find adequate treatment

While conventional medicine considers mild to moderate cramping pain to be normal, Chinese medicine and acupuncture considers this pain to be a sign of a primary imbalance in the body and offers treatment options to not only relieve the current pain, but to keep the pain from returning month after month. For some, the pain can be so severe that they may be absent from work or school a few days every month, representing a serious disability.

Chinese medicine and acupuncture have a long history of recognizing the specialized health concerns that face women and have established treatment protocols that effectively treat many common health complaints. An analysis of 13 random controlled trials, published in 2022 in Clinical Nursing Research, investigated the effect of acupuncture to manage period pain. It was shown that acupuncture was significantly beneficial in reducing period pain and, in addition, there were fewer adverse effects as compared to standard care, such as NSAIDs, which included stomach upset and pain.

Trigeminal neuralgia causes sudden, severe pain on one side of the face. The trigeminal nerve, which travels from the brain to the face, can become inflamed due to compression by overly tense muscles, bones, blood vessels, or because of infection. As implied by the name, the trigeminal nerve has three branches that supply the forehead, the area around the eyes, and the jaw. Trigeminal neuralgia can severely impact the quality of life of those people affected by it.

The pain is often triggered by touching the face, chewing, or brushing your teeth. The symptoms include:

• Shooting, electric pain
• Facial spasms
• Single-side face pain
• Brief episodes or chronic pain lasting months or more
• Pain increases in intensity over time

Acupuncture has long been recognized for its ability to reduce pain in difficult-to-treat conditions. In an analysis of 58 random controlled trials, published in Evidence-Based Complementary and Alternative Medicine in 2022, the efficacy and safety of acupuncture to reduce pain in trigeminal neuralgia was investigated. It was found that acupuncture, especially electroacupuncture, was significantly effective in reducing pain intensity in trigeminal neuralgia and also showed a low incidence adverse effects. The study also stated that acupuncture was superior to standard care (the medication carbamazepine, an anti-convulsant with a long list of serious adverse effects) in pain reduction intensity and response rate.

Shingles is a painful blistered rash that is caused by a lingering infection by the virus, varicella-zoster, which causes chicken pox. Once you’ve had chicken pox, the virus stays in your body for the rest of your life—it can be reactivated at any time as shingles. The rash develops along the course of a peripheral nerve and is characterized by a painful stripe of blisters along one side of the body or face. It is common for shingles to develop into postherpetic neuralgia (PHN), a chronic pain condition that persists long after your rash has cleared.

IMPORTANT: If the rash develops near the eyes, it is essential to see your primary care doctor immediately, as this can possibly lead to permanent eye damage.

The standard care for the treatment of postherpetic neuralgia is tricyclic antidepressants (amitriptyline and nortriptyline), gabapentin, pregabalin, and opioids. Because tricyclic antidepressants have cardiovascular and renal adverse effects and opioids are now recognized for their high addiction potential, non-pharmacological treatments for PHN have long been sought after. A review of 8 studies on the effectiveness of acupuncture to reduce pain in people with PHN compared to pharmacological treatment was published in Journal of Pain Research in 2019. The analysis examined the effect of acupuncture to reduce pain, reduce anxiety (common in PHN), and incidence of adverse effects compare to the medications indomethacin, lofen, carbamazepine, and pregabalin. It was demonstrated that acupuncture reduced pain intensity, relieved anxiety, improved quality of life more than the pharmaceuticals while simultaneously recording no adverse effects during the trials.

Frozen shoulder, also called adhesive capsulitis, causes pain and stiffness in the shoulder—overtime the shoulder may become very hard to move, becoming “frozen.” Frozen shoulder is most common in people between the ages of 40–60, more often in women than men, and people with diabetes are at an increased risk for developing the condition.

Rotator Cuff Impingement, is caused by inflammation of the rotator cuff tendons due to rubbing of the tendons between the bones of the upper arm and shoulder blade, often from heavy lifting or overhead work. As the tendons become irritated, they further swell, reducing the space between the bones, leading to increased rubbing—a vicious circle of pain and loss of movement.

Both conditions, due to inflammation of the tendons and connective tissue of the shoulder, are the most common forms of shoulder pain, and are a leading cause of disability. When they become chronic, they can represent a significant loss to the quality of life for those that are affected by the inability to fully use one of their arms.

Standard care can include cortisone injections into the shoulder joint to reduce inflammation. However, care should be taken before proceeding with this treatment. Cortisone is known to both reduce the body’s ability to absorb calcium and to increase how fast bone is broken down in the body. Cortisone treatment is the most common cause of secondary osteoporosis and the primary cause in young people. Acupuncture, an all-natural and safe treatment option for shoulder pain is effective in reducing pain without any serious adverse effects.

An analysis of 13 publications published in Evidence-Based Complementary and Alternative Medicine in 2020, investigated the effect of acupuncture on frozen shoulder in the categories of pain reduction, shoulder function, and shoulder range of motion. Regarding pain, this analysis concluded that acupuncture demonstrated a greater reduction in pain when compared to the standard care modalities of physical therapy and extracorporeal shockwave therapy (ESWT), both at the time of treatment and at a 3-month follow-up after the end of treatment.

With regards to shoulder function, acupuncture again demonstrated significantly greater effect in improving shoulder function when compared to physical therapy and ESWT.

For shoulder ROM, acupuncture did shown significant improvements to range of motion of the shoulder, but performed equally as well as physical therapy.