Is Acupuncture More Effective Than Morphine?
For most Americans, this very controversial question that was recently answered by a remarkable new study, conducted at a large hospital’s emergency room. Researchers wanted to determine which treatment is more effective reducing significant pain in a medical setting.
The new study, recently published in the American Journal of Emergency Medicine titled, “Acupuncture vs intravenous morphine in the management of acute pain in the ED,” was conducted in Tunisia, North Africa at a large hospital’s emergency room, sought to determine which treatment is more effective reducing significant pain.
We are in the midst of an explosion of narcotic addiction, with few treatment options. The overuse of narcotics for pain relief is the leading cause of the dramatic increase in addiction experienced in the US and abroad.
Acupuncture in the US
Acupuncture is perhaps the oldest techniques to treat pain and is commonly used for a large number of conditions. The term “acupuncture” describes a family of procedures involving the stimulation of points on the body using a variety of techniques. The acupuncture technique that has been most often studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation. Practiced in China and other Asian countries for thousands of years, acupuncture is one of the key components of traditional Chinese medicine.
The treatment was initially introduced to most modern Americans to acupuncture occurred in 1972 when then President Nixon's Secretary of State, Henry A. Kissinger, traveled to China accompanied by a journalist for the New York Times. While in China the journalist, named James Reston, fell ill and ended up in a Chinese hospital requiring an emergency appendectomy. To relieve his pain doctors used acupuncture.
Intrigued and impressed with the effectiveness of his experience with acupuncture, James Reston wrote about his hospitalization and acupuncture treatment in the New York Times, exposing countless Americans for the first time to acupuncture.
Currently, millions of Americans use acupuncture each year, often for chronic pain, there has been considerable controversy surrounding its value as a therapy and whether it is anything more than placebo. Research exploring a number of possible mechanisms for acupuncture’s pain-relieving effects is ongoing.
Today it is widespread and one of the most frequently researched, “alternative and complementary” therapies.
Despite its long term use, there is no sufficient evidence to support its use in acute medical setting. This study was designed to determine its effectiveness in an emergency room setting. The study was conducted over the course of a 1-year period at the Fattouma Bourguiba University Hospital in Tunisia, a tertiary care facility with over 100,000 Emergency Department (ED) visits per year. It was a prospective, randomized trial of acupuncture vs morphine to treat ED patients with acute onset moderate to severe pain.
The primary outcome consists of the degree of pain relief with significant pain reduction defined as a pain score reduction ≥50% of its initial level. The researchers also analyzed the pain reduction time and the occurrence of short-term adverse effects. They included in the protocol 300 patients with acute pain: 150 in each group.
300 Emergency Department patients with acute pain were included in the study: 150 in the morphine group (administered up to 15 mg a day) and 150 in the acupuncture group. The two groups were very similar, in terms of age, sex, and co-morbidities, with the only significant difference being that there were more abdominal pain patients in the morphine group and more low back pain cases in the acupuncture group.
The outcomes were reported as follows:
“Success rate was significantly different between the 2 groups (92% in the acupuncture group vs 78% in the morphine group P b .01). Resolution time was 16 ± 8 minutes in the acupuncture group vs 28 ± 14 minutes in the morphine group. The difference was statistically significant. The mean absolute difference in pain score between the 2 groups was 7.7. This difference is not clinically significant because the minimal clinically significant absolute difference reported by Todd et al is 13. In morphine group, the mean total dose of morphine administered was 0.17 ± 0.08 mg/Kg.
The pain scale change from baseline at each time point in the 2 groups is shown in Figure. From the 5-minute time point, the acupuncture group reported significantly larger pain decrease compared with the morphine group. This difference persisted during the entire study period. Change of blood pressure, HR, RR, and oxygen saturation was not significant in both groups.
Overall, 89 patients (29.3%) experienced minor adverse effects: 85(56.6%) in morphine group and 4 (2.6%) in acupuncture group; the difference was significant between the 2 groups. The most frequent adverse effect was dizziness in the morphine group (42%) and needle breakage in the acupuncture group (2%). No major adverse effect was recorded during the study protocol.
Success rate was significantly different between the 2 groups (92% in the acupuncture group vs 78% in the morphine group P < .001). Resolution time was 16 ± 8 minutes in the acupuncture group vs 28 ± 14 minutes in the morphine group.
Overall, 89 patients (29.6%) experienced minor adverse effects: 85 (56.6%) in morphine group and 4 (2.6%) in acupuncture group.
No major adverse effects were recorded during the study protocol. In patients with acute pain presenting to the ED, acupuncture was associated with more effective and faster analgesia with better tolerance.
This article provides an update on one of the oldest pain relief techniques (acupuncture) that could find a central place in the management of acute care settings. This should be considered especially in today's increasingly complicated and multiple drug (polymedicated ) patients to avoid adverse drug reactions.
Acupuncture happens to be one of the most extensively supported alternative modalities, with clinical trial data supporting its value in over 100 different conditions. If you do a pubmed.gov search you'll find over 6700 studies.
NIH, National Center for Complementary and Integrative Health: https://nccih.nih.gov/health/acupuncture
Pub Med Acupuncture studies: 6,700 published studies