By Jerry S. Y. Wang, M.D.
Chronic non-cancerous pain, also known as CNP, has been the main concern in the field of pain management. CNP has primarily been treated with pain relief medications. These are Opionoids, including Excodome, Morphine, Methodone, and a variety of Depressants. Opionoids have been very effective in pain relief. At the same time, they also produce feedback situations. In ordinary physiology, the human body produces Endorphins (endogenous morphine) to protect the body from painful situations.
If the body gets an external pain reliever, such as opionoids, the body, by the feedback response, will decrease or even stop producing endorphins. This makes the body gradually dependent on external opionoids. This situation is called drug tolerance, drug addiction, or drug misuse. Without the drug or increased dosage, the patient will suffer continuous pain and will not be able to live peacefully. The end result is severe unlawful drug seeking, street drug trafficking, robbing, and killing. To improve this situation, acupuncture has been used in conjunction with CNP management.
Acupuncture has been proven to stimulate the body's system to produce Endorphins (endogenous morphine). After the acupuncture treatment, most of the patients feel pain relief immediately. This initial relief usually lasts from a few hours to a couple of weeks. It is important to keep up the acupuncture treatment to maintain the pain relief. In the last 13 years of my practice, my outpatient population has numbered up to 2,350. The patients had been given prescribed medication of opionoid and muscle relaxants in addition to acupuncture.
The patients that came to the clinic at least once every week saw the best results. These patients saw satisfactory pain relief, pain that they had originally rated as a 9 or 10 on a 1 to 10 scale dropped down to between 2 and 5. They lived in peace and could efficiently continue their daily routines and jobs. The drugs they were also given include Vicodin E.S. (oxicodone), or Lortab 5.5 mg (hydrocodone), Percocet (oxycodne), 7.5 mg G.I.D., and Soma 350mg (Carisoprodol). These drugs were always effective at the same dosage without tolerance or increased dosage. Most patients were long-term visitors over the course of several months or up to twelve years. In conclusion, acupuncture has a good effect on CNP management. Most importantly, it prevents drug addiction, drug misuse, and drug related crime. However, the fact remains Medicare still does not recognize acupuncture. For this reason, many patients only seek acupuncture as a last resort once the pain is intolerable. If the patient continues acupuncture consistently for a few months, the pain will not return for a long period of time, or could even be permanently relieved. This situation is a routine practice in China because the government pays the cost. These facts, however, are not as well known here. It is like a piece of gold by the roadside that has yet to be noticed. In fact, this is a loss to the medical field of chronic pain management.
Patient Sample: Case 1
T.R. is a 37-year-old man. He came to my clinic on April 25, 2007 with a chief complaint of pain in the lower back and right leg as a result of an accident seven years previous. He was cared for by his neurosurgeon, and surgery was advised for repair of a disc rupture at two levels. The treatment he received in my clinic included acupuncture and prescribed medicine of Vicodin E.S. x 60#, with 1# Q.I.D. as well as Soma 350mg x 50#, with 1#T.I.D. each visit. He had satisfactory relief of the pain for about 5 - 7 days after each treatment. The pain then came back with a crescendo pace as the time passed. It also depended on the workload he experienced: the more work, the more intense the pain.
He needed to come back for a treatment every two weeks just so that he could continue his job as an auto body technician. This had been going on for 34 visits up until July 17, 2008. The point is that he continued to get the same treatment with the same satisfactory good result without drug tolerance. He felt good and was able to continue his job. This is true for all my patients in similar situations. The longest on-going treatment I have administered was 13 years and the maximum number of visits for one patient was 315.
Patient Example: Case 2
T.J. is a 50 year-old female. She first came to this clinic 11 years ago, on November 24, 1997, with the chief complaint of pain in the neck and left shoulder for the past 15 years. The onset of the pain was insidious since 15 years ago in 1982. More than a dozen physicians had seen her. These included: 1982 --- A family physician treated T.J. with a cortisone injection to the left shoulder, followed with physical therapy via heat, electric stimulation, and exercise for four weeks. 1983 --- A general practitioner referred her to an orthopedic physician who told her that she had cervical vertebral arthritis. From 1983 through to the present date, the patient had changed several physicians. She also had a second cortisone injection to the left shoulder in 1993. She was told that she has a degenerative disease of the cervical spine after she had an MRI in October 1997.
The patient described the pain as a constant dull ache and tightness in the back of the neck and upper back, as well as the lateral aspect of the left shoulder and arm. The pain became a sharp stabbing sensation during certain activities. It also became pronounced at the end of the day after long hours of working. Sitting straight up would aggravate the pain. Lying down would ease the pain, but she was only able to sleep about five hours a night. She was taking Vicodin and Lortab off and on during the past few years at home. Personal history --- She has been married for 15 years. She has 3 children of ages 15, 12, and 10 respectively. No cigarette smoking or drinking alcoholic beverages regularly. She worked as a court reporter since 1979 with an average of 5 hours per day, sitting in front of a computer. Physical Examination --- The patient appears quiet. Her weight is 130 lbs. Height - 5'5". There's marked tenderness over the back of the neck and left cervico-shoulder area. There's no restricted passive range movement of head and arms. Her pain intensity was 9 on a 10-point linear analogue pain scale.
She was given my clinic treatment including:
1. A cupuncture
2. Vicodin E.S. x 30# with 1# QID.
3. Soma 350mg x 30# with 1# TID. She came to the clinic once a week and got the same treatment until two years later on November 8, 1999 when the pain scale improved to 6. The treatment plan was changed to:
1. A cupuncture
2. Vicodin E.S. x 60# with 1# QID.
3. Soma 350mg x 50#, with 1# TID.
She came to the clinic once every two weeks and the last visit was on July 22nd, 2008. The patient had satisfactory relief of the pain after each treatment, with the same result as described of patient T.R. above. The difference is that she had a longer lasting treatment: 11 years duration, 267 visits, without side effects or decreased improvement or drug tolerance.