Pain can be life altering, as any sufferer can tell you.  It changes personalities, erodes relationships, and interferes with the enjoyment of life.  It's a huge societal drain, with countless work hours sacrificed.  Pain management, in all its manifestations, is a multi-billion dollar industry.

     It is no wonder that one of the most common reasons people seek acupuncture treatment is for the resolution of pain.  And indeed acupuncture typically is a very successful modality for pain relief.  Even main stream medical doctors are beginning to recommend it when the prognosis of their patients falls beyond the reach of conventional medical care.

     Conventional medicine has only a few options in dealing with pain - namely surgery, drugs and physical therapy.  These options can be very powerful and I highly recommend them where appropriate.  My general philosophy about medical intervention, however, is that it is wise to start with the least invasive methods first, using more intrusive measures as the last resort.  All too often, this process gets reversed.  For fully comprehensive and effective medical care, acupuncture should be considered very early in the treatment process.  What role it best plays will depend on the nature of the underlying medical condition.

     Beginning a discussion on the use of acupuncture requires an exploration of pain from a Chinese medical point of view.  In Chinese medicine, we relate the functioning of the body to the role of Qi.  Qi generally is described as vital energy that gives rise to both the form and function of the human body.  Much like the blood circulatory system, Qi flows throughout the body in channels we call meridians.  Freedom from pain requires the unimpeded flow of Qi in a continuous circuit.  Think of a moving water system, like a stream.  If nothing obstructs the pathway, the water flows freely.  If rocks, trees or a dam blocks the flow, the water, to varying degrees, stops flowing.  With an obstruction, there is less water flowing downstream, a backup of water upstream, and increased pressure at the point of obstruction.  If we substitute the concept of Qi for the water, we can get less Qi flowing downstream (perhaps numbness or coldness), an excess back up of stagnant Qi upstream (perhaps edema or distention), and pain at the point of obstruction.  

     Treatment strategies for treating pain are relatively straightforward.  The goal is to relieve obstructions in the meridian systems and return the free flow of the Qi to its natural continuous circuit.  Diagnostically, the nature of the pain will reveal the nature of the obstruction and guide treatment strategies.  Dull pains tell us one thing, sharp stabbing pains another, roving pains something different again.  Other clues will be the location and duration of the pain, influences from either heat or cold application, etc.

     The successful treatment of pain lies, not only in identifying the nature of the obstruction, but also its underlying causes.  It is here that we start to discern the value of acupuncture as a medical treatment.  For this discussion, it is helpful to categorize pain into two general classes:  pains with a known physiological cause and those without a such a cause.  

     The first category usually comes with a meaningful medical diagnosis, perhaps through x-ray, MRI, CT scan, sonogram, or other medical technology.  What is usually at issue here is physical trauma or some abnormality in form.  For example, arthritis, tumors, nodules, bone spurs, degenerated discs, abdominal adhesions.  This diagnostic information is enormously helpful in determining the likely prognosis and in choosing appropriate acupuncture treatment strategies.  

     Pain from soft tissue injuries, such as muscle tears or tendonitis, tend to resolve relatively quickly without a need for continued acupuncture treatment once the injury is healed.  The more intractable the physiological issue is, however, the more treatments it may take to obtain significant pain relief.  This is because acupuncture will not reverse the underlying cause.  This is typically the case with degenerative arthritis or bone spurs.  With sustained treatment, acupuncture can often achieve impressive pain relief in these cases.  Patients do, however, need to understand that it becomes a pain management tool, not a one time cure.  Many patients find this acceptable, especially where traditional medical approaches are inappropriate, ineffective or undesirable.  Some patients can't have surgery, have maxed out on pain medications or have taken physical therapy as far as it can go.  Acupuncture may give the desired pain relief and can be used as primary care.  

     Obviously, there are times when surgery and/or physical therapy are the best treatments possible.  In these instances, acupuncture plays an important adjunctive role.  It dramatically speeds healing time, returns greater functioning, like strength and range of motion, as well as reducing post-operative pain and the use of addictive drugs.  The marriage of acupuncture and traditional orthopedic care should be routine.

     One other purely physiological cause that is often overlooked is pain as a side effect of certain prescription drugs.  In particular, cholesterol lowering statin drugs, such as Lipitor and Crestor, are well known to cause muscle and neurological pain.  The Chinese medical remedy to drug induced pain is to cease taking the drug.  Alternative approaches should be explored whenever possible.

    Now to the really juicy topic - those painful conditions that have no known physiological cause.  In other words, the MRIs and x-rays show nothing.  These cases often come with no diagnosis at all or with a diagnosis that lacks medical meaning. 
    
     Fibromyalgia is a prime example of a meaningless diagnosis.  It isn't that fibromyalgia isn't real.  I have successfully treated patients with this label and they all had very real pain.  After all, the term simply means "muscle pain."  The diagnosis lacks real medical meaning, by their own terms, because there is no physical cause ascribed to it and hence no curative model of treatment.  The drugs used for this, as well as many other chronic conditions, provide temporary symptomatic relief only.  Because there is no curative effect, prescribed use of the drugs is indefinite.  The longer drugs are used, they tend to work less and generate more side effects.  This usually induces doctors to increase dosage, try additional drugs with similar action, and write yet more prescriptions to counter the side effects.  The tangled web of being uncured and over drugged begins.

     We have now touched upon the realm where Chinese medicine is enormously advantageous and, frankly, should be used as primary care.  There is pain, but no cause that shows up physically.  No tumors, no injuries, no arthritis.  This covers a huge spectrum of chronic pain sufferers.  Included in this list of conditions are most migraines and headaches; menstrual pain; abdominal pain; non-arthritic joint pain; muscle pains absent injury; premenstrual breast pain; lingering pain from statins, even after they are out of the bloodstream; post surgical or injury pain where the tissue is completely healed; and really any pain where the doctor shrugs his shoulders and gives a prescription for pain killers and Xanax.  

     Here we are talking about Qi obstruction rather than physical impairments.  In the treatment room, we look to the energetic causes of the Qi obstructions that create the pain.  Common causes we recognize in Chinese medicine include:  a lingering Qi obstruction from physically healed injuries or surgeries (even decades old); exposure to extreme cold (including from an operating room); latent toxic heat (such as from radiation or viral infections, like chicken pox); stored emotional or physical trauma, particularly in the case of abuse; poor dietary habits that lead to Qi obstruction in the abdomen; systemic imbalances that cause the Qi to rise forcefully to the head without completing its circuit downward, causing a headache.  In short, we identify and treat any underlying imbalance that creates a disruption in the proper flow of Qi. 

     This approach is outside the purview of conventional medical belief and practice.  Instead, doctors are using physical medicine for pain that usually has an energetic origin.  It's the wrong tool for the job and this is what makes such practice ineffectual.  Chinese medicine, on the other hand, offers an array of appropriate tools for the circumstances.  It is the treatment of choice in these cases.

     From the vantage point of Chinese medicine, pain can be effectively treated where there is either a physical or non-physical cause.  Because it is a more holistic paradigm, acupuncture can often successfully treat pain beyond the limits of conventional medicine.  It is a relatively non-invasive treatment that offers relief of needless suffering at lower cost and risk.  Any sufferer of pain, whether chronic or acute, should consider it a viable treatment option.