While pharmacologic therapies are available to address SCI-induced neuropathic pain, they often are associated with incomplete analgesia, patient dissatisfaction and adverse effects. Moreover, consistent use of opioids has been linked to a risk for abuse and/or addiction. Acupuncture treatment has also shown some efficacy for reducing, but not eliminating, mild to moderate SCI pain.
According to the authors, successful treatment of neuropathic pain requires addressing emotional and cognitive aspects in addition to sensory manifestations. Acupuncture may accomplish both by modulating ventral tegmental area (VTA)-GABA neuronal activity associated with sensory (pain) and also psychiatric (reward) behaviors.
As such, acupuncture and pharmacologic therapies could provide a synergistic effect in SCI, suggests Rey Ximenes, MD, a pain management physician from Austin, Texas.
“It is easy to see that some of the mechanisms that are induced by the pharmacology are very similar, if not identical, to the ones induced by acupuncture. Why wouldn’t we combine the two, or even other modalities to get a better effect without encouraging more adverse events?” Dr Ximenes told Clinical Pain Advisor.
Dr Ximenes employs a multidisciplinary approach to treating pain, combining conventional therapy with other methods such as acupuncture, nutrition, Tai Chi, Qigong, herbs, cognitive behavioral therapies, and relaxation techniques.
“I see no need to separate [Western and Eastern medicine]. This is the integrative approach. I really think we need to stop using terms [such as] ‘alternative’ and ‘complementary’ — they imply [that] one is lesser than the other,” Dr Ximenes pointed out.
“If we really look, we will find that Western allopathic medicine is actually the alternative, as it is the ‘new kid on the block.’ Primary therapy should always be nutrition and herbs. Let’s use the best of all worlds. It’s all medical therapy,” Dr Ximenes emphasized.
Acupuncture: A Forgiving Modality
While allowing that the feasibility of a dual-pronged approach is yet to be determined, the authors state that recent randomized controlled trials and preclinical studies support the use of acupuncture with pharmacotherapy as an effective option for pain management and psychiatric treatment.