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References for “Acupuncture in Pain Management…”

Oregon Conference

References for “Acupuncture in Pain Management: A Pathway to Interdisciplinary Collaboration in Oregon”

As presented at the 2024 Oregon Conference on Opioids + other Drugs, Pain + Addictions Treatment

John Rybak, LAc, Medical Director

The purpose of the OPAT conference is to collaborate and share our lessons in pain management and the opiate crisis to create better interventions leading to prevention and actionable steps forward. This year’s conference is unique in that it has two acupuncturists presenting on this crucial topic.  If there’s one thing that’s been missing from this crisis it is acupuncture as an integrative approach. My purpose here at the conference is to expand the conversation and actionable tools for providers, policy makers, and patients in the effort to provide better care for pain management, addiction prevention, and addiction recovery.

Acupuncture has been hidden behind bias for decades. Over 50 years of research into the mechanisms of action have shown fascinating prospects of how acupuncture can be integrated to provide care for multiple health conditions including pain and addiction therapies.   These are the references of my presentation given at the Oregon Conference on Opioids Other Drugs Pain and Addictions Treatments for Lines of Life in 2024.

I’m here to provide a high level review of evidence based acupuncture mechanisms of action and how this medically relevant therapy can be implemented on a broader scale. It’s important to note that in 2022 a National Institutes of Health survey showed that only 1.7% of Americans utilized acupuncture therapies. My purpose is not to say acupuncture is the complete answer to pain management, opiate alternatives, addiction prevention and addiction recovery. Rather, my purpose is to raise awareness of a tool that is frighteningly underused and subjected to disproportionate bias.

I fully acknowledge that the acupuncture profession has not communicated its value in evidence-based terms using modern physiologic terminology. You are invited to use these references as a jumping off point to better understand the evidence base, cost savings, implementation models, and opportunities for integration and collaboration amongst a greater field of medical professionals. In doing so the evidence indicates that not only do patient outcomes improve but patients also report an improved quality of life with acupuncture care.


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Amorim, D., Amado, J., Brito, I., Fiuza, S. M., Amorim, N., Costeira, C., & Machado, J. (2018). Acupuncture and electroacupuncture for anxiety disorders: A systematic review of the Clinical Research. Complementary Therapies in Clinical Practice, 31, 31–37. https://doi.org/10.1016/j.ctcp.2018.01.008

Armour, M., Smith, C., Wang, L.-Q., Naidoo, D., Yang, G.-Y., MacPherson, H., Lee, M., & Hay, P. (2019). Acupuncture for depression: A systematic review and meta-analysis. Journal of Clinical Medicine, 8(8), 1140. https://doi.org/10.3390/jcm8081140

Becker, R. O. (2020). The Body Electric: Electromagnetism and the Foundation of Life. William Morrow.

Bleck, R., Marquez, E., Gold, M. A., & Westhoff, C. L. (2020). A scoping review of acupuncture insurance coverage in the United States. Acupuncture in Medicine, 39(5), 461–470. https://doi.org/10.1177/0964528420964214

Bonafede, M., Dick, A., Noyes, K., Klein, J. D., & Brown, T. (2008). The effect of acupuncture utilization on healthcare utilization. Medical Care, 46(1), 41–48. https://doi.org/10.1097/mlr.0b013e3181589b7d

Davis, R. T., Badger, G., Valentine, K., Cavert, A., & Coeytaux, R. R. (2018). Acupuncture for chronic pain in the vermont medicaid population: A prospective, pragmatic intervention trial. Global Advances in Health and Medicine, 7, 216495611876955. https://doi.org/10.1177/2164956118769557

Ding HL, Huang ZH, Ren ZF, et al. Effects of acupuncture on endoplasmic reticulum pathway in exercise-induced skeletal muscle damage in rats and its mechanism. Zhongguo Ying Yong Sheng li xue za zhi = Zhongguo Yingyong Shenglixue Zazhi = Chinese Journal of Applied Physiology. 2021 Jul;37(4):359-364. DOI: 10.12047/j.cjap.6097.2021.044. PMID: 34374254.

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Han, J.-S. (2004). Acupuncture and endorphins. Neuroscience Letters, 361(1–3), 258–261. https://doi.org/10.1016/j.neulet.2003.12.019

Jiang, Y., Wang, H., Liu, Z., Dong, Y., Dong, Y., Xiang, X., Bai, L., Tian, J., Wu, L., Han, J., & Cui, C. (2013). Manipulation of and sustained effects on the human brain induced by different modalities of acupuncture: An fmri study. PLoS ONE, 8(6). https://doi.org/10.1371/journal.pone.0066815

Kim, S.-Y., Lee, H., Chae, Y., Park, H.-J., & Lee, H. (2012). A systematic review of cost-effectiveness analyses alongside randomised controlled trials of acupuncture. Acupuncture in Medicine, 30(4), 273–285. https://doi.org/10.1136/acupmed-2012-010178

Kim, N. J., Ryu, Y., Lee, B. H., Chang, S., Fan, Y., Gwak, Y. S., Yang, C. H., Bills, K. B., Steffensen, S. C., Koo, J. S., Jang, E. Y., & Kim, H. Y. (2018). Acupuncture inhibition of methamphetamine‐induced behaviors, dopamine release and hyperthermia in the nucleus accumbens: Mediation of group II MgluR. Addiction Biology, 24(2), 206–217. https://doi.org/10.1111/adb.12587

Langevin, H. (2023, June 14). Gathering data points for acupuncture research. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/about/offices/od/director/past-messages/gathering-data-points-for-acupuncture-research

Lei BK, Zhao S, Xu T, et al. TGF-β1/ERK/CTGF pathway involved in effect of acupuncture on exercise-induced skeletal muscle fibrosis. Zhen ci yan jiu = Acupuncture Research. 2021 Apr;46(4):306-311. DOI: 10.13702/j.1000-0607.200471. PMID: 33931996.

Levin, M. (2022, October 5). The secret to how the body works: Biologists explains bioelectricity: Michael Levin and Lex Fridman. YouTube. https://youtu.be/ZSddchIGNG0?si=LM2fGdTixyAjKNlG

Liao, C.-C., Liao, K.-R., Lin, C.-L., & Li, J.-M. (2020). Long-term effect of acupuncture on the medical expenditure and risk of depression and anxiety in migraine patients: A retrospective cohort study. Frontiers in Neurology, 11. https://doi.org/10.3389/fneur.2020.00321

Liddle, C. E., & Harris, R. E. (2018). Cellular reorganization plays a vital role in acupuncture analgesia. Medical Acupuncture, 30(1), 15–20. https://doi.org/10.1089/acu.2017.1258

Lin, Jaung-Gen, Kotha, P., Chen, Y-H. (2022). Understandings of Acupuncture Application and Mechanisms. American Journal of Translational Research, 14(3), 1469-1481. PMID: 35422904; PMCID: PMC8991130.

Maeda, Y., Kim, H., Kettner, N., Kim, J., Cina, S., Malatesta, C., Gerber, J., McManus, C., Ong-Sutherland, R., Mezzacappa, P., Libby, A., Mawla, I., Morse, L. R., Kaptchuk, T. J., Audette, J., & Napadow, V. (2017). Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture. Brain, 140(4), 914–927. https://doi.org/10.1093/brain/awx015

MacPherson, H., & Hammerschlag, R. (2012). Acupuncture and the emerging evidence base: Contrived controversy and rational debate. Journal of Acupuncture and Meridian Studies, 5(4), 141–147. https://doi.org/10.1016/j.jams.2012.05.001

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MacPherson, H., Hammerschlag, R., Coeytaux, R., Davis, R., Harris, R., Kong, J., Langevin, H., Lao, L., Milley, R., Napadow, V., Schnyer, R., Stener-Victorin, E., Witt, C., & Wayne, P. (2016). Unanticipated Insights into Biomedicine from the Study of Acupuncture. Journal of Alternative Complementary Medicine, 22(2), 101-107. doi: 10.1089/acm.2015.0184

MacPherson, H., Vertosick, E. A., Foster, N. E., Lewith, G., Linde, K., Sherman, K. J., Witt, C. M., & Vickers, A. J. (2016). The persistence of the effects of acupuncture after a course of treatment: A meta-analysis of patients with chronic pain. Pain, 158(5), 784–793. https://doi.org/10.1097/j.pain.0000000000000747

Martin, B. I., Mirza, S. K., Spina, N., Spiker, W. R., Lawrence, B., & Brodke, D. S. (2019). Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015. Spine, 44(5), 369–376. https://doi.org/10.1097/brs.0000000000002822

Nahin, R. L. (2022). Use of multimodal multidisciplinary pain management in the US. JAMA Network Open, 5(11). https://doi.org/10.1001/jamanetworkopen.2022.40620

Nahin, R. L., Rhee, A., & Stussman, B. (2024). Use of complementary health approaches overall and for pain management by US adults. JAMA, 331(7), 613–615. https://doi.org/10.1001/jama.2023.26775

Napadow, V., Kettner, N., Liu, J., Li, M., Kwong, K. K., Vangel, M., Makris, N., Audette, J., & Hui, K. K. S. (2007). Hypothalamus and amygdala response to acupuncture stimuli in carpal tunnel syndrome. Pain, 130(3), 254–266. https://doi.org/10.1016/j.pain.2006.12.003

National Center for Complementary and Integrative Health. (2024, February 21). Get the facts about acupuncture. National Center for Complementary and Integrative Health. https://content.govdelivery.com/accounts/USNIHNCCIH/bulletins/38b62ca 

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Theysohn, N., Choi, K.-E., Gizewski, E. R., Wen, M., Rampp, T., Gasser, T., Dobos, G. J., Forsting, M., & Musial, F. (2014). Acupuncture-related modulation of pain-associated brain networks during electrical pain stimulation: A functional magnetic resonance imaging study. The Journal of Alternative and Complementary Medicine, 20(12), 893–900. https://doi.org/10.1089/acm.2014.0105

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Vickers, A. J., Cronin, A. M., Maschino, A. C., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., Witt, C. M., Linde, K., & Acupuncture Trialists’ Collaboration. (2012). Acupuncture for chronic pain. Archives of Internal Medicine, 172(19), 1444–1453. https://doi.org/10.1001/archinternmed.2012.3654

Vickers, A. J., Vertosick, E. A., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., Irnich, D., Witt, C. M., & Linde, K. (2018). Acupuncture for chronic pain: Update of an individual patient data meta-analysis. The Journal of Pain, 19(5), 455–474. https://doi.org/10.1016/j.jpain.2017.11.005

Wu, M.-S., Chen, K.-H., Chen, I.-F., Huang, S. K., Tzeng, P.-C., Yeh, M.-L., Lee, F.-P., Lin, J.-G., & Chen, C. (2016). The efficacy of acupuncture in post-operative pain management: A systematic review and meta-analysis. PLOS ONE, 11(3). https://doi.org/10.1371/journal.pone.0150367

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