Acupunture is a key component in pain management.

Results of 10 year multidisciplinary complementary and alternative outpatient program for chronic pain patients.

Dominik Irnich, Multidisciplinary Pain Ctr., Dept. of Anaesthesiology, Univ. of Munich, Muenchen, Germany


Purpose:

To evaluate a multidisciplinary outpatient program in complementary and alternative medicine (MOCAM) for chronic pain patients based on Traditional Chinese Medicine (TCM) and Classical Natural Medicine/Naturopathy (CNM) and to define the role of individualised acupuncture in this setting.


Methods:

MOCAM consists of a 4-week outpatient program (phase 1) and a follow-up program (phase 2 and 3). It includes methods of TCM (Acupuncture, Qigong, Tuina, Dietetics), CNM (Phytotherapy, Breath therapy, Nutrition, Imagination, Body awareness) and educational seminars (chronic pain, pain treatment, life style according to TCM and CMN). Emphasis is placed upon reinforcing patient confidence, self-understanding and self-responsability.


Acupuncture plays a crucial role in this program and was applied 8 times in 4 weeks. Different styles of acupuncture were chosen according to patients condition. It includes microsystem acupuncture, dry needling of myofascial trigger points, Japanese acupuncture in most sensitive patients and TCM based acupuncture if differentiation according to ancient theories seemed to be advisable.


Outcome measures of the program included pain intensity, health related quality of life (SF 36), disability (PDI), return to work and number of doctor visits. Credibility of treatment and motivation (pain stages of change) were evaluated, too. The role of acupuncture was defined by questionnaires on pain relieving effects, credibility and acceptance.


Results:

281 patients suffering from chronic pain were included. They were characterised by continuous pain, resistance to previous treatments, disability to work and additional symptoms. Mean duration of pain was 110 months. All outcome measures were significantly improved (t-test, P< 0.001) immediately and 2 years after completion of the 4-week program compared to baseline. The credibility scale showed high values, motivation was a weak predictor. Acupuncture was characterised as highly effective in pain relieve


Conclusion:

Complementary and alternative Medicine can be an effective part of a multimodal treatment approach for chronic pain. Acupuncture was evaluated by patients as a crucial part of multimodal treatment.