We had all just sat down for dinner when the call came into the station: an unresponsive male patient and no other information. By the time we had pulled out in our rig, we were updated by our dispatcher. The patient was in cardiac arrest and bystanders were performing CPR. Once we arrived, it was an all too familiar scene–drug paraphernalia scattered throughout the room, an old belt used to make veins pop for better access, with all the signs pointing towards an opioid overdose. My team immediately jumped into action and attempted to resuscitate the patient, but we were too late. Another otherwise healthy community member in their mid-thirties gone because of their addiction, one that likely began with a prescription to control chronic pain.
Unfortunately, this harsh reality is present in many cities and towns throughout the U.S. and despite the public health initiatives pushing NARCAN and safe injection practices, nothing has yet to address the root of the problem with any success. However, there may be a solution. Eastern medical practices are often very foreign to people in the U.S. due to the traditionally strict adherence to western medicine, despite their potential benefits. Acupuncture, for example, has been shown to have incredible benefits in the management of chronic pain, but many people consider it little more than a placebo or glorified spa treatment. Many studies demonstrate that acupuncture is an effective first line treatment for chronic pain. If acupuncture were more widely accepted, physicians and healthcare providers could limit prescription of opioid based pain medication and have a significant impact on those struggling with addiction.
For one to fully understand the true breadth of the opioid epidemic and the need for alternative treatment, we must first discuss its origins. The so-called “first wave” of the opioid epidemic began in the early 1990’s with the invention and FDA approval of the semi-synthetic opioid Oxycontin. Along with the rollout of this drug came intense and targeted advertising campaigns that marketed Oxycontin as a sort of “miracle drug” for the treatment of pain.
Additional campaigns created greater advocacy of pain control in medicine and specified Oxycontin and other opioids as the cure. What these major drug companies failed to mention was the addictive properties of these medications that would soon spiral into what we now know as the opioid epidemic. From 1999-2010, opioid medication sales quadrupled and during this same period, opioid related deaths more than doubled from 2.8 to 6.9 per 100,000 people (“The Opioid Crisis” 1).
Around the early 2010’s, the second wave of the opioid epidemic began. During this time, people who had become reliant on prescribed opioid pain medication started turning to a cheaper, more available source in the form of the illegal substance heroin. From 2010 to 2016, the rate of heroin related deaths rose from 1 per 100,000 people to 4.9 per 100,000 people (“The Opioid Crisis” 2). This five-fold increase began to shock the world as many people lost close friends and family to the drug, but this was unfortunately not the end. In 2016, a new synthetic opioid hit the market touting a potency 50-times greater than heroin: fentanyl. Opioid-related overdose deaths again began to rise at a rate not yet seen. This third wave marked an increase in synthetic opioid-related deaths from 10.4 to 21.4 per 100,000 people from 2015-2020 (“The Opioid Crisis” 2). Despite many efforts made by both government and private entities, these deaths continue to rise and unless we can find an alternative to modern pain treatment, the trend will continue.
For those suffering from chronic pain, opioids are often seen as an attractive solution to their problem. Because of what is now known about opioid medications, physicians and healthcare professionals are less keen on prescribing them long term, sometimes leading to those suffering to seek out their own medication illegally. To help combat the opioid crisis at its root, new and innovative effective pain treatment modalities are necessary. One method that has recently offered hope is Eastern medicine: more specifically acupuncture, which is a traditional practice that has been used for centuries. The treatment involved small needles being inserted into the skin and muscle at specific points throughout the body. Many studies have been conducted surrounding the efficacy of acupuncture and recent results seem promising in the treatment of chronic pain.
One recent study found that acupuncture is beneficial in the treatment of endometriosis related pain. Endometriosis is a condition that effects almost 176 million women across the world and accounts for the largest economic burden among all gynecologic diseases. Women with this condition often suffer from chronic pelvic pain caused by the adhesions and inflammation associated with the disease. Common treatments for endometriosis include hormonal birth control, surgical intervention, and pain medication. In this study, the researchers utilized clinical acupuncture administered by trained physicians who completed an intensive training course prior to participating. Subjects enrolled in the study underwent three acupuncture sessions per week beginning during their menstrual period and continued the treatment for 12 weeks. Subjects remained enrolled for an additional 12 weeks without treatment and their pain scores were assessed at the end of each 12-week period. The study found that in the group that received that received the actual acupuncture treatment reported significantly lower pain when receiving treatment and blood serum analysis showed lower levels of CA-125, an inflammatory marker, when compared to baseline (Li et al. 5). While opiate pain medication is not commonly prescribed for endometriosis, many women experience debilitating pain and could potentially turn to self-medication with illicit opioids. There is additional literature surrounding this disease that outlines the difficulties and mental health challenges that are associated with this chronic pain condition. The increased accessibility and use of acupuncture in the treatment of this pain could potentially help many women avoid having to self-medicate and thus curb addiction to opiate-based medication.
Despite the overwhelming proof of concept research surrounding acupuncture, many people still remain skeptical of its benefits. What most fail to see is both the structural and functional changes that occur when an individual undergoes acupuncture from a trained medical professional. In a recent study exploring this phenomenon in female patients with chronic neck and shoulder pain, the authors demonstrate how acupuncture can alter functional connectivity within brain circuits involved in chronic pain. The authors collected functional connectivity data within a specific brain area known as the periaqueductal grey (PAG) from patients who experienced chronic neck and shoulder pain as well as from those in a healthy control group. The team then administered 20 sessions of acupuncture over the course of four weeks to both groups, after which the functional connectivity measurements were repeated. The study found that in those patients with neck and shoulder pain, there was an increased functional connectivity between the PAG and an area known as the bilateral posterior insula (PINS). This connectivity was speculated to relate to the heightened sensations of pain and the use of acupuncture was enough to help modify this circuit leading to an overall decrease in levels of chronic pain (Xu et al. 5).
Even with the growing opioid crisis in the United States, medical professionals and their respective governing bodies still advocate for opioid-based pain medication in certain circumstances, guidance with which I agree. For most, the responsible use of opioids to treat postoperative pain or acute trauma does not result in long-term, debilitating addiction. In fact, these medications help reduce pain and mental trauma that could drive a person to addiction after the fact. I too can see how opioids, when used responsibly, can be labeled as the miracle drug they were originally marketed as in the early 90’s and they do still have a very important place in modern medicine. However, opioids can be harmful as a long-term solution to chronic pain. The detrimental effects outlined here are far reaching and unfortunately, have affected almost every family throughout the U.S. in some way.
Opiates have been utilized in medicine since the early 1200’s when the Greeks were known to soak sponges in natural opium as a form of pain relief (Harrah 1). Now, with the advent of modern anesthesia and pain treatment, more potent and addictive forms of this naturally occurring compound are leading hundreds of thousands of people into addiction. The overprescription of opioids and under-treatment of chronic pain have led many to search for illegal and sometimes deadly alternatives. If medical professionals begin to accept acupuncture as the viable, science-backed treatment that it is, the number of opioid prescriptions throughout the U.S. could decline significantly and ideally make the opioid crisis a thing of the past.
Works Cited
Harrah, Scott. “Medical Milestones: Discovery of Anesthesia & Timeline.” UMHS, www.umhs-sk.org/blog/medical-milestones-discovery-anesthesia timeline#: ~:text=Early %20anesthesia%20can%20be%20traced,%5D%20for%20surgical%20pain%20relief%2C%22. Accessed 7 Oct. 2023.
Li, Pei Shuang, et al. “Efficacy of Acupuncture for Endometriosis-Associated Pain: A Multicenter Randomized Single-Blind Placebo-Controlled Trial.” Fertility & Sterility, vol. 119, no. 5, May 2023, pp. 815 23. EBSCOhost, https://doiorg.libdatabase.newpaltz. edu/1 0.1016/ j.fertnstert.2023. 01.034.
The Opioid Crisis in the United States: A Brief History – CRS Reports, crsreports.congress.gov/product/pdf/IF/IF12260. Accessed 3 Oct. 2023.
Xu, Hui, et al. “Modulation Effect of Acupuncture Treatment on Chronic Neck and Shoulder Pain in Female Patients: Evidence from Periaqueductal Gray‐based Functional Connectivity.” CNS Neuroscience & Therapeutics, vol. 28, no. 5, May 2022, pp. 714. EBSCOhost, https://doi-org.libdatabase.newpaltz.edu/10.1111/cns.13803.
