*Last edited: May 2021 by Eric Chan, ND

Naturopathic Chronic Pain Treatments

In addition to naturopathic treatment options for those patients that meet the criteria for fibromyalgia, often Dr Chan, ND, will see patients in his office with more recent onset, acute, localized pain that is musculoskeletal. It may be related to a sports or overuse injury, or often associated with prolonged sedentary work which seems to affect the upper back and neck significantly.

While there are many difficult cases which are hard to treat, when the pain is strictly myofascial related, (eg palpable “knots” and “ropes” in the muscles that are the source of the pain), many cases are some of the most rewarding to treat given the response that can happen. After a history taking and exam, if it is apparent that the muscles are quite hypertonic and manipulation or pressure on the affected muscles reproduce some degree of the type of pain, then often a treatment is trialed to see if there is an immediate partial response. If there is an improvement, then a few treatments are done until the pain is minimized.

One particular study looked at an area of pain that I commonly see in my practice - the upper back and neck. The study compared biofeedback and relaxation with acupuncture and electrical stimulation:

Similar to my experience, the acupuncture with electrical stimulation had a very good treatment response.

Results: Fifty patients (39 women, 11 men) with a mean age (years) ± SD of 39.0±5.5 and neck pain duration (weeks) of 6.0±2.2 were analyzed. All parameters, except for PPT of the lower trapezius and paravertebral muscles were improved significantly in both groups, while baseline values were controlled. The primary outcome was achieved more significantly in the acupuncture group than in the biofeedback group: 20 (80.0%) vs 10 (40.0%); rate ratio=2 with 95% confidence interval (CI), 1.19-3.36; number needed to treat (NNT)=2.5 with 95% CI, 1.54-6.58. Advantages of acupuncture over biofeedback were observed according to values obtained from the NDI, VAS, extension and left lateral-bending ROM, and PPT on the left upper trapezius after the last session of intervention until 3 months (P<.05).

Common side effects that I see in my practice are temporary change in the quality of pain, usually to a fatigued, or “achy” pain. There can be temporary aggravation of pain, but typically acupuncture with electrical stimulation gives more immediately relief of pain which allows us to assess if the correct areas are treated. As with any procedure, there is very rare risk of infection. There is also extremely rare risk of puncture of tissue other than the muscle intended, such as organ injury.

I have not seen as good response with acupuncture alone, although that is likely dependent on the number of treatments. Typically if the pain is predominantly related to a trigger point, an average course of treatments in my practice is 4-6.

There have also been comparison studies between acupuncture with trigger point injections. 2 studies in the elderly showed very similar responses between the two groups.

My own preference has been to start with acupuncture and electrical stimulation. The additional electrical stimulation to repeatedly elicit a “twitch” response seems to be a rapid way to assess whether or not the pain will be responsive to predominantly musculoskeletal treatment. Trigger point injections into the muscle belly can be done, and saline is a reasonable choice that reduces the risk of allergy that injections such as local anesthetics can have.

In contrast to the above studies, I find that acupuncture with electrical stimulation seems to be a more consistent treatment option. There was one study that compared intramuscular stimulation (just the needling of the muscle, without electrical stimulation) to the trigger point injections and this study did find it to be somewhat more effective:

If you have a localized muscle pain problem and would like to see if such treatments would be an option, please call the office at 604 275 0163 to make an appointment with Dr Chan, ND.