How Fast Shoulder Pain Can Be Relieved: Dry Needling, TCM Acupuncture & Ancient Needles
Shoulder pain is one of the common reasons patients visit a physio, chiro or acupuncture clinic. The lifetime prevalence of shoulder disorders may affect up to 70% of the population (Cadogan A, 2011). There are many medical interventions available which are used to address shoulder pain. Conventional physical therapy, dry needling, TCM acupuncture are a few examples.
But few healthcare practitioners in the world today are aware that the best medical intervention in medical history for pain, more exactly, for any pain including shoulder pain had been already performed every day in every clinic in China prior to the times of about 100 BC.
Knock out Pain on The Spot: Almost No Miss Fire
Here let's focus specifically on shoulder pain. Millennia ago in China of Huandi Neijing era, instantly relieving shoulder pain was just a piece of cake for Chinese physicians. The Neijing provided example cases:
Nothing Works but Exercise
With modern medicine advanced into 21 century, the term “shoulder pain” also advanced into “subacromial impingement syndrome”, “rotator cuff tendinopathy”, and, more recently, “rotator cuff–related SP”. But how much can modern medicine help patients with SP?
In 2013, Littlewood et al reviewed the scientific literature on how physiotherapy worked for shoulder pain and summarized: No definite conclusion can be reached except regarding exercise, which “might be effective” although “clinical significance remains unclear”.
In 2020, Pieters et al updated Littlewood's review by looking into 16 quality-tested new studies (by AMSTAR checklist) and reached a clear conclusion:
Exercise improved pain scores and range of motion at 6–12 weeks and follow-ups (>3 months), although the efficacy of other PT techs still remain uncertain which include:
These findings are rather disappointing for exercise phobia patients. Note that the above reviews did not mention dry needling (DN) which has become popular since 1990s in mainstream medicine.
Dry Needling: Taking 14 Days to Reduce Pain by 62% with One Stabbing
Will dry needling (DN) help with SP? If does, how effective?
Very recently, Pai et al (Jul, 2021) reported their trial on the efficacy of DN for chronic shoulder pain. A single session of TrP-pricking (n = 20) resulted in an average pain reduction by 62% (from VAS 6.30 to 2.40), while sham group (n = 21) saw a reduction of only 15% (from 6.04 to 5.14). Great news for patients!
However, as Pai et al reported, the pain relief caused by TrP-pricking did not start until 2 days after needling; it gradually increased thereafter; the 62% pain reduction was not observed until the 14th day. “Interestingly, the analgesic effects of dry needling [for SP] were not immediate as would have been expected...”, Pai wrote.
Now we see, a needle in ancient China could knock out shoulder pain instantly on the spot; a needle today requires 14 days to reduce the same pain by 62%.
TCM Acupuncture: 61% Pain Relief after 5 Tx in 10 Days
But how fast will acupuncture relieve shoulder pain? The acupuncture we talked about here is the one which was established in 1950s and is currently standardized and accepted worldwide in alternative medicine community, very famously called “TCM acupuncture”.
Green et al (2005) conducted a review on “acupuncture for shoulder pain” including 9 studies and did not find any significant result in favor of acupuncture due to the small sample size and the low studies quality (Green S et al, 2005). A systematic review and meta-analysis by Peng W et al (2007) could not recommend acupuncture as a treatment for frozen shoulder due to a small number of studies.
领英推荐
Very recently, Eyal Ben-Arie, et al (2020) conducted an extensive review on the efficacy of [TCM] acupuncture on frozen shoulder. The review was based on a database including PubMed, Cochrane Library, Embase, and Web of Science. A total of 966 frozen-shoulder patients from 13 publications were included in this review.
The review shew that although some unstable remedy effect of TCM acupuncture was seen in the short-term and midterm (< 3 months), “In all meta-analysis, the strength of evidence (GRADE) was very low. Some of the studies failed to provide a reliable measurement method, adequate patient randomization, and allocation. All of the studies have an unknown publication bias and we could not find any published study protocols for the included studies.” In the conclusion, the authors recommended “More high-quality and longer studies are needed in order to robust the evidence”.
In terms how fast the pain relief for frozen shoulder, the best result was seen in an electricity-stimulated TCM acupuncture study, in which acupuncture treatment reduced the mean VAS score of pain by 61% (from 6.4 to 2.5) after 5 treatments in 10 days (Shi H et al, 2012).
How Much Has Our Pain Management Science Advanced ?
Now we can get a general idea about the efficacy of at least three different types of needling modality which have evolved in our medical history for shoulder pain:
Although this is a rough comparison, it does depict a big picture about how our pain management science has advanced in the past 2000 years.
How much has it advanced so far?
References
AshleyJane Kneeland, Dry Needling: The Most Painful Thing I’ve Ever Loved, 2015, everydayhealth.com
Cadogan A, Laslett M, Hing WA, McNair PJ, Coates MH. A prospective study of shoulder pain in primary care: prevalence of imaged pathology and response to guided diagnostic blocks. BMC Musculoskelet Disord 2011;12:119.
Eyal Ben-Arie, et al, The Effectiveness of Acupuncture in the Treatment of Frozen Shoulder: A Systematic Review and Meta-Analysis, Evidence-Based Complementary and Alternative Medicine, vol. 2020.
Green, S. et al, “Acupuncture for shoulder pain,” Cochrane database of Systematic Reviews, vol. 2, Article ID Cd005319, 2005.
Littlewood C et al, 2013, A review of systematic reviews of the effectiveness of conservative interventions for rotator cuff tendinopathy, Shoulder & Elbow, Vol 5, Iss 3, 2013, 151-167.
Louise Pieters, et al, An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain, Journal of Orthopaedic & Sports Physical Therapy, 2020, Vo. 50, Iss 3, 131-141.
Pai, M. Y.B et al, 2021, Dry needling has lasting analgesic effect in shoulder pain: a double-blind, sham-controlled trial, Pain Rep. 2021 Jun 28;6(2):e939.
Peng, W. et al, Review of acupuncture for frozen shoulder, World Journal of Acupuncture Moxibustion, vol. 17, pp. 1–15, 2007.
Shi H. et al, “Efficacy assessment for different acupuncture therapies in the treatment of frozen shoulder,” World Journal of Acupuncture—Moxibustion, vol. 22, no. 2, pp. 6–11, 2012.