Alternate therapies for pain management

Electroacupuncture, Chinese herbal therapy, extracorporeal shockwave therapy (ESWT), photobiomodulation/photoceutical therapy, and targeted pulsed electromagnetic field therapy (tPEMF) are multiple ways to treat pain but have historically been referred to as unconventional. These therapies, although some are relatively new to the veterinary industry, have proven to be effective on the human side, yet some professionals are choosing to believe anecdotal experience rather than objective evidence.

During his lecture at the Directions in Veterinary Medicine Symposium (DIVM) in Miami, Florida, Curtis W. Dewey, DVM, MS, CTCVMP, CCRP Diplomate ACVIM (Neurology), Diplomate ACVS, shared the alternative therapeutic options veterinary professionals can explore when treating their patients, plus the research behind them.¹

Chinese herbal therapy

Phytochemicals, biologically active molecules in plants, have been identified from Dang Gui (Angelica Sinensis), Du Huo (Angelica Pubescens), Ru Xiang (Boswellia Sacra), Yan Hu Suo (Corydalis Yanhusuo), and Chi Shao (Paeonia Lactiflora).¹ From these plants, numerous anti-pain phytochemicals were identified, and their mechanisms of action were elucidated. Studies on rodents and clinical studies on humans have demonstrated these are effective ways to treat pain.

“So why use Chinese herbal medicine? This is often used in my hospitals and adjunct to medication it's not common that are just using Chinese herbal and I have found that I don't have to use as much in the way of drugs if I use the combination. This also, sometimes effective as a sole therapy, if it's very fairly mild, but remember, these are the not actually drugs. They're plant extracts, multiple different modes of action for each different plant. Some individual plants have multiple chemicals that have multiple modes of action, but they're not typically as strong as drugs but they also very rarely have any observable side effects,” said Dewey.

Unlike pain management medications, Chinese medicine targets multiple biochemical pathways identified as being responsible for a certain disease state. This is beneficial for patients because drugs target one specific pathway, so this gives patients a chance to feel more relief with a very low chance for adverse side effects.

Acupuncture/electroacupuncture

Acupuncture for treating a multitude of conditions has grown in popularity in recent years, but electroacupuncture (EA) is proven to be more potent and longer-lasting clinical effects than “dry needling.” From an analgesic perspective, the effects of EA can be divided into the region of needle insertion (local), spinal cord (segmental), and brain (suprasegmental), with contributions from segmental and suprasegmental being more likely with EA.

“How do you do it, you can do [acupuncture], you can come up with your own protocol. My experience was when I was trained in acupuncture, I actually took courses with a chi and Ibis that this wasn’t a covered with a lot of well, but not much time was devoted to electroacupuncture, right? I had to do a lot of stuff, looking at stuff myself,” explained Dewey.

“So low frequency, 2-10hertz and some publications say 2-20 hertz, mainly endorphins and enkephalins, higher frequency, more like endorphins, and higher frequencies, closer or a little more than 200 serotonin… So, evidence of efficacy, lots of animal model studies, including dogs, some functional MRI studies. I won't really discuss point specificity, it's sort of a different topic, but a lot of human clinical trials and a few veterinary clinical studies,” he continued.

According to Dewey, veterinary professionals interested in treating patients with electroacupuncture would see results if they do EA every 3 weeks to effectively treat chronic pain. For acute pain scenarios, more frequent sessions are recommended by Dewey, who informed attendees he often complements EA with ESWT 1-2 times per week.

Reference

Dewey T. Alternate Therapies to Pain Management: Where’s the Evidence? Presented at: Directions in Veterinary Medicine; Miami, Florida. May 19-20, 2023.