Archives of Physical Medicine and Rehabilitation
Volume 88, Issue 10 , Pages 1276-1283 , October 2007

Acupuncture for Chronic Shoulder Pain in Persons With Spinal Cord Injury: A Small-Scale Clinical Trial

Presented in part to the American Academy of Physical Medicine and Rehabilitation, October 27−30, 2005, Philadelphia, PA, and the American Paraplegia Society, September 5−7, 2006, Las Vegas, NV.

  • Trevor A. Dyson-Hudson, MD

      Affiliations

    • Kessler Medical Rehabilitation Research and Education Center, West Orange, NJ
    • Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ
    • Corresponding Author InformationReprint requests to Trevor A. Dyson-Hudson, MD, Spinal Cord Injury Research, Kessler Medical Rehabilitation Research and Education Center, 1199 Pleasant Valley Way, West Orange, NJ 07052
  • ,
  • Peter Kadar, CA, DiplAc, DOM

      Affiliations

    • Acupuncture Center of New Jersey, Morristown, NJ
    • Eastern School of Acupuncture, Montclair, NJ
  • ,
  • Michael LaFountaine, MEd, ATC/L

      Affiliations

    • Kessler Medical Rehabilitation Research and Education Center, West Orange, NJ
  • ,
  • Racine Emmons, MA

      Affiliations

    • Kessler Medical Rehabilitation Research and Education Center, West Orange, NJ
  • ,
  • Steven C. Kirshblum, MD

      Affiliations

    • Kessler Medical Rehabilitation Research and Education Center, West Orange, NJ
    • Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ
    • Kessler Institute for Rehabilitation, West Orange, NJ.
  • ,
  • David Tulsky, PhD

      Affiliations

    • Kessler Medical Rehabilitation Research and Education Center, West Orange, NJ
    • Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ
  • ,
  • Eugene Komaroff, PhD

      Affiliations

    • Kessler Medical Rehabilitation Research and Education Center, West Orange, NJ
    • Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ

References 

  1. Dyson-Hudson TA, Kirshblum SC. Shoulder pain in chronic spinal cord injury, Part I: Epidemiology, etiology, and pathomechanics. J Spinal Cord Med. 2004;27:4–17
  2. Consortium for Spinal Cord Medicine. Preservation of upper limb function following spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med. 2005;28:433–470
  3. Sie IH, Waters RL, Adkins RH, Gellman H. Upper extremity pain in the postrehabilitation spinal cord injured patient. Arch Phys Med Rehabil. 1992;73:44–48
  4. Dalyan M, Cardenas DD, Gerard B. Upper extremity pain after spinal cord injury. Spinal Cord. 1999;37:191–195
  5. Curtis KA, Roach KE, Applegate EB, et al. Development of the Wheelchair User’s Shoulder Pain Index (WUSPI). Paraplegia. 1995;33:290–293
  6. Gerhart KA, Bergstrom E, Charlifue SW, Menter RR, Whiteneck GG. Long-term spinal cord injury: functional changes over time. Arch Phys Med Rehabil. 1993;74:1030–1034
  7. Nichols PJ, Norman PA, Ennis JR. Wheelchair user’s shoulder? (Shoulder pain in patients with spinal cord lesions). Scand J Rehabil Med. 1979;11:29–32
  8. Ohry A, Brooks ME, Steinbach TV, Rozin R. Shoulder complications as a cause of delay in rehabilitation of spinal cord injured patients. (Case reports and review of the literature) Paraplegia. 1978;16:310–316
  9. Green S, Buchbinder R, Glazier R, Forbes A. Interventions for shoulder pain. Cochrane Database Syst Rev. 2000;(2):CD001156
  10. van der Windt DA, van der Heijden GJ, Scholten RJ, Koes BW, Bouter LM. The efficacy of non-steroidal anti-inflammatory drugs (NSAIDS) for shoulder complaints (A systematic review). J Clin Epidemiol. 1995;48:691–704
  11. van der Heijden GJ, van der Windt DA, Kleijnen J, Koes BW, Bouter LM. Steroid injections for shoulder disorders: a systematic review of randomized clinical trials. Br J Gen Pract. 1996;46:309–316
  12. Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev. 2003;(1):CD004016
  13. van der Heijden GJ, van der Windt DA, de Winter AF. Physiotherapy for patients with soft tissue shoulder disorders: a systematic review of randomised clinical trials. BMJ. 1997;315:25–30
  14. Green S, Buchbinder R, Hetrick S. Physiotherapy interventions for shoulder pain. Cochrane Database Syst Rev. 2003;(2):CD004258
  15. Ejnisman B, Andreoli CV, Soares BG, et al. Interventions for tears of the rotator cuff in adults. Cochrane Database Syst Rev. 2004;(1):CD002758
  16. Weiler JM. Medical modifiers of sports injury (The use of nonsteroidal anti- inflammatory drugs (NSAIDs) in sports soft-tissue injury). Clin Sports Med. 1992;11:625–644
  17. Amadio P, Cummings DM, Amadio PB. NSAIDs revisited: selection, monitoring, and safe use. Postgrad Med. 1997;101:257–260263-7, 270-1
  18. Tramer MR, Moore RA, Reynolds DJ, McQuay HJ. Quantitative estimation of rare adverse events which follow a biological progression: a new model applied to chronic NSAID use. Pain. 2000;85:169–182
  19. Kaplan RJ. Current status of nonsteroidal anti-inflammatory drugs in physiatry: balancing risks and benefits in pain management. Am J Phys Med Rehabil. 2005;84:885–894
  20. Kennedy JC, Willis RB. The effects of local steroid injections on tendons: a biomechanical and microscopic correlative study. Am J Sports Med. 1976;4:11–21
  21. Tillander B, Franzen LE, Karlsson MH, Norlin R. Effect of steroid injections on the rotator cuff: an experimental study in rats. J Shoulder Elbow Surg. 1999;8:271–274
  22. Speed CA. Fortnightly review: corticosteroid injections in tendon lesions. BMJ. 2001;323:382–386
  23. Subbarao JV, Klopfstein J, Turpin R. Prevalence and impact of wrist and shoulder pain in patients with spinal cord injury. J Spinal Cord Med. 1995;18:9–13
  24. Bayley JC, Cochran TP, Sledge CB. The weight-bearing shoulder (The impingement syndrome in paraplegics). J Bone Joint Surg Am. 1987;69:676–678
  25. Goldstein B, Young J, Escobedo EM. Rotator cuff repairs in individuals with paraplegia. Am J Phys Med Rehabil. 1997;76:316–322
  26. Green S, Buchbinder R, Hetrick S. Acupuncture for shoulder pain. Cochrane Database Syst Rev. 2005;(2):CD005319
  27. NIH Consensus Conference. Acupuncture. JAMA. 1998;280:1518–1524
  28. Dyson-Hudson TA, Shiflett SC, Kirshblum SC, Bowen JE, Druin EL. Acupuncture and Trager psychophysical integration in the treatment of wheelchair user’s shoulder pain in individuals with spinal cord injury. Arch Phys Med Rehabil. 2001;82:1038–1046
  29. Ernst E. Acupuncture research: where are the problems?. Acupunct Med. 1994;12:93–97
  30. World Health Organization. Guidelines for clinical research on acupuncture. Geneva: WHO Regional Publications; 1995;Western Pacific Series No. 15
  31. Birch S, Hammerschlag R, Trinh K, Zaslawski C. The non-specific effects of acupuncture treatment: when and how to control for them. Clin Acupunct Orient Med. 2002;3:20–25
  32. Ezzo J, Berman B, Hadhazy VA, Jadad AR, Lao L, Singh BB. Is acupuncture effective for the treatment of chronic pain? (A systematic review). Pain. 2000;86:217–225
  33. Magee DJ. Orthopedic physical assessment. 3rd ed.. Philadelphia: WB Saunders; 1997;
  34. Hawkins RJ, Bokor DJ. Clinical evaluation of shoulder problems. In:  Rockwood CA,  Matsen FA editor. The shoulder. 2nd ed.. Philadelphia: WB Saunders; 1998;p. 164–197
  35. ASIA Neurological Standards Committee 2002Marino RJ, Barros T, Biering-Sorensen F, et al. International standards for neurological classification of spinal cord injury. J Spinal Cord Med. 2003;26(Suppl 1):S50–S56
  36. Cheng XN. Chinese acupuncture and moxibustion. Beijing: Foreign Language Pr; 1987;
  37. O’Connor J, Bensky D. Acupuncture: a comprehensive text. Chicago: Eastland Pr; 1981;
  38. Curtis KA, Tyner TM, Zachary L, et al. Effect of a standard exercise protocol on shoulder pain in long-term wheelchair users. Spinal Cord. 1999;37:421–429
  39. Curtis KA, Roach KE, Applegate EB, et al. Reliability and validity of the Wheelchair User’s Shoulder Pain Index (WUSPI). Paraplegia. 1995;33:595–601
  40. Dworkin RH, Turk DC, Farrar JT, et al. IMMPACT Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005;113:9–19
  41. Curtis KA, Drysdale GA, Lanza RD, Kolber M, Vitolo RS, West R. Shoulder pain in wheelchair users with tetraplegia and paraplegia. Arch Phys Med Rehabil. 1999;80:453–457
  42. Farrar JT, Young JP, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94:149–158
  43. Rowbotham MC. What is a ”clinically meaningful” reduction in pain?. Pain. 2001;94:131–132
  44. Hanley MA, Jensen MP, Ehde DM, et al. Clinically significant change in pain intensity ratings in persons with spinal cord injury or amputation. Clin J Pain. 2006;22:25–31
  45. Sherman KJ, Cherkin DC. Developing methods for acupuncture research: rationale for and design of a pilot study evaluating the efficacy of acupuncture for chronic low back pain. Altern Ther Health Med. 2003;9:54–60
  46. Lewith GT, Machin D. On the evaluation of the clinical effects of acupuncture. Pain. 1983;16:111–127
  47. Witt C, Brinkhaus B, Jena S, et al. Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Lancet. 2005;366:136–143
  48. Vincent C, Lewith G. Placebo controls for acupuncture studies. J R Soc Med. 1995;88:199–202
  49. Molsberger AF, Mau J, Gotthardt H, Schneider T, Drabik A. Designing an acupuncture study to meet evidence-based medical criteria: methodological considerations for logistic design and development of treatment interventions arising from the German randomized controlled acupuncture trial on chronic shoulder pain (GRASP). Eur J Med Res. 2004;9:405–411
  50. Kleinhenz J, Streitberger K, Windeler J, Gussbacher A, Mavridis G, Martin E. Randomised clinical trial comparing the effects of acupuncture and a newly designed placebo needle in rotator cuff tendinitis. Pain. 1999;83:235–241
  51. Park J, White A, Stevinson C, Ernst E, James M. Validating a new non-penetrating sham acupuncture device: two randomised controlled trials. Acupunct Med. 2002;20:168–174
  52. White P, Lewith G, Hopwood V, Prescott P. The placebo needle, is it a valid and convincing placebo for use in acupuncture trials? (A randomised, single-blind, cross-over pilot trial). Pain. 2003;106:401–409
  53. Wayne PM, Krebs DE, Macklin EA, et al. Acupuncture for upper-extremity rehabilitation in chronic stroke: a randomized sham-controlled study. Arch Phys Med Rehabil. 2005;86:2248–2255
  54. Nayak S, Shiflett SC, Schoenberger NE, et al. Is acupuncture effective in treating chronic pain after spinal cord injury?. Arch Phys Med Rehabil. 2001;82:1578–1586
  55. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994;23:129–138
  56. Keller S, Bann CM, Dodd SL, Schein J, Mendoza TR, Cleeland CS. Validity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain. 2004;20:309–318
  57. Jensen MP, Hoffman AJ, Cardenas DD. Chronic pain in individuals with spinal cord injury: a survey and longitudinal study. Spinal Cord. 2005;43:704–712
  58. Fuhrer MJ. Conducting multiple-site clinical trials in medical rehabilitation research. Am J Phys Med Rehabil. 2005;84:823–831
  59. Fuhrer MJ. Overview of clinical trials in medical rehabilitation: impetuses, challenges, and needed future directions. Am J Phys Med Rehabil. 2003;82:S8–S15
  60. Ragnarsson KT, Wuermser LA, Cardenas DD, Marino RJ. Spinal cord injury clinical trials for neurologic restoration: improving care through clinical research. Am J Phys Med Rehabil. 2005;84:S77–S97quiz S98-100
  61. Siddall PJ, Middleton JW. A proposed algorithm for the management of pain following spinal cord injury. Spinal Cord. 2006;44:67–77

 Supported by the New Jersey Commission for Spinal Cord Research, the Henry H. Kessler Foundation, and the National Institute for Disability and Rehabilitation Research (grant no. H133N000022).

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

PII: S0003-9993(07)00433-9

doi: 10.1016/j.apmr.2007.06.014

Archives of Physical Medicine and Rehabilitation
Volume 88, Issue 10 , Pages 1276-1283 , October 2007