The therapeutic alliance between patient and practitioner found in the Eastern approach to medicine resonates with women who are often told that period pain is ‘just something they have to put up with’, says Dr Mike Armour.
Armour, a native of New Zealand, gained an honours degree in biomedicine at the University of Auckland and then trained and worked as a clinical practitioner of acupuncture before becoming a postdoctoral fellow at Western Sydney University leading a research project into period pain.
He was one of the speakers at Acupuncture New Zealand’s annual conference and AGM held over the weekend.
After spending some in clinical acupuncture practice, Amour said he realised that his long-term future and interest lay in applying the Western research methodologies to his passion for traditional Chinese medicine. This led eventually to a PhD examining the effect of acupuncture on the treatment of primary dysmenorrhea (period pain).
Asked whether there is a convincing weight of peer reviewed, high-quality clinical evidence to support the efficacy of acupuncture, his answer is not the simple one many might be hoping for.
“There’s some good evidence for its efficacy in some areas, and there’s also good evidence for a lack of efficacy in other areas,” he said.
“I think that there’s a lot of difficulty around trial design and interpreting evidence in many past studies of acupuncture efficacy. I think they’re getting better, but what I mean by that, is that a lot of the early trials were designed by research scientists who had a great understanding of clinical trial methodology, but very poor understanding of acupuncture theory. So I think there’s a pretty good argument that a lot of studies didn’t reflect how acupuncture is practiced.
“[Many studies] seem to have been looking at it in terms of basically swapping out acupuncture for a drug. That creates difficulties around things like dosage for example – how many needles are being used? How frequent is the cumulative number of treatments? A lot of the early trials suffered from flaws of that type.”
He said early trials often didn’t have good controls. Many, he says, used a ‘no treatment’ control group to compare with acupuncture therapy. This meant that no account was taken for non-specific effect: it became impossible to tell whether the acupuncture itself was the mechanism of effect, or whether the acupuncture functioned as a placebo.
The therapeutic alliance
The majority of Armour’s acupuncture research work has been around menstrual pain, and while he says his team have unearthed promising efficacy results, that come with the caveat that they remain early phase results.
What he’s prepared to say is that it’s “likely” that acupuncture provides some relief to this type of pain. But questions remain: how much of this effect is the result of the needles and how much is a result for the act of treatment? How big is the magnitude of effect? He can’t provide any easy answers, but he’s working on it.
Armour, as a student, advocate, and practitioner of both the western and ‘eastern traditional’ approach to medicine, he believes what the West could – and should – learn from the East is the therapeutic alliance between practitioner and patient. This is also a theme that resonates in his long-term field of inquiry into menstrual pain and endometriosis.
“That’s something that’s we find is so important. Speaking to friends of mine who are GPs, a lot of them try to provide those kinds of interactions in their clinical practice, but I think it’s very hard. I don’t know how you bridge that gap, when you’ve got an 8-15-minute treatment model, whereas acupuncturists typically have 45 minutes to an hour.
“What we hear from our patients when we follow up after research, is that they feel heard and understood. That’s key.
“We think that acupuncture, and probably other complementary medicine therapies fulfill what’s called Engel’s Double Need – that refers to Engel, a medical philosopher in the 80s, who talked about patients having two needs: to know what’s going on with them, and to be known and understood, so to feel like their practitioner has heard them. That’s the feedback that we get a lot, that they feel more heard and understood.
“[Concerning primary dysmenorrhea] women often feel that they’re not being heard when they go to their GP. They’re told that it’s normal, that it’s just something they have to put up with, or that it’s all in their head. To have someone take them seriously, and have someone say, ‘okay, well this is the traditional Chinese explanation for why this is happening’, I think that allows them to have a new understanding of their bodies, and that’s really empowering. I do think that plays a critical role in treatment.”
Need to know: Five key points on period pain from Dr Mike Armour
- Primary dysmenorrhea (period pain) is very common in adolescents and young women. In Australia around 90% of young women regularly experience period pain.
- While period pain is common, it’s not ‘normal’ if it can’t be well managed by analgesics (like ibuprofen) or it significantly impacts your life by missing school or work on a regular basis.
- Ibuprofen and mefenamic acid (ponstan) are common anti-inflammatories that can reduce period pain in many women when taken correctly. The oral contraceptive pill can also work for many women. Speak to your doctor about treatment options
- If you get pain on a regular basis during your period then try taking the pain reducing medication before the pain starts. This is much more effective than waiting till it’s already very painful. And follow the dosage instructions on the box. Taking less than the recommended dose can mean you aren’t getting the full effect of the pain relief.
- Heat is another effective treatment option for period pain. Hot water bottles and wheat packs are common but can cause burns due to being too hot. Try using adhesive heat patches that deliver a steady 38-39 degrees.
- If you are using the contraceptive pill or analgesic medication and you are still getting a lot of pain, go and see your doctor. You may have something else causing your period pain, so they may need to do some more tests. You don’t just have to put up with severe pain!