Acupuncture for Tonsillectomy Pain?

Wong Baker Pain Faces Scale

Image: Wong-Baker Pain Scale Faces

“Alternative” Treatments for Children:

You may have already read about the benefits of Yoga for asthma, and my review of Acupuncture in Children, or how it may be used to improve (reduce) asthma symptoms. Me? Acupuncture helps reduce my back pain. Placebo effect, or “real” reduction of perceived pain through substance P and beta-endorphins (as indicated by pain research in a mouse model)? I really don’t care! So what if it IS placebo effect! Yes, scientific studies suggest otherwise, but I don’t really care: I only care that I perceive a reduction in my pain levels. Recent Development: One of the challenges in the world of Pediatric ENT (Ear, Nose & Throat) is how to manage the pain following a tonsillectomy (or adenotonsillectomy – “T&A”). Historically, post-tonsillectomy pain has been managed using liquid codeine (usually combined with acetaminophen). However, the FDA recently issued a strong warning against this – it can be fatal! What about using acupuncture for tonsillectomy pain? My good friend, Dr. Jim Ochi, just published his preliminary results on the use of Acupuncture Instead of Codeine for Tonsillectomy Pain in Children (free download here).

The danger of codeine (an “opiate” narcotic) to treat tonsillectomy pain is that opiates are respiratory suppressants: they reduce the drive to breathe. That is especially worrisome in children following tonsillectomy because many tonsillectomies are performed to relieve upper airway obstruction. That is, to treat obstructive sleep apnea (OSA) in a child. People with OSA – children and adults – can have an altered respiratory drive due to chronic changes in oxygen and CO2 levels. Therefore, treating tonsillectomy pain with codeine or other narcotics can be fatal: they can stop breathing. That makes Dr. Ochi’s report very encouraging!

Acupuncture For Tonsillectomy Pain?

Here are some highlights from his study:

  • This was a retrospective review of children and adolescents who had tonsillectomies over a three-month period. No narcotics were prescribed after surgery. Patients who wanted help with pain relief were offered acupuncture.
  • Perceived pain levels were assessed before and after acupuncture, using a pain scale of 0-10. After a 10-day recovery period, children and parents were queried regarding the length of relief that they achieved from the acupuncture.
  • Over the 3-month period studied, 31 patients (ages 2-17 years) received acupuncture for post-tonsillectomy pain.
  • Mean reported Tonsillectomy Pain Assessment before acupuncture: 5.52 (SD=2.28) on scale of 10.
  • Mean reported Tonsillectomy Pain Assessment after acupuncture: 1.92 (SD=2.43) on scale of 10.

Got that?

Acupuncture Reduced Pain From 5.5 to 1.9!! 

That’s right: acupuncture resulted in a reduction in reported tonsillectomy pain from an average of 5.5 to 1.9 out of 10 (worst). And statistical analysis indicates that this pain reduction was real. It’s legit.

So, any problems with the study?

It doesn’t quite meet the “gold standard” of the best science: it was a retrospective study instead of controlled, prospective. It was also a relatively small sample size. In a perfect world, we would have a “placebo” control: that is, sham acupuncture needles to see whether the reduction in pain is really due to Acupuncture needle placement, or merely a reduction in perceived pain due to the expectation of reduced pain – recall my experience with acupuncture to reduce my back pain. Again: I don’t care if my reduced pain is placebo! As you imagine, most parents are reluctant to give consent to have random needles placed in their children to provide controls for such a study.

I don’t think that any of these considerations detract from the value of Dr. Ochi’s study. All but one of these children experienced reduced pain. Reduced pain is ALWAYS a good thing. Especially in children.

One curious thing about this study was the variability in duration of the analgesic effect:

  • About a third of these children achieved less than 3 hours of pain relief from acupuncture
  • About a third of these children achieved more than 60 hours of pain relief from acupuncture

That’s quite a range; the standard deviation (SD) was nearly 65 hours!

Similar to other studies on the use of acupuncture for post-surgical pain relief, there were no adverse effects from acupuncture.

In summary, in a recent study on the use of acupuncture for tonsillectomy pain, acupuncture significantly relieved pain in 30 of 31 children, from mean pain score of 5.5 to 1.9. As always, such a retrospective study that provides encouraging preliminary results warrants a larger, prospective follow up study. Regardless, this is a wonderful contribution to the quality of life for our children who require tonsillectomy!

Resources:

  • Dr. James Ochi is a Pediatric ENT doc who practices integrative medicine, including acupuncture: http://ent4mykids.com/
  • Robin Green, L.Ac., MTCM, is one of the few Licensed Acupuncturists who specialize in treating children. Check out her site here: http://www.kidsloveacupuncture.com/
  • For transparency, I have no financial relationship with either Dr. Ochi or Robin Green. They are both great resources! I consider them both to be friends.

 

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Hi, I’m Russell Faust, author of this medical education blog. That wonderful photo of me is by Chris Stranad; here is his site: http://www.chrisstranadphotography.com/Index.html

Russell Faust, PhD, MD boogordoctor / healthy children
Image: Dr. Faust and friend

Let me know what topics are important to you and your child’s respiratory health. Join the conversation by leaving a comment / reply below, or email me any time. Thanks for visiting, see you here later. In invite you to subscribe to this blog (it’s FREE). Be sure to type in your best email address (the one that you actually use).  You will then receive an email with a “confirmation link” – click on that link to get weekly updates from this blog in your email. It’s free, it’s convenient, it’s an easy way to stay up-to-date on information to keep you and your family healthy.  You can un-subscribe at any time. Stay informed. Stay healthy. Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)

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Comments

  1. Hi Dr. Faust,
    Love your site! I am a 41 year old female considering tonsillectomy because of recurrent sore throat and tonsil stones. I have been on the fence for almost 2 years, because I fear the surgery and the pain of recovery, and because I wonder if it will really be worth it. My left tonsil is worse than the right, and my left ear also frequently hurts, but when checked, does not look infected. I also experience fatigue, dizziness and low grade fever on a regular basis. Do you have any recommendations for tonsil stones other than tonsillectomy? Is it safe for someone in their 40’s to undergo such a surgery? Especially, because I am a slow healer and seemingly immunocompromised, but I suspect a big part of my problem is the fact that chunks of bacteria live in my tonsils, which must tax my entire lymph system. Thanks!

    • Russell A. Faust, PhD, MD says:

      Hi Mitzi:
      I feel for you … I clearly remember the last two adults on whom I performed a tonsillectomy: much more “discomfort” than children experience. And in my experience, adults experience a higher complication rate. The most serious risk is bleeding. Mi advice: find yourself an ent with a great reputation and ask them your questions.
      Best success

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