In 2015, the American Animal Hospital Association (AAHA) published pain management guidelines stating, “Acupuncture offers a compelling and safe method for pain management in veterinary patients and should be strongly considered as a part of multimodal pain management plans.”1 Indeed, a multitude of papers and reviews supports this view.2 3 4
In contrast, the recently released 2022 Guidelines ignore both precedent and expanding research in their sole paragraph on acupuncture, stating:
“There is not an abundance of evidence-guided studies supporting the use of acupuncture. However, a 1997 National Institutes of Health Consensus Statement indicated promising results for the use of acupuncture in humans postoperatively, for treating chemotherapy nausea and vomiting, and in cases of postoperative dental pain. In the veterinary literature, acupuncture has been reported to be helpful as an adjunct treatment for postoperative pain following ovariohysterectomy in cats130 and dogs and for managing intervertebral disc disease, but it was not found to be beneficial for the treatment of pain associated with OA in dogs.131 Further work is needed to fully define the role of acupuncture in pain control.“5
The statements made by the authors of the 2022 Guidelines fail to convince. Acupuncture, in fact, already has both a substantial research foundation and a well-defined role in pain control. It is being “successfully and meaningfully utilized by the Veterans Administration and various branches of the US Military.”6 The American College of Physicians recommends it as first-line treatment for low back pain instead of opioids.7 Acupuncture controls cancer pain8 and provides effective analgesia in palliative care settings.9
Why the 2022 Guidelines minimize acupuncture remains unclear. What we do know is that the statements contained therein misrepresent the facts and evidence. They could negatively impact pain control in dogs and cats by discouraging the inclusion of acupuncture in multimodal pain control regimens. We request that these guidelines be modified to reflect the breadth and depth of acupuncture research more accurately.
NOTE: The 2022 AAHA Pain Management Guidelines for Dogs and Cats states that correspondence should be directed to the authors at megruen@ncsu.edu and dxlascel@ncsu.edu. You may also wish to contact the CEO of AAHA, Garth Jordan, at garth.jordan@aaha.org.
1Epstein M, Rodan I, Griffenhagen G, et al. 2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats. J Am Anim Hosp Assoc. 2015;51:67-84. Accessed at https://www.aaha.org/globalassets/02-guidelines/pain-management/2015_aaha_aafp_pain_management_guidelines_for_dogs_and_cats.pdf on 04-01-2022.
2Dewey CW and Xie H. The scientific basis of acupuncture for veterinary pain management: a review based on relevant literature from the last two decades. Open Veterinary Journal. 2021;11(2):203-209. Accessed at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8288732/ on 04-01-2022.
3Xie H and Wedemeyer L. The validity of acupuncture in veterinary medicine (Review). AJTCVM. 2012;7(1):35-43. Accessed at http://people.tamu.edu/~e-tebeaux/ode/oldtechwrite/Validity%20of%20Acupuncture.pdf on 04-01-2022.
4Silva NEOF, Luna SPL, Joaquim JGF, et al. Effect of acupuncture on pain and quality of life in canine neurological and musculoskeletal diseases. Can Vet J. 2017;58:941-951. Accessed at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5556488/pdf/cvj_09_941.pdf on 04-01-2022.
5Gruen ME, Lascelles DX, Colleran E, et al. 2022 AAHA Pain Management Guidelines for Dogs and Cats. J Am Anim Hosp Assoc. 2022;58:55-76. Accessed on 04-01-2022. Updated due to an “error” after the authors saw our initial concerns. Link is now https://www.aaha.org/globalassets/02-guidelines/2022-pain-management/resources/2022-aaha-pain-management-guidelines-for-dog-and-cats_updated_041822.pdf ad accessed on 04-27-22.
6Fan AY, Miller DW, Bolash B, et al. Acupuncture’s role in solving the opioid epidemic: evidence, cost-effectiveness, and care availability for acupuncture as a primary, non-pharmacologic method for pain relief and management- White Paper 2017. J Integr Med. 2017;15(6):411-425. Accessed at http://www.orientalmedicine.edu/downloads/Acupunctures%20Role%20in%20Solving%20the%20Opioid%20Epidemic%20_Final_September_20_2017.pdf on 04-01-2022.
7Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: A Clinical Practice Guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. Accessed at https://www.acpjournals.org/doi/full/10.7326/M16-2367?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org on 04-01-2022.
8He Y, Guo X, May BH, et al. Clinical evidence for association of acupuncture and acupressure with improved cancer pain: a systematic review and meta-analysis. JAMA Oncol. 2020;6(2):271-278. Accessed at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990758/ on 04-01-2022.
9Yang J, Wahner-Roedler DL, Zhou X, et al. Acupuncture for palliative cancer pain management: systematic review. BMJ Supportive & Palliative Care. 2021;11:264-270. Accessed at https://pubmed.ncbi.nlm.nih.gov/33441387/ on 04-01-2022.