Patients’ experiences of acupuncture and counselling for depression and comorbid pain: a qualitative study nested within a randomised controlled trial

Abstract

IntroductionDepression and pain frequently occur together and impact on outcomes of existing treatment for depression. Additional treatment options are required. This study aimed to explore patients’ experiences of depression, the processes of change within acupuncture and counselling, and the elements that contributed to longer-term change.MethodsIn a substudy nested within a randomised controlled trial of acupuncture or counselling compared with usual care alone for depression, semistructured interviews of 52 purposively sampled participants were conducted and analysed using thematic analysis.ResultsDifferences were reported by participants regarding their experience of depression with comorbid pain compared with depression alone. Along with physical symptoms often related to fatigue and sleep, participants with depression and comorbid pain generally had fewer internal and external resources available to manage their depression effectively. Those who had physical symptoms and were receiving acupuncture commonly reported that these were addressed as part of the treatment. For those receiving counselling, there was less emphasis on physical symptoms and more on help with gaining an understanding of themselves and their situation. Over the course of treatment, most participants in both groups reported receiving support to cope with depression and pain independently of treatment, with a focus on relevant lifestyle and behaviour changes. The establishment of a therapeutic relationship and their active engagement as participants were identified as important components of treatment.ConclusionsParticipants with and without comorbid pain received acupuncture or counselling for depression, and reported specific identifiable treatment effects. The therapeutic relationship and participants’ active engagement in recovery may play distinct roles in driving long-term change. Patients who present with depression and physical symptoms of care may wish to consider a short course of acupuncture to relieve symptoms prior to a referral for counselling if needed.Trial registration numberISRCTN63787732.

More Than Needles: The Importance of Explanations and Self‐Care Advice in Treating Primary Dysmenorrhea with Acupuncture

“…Acupuncture practitioners view this advice as “empowering” rather than “instructional” and an important factor in allowing patients to move from passive to active roles with regard to their health [ 33 ]. Feelings of empowerment and increased agency have been expressed by patients following treatment [ 38 – 41 ]. This self-care advice can allow patients to come to a different understanding of their current condition [ 32 , 37 , 39 ].…”

Pain-related distress and clinical depression in chronic pain: A comparison between two measures

“…Apart from one qualitative study [12], there are at present no studies available which investigated with qualitative methodology the area of com-morbid depression in the context of chronic pain, which currently represents a neglected area of study. Accumulating evidence that the quality and content of depression in the context of persistent back pain is different compared to clinical depression [27,28], may advocate the development of new treatment modalities for this specific group of back pain patients [12].…”

“…All patients had persistent pain for more than 3 months. Pain patients were only included if they rated their current level of pain, and the level of pain that they had experienced in the past few months as 3 or above on an 11-point Numerical Rating Scale (NRS), where 0 was 'no pain' and 10 was 'extremely painful' [12]. General practitioners and clinicians excluded patients with signs and symptoms of more severe pathology [33] or progressive disorders such as cancer.…”

Acupuncture for Depression: A Systematic Review and Meta-Analysis

“…We know that when a patient is depressed, they often are experiencing a range of other symptoms, commonly chronic pain, insomnia, digestive disorders, and low energy. Typically, a traditional acupuncturist will take into account this range of symptoms when constructing a treatment plan [71]. In cases where multi-morbidity from the perspective of biomedicine is perceived as problematic, research is needed to confirm, or otherwise, whether a multi-faceted acupuncture treatment provides a useful single modality solution.…”