Acupuncture

These little electric signals over stimulate the nerve without any pain. When the nerve is over stimulated, it is unable to transmit any other sensations, such as the pain associated with the surgery. Its a little bit like when there's loud music in the room and you're trying to talk on the phone. The nerves in your ears are overstimulated by the volume of the music, and so you can't hear anything on the phone. Once the music is turned down, you can hear again. That's pretty much the reasoning with needles inserted along a nerve pathway for acupuncture anesthesia.

 

Introduction

When Chinese acupuncture was first introduced to the West in 1970's, most scientists thought it was just another typical pseudo-scientific and paranormal claim. Gradually they came to understand, with some evidence, that acupuncture works at least in part by releasing morphine like substances called "endorphin" which creates acupuncture analgesia ......... The images of brain scans showed dramatic changes in the regions of the central nervous system that coordinate the perception of pain. Research has also shown that there are correlation between some acupuncture points and the corresponding brain cortices using functional MRI.

What many people do not realize is that the most essential and fundamental concept behind all these amazing Chinese wonders is Qigong. Qigong is the system that has produced many treasures in the Chinese culture such as Acupuncture, Tai Chi, Kung Fu, Chinese Medicine, Ying-Yang, I Ching, Five Elements theory, philosophy and culture in general ........ It has also profoundly shaped all aspects of the extraordinary Chinese long history.

However, the cycle seems to be repeating. Qigong, like the Acupuncture in 1970's, is being labeled as pseudo-scientific paranormal claim. Acupuncture was listed for many years by the American Medical Association as an experimental procedure that should only be performed under the supervision of a western doctor. To the West, Chinese acupuncture springs from a system of faith that modern scientists find incomprehensible - the equilibrium of Ying and Yang Qi inside your body. In other words, although it worked, it was not widely accepted until it was shown scientifically how it worked. In 1996, US Food and Drug Administration finally took it off the list of "experimental" medical devices. Now acupuncture is widely used in the United States and other countries. It is estimated that there are more than 10,000 licensed acupuncturists in U.S. alone and most of insurance companies now cover their services. This would probably be the same route that Qigong will take to the acceptance in countries outside of China.

NEWS FROM JCM 67 OCTOBER 2001 SAFETY OF ACUPUNCTURE

Two major studies carried out into the safety of acupuncture and published in the British Medical Journal (BMJ) have confirmed that it is indeed a fundamentally safe form of medicine.

The York Acupuncture Safety Study audited 34,407 treatments by 574 traditional acupuncturists during a four week period. Practitioners reported no "significant" (i.e. serious) adverse events as a result of treatment and only 43 minor adverse events, most commonly severe nausea and fainting, with two cases of needles being left in, and one of moxibustion burns to the skin. Mild transient reactions occurred in around 15%of treatments including mild bruising, pain and bleeding. Patients experienced an aggravation of existing symptoms in 2.8% of treatments, but 86% of these were followed by an improvement, possibly indicating a positive "healing crisis". The most commonly reported mild transient reactions were "feeling relaxed" and "feeling energised". Another study carried out into 32,000 treatments given by doctors and physiotherapists reported essentially similar results. A BMJ editorial states "Both [studies] suggest that the rate of complications is remarkably low and that most complications are transient, lasting two weeks at most". There are two recent reports however, of significant adverse events concerning acupuncture. In the first, a Chinese patient developed a severe occipital headache, nausea and vomiting following needling of Fengfu DU-16 for chronic neck pain. A CT scan showed haemorrhage in the fourth ventricle. The headache lasted 28 days (Headache 2000;40:397-8). In the second an emaciated 83 year old female patent developed bradycardia and syncope 20 minutes after an acupuncture was inserted perpendicularly at Shanzhong REN-17. At thoracotomy a 2-3mm perforation was found in the anterior wall of the right ventricle but the patient survived. In a previously well-reported case a patient died afer a needle at Shanzhong REN-17 penetrated the sternal foramen. In this case no sternal defect was found and it is assumed that the point location was significantly incorrect. Sternal foramina, which lie beneath Shanzhong REN-17, occur in 9.6% of men and 4.3% of women. (Chest 2000;117:1510-1 and Chest Surg Clin N Am 2000;261-76).

ACUPUNCTURE AND AUTISM

Autism is a complex developmental disability that normally appears within the first three years of life. It is estimated to occur in up to one in every 500 children, is more common in boys than girls, and can severely affect a child's social interactions and communication skills. Many children develop normally for the first year of life, even walking, talking or crawling earlier then the average child, but then autistic symptoms begin to appear. Language is either slow to develop or does not develop at all, whilst some autistic children master speech but have difficulty processing information. Some will isolate themselves, rarely interacting with others. Sight, hearing, touch, smell or taste, may be impaired. Autistic children may lack the ability to play spontaneously and imaginatively, and may exhibit aggressive behaviour (to themselves or others). They may show obsessive interest in one particular thing whether a person, an activity or an object, staring at or playing with the same item, or rocking repetitively for hours, and laughing or crying for no apparent reason. There are many different approaches to the treatment of autism, none offering spectacular success, but acupuncture and Chinese herbal medicine have shown promising results. Now a new acupuncture method has been pioneered by Prof. Virginia Wong of the University of Hong Kong. The technique involves stimulating regions on the tongue which, by using brain imaging techniques, were shown to affect areas of the brain related to autism. Children who were treated by this method showed improvements in language and social skills, cognition, hyperactivity, attention span and aggression. (Proceedings of the World Congress of Neurology, London).

ACUPUNCTURE SATISFACTION

Patients of 4 acupuncturists in York, England, filled in questionnaires and were interviewed to find out their experience of the outcome of their treatment. The main reasons for seeking acupuncture treatment were physical symptoms in 90% of cases, mental and emotional problems in 9%, and general health and well-being in 1%. Patients reported definite change 75% of the time with physical symptoms, 67% of the time with emotional and mental symptoms. 40% of the patients experienced lifestyle changes, 27% had major life changes, and 54% reported inner life changes. Emotional changes, irrespective of the initial reason for attending, were experienced in 83% of the patients. The authors conclude that acupuncture results in a broad range of outcomes and that existing outcome measures are not adequate to assess wider benefits often observed with acupuncture. (Patient perspectives on outcomes after treatment with acupuncture., Gould, A.; MacPherson,H., J Altern Complement Med, 2001, Vol. 7(3) p. 261-268).

ACUPUNCTURE & BACK PAIN

Acupuncture has performed poorly in a recent study comparing its effect on back pain to that of therapeutic massage and self-care education. 262 patients with chronic back pain of greater than 6 weeks duration, were randomly assigned to three groups. The acupuncture group received up to 10 treatments over 10 weeks from seven acupuncturists, five of whom received their clinical training in China. Although acupressure, massage, and herbs were disallowed, the acupuncturists were allowed to use cupping, moxibustion and infrared heat. Deqi was obtained in 89% of cases, with a mean of 12 needles per session. Electrical stimulation of the needles was used in 51% of the cases. The massage patients received up to 10 treatments over 10 weeks. The self-care group received a book and 2 professionally-produced videotapes. All patients were evaluated at 4, 10, and 52 weeks following commencement of treatment. Although there were few differences between the groups after 4 weeks, over longer periods of time the massage group fared consistently better than the acupuncture group, and over a one-year period of assessment, so did the self-care group. The study authors concluded that therapeutic massage was effective for persistent low back pain, apparently providing long-lasting benefits, whilst traditional Chinese medical acupuncture was relatively ineffective. (Randomized Trial Comparing Traditional Chinese Medical Acupuncture, Therapeutic Massage, and Self-care Education for Chronic Low Back Pain. Cherkin, D. C., Eisenberg, D., Sherman, K. J., Barlow, W., Kaptchuk, T. J., Street, J, and Deyo, R., A. Arch Intern Med, Vol.161, April 23,2001, p. 1081-1088). Another study has shown that patients who expected either acupuncture or massage to effectively treat their back pain were five times more likely to report a substantial improvement in their symptoms than those with average expectations. Patients with high expectations for massage tended to do better if they were assigned to the massage group and those with high expectations for acupuncture tended to do better if they received acupuncture, and the authors point out that "general optimism about treatment, divorced from a specific treatment, is not strongly associated with outcome" (Spine 2001;26). Another study compared true acupuncture with sham acupuncture in the treatment of lumbar disc protrusion, both before and after surgery. The true acupuncture group were needled at points Dachangshu BL-25, Huantiao GB-30, Yanglingquan GB-34, Weizhong BL-40, Shenshu BL-23, Guanyuanshu BL-26, Fengshi GB-31, Chengfu BL-36 and Shenmai BL-62 (listed in order of frequency of use) with deqi obtained, whilst the sham group were needled at nearby non-points with no deqi produced. True acupuncture resulted in significant pain relief compared to the sham. (Am J Chin Med 2000;28:25-33). A further study has compared acupuncture with physiotherapy in the treatment of lumbar and pelvic pain in pregnancy, with the acupuncture group improving to a greater degree than the phsyiotherapy group in terms of pain and disability. (Acta Obstet Gynecol Scan 2000;79:331-5).

ACUPUNCTURE & HIP OSTEOARTHRITIS

In a challenge to traditional acupuncture, a study in Germany compared (non-individualised) traditional point needling and manipulation with non traditional placement (i.e. non-points) and non manipulation, for patients with osteoarthritis of the hip. In both groups needles were placed within the L2 to L5 dermatomes. For all patients there was a significant improvement in both groups 2 weeks and 2 months following treatment, but no significant difference between the two treatment groups. The authors conclude that needle placement in the area of the affected hip is associated with improvement in the symptoms of osteoarthritis whilst it appears to be less important to follow the rules of traditional acupuncture techniques (Non-specific effects of traditional Chinese acupuncture in osteoarthritis of the hip, Fink MG, Wipperman B, Gehrke A., Complement Ther Med 2001 Jun;9(2):82-9). Another study compared acupuncture with advice and an exercise routine for patients with osteoarthritis of the hip among 32 patients waiting for hip replacement surgery. Patients were excluded from the study if they had rheumatoid arthritis, previous hip injury or surgery, intra-articular steroid injection in the last 3 months, were pregnant, or had epilepsy or an allergy to metal. 16 patients received acupuncture at Juliao GB-29, Huantiao GB-30, Yanglingquan GB-34, Xiaxi GB-43, Neiting ST-44, Hegu L.I.-4 bilaterally, and 4 ahshi points around the greater trochanter, once a week for 6 weeks. Results showed that acupuncture was more effective than advice and exercises in the symptomatic treatment of osteoarthritis of the hip. (Med Acup 2001, Vol.19(1) p. 19-26).

ACUPUNCTURE & NECK PAIN A study published in the British Medical Journal shows that acupuncture is an effective short term treatment for patients with chronic neck pain. A total of 177 patients with chronic neck pain were randomly allocated to five treatments of three different kinds over a three week period. 56 patients received needle acupuncture, 60 were given conventional massage, and 61 received "sham" laser acupuncture (a dummy procedure to provide a control group to compare with real acupuncture). The most commonly used points were Houxi SI-3, Tianzhu BL-10, Kunlun BL-60, Taichong LIV-3, Fengchi GB-20, Yanglingquan GB-34, Waiguan SJ-5, and the ear point "cervical spine." Active myofascial trigger points were located predominantly in the trapezius and levator scapulae muscles. One week after the end of treatment, the acupuncture group showed a significantly greater improvement in movement-related pain compared with the massage (although not compared with the sham laser acupuncture group). Differences between acupuncture and massage or sham laser were greater in the subgroup who had had pain for longer than five years and in patients with myofascial pain syndrome. The acupuncture group had the best results in most secondary outcome measures. However, after three months follow up, there were no significant differences in mobility and pain between the groups. This is consistent with the experience of most acupuncturists who would expect a longer period of treatment to consolidate the benefits gained in the treatment of most chronic conditions. (Randomised trial of acupuncture compared with conventional massage and "sham" laser acupuncture for treatment of chronic neck pain, Irnich et al, BMJ 2001;322:1574).

related articles

http://www.ucihs.uci.edu/radiosci/radphysics.html Further Evidence For the Correlation between Acupuncture Stimulation and Cortical Activation

http://www.jcm.co.uk/News.html

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Acupucture, Chinese Medicine Colleges & Schools - UK

 

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