Acupuncture Anesthesia / Analgesia in Surgery

In 2002, I was part of a delegation that traveled to Cuba (on a license through Global Exchange) to attend a medical conference and associated events. It was an incredible trip! Here are some photos from a carpal tunnel surgery at the hospital where acupuncture was used, as well as photos from the conference itself. I included a photo of myself because I was so excited to be able to attend the surgery and witness this with my own eyes, something evident in the photo.

The surgery as I remember it: A needle was inserted deep into the axilla (armpit) with electrical stimulation for approximately 20minutes. When the patient reported numbness down her extremity, a local anesthetic was injected at the surgical site (her wrist) to further produce numbness. There was a drape hung so that the patient would not see the surgery itself. As far as I know she was not given any oral sedatives: she was alert, calm, and able to respond to physician questions. As the doctor performed surgery, he would ask questions to the patient such as, “please move your index finger” and the patient, non-drowsy and fully awake, would do so with ease. There was an explanation provided that being able to communicate well with the patient helped the surgeon because he could confirm which tendons he was working with, which of course was useful since he was about to surgically cut one. After the surgery, the patient was calm, happy, and shared a beautiful smile with us. No stress.

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Here’s a 2016 video about acupuncture anesthesia in the US: http://www.cctv-america.com/2016/02/07/us-patients-offered-acupuncture-as-anesthesia-alternative

 

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Acupuncture in Pregnancy

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Recently I ran into a patient who I had worked with across two pregnancies. It brought so much joy to see her out with her baby. While chatting, she told me how acupuncture helped her through each of her pregnancies. I love that!

I really enjoy working with pregnant women. It’s such a special time in life and I feel lucky to be able to offer something tangible that may help them through this time of great transition. 

Women’s bodies are going through so much change during pregnancy and I find, anecdotally from my own clinical experience, that their bodies are often more sensitive and receptive to the gentle art of acupuncture. During gestation, we give careful consideration to both the mother and fetus so as to nurture and support the process. 

Pregnant women are often particularly careful about what they consume and receive advice from their doctors about which over the counter and prescription medicines are safe while pregnant. Knowing that acupuncture can be safe and effective offers another treatment option where other options may not be advised. 

Another thing with pregnancy is that underneath the exterior of a what a blessed time this is, is perhaps a woman with stress.

Questions about readiness and change, possibly coupled with low energy, diminished sleep, appetite changes (to name a few) are often occurring simultaneously as they continue with regular responsibilities of work and/or childcare, making plans for changes in the future, re-shaping their homes, etc. It’s a lot! Getting acupuncture is a quiet time and allows them a place to rest and receive support. Patients often tell me they feel better coming in. 

Here is a partial list of general conditions common to pregnant women that I’ve worked with and found acupuncture to be helpful:

Fatigue 

Musculoskeletal aches and pains

Headache 

Nausea and/or vomiting

Stress

Depression

Constipation 

As we move towards greater integration of conventional / Western care and treatment with other complementary modalities (such as acupuncture), I hope we’ll see more studies on the safety and efficacy of acupuncture as part of a potential treatment plan for those with risk of pre-eclampsia (PE), gestational diabetes, and other riskier pregnancies. We’ll see… 

In the meantime, here are some links to scientific evidence around acupuncture and pregnancy: 

Debra Betts’ robust website with links to research for pelvic pain, nausea, breech presentation, prebirth, cervical ripening, and depression in pregnancy. Here’s the link to pain relief in labor: http://acupuncture.rhizome.net.nz/acupuncture/research/reducing-labour-pain/

Nei-Guan point acupressure is a useful treatment for relieving symptoms experienced by women with hyperemesis gravidarum.” http://www.ncbi.nlm.nih.gov/pubmed/17645494

There is high-quality evidence reporting the benefits of herbal medicines and acupuncture to treat nausea in pregnancy.” http://www.ncbi.nlm.nih.gov/pubmed/26866600

In women’s health, acupuncture has been found to be beneficial for patients with premenstrual syndrome, dysmenorrhea, several pregnancy-related conditions, and nausea in females who have cancers.” http://www.ncbi.nlm.nih.gov/pubmed/18803496

[This study was designed to check for a different condition, but also said the following.] Good clinical evidence has been reported for the effect of PC6 acupuncture in preventing or attenuating postoperative and pregnancy related nausea.”  http://www.ncbi.nlm.nih.gov/pubmed/18356796

[Fourth year medical students in London can take a course in Chinese Medicine. Here’s an essay on migraine + acupuncture + pregnancy.] “…acupuncture for migraine relief has been recommended by NICE as a non-pharmacological measure for migraine headaches(59). Since acupuncture has the potential to relieve migraine pain without the added fear of teratogenicity, it may be a useful alternative or adjunct for analgesic medications given in pregnancy.” http://www.cmir.org.uk/kcl-ssc-student-submissions

“Given the high prevalence of nausea and vomiting in early pregnancy, women and health professionals need clear guidance about effective and safe interventions, based on systematically reviewed evidence. There is a lack of high-quality evidence to support any particular intervention. This is not the same as saying that the interventions studied are ineffective, but that there is insufficient strong evidence for any one intervention. The difficulties in interpreting and pooling the results of the studies included in this review highlight the need for specific, consistent and clearly justified outcomes and approaches to measurement in research studies.” http://www.ncbi.nlm.nih.gov/pubmed/26348534

The summarized findings indicated a small but growing body of acupuncture research, with some evidence suggesting a benefit from acupuncture to treat nausea in pregnancy. Findings from the review also highlighted promising evidence for the effectiveness of acupuncture to manage back and pelvic pain, acupuncture-type interventions to induce change in breech presentation, and pain relief in labor. The methodological quality of recent trials has improved, and the quality of systematic reviews was high. CONCLUSIONS: Interest is growing in the use of acupuncture to treat some complaints during pregnancy and childbirth, and evidence is beginning to consolidate that acupuncture may assist with the management of some complaints during pregnancy. However, definitive conclusions about its effectiveness cannot be reached and further research is justified.” http://www.ncbi.nlm.nih.gov/pubmed/19747272

** Image on this page released under Creative Commons CCO. See https://pixabay.com for more info or to download images you like.

Headaches / Migraines

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From the Washington Post,  an account of treating migraines well with acupuncture,

“A month into my treatment, after eight sessions, I noticed that my migraines had begun to slow down in frequency and weaken in intensity. At the end of two months, I felt strong enough to scale my appointments down to once a week. Five months after I started acupuncture, I felt essentially cured. I rarely got the drowsy fog of fatigue — and if I did, it almost always went away on its own. I could work on my computer and spend time on the beach, and I was able to drink wine again. It has now been five years since I discovered acupuncture. I still occasionally get migraines, and if they seem to be amping up, I’ll use acupuncture, even a couple of times a week. But there have been months when I don’t need it at all.”

https://www.washingtonpost.com/national/health-science/migraines-were-destroying-my-life-heres-what-finally-cured-me/2016/05/02/7007b840-f6b1-11e5-9804-537defcc3cf6_story.html?postshare=461462290441410&tid=ss_tw

I’d like to add a couple notes:

  1. Please notice that the patient really tried acupuncture. She didn’t just come once or twice but having noticed that she was trending well after a round of eight treatments, she continued on for further benefits.
  2. It’s not often that I’ll quote WebMD for acupuncture because quite frankly, I don’t always see them mention acupuncture as a viable treatment option for conditions that I’ve seen treated first-hand with acupuncture. But times may be a’changing and headaches are commonly treated by acupuncture so here you go, titled “Acupuncture May Be Effective for Migraines” at http://www.webmd.com/migraines-headaches/news/20120112/acupuncture-may-be-effective-for-migraines — Here’s a quote from the article, “Three months after treatment, people who received traditional Chinese acupuncture continued to report a reduction in migraine days, frequency, and intensity.” There was also this gem, “Another study of nearly 800 people showed that 11 acupuncture treatments over six weeks were at least as effective as the blood pressure drugs called beta-blockers — often used for migraine prevention — taken daily for six months, Molsberger tells WebMD.”
  3. An essay exploring acupuncture for migraines (particularly in pregnant women) from a 4th year medical student in London: “acupuncture for migraine relief has been recommended by NICE…Since acupuncture has the potential to relieve migraine pain without the added fear of teratogenicity…necessary to carry out further research on the effects of acupuncture on those who are pregnant.” http://www.cmir.org.uk/kcl-ssc-student-submissions
  4. Here’s a nice link about tension-type headaches from Cochrane last month: http://www.cochrane.org/CD007587/SYMPT_acupuncture-tension-type-headache — First line, “The available evidence suggests that a course of acupuncture consisting of at least six treatment sessions can be a valuable option for people with frequent tension-type headache.” This was a review of 12 trials with 2,349 adults!

I hope more people suffering from headaches will consider acupuncture!

 

** Image on this page released under Creative Commons CCO. See https://pixabay.com for more info or to download images you like. Yay!

 

Gentle Acupuncture & Needle Fear

I think I’m pretty good at working with people who have some fear about acupuncture because of the needles. For one, I let patients know that in No Event am I going to do something they don’t want me to do and that I will only perform acupuncture after asking them if it’s okay. I also remind them that I will only be working in a specific location that we’ve talked about and that they have the power to say “not there”.

So essentially, I:

  • remind them that they’re in control
  • that nothing happens without their consent
  • that they can consent and then change their mind

In the treatment room, I can use needles that are more gentle, intended for children or babies, and employ techniques that are mild in nature.

I let them know that some patients, on the other end of this spectrum, prefer “stronger techniques” and that as practitioners, we don’t always know which techniques a patient will prefer or respond best to. Communication is key.

I assure them that I’ll be conservative in my approach and will give a lighter treatment, even at the risk of non-effectiveness, instead of a stronger treatment, and that we can always build up to stronger-feeling treatments if they like and as they’re ready.

Some patients prefer to see the needles first while others prefer not to, so together we decide best approaches to facilitate comfort and ease. I can also describe how thin needles are, more similar to the width of a hair than what they may have experienced at doctor’s offices. I also ask if they have any concerns or questions around safety and that I’m trained to be safe.

Also, some prefer to chat or listen through the act of insertion and others prefer silence so they can breathe in/out without disruption. We discuss their preferences and then I take steps to honor them. At any time, we can slow down or stop altogether.

So this:

  • creates the expectation of mellow, starting simple/light
  • reminds them that different people respond and prefer different techniques
  • reminds them they’re in control and we’re in this together

If they elect for just one insertion, I let them know this is a great start and that some entire treatments are just that: they shouldn’t feel like it’s not a full treatment. If they like, I will hang out with them for a few minutes making sure they’re comfortable with the feeling acupuncture produces, which is typically quite calming but is also something one feels.

We discuss whether they want me to check in on them and I give them a bell to ring me if they need me to come for immediate assistance. If they say they want to be checked in 5 minutes, I tell them that “I will return in 5minutes, not 6 or more minutes. I’m going to set a timer” and then I do.

Together, we make agreements that are followed, which helps establish trust. Anxiety and/ or panic can rise and blossom so I try to be very diligent in approach so that they trust that I’ll be there if they need me.

Acupuncture is typically relaxing, calming, sometimes even sedating, and some describe a sort of floaty sleep-like session, an “acu-nap”. Acupuncture can be very good for people who have anxiety, insomnia, depression, etc. Once they feel it, they typically come back for more. Acupuncture can be great for sensitive people.

 

 

What about the research (RCT, randomized controlled trial) on Chinese medicine?

Search to see if there’s published research in a subject area that interests you.

On 3/1/2016, I searched several acupuncture topics (for fun) on MedPub (a database of the US National Library of Medicine, National Institutes of Health). I could have easily chosen other search examples such as “acupuncture + digestion” or “acupuncture + nausea and vomiting” but here are some examples of how many research trials were found:

“acupuncture” yielded 24,194 results

“acupuncture pain” yielded 6,493 results

“acupuncture low back pain” yielded 607 results

“acupuncture cancer” 1,263 results

“acupuncture chronic pain” 1,392 results

“acupuncture pregnancy” 849 results

“acupuncture migraine” 403 results

“acupuncture anxiety” 548 results

“acupuncture depression” 793 results

And one example:

JAMA, journal of the AMA, a meta analysis (comparing research studies) of 17,922 patients, regarding back and neck pain, osteoarthritis, chronic headache, and shoulder pain, found that “acupuncture was superior to both sham and no-acupuncture control for each pain condition – – Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option”

[ Oct 2012:   http://archinte.jamanetwork.com/article.aspx?articleid=1357513 ]

Definition “Research”: Webster’s 2nd Edition, c.1934 (1910)

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From http://www.merriam-webster.com March, 2016:

Full Definition of research

  1. 1:  careful or diligent search

  2. 2:  studious inquiry or examination; especially :  investigation or experimentation aimed at the discovery and interpretation of facts, revision of accepted theories or laws in the light of new facts, or practical application of such new or revised theories or laws

  3. 3:  the collecting of information about a particular subject

What conditions does acupuncture treat?

“Since at least 200 BC, the application and effects of acupuncture and herbs have been documented. It is only recently, however, that systematic exploration of Chinese Medicine using the scientific method has become more recognized and accepted in the West.

Chinese and Western scientists have proven that acupuncture does indeed increase levels of endogenous morphine-like substances. Clinical studies of acupuncture in the treatment of a wide range of illnesses have led to acupuncture’s acceptance beyond pain control.

The following is the World Health Organization’s now famous list of diseases that lend themselves to treatment by acupuncture. The inclusion of herbal remedies in a scope of practice may broaden the range of disorders that may be successfully treated.” 

http://www.pacificcollege.edu/resources/about-medicine/treatable-disorders ]

Gastrointestinal Disorders

Acute and chronic colitis

Acute and chronic gastritis

Acute bacillary dysentery

Acute duodenal ulcer (without complication)

Chronic duodenal ulcer (pain relief)

Constipation

Gastric hyperacidity

Gastroptosis

Diarrhea

Hiccough

Irritable bowel and colitis

Paralytic ileus

Spasms of esophagus and cardia

Gynecological Disorders

Benign amenorrhea

Benign irregular menstruation

Dysmenorrhea

Infertility (Not WHO recognized. Clinical experience proves effective.)

Menopause syndrome

PMS

Cardiovascular Disorders

Essential hypertension

Neurological Disorders

Cervicobrachial syndrome

Disc problems

Facial palsy (early stage, within three to six months)

Headache and migraine

Intercostal neuralgia

Meniere’s Disease

Neurogenic bladder dysfunction

Nocturnal enuresis

Paresis following stroke

Peripheral neuropathies

Trigeminal neuralgia

Musculo-skeletal Disorders

Arthritis

Fibromyalgia

“Frozen shoulder”, “tennis elbow”

Localized traumatic injuries, sprains, strains, tendonitis, contractures

Low back pain

Muscle pain, swelling, stiffness and weakness

Osteoarthritis

Sciatica

Work and sports related injuries

Respiratory System Disorders

Acute bronchitis

Acute rhinitis

Acute sinusitis

Acute tonsillitis

Bronchial asthma

Common cold

Disorders of the Eye, Ear, Nose & Mouth

Acute and chronic pharyngitis

Acute conjunctivitis

Cataract (without complications)

Central retinitis

Gingivitis

Myopia (in children)

Toothaches, post extraction pain

Psychological Disorders

Anxiety

Depression

Hypersomnia

Insomnia

OCD

PTSD

Somatization disorder

Other Disorders

Appetite suppression

Withdrawal from street and pharmacological drugs

One of my favorite questions people ask me about acupuncture…

Question: Do I get acupuncture and who do I see?

Answer and Explanation: Yes, I do (sometimes) and I sometimes see different practitioners based on what health concern(s) I’m working on, usually not at the same time. If it is at the same time, I tell each practitioner what kinds of other work I’m getting or doing so we’re all on the same page and so recommendations don’t overlap (for example, I’ll take herbs from only one practitioner at any given time).

Sometimes I’m using Chinese medicine to treat one thing and sometimes I’m using it to treat another, or another, etc. For example, if the condition is physical pain-related, I may opt for a practitioner who works with that specific condition or otherwise treats a lot of musculo-skeletal pain. Generally-speaking, we all work with conditions of pain, but some will have sub-specialties in certain types of pain (example: someone who focuses on the neck or joints or whatever).

Because acupuncturists (as we are called) often have specialties or sub-specialties, I try to pay attention (and ask questions!) regarding what practitioners are focusing on in their continued studies, which we all do. Some may be particularly strong in the area of herbal medicine, medicinal massage, a particular style of acupuncture (of which, there are many), etc.

If I’m looking instead for treatments for a different kind of health concern, like to improve my energy levels, sleep, digestion, stress, than I may work with another practitioner based on fit, their training and approach, etc.

I think Chinese medicine generally works better when utilized as a series of appointments so depending on whether it’s an acute or chronic condition, I consider how many appointments, and how often will I get them (weekly, 2x p/week, more often?) and for how many weeks. Sometimes I like to consider a routine 4-6 appointments just to see how I’m responding to a round of treatments.

As a general note: For acute conditions, sometimes one can need less appointments and for chronic conditions, sometimes one can need multiple rounds of treatments. Alternatively, sometimes just a random appointment on a monthly basis can be very nice as a “tune-up” (of sorts) or perhaps, as a preventive measure to help the body stay in harmony.

It’s amazing how much variety can be found within the field of acupuncture! I can’t emphasize that enough.