Many different approaches are used to manage pain in medicine, and most therapies are pharmacologically based. Acupuncture is one therapeutic modality that can be used as a viable treatment option for painful diseases and conditions (including those seen in dermatology) without the occurrence of the adverse events that can take place with topical, oral or intravenous drug therapies.
Acupuncture has truly stood the test of time and has been used in traditional Chinese medicine for more than 2,500 years. Today, acupuncture is used for a mosaic of conditions encompassing the musculoskeletal system and for headaches and migraines.
At first glance, perhaps the idea of sticking needles into a patient with real medical issues seems like voodoo medicine. However, this notion is far from the truth. The fact is, acupuncture works.
“For more orthodox-thinking people, acupuncture is sometimes looked upon as a mysterious, esoteric practice with only anecdotal effectiveness. The truth is, acupuncture works and has a scientifically recognized efficacy for a variety of conditions, including acute and chronic pain issues,” says Michael Bennett, M.S., L.Ac., Dipl.O.M., director of Metropolitan Acupuncture & Herbal Medicine, New York.
Dermatologic uses
The American Academy of Medical Acupuncture has outlined certain conditions for which acupuncture is indicated, some of which include both acute and chronic dermatologic diseases/conditions such as herpes zoster and post-herpetic pain, pruritis, eczema, urticaria and psoriasis. Severe pruritus can be disfiguring and painful and a source of great frustration and anxiety to the affected patient. Mr. Bennett says he has used acupunct
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Acupuncture has been used successfully in Chinese veterinary practices for thousands of years to treat many conditions, such as:
* Musculoskeletal problems.
* Skin problems and allergies (including allergic dermatitis.)
* Respiratory problems including asthma.
* Gastrointestinal problems.
* Reproductive problems.
* Nervous system problems (including facial nerve paralysis.)
* Post-surgical pain.
* After-effects of traumatic accidents.
It’s also been used as a preventative measure to ward off conditions like founder and colic in horses, and to keep performing animals healthy and in top condition. Acupuncture isn’t a cure-all; it works well as a diagnostic tool and as a treatment option when indicated. As with humans, it can assist the animal body to heal itself by stimulating nerves and organs, increasing blood circulation, relieving muscle spasms and releasing hormones such as pain-controlling endorphins and the natural steroid cortisol.
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The ancient Chinese art of acupuncture can help patients to manage effective weight-loss, especially when weight has been gained by overeating. This kind of weight-gain can be directly attributed to the emotional state of the patient, who may use food as a form of comfort, rather than through the need to relieve hunger. The acupuncture needles are used to stimulate the release of endorphins, from the pituitary glands. These are the feel-good hormones that are normally released after a strenuous workout.
Before the practitioner decides where to insert the needles, they will examine the patient’s tongue, to look for any signs that indicate health issues that might have contributed to the weight-problems. The acupuncturist will also determine the pulse-rate to detect the person’s energy levels, and general health of the stomach.This, together with a history of the patient’s eating patterns, is to help the practitioner decide where to insert the needles for that particular patient.
The needles will be inserted in the ear, and in two or three other body points, depending on the diagnosis. These may include the mouth, thyroid, lungs, stomach, kidney, spleen, or in one or other of the main endocrinal glands. In the initial treatment, the “four gates” points will be used to enable any blocked energy to flow through the body. The “four gates” are located in the hands and feet; in the webbing between the index finger and the thumb, and similarly between the big toe and its neighbor.
Acupuncture needles are inserted at a point in muscle tissue near nerve endings, to best stimulate the production of endorphins, the natural pain and fever relievers. A prime point for weight-loss is behind the ears, as it stimulates the release of endorphins in large doses. If the patient feels emotionally well, they are better able to resist the temptation to use food for comfort eating.
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After nine years of smoking, Tina Volz, 29, was finally able to hang up the cigarettes by using acupuncture. Volz went through a three- to four-week process in which little metal discs were bandaged behind her ear twice a week. The discs, about a centimeter in diameter, were left there for the whole process. The first week of treatment, she smoked one pack. During the second week, she only smoked two or three cigarettes. By week three she had zero cigarettes.
“I felt some cravings, but nothing too out of control. It felt like a weight was lifted from my chest. I could taste and smell things more. I never realized how much I was lacking those senses,” Volz said.
Dr. William Terrell uses acupuncture to treat smoking at the Iowa Acupuncture Clinic in Clive, but with a slightly different method. He puts acupuncture needles in the ear’s auricle (the outer portion of the ear). The cost is around $58 a treatment, but Terrell offers a sliding scale. “The ear is basically the control panel for the whole body,” Terrell said. “Smoking calms you down, and that’s what acupuncture does. It’s tuning up your central nervous system and getting more blood flowing to the brain. It’s the same reason you feel so good after exercising.” Exercise releases endorphins, which leads to the feeling known as a “runner’s high.”
Bobbie Jo Sheridan with the American Lung Association said the organization doesn’t endorse acupuncture or hypnotism as a treatment tool, but doesn’t discourage them either.
“If a person is ready to quit, whatever method they use will probably work for them,” Sheridan said. “While we as an organization don’t endorse it, if someone wants to quit, we encourage them to use whatever will work for them.”
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The ancient Chinese believed that an energy, called “qi,” flows through the body and maintains health. The energy moves through pathways in the body called meridians. If this flow were disrupted, it would result in ill health or disease. To restore the correct flow of energy, the Chinese would insert needles at certain points along these pathways, a technique known as acupuncture. As explained in an article on www.MayoClinic.com, acupuncture originated more than 2,000 years ago in China and over the past 30 years has become a popular medical tool.
Today, acupuncture involves inserting thin metal needles at various points throughout the patient’s body. Although the theory of qi and meridians, still believed by traditional Chinese practitioners, is not widely accepted among Westerners, studies have shown that acupuncture is useful for a variety of medical conditions. Acupuncture has been known to help patients with osteoarthritis and to ease the feeling of nausea after chemotherapy. It also can act as a painkiller for several conditions including headaches, migraines, pain after dental surgeries, and even labor pain.
Although the exact mechanism by which acupuncture works is still unknown, certain theories have been made. According to an article on www.MedicineNet.com, scientists believe that the needles might stimulate certain sensory nerves and cause a series of effects. One possible effect of this nerve stimulation is the release of opioids produced in the body. Opioids are a class of chemicals that act as painkillers; one of the more well-known members of the group is morphine. The human body produces certain endogenous opioids or endorphins, which bind to receptors in the brain and help reduce the feeling of pain. Studies have shown that if chemicals that counteract the effects of opioids are administered during acupuncture, the acupuncture treatment has no effect.
Another theory that has been proposed is that acupuncture helps stimulate the pituitary gland. The pituitary gland regulates the release of a variety of hormones that travel through the body. Hence, stimulation of this gland could cause a multitude of different effects on many parts of the body.
Acupuncture has also been known to alter the regulation of blood flow in the body.
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Dr Clare Thornley looks at the evidence-based studies investigating the effects of acupuncture on migraine and chronic tension-type headache
There is now compelling evidence that migraine and chronic tension-type headache — common conditions that are challenging to treat in general practice — respond to acupuncture.
Cochrane Reviews, now 4,000 in number, are internationally recognised as the highest standard in evidence-based healthcare. The first Cochrane Review on acupuncture for idiopathic headache appeared in 2001 and was tentatively positive. Since then, a number of large, randomised, controlled acupuncture trials have been published.
In 2008, the Cochrane Review was updated and split into two separate reviews: acupuncture for migraine prophylaxis and acupuncture for tension-type headache. The results of these are recorded in the Cochrane Database of Systematic Reviews, with the authors concluding that acupuncture should be considered a treatment option for both these conditions.
This article looks at the evidence contained in the two Cochrane Reviews on acupuncture for migraine and chronic headache, and examines the contentious matter of placebo controls in acupuncture trials.
The size of the problem
* Migraine
Migraine affects around 15-20 per cent of the adult population, with a female-to-male ratio of two to one. In addition, 10 per cent of children are affected, with equal prevalence in boys and girls. Despite suffering on average 13, often debilitating, attacks a year, fewer than half of migraineurs are receiving any treatment.
Prophylaxis is not always required if migraine attacks are infrequent, and identifying and avoiding triggers can sometimes reduce the frequency or severity of episodes. However, for those whose migraines are severe enough to require prophylaxis, medication is usually the next step.
Beta-blockers may be particularly useful when the migraineur also has hypertension, but contraindications such as asthma, depression and peripheral vascular disease limit their use. The side-effect profiles of treatments such as amitriptyline and topiramate are not insignificant, whilst pizotifen is of doubtful efficacy. Triptans, although often dramatically beneficial in acute migraine, do not appear to alter the frequency of attacks in the long term, and overuse can result in worsening headaches.
* Chronic headache
Tension-type headaches are very common, usually episodic, and of mild-to-moderate intensity. Most respond to simple over-the-counter analgesics. However, around 3 per cent of women and 1.5 per cent of men experience this type of headache on at least 15 days a month, which fulfils the International Headache Society diagnostic criteria for chronic daily headache – a significant cause of work absenteeism.
After clear-cut aetiology (e.g. analgesic overuse) has been identified and been dealt with, chronic daily headache remains one of the most challenging common conditions to treat in general practice.
Guidelines recommend antidepressants such as ami-triptyline for chronic tension-type headaches. However, these are often unacceptable to, and poorly tolerated by, patients.
Controlled acupuncture trials
In acupuncture trials, true acupuncture (also known as verum acupuncture) is usually compared with one or more of the following:
1. standard drug treatment;
2. standard non-drug treatment;
3. routine care/waiting list (typically receiving acute treatment only);
4. a ‘sham’ acupuncture technique. Also sometimes called ‘fake’ acupuncture, sham techniques usually involve placing needles in non-traditional areas and/or inserting them more superficially than in normal practice.
Verum acupuncture points are usually standardised to some degree for trials, as are the frequency of treatment and number of sessions. This is a somewhat artificial approach, as these could vary considerably in real-life practice. Most trials consist of around 10-15 sessions of treatment once or twice weekly.
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AUSTRALIAN hospitals are finally catching up with what the Chinese have long known ?acupuncture is a great alternative form of pain relief.
Acupuncture is fast gaining acceptance in mainstream medicine right across the Western world. It’s already used routinely in several Australian emergency departments and is now undergoing a randomised, controlled trial in three Melbourne hospitals to alleviate pain from acute migraines, back pain and ankle sprain.
Researchers at the University of York and Hull York Medical School in the UK have just mapped acupuncture’s effect on the brain and have found that it changes specific neural structures, deactivating the areas in the brain associated with the processing of pain.
This is key, says Professor Marc Cohen, head of the trial and professor of complementary medicine at RMIT University.
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“We know that pain is the most common reason for people coming to emergency departments, and we know that it’s not very well treated in that a lot of people don’t get sufficient pain relief,” he says.
“We also know that pharmacotherapy, the main method of treating pain in emergency situations, has severe side effects. Some people can’t tolerate drugs, others find that opioid medication such as pethidine or morphine causes nausea and constipation.
Once you give morphine you have to watch the patient for several hours and monitor blood pressure and nausea.
“What we’ve found anecdotally is that people who have come into an emergency department in pain and tried acupuncture, have had their pain relieved in a very short period of time.”
Acupuncture can also be safely combined with most conventional drugs and treatments and has very few side effects.
Scientific proof
Today, acupuncture is one of the most accepted complementary therapies in the country, with more than 80 per cent of GPs referring patients to an accredited acupuncturist in the past 12 months.
And, despite not being part of the standard curriculum, about one-fifth of GPs have gone on to do post-graduate training in acupuncture.
You can thank modern science for that, says Dr Morton Rawlin, vice president of the Royal Australian College of General Practitioners.
“Acupuncture has gradually increased its acceptability over the last 20 years [because] it has good, double-blind, scientific proof that it is of assistance for pain and other disorders.”
But has it reached a tipping point? “We’re on the verge,” says Professor Cohen. “Emergency physicians and GPs have taken it up on their own initiative because they see the benefits. If we find positive results [in the study] it will open the door for it to be included in all Western emergency departments and that will be a major shift.”
Modern panacea?
So when should you be demanding acupuncture over mainstream medical treatments?
“Acupuncture, like all modalities of treatment for different conditions, needs to be discussed by the individual with their doctor,” says Dr Rawlin.
Professor Cohen agrees. “Everyone’s situation is individual, but the one thing I can say is that acupuncture can’t really hurt. So try it.”
Just be warned: it’s not a panacea.
“Acupuncture won’t help everyone for everything,” says Professor Cohen. “But there are cases where people have gone the gamut of Western medicine, had no relief and then acupuncture has given significant relief.
“Acupuncture provides a different perspective on a treatment program and, in the hands of a trained therapist, has been shown over thousands of years to be extremely safe.”
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According to the National Institutes of Health, nearly 40 percent of Americans use some form of medicine deemed “alternative” or “complimentary” to established medicine. We discuss four popular forms: acupuncture, chiropractics, osteopathy and homeopathy.
Kate Dailey, health editor for Newsweek, helps us unpack which forms of alternative medicine have been shown to help patients when conventional medicine has failed. Dr. Jack Killen, deputy director of the Center for Complimentary and Alternative Medicine at the National Institutes of Health says there’s a long history of practices once called “alternative” that have entered the mainstream, like hospice care or Lamaze birthing classes. The scientific community eventually works to find out why or exactly how these therapies help patients.
Do you find acupuncture, chiropractics, osteopathy or homeopathy helpful in your overall health regimen? Or are you skeptical of these treatments?
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Recently I’ve been involved in creating and hosting a series of documentaries on integrative medicine. The three films are aimed at healthcare professionals. The first is about the science of tai chi, the second is about the science of meditation and the third is about the science of acupuncture. I’ve just wound up the last on-location filming (interviewing experts) for the acupuncture film, and am struck by how this ancient healing modality is blossoming in popularity across the country.
A healing tool of Traditional Chinese Medicine (TCM), acupuncture has been successfully administered for more than 2,500 years. According to the TCM view, a vital energy called qi flows through the body along channels called meridians. I like to think of these channels as a sprinkling system for the body, bringing qi to vital organs and extremities in much the way hoses bring water to your garden. In the TCM model of health and disease, when qi flow is blocked it stagnates. Stagnating qi causes illness. Acupuncture therapy unblocks the qi flow, strengthens or weakens the qi (think opening and closing the garden spigot) and directs it to areas of need.
A holistic practice, acupuncture seeks to re-establish the body’s healthy equilibrium and function, as opposed to forcing healing using surgery or pharmaceuticals. Interestingly, Chinese practitioners were not the only (and may not have been the first) to identify these energy pathways in the body. The frozen body of a man recovered well-preserved from the Alps features tattoos that correspond to Chinese acupuncture’s qi meridians.
Much research is afoot to attempt to define qi in Western terms. This is a challenge, as the word runs deeply through not only Chinese medicine, but through Chinese art, literature, philosophy, pugilism and daily life. From the standpoint of Western medical science, qi is likely to be revealed as some amalgam of endorphins, the bioelectric potential of cell membranes, nervous conduction, circulating hormones and perhaps even photons (light) and infrared radiation (heat). In attempting to define and quantify qi, acupuncture research may end up identifying a whole new system of biological information, such as the conduction of impulses through the body’s connective tissue.
A typical acupuncture treatment involves penetrating the skin with tiny needles, but some styles of acupuncture (Japanese toyohari, for instance) don’t require such penetration. Some researchers link such distant healing to the so-called “non-local” effects of quantum physics. Cutting edge stuff! Still, studying the effects of acupuncture with the traditional, Western, double-blind placebo controlled model presents certain difficulties. These center on the fact that since we don’t fully understand how acupuncture works, we don’t know what the variables are; not understanding those elements, we can’t adequately control for them. More, the term “placebo effect” (as in this treatment or that pill is no more effective than a placebo) is an inaccurate and pejorative term that is rapidly losing relevance as we learn more about the body’s ability to heal itself. It turns out that the effect is powerful, and desirable, perhaps the new “gold standard” for the way the body should heal.
Despite the challenges of study design and the mind-bending possibilities for a new understanding of how the body works, acupuncture has been extensively studied and verified both by international studies and by our own National Center for Complementary and Alternative Medicine (NCCAM). Part of the National Institutes of Health, NCCAM alone sponsors more studies than I can list here, and their website (merely one, orthodox outlet for medical information from a Western point of view) addresses acupuncture for pain, Post Traumatic Stress Disorder, osteoarthritis, fibromyalgia and more.
Some folks, including older Western M.D.s, still talk about whether or not they “believe” in acupuncture. Such thinking is ill-informed and outdated. One might as well speculate about whether to believe in aspirin, morphine, insulin, surgery or an MRI. The question is not whether acupuncture works, but how it works, and whether it is the appropriate therapy for a particular syndrome, problem, symptom, disease or patient. In a clinical setting and performed by a licensed professional (licensure is by state) acupuncture is effective for a variety of complaints.
Over the years, I have received acupuncture myself and watched scores of people from different walks of life receive the treatment for a spate of different ills. While practitioners vary in their needling technique, for the most part acupuncture is not painful and gives results readily. Practitioners use smaller needles here than they do in China, and are generally gentler in their application, citing the lower pain threshold of American patients. In China, needles are thicker, longer, and sometimes as enthusiastically “rowed” while in a patient as an oar in the hands of a whitewater kayaker. Ouch. Discomfort seems to be expected by Chinese patients–here, not so much.
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Brisbane women are shunning Botox in favour of a natural alternative that promises to wipe up to 10 years off your looks while also improving your health.
The Paddington Clinic acupuncturist Rachel Steward said health-conscious women and men were embracing the natural alternative because they feared the effects of long-term Botox use.
The Constitutional Facial Acupuncture Renewal program, introduced to Brisbane three years ago, is said to erase many of the signs of ageing without the risks associated with surgery or the unnatural waxy look attributed to Botox.
“I think there’s a growing trend for people to opt for natural beauty alternatives,” Ms Steward said.
Facial acupuncture, which has been around for centuries, works by treating the face as an extension of the energy channels of the body which flow from the soles of the feet to the crown of your head.
Australian Medical Association Queensland president Dr Gino Pecoraro urged people to carefully research any natural treatment program before committing to it.
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