IAMA Fall 2007 Acupuncture And Pain Management

Acupuncture and Pain Management: an Integrated Perspective

PK Melethil, L. Ac.

Melethil Acupuncture Services, LLC

Wilsonville, OR 97070

Overview

Acupuncture in the context of Traditional Chinese Medicine(TCM)- a Whole Medical system(NIH).

Basic TCM theory of pain and diagnostics and therapeutics.

Clinical considerations in the use of acupuncture.

Headache, Bi (Arthritic) Syndrome for which recent scientific studies (i.e., Evidence Based Medicine) show the value of acupuncture.

Potential applications of acupuncture for surgery and post-surgery treatments to improve outcomes.

3 case studies

IAMA Fall 2007 Acupuncture and Pain Management

Anthropological Record Archaeological evidence: 10,000+ years.

Ma Wang Dui site: 2,000+ years

– clinical tools, philosophical and qigong manuscripts.

Written Texts: 2,000-3,000 years old.

– Herbal Medicine, Acupuncture, Body work

Medicine guided by empiricism Daosim, Confucianism, Buddhism Multiple overlapping and co-existing models

Shared knowledge with Yoga, Ayurveda (India) Greek Influences Conversations between Huang Di and Chih-Po


Background • Harmony and Balance

• Movement of Qi and Blood

12 Primary Meridians- 6 on each side (symmetry) 8 Secondary (Extraordinary) Meridians

• Acupuncture Points (400-500 x 2) Jing-Luo Network of points

analogy: a river and its tributaries, a net

Variable size, shifting locations Ah-shi points

• Mechanism of Action- Contemporary Ideas • Conductivity gradients (Prognos)

Electrochemical gradients • Optical/Thermal gradients • Acoustics- variations in visco-elastic properties of tissues



TCM Zang-Fu (organ networks) and their connectivity based on classical texts such as the Huang Di Nei Jing- The Yellow Emperor’s Canon of Internal Medicine. In some TCM models, Qi flows through these 12 organ networks every 24 hours with each organ being assigned a 2 hour window when its Qi is at its peak. Qi flows out from the torso to the upper extremity and back followed by a circuit through the lower extremity and the cycle continues again.

Yin Yang Comments*

Lung (3-5 A.M, Arm-Taiyin)

Large Intestine (5-7 A.M., Arm-Yangming)

Upper Body, Metal

Spleen (9-11 A.M., Leg-Taiyin)

Stomach (7-9 A.M., Leg-Yangming)

Lower Body, Earth

Heart (11 A.M.-1 P.M., Arm-Shaoyin)

Small Intestine (1-3 P.M., Arm-Taiyang)

Upper Body, Fire

Kidney (5-7 P.M., Leg-Shaoyin)

Urinary Bladder (3-5 P.M., Leg-Taiyang)

Lower Body, Water

Pericardium (7-9 P.M., Arm-Jueyin)

Triple Warmer (9-11 P.M., Arm- Shaoyang)

Upper Body, Fire

Liver (1-3 A.M., Leg-Jueyin)

Gall Bladder (11P.M–1 A.M., Leg-Shaoyang)

Lower Body, Wood

* regions of the body associated with the primary channels of the12 Zang-Fu organ networks and their 5 Phase/Element associations in TCM.

TCM Models of Pathology- “Disharmony” Models of Pathology

Cold Induced Illnesses Progresses from External (Yang) to Internal (Yin) channels- 6 Levels

Zang-Fu Theory

Based on Organ Disorders (Meridians)

Warm-Febrile Diseases Progresses from Outer to Inner layers Models: Triple Burner, 4 Levels

Causative factors

External /Environmental Pathogenic Influences Damp, Cold, Heat/Fire, Wind, Dryness, Summer heat

Internal Pathogenic Influences

Emotions (Stagnation) Phlegm << Body Fluids + “Heat” Deficiency Patterns


ACUTE

CHRONIC

Diagnostics & Therapeutics • Diagnostics

Interview

Palpation

Tongue

Pulse

• Therapeutics Acupuncture

TuiNa (Medical Massage)

Internal Medicine Diet/Nutrition, Herbs, Minerals, Animal products

Qigong, Tai Ji Quan, meditation (Exercises)


Ma Wang Dui- Ancients Qi Gong


Pain • Stagnation/Anisotropy

Qi, Blood

• Bi Syndrome (external pathogen)

• Types of pain (paresthesias)

Sharp, piercing

Dull, throbbing

(Heaviness)

(Numbness)


Advantages of Acupuncture

Simple, Gentle Painless (200-300 mm,

single-use needles) Safe, Minimal side effects Reduced use of narcotics &

other medications Effective, Economical


Veterinary Acupuncture

Equine, etc.

No ‘placebo effect’

Highly effective

Well-established

veterinary practices in

China & US


Microsystem Acupuncture “Holographic” Models

• Ear Developed by French MD (1950s)

Paul Nogier

• Scalp Jiao, Zhu models

• Feet Reflexology

TuiNa


Needle Techniques • Depth of insertion • Angle of insertion • Feeling the Qi • Viscoelastic aspects of tissues • De Qi and propagated sensations

• Reinforcing & Reducing techniques

• Electro-acupuncture

Low frequency ( <10 Hz) and high frequency (~100 Hz)


Arthritis (“Bi”) Syndromes EARLY STAGE: EXCESS PATTERN >>>>> LATE STAGE: DEFICIENCY PATTERN

6 Constitutional Patterns • Wind (Wandering) Bi Migrating pain in muscles, joints

• Cold (Painful) Bi Fixed pain, Alleviated by warmth

• Damp (Fixed) Bi Marked soreness, numbness, heaviness

• Heat Bi Swelling, soreness & pain w local redness

• Stagnation of Blood & Phlegm Swelling, rigidity, deformity joints & limited ROM

• Liver & Kidney Deficiency alleviated by rest; sore and weak low back, knees

“Acupuncture Found To Be of Benefit in Knee Osteoarthritis” http://nccam.nih.gov/news/newsletter/2005_winter/acupuncture.htm

Acupuncture for knee osteoarthritis--a randomised trial using a novel sham. Acupunct Med. 2006 Dec;24 Suppl:S7-14. Manheimer E, Lim B, Lao L, Berman B.


http://nccam.nih.gov/news/newsletter/2005_winter/acupuncture.htm

Headache (9 Constitutional patterns) External, Internal (Stagnation, Deficiency)

• Wind Heat acute onset, yellow nasal discharge, sore throat, red

• Wind Cold acute onset, stiff neck, no thirst

• Wind Damp fuzzy head, chest oppression, heavy feeling

• Liver Yang Rising irritable, restless, insomnia, sore low back/knees

• Qi Deficiency positional HA, worse with stress or lassitude

• Blood Deficiency dizziness, palpitations

• Turbid Phlegm nausea, vomit with sputum, dizziness

• Blood Stagnation stabbing pain, prolonged & fixed, history of trauma

• Kidney Deficiency dizziness, tinnitus, “empty” head feeling


External

Internal

Acupuncture for Post-operative pain • Differentiation (8 principles, 5 Elements, 4 Levels, 3 Burners)

• Before the operation (improve outcomes)

Constitutional issues, Shen

• After the operation (move Qi & Blood, tonify)

External Pathogenic Influences (cold, dryness)

Emotions

Nature of pain

Affected Organs


Case Studies • Anesthesia (Surgery)

Acupuncture was successfully used as the sole means of anesthesia during a surgery for breast reconstruction following cancer, and also substantially facilitated pre-operative procedures. The combination of eastern and western medicines substantially reduced patient disability, hospitalization and cost.

• Low back (Lumbar) Pain male, 40 , suffering from low back pain, unable to sit for more than 2 hours at a time. Reported as possible effects of sports injury from 20 years ago. Assess- tight IT band.

Dx- Qi/Blood stagnation in GB, Bl channels. Tx- acupuncture and electro-acupuncture, GB and Bl channels. Condition resolved in 4 treatments, include exercise to stretch IT band; follow-up after one month indicated that pain had been resolved completely.

• Post-Shingles Paresthesia female, 93, suffering from limited vision, post herpetic uveitis (Western Dx) and paresthesia around L eye. No improvements in 2 months w acyclovir tablets, ciproflaxin eye drops.

Dx- Damp Heat-GB channel, Qi/Blood deficiency. Tx: acupuncture (local/distal), GB channel and TuiNa; significant improvement (uveitis) in 4 visits and vision in 9 visits, confirmed by opthalmologist. Patient reports increased energy w ongoing treatment.


Acupuncture for Breast Reconstruction Surgery Photo provided by Roger Lore, DAOM


Treatment Approaches

• Local and Distal points

• Channel based

• Complementary (Yin/Yang) Channel based

• Microsystem Techniques

• External vs Internal Syndromes

• Frequency of Treatments


Other Techniques for Pain • TuiNa

Orthopedic massage and muscle alignment techniques

• Qigong

• Internal Medicine Over 1000 herbs in TCM pharmacopoeia

formulas are well-tested, hundreds to thousands of years old

Herbs are classified by

their flavor and nature

the channels/organs they act upon

the specific actions on a given organ

e.g., Ju Hua (chrysanthemum) is considered to be slightly cold, sweet, bitter, and acrid, enters the Liver channel and soothes the eyes. Its’ found in formulas used to treat Wind Heat- fever w chills, aversion to cold, sore throat.

Current herbal products manufactured under cGMP guidelines


Further Readings • The Web That Has No Weaver, Ted Kaptchuk

• Medicine in China, Paul Unschuld

• Acupuncture: A Comprehensive Text, John O’Connor, Dan Bensky

• The Practice of Chinese Medicine, Giovanni Maciocia

• The Management of Post-operative Pain with Acupuncture, Sun Peilin

Acupuncture of chronic headache disorders in primary care: randomised controlled trial and economic analysis. Health Technol Assess (UK) 2004;8(48). VickersAJ, Rees RW, Zollman CE, McCarney R, Smith CM, Ellis N, Fisher P,Van Haselen R, Wonderling D and Grieve R.

Designing an acupuncture study: the nationwide, randomized, controlled, German acupuncture trials on migraine and tension-type headache. J Altern Complement Med. 2006 Apr;12(3):237-45. Molsberger AF, Boewing G, Diener HC, Endres HG, Kraehmer N, Kronfeld K, Zenz M.


Documents

IAMA Fall 2007 Acupuncture And Pain Management