Emergency doctors are using Acupuncture to treat pain, now here’s the evidence

Emergency medicine is not all about life and death situations and high-tech solutions. Our study, the largest of its kind in the world, shows using acupuncture in the emergency department can relieve acute pain.

The study, published today in the Medical Journal of Australia, finds acupuncture is as effective as medication in treating pain for lower back pain and ankle sprain. But it took more than an hour for either to provide adequate pain relief.

Our study builds on previous research to show the effectiveness of acupuncture to treat chronic (long-term) pain.

Yet, there are several barriers to using acupuncture routinely in emergency departments.

What is acupuncture and who practices it?

Using acupuncture to relieve pain involves placing needles in various parts of the body to stimulate the release of endorphins and other neurochemicals, which can act as the body’s naturally occurring pain relievers.

For generations various cultures around the world have used acupuncture to treat multiple conditions, including providing pain relief. And in Australia, it is reimbursed through the Medicare Benefits Schedule when administered by a medical doctor.

Further reading: Modern acupuncture: panacea or placebo?

Acupuncture is one of the most accepted forms of complementary medicine among Australian general practitioners. It also appears in treatment guidelines for doctors in how to manage pain.

Why we ran the study and what we did

Anecdotally, we were aware that several emergency department doctors, in both public and private hospitals in Australia, were treating patients’ pain with acupuncture. But until this large federally-funded study, no-one had set up a trial like it to show how effective it was.

Our trial was an “equivalence” study, which means we aimed to see if the different treatments were equivalent rather than seeing if they were better than placebo. We did this as it would not be ethical to give a placebo to people coming to an emergency department for pain relief.

So, we randomly assigned more than 500 patients to receive standard painkillers, standard painkillers plus acupuncture, or acupuncture alone when they presented with back pain, migraine or ankle sprain at four Melbourne hospitals (some private, some public). While the patients knew which treatment they had, the researchers involved in assessing their pain didn’t (known as a single-blind study).

The type of acupuncture we used included applying needles at specific points on the body for each condition, as well as along points chosen by the treating acupuncturist. This was to reflect what would happen during regular clinical practice.

Doctors who were also qualified medical acupuncturists and practitioners of traditional Chinese medicine (registered in Victoria with the Chinese Medicine Registration Board of Australia) performed the acupuncture.

After treatment, we assessed patients’ pain after an hour, and every hour until discharge. We also rang them for an update 24-48 hours after being discharged.

What we found

We found acupuncture, either alone or with painkillers, was equivalent to drugs-alone in providing pain relief for lower back pain, ankle sprain, but not for migraine.

When patients looked back on their treatment, the vast majority (around 80%) were satisfied with their treatment regardless of which treatment they had.

However, no treatment provided good pain relief until after the first hour.

What are the implications?

Our findings suggest acupuncture may be a viable option for patients who come to the emergency department for pain relief. This is especially important for those who cannot or choose not to have analgesic drugs.

This is also an important finding in light of the potential for side effects and abuse with opioid analgesics, which might otherwise be used to relieve pain in the emergency department.

Previous research shows using acupuncture to treat chronic pain is comparable to morphine, is safer and doesn’t lead to dependence. Our findings suggest acupuncture also has a role in treating acute pain.

However, our research raises several issues, not only about conducting such research but also in implementing our findings in practice.

We had to overcome many ethical, policy and regulatory issues before we started. These included issues around the qualifications of medical and non-medical acupuncturists and employing traditional Chinese medicine practitioners to deliver acupuncture in a western medical hospital.

And to more widely implement our findings, we need to discuss the type of practitioners best placed to deliver acupuncture in hospital, what type of training they need to work in the emergency department and what type of conditions they should treat.

Hopefully, our study will spark further research to address these issues and lead to the development of safe and effective protocols for acute pain relief that may involve combining both modern and ancient forms of medicine to achieve rapid and effective analgesia for all emergency department patients.

This article originally appeared on theconversation.com

Does Acupuncture Work?

For certain conditions—particularly pain—there’s evidence it works. Exactly how it works is an open question.

You hear the term “acupuncture,” and visions of needles may dance in your head. But the 3 million Americans (and counting) who have tried it know there’s a lot more to the treatment than pokes and pricks.

A typical visit to an acupuncturist might begin with an examination of your tongue, the taking of your pulse at several points on each wrist and a probing of your abdomen. “They didn’t have MRIs or X-rays 2,500 years ago, so they had to use other means to assess what’s going on with you internally,” says Stephanie Tyiska, a Philadelphia-based acupuncture practitioner and instructor.

These diagnostic procedures inform the placement of the needles, Tyiska says. But a visit to an acupuncturist could also include a thoughtful discussion of your diet and personal habits, recommendations to avoid certain foods or to take herbal supplements and an array of additional in-office treatments—like skin brushing or a kind of skin suctioning known as “cupping”—that together fall under the wide umbrella of traditional Chinese medicine.

But does it work? Figuring out whether each one of these practices may be therapeutically viable is a challenge, and determining how all of them may work in concert is pretty much impossible. Combine them with acupuncturists’ frequent references to “qi,” or energy flow, and it’s easy for a lot of people to dismiss the practice as bunk.

This article originally appeared on time.com and was written by Markham Heid

Ask Smithsonian: Does Acupuncture Work?

Acupuncture - The Oldest Health Care System in the World

The origins of acupuncture in China can be traced back at least 2000 years, making it one of the oldest and most long-standing health care systems in the world. Today, acupuncture is an effective, natural and increasingly popular form of health care that is being used by people from a wide range of cultural and social backgrounds.

Acupuncture is a time-honoured medicine and takes a holistic approach to understanding normal function and disease processes and focuses as much on the prevention of illness as on the treatment.

What is qi & how does it affect the body?
When healthy, an abundant supply of qi (pronounced chee) or "life energy" flows through the body's meridians (a network of invisible channels through the body). If the flow of qi in the meridians becomes blocked or there is an inadequate supply of qi, then the body fails to maintain harmony, balance and order, and disease or illness follows. This can result from stress, overwork, poor diet, disease pathogens, weather and environmental conditions, and other lifestyle factors and becomes evident to TCM practitioners through observable signs of bodily dysfunction. TCM practitioners look carefully for these signs of health and dysfunction, paying particular attention not only to the presenting signs and symptoms, but also to the medical history, general constitution, and the pulse and tongue.

How does acupuncture work?
Acupuncture treatment involves the insertion of fine, sterile needles into specific sites (acupuncture points) along the body's meridians to clear energy blockages and encourage the normal flow of qi through the individual. The practitioner may also stimulate the acupuncture points using other methods, including moxibustion, cupping, laser therapy, electro-stimulation and massage, in order to re-establish the flow of qi.

As a natural form of healing, acupuncture has the following benefits:

• provides drug-free pain relief
• effectively treats a wide range of acute and chronic ailments
• treats the underlying cause of disease and illness as well as the symptoms
• provides an holistic approach to the treatment of disease and illness, linking body, mind and emotions
• assists in the prevention against disease and illness as well as the maintenance of general well-being

Acupuncture is known to treat a wide range of disorders including:

• Neurological conditions such as headaches, migraines, difficulty sleeping, nervous tension, stroke, some forms of deafness, facial and inter-costal neuralgia, trigeminal neuralgia, some forms of paralysis, sequelae of poliomyelitis, peripheral neuropathy, noises in the ears, dizziness, and Meniere's disease.
   
• Cardiovascular disorders such as high or low blood pressure, fluid retention, chest pain, angina pectoris, poor circulation, cold hands and feet, and muscle cramps.
   
• Respiratory conditions such as bronchial asthma, acute and chronic bronchitis, acute tonsillitis, rhinitis, sinusitis, hay fever, chronic cough, laryngitis, sore throat, influenza and the common cold.
   
• Digestive system disorders such as toothache, post-extraction pain, gingivitis, mouth ulcers, hiccough, spasms of the oesophagus, gastric and duodenal ulcers, gastric hyperacidity, gastritis, heartburn, hiatus hernia syndrome, flatulence, paralytic ileus, colitis, diarrhoea, constipation, haemorrhoids, liver and gall bladder disorders, and weight control.
   
• Urogenital disorders such as cystitis, prostatitis, orchitis, low sexual vitality, urinary retention, kidney disorders, nocturnal enuresis, and neurogenic bladder dysfunction.
   
• Gynaecological and obstetric disorders such as premenstrual tension, painful, heavy or irregular, or the absence of periods, abnormal uterine bleeding or discharge, hormonal disturbances, disorders associated with menopause, prolapse of the uterus or bladder, difficulty with conception, and morning sickness.mu
   
• Skin conditions such as eczema, dermatitis, psoriasis, nerve rash, herpes zoster, acne, scar tissue and resultant adhesions, hair loss and dandruff.
   
• Eye conditions such as visual disorders, red, sore, itchy or watery eyes, conjunctivitis, simple cataracts, myopia in children, and central retinitis.
   
• Musculoskeletal disorders such as osteoarthritis, sciatica, lumbago, weak back, low back pain, rheumatoid arthritis, gout, tenosynovitis, shoulder and neck pain, cervicobrachial syndrome, 'frozen shoulder', and 'tennis elbow'.
   
• Sporting injuries such as sprained ankles and knees, cartilage problems, corking and tearing of muscles, torn ligaments and bruises.
   
• Psychological conditions such as depression, phobias, emotional disturbances, anxiety, nervousness and addictions such as smoking.

* The disorders above which appear in bold have been recognised by the World Health Organisation (December 1979) as having been successfully treated by acupuncture. The disorders which do not appear in bold above are other common disorders which have been found to respond well to acupuncture.

This article originally appeared on http://www.acupuncture.org.au

7 Ways to Maximize the Effects of Acupuncture

To make the most of acupuncture and reap the benefits of treatment it is best if you keep the following 7 points in mind:

Make sure you have something to eat beforehand.

Acupuncture works by directing the body’s energies (known as Qi) in specific ways. Qi is produced from the food you eat so if you haven’t been eating well, or skipping meals, you will have less Qi or energy to begin with. Having food in your stomach means that there’s more Qi or energy to use which helps the acupuncture treatment to be more effective.

Avoid any stimulants such as caffeine or alcohol.

Having caffeine or alcohol beforehand means that your body has been stimulated when it should be relaxing and enabling the Qi to flow. Acupuncture works by increasing the production of a neurotransmitter in the brain called Adenosine. This neurotransmitter helps you to relax, feel calm and rested during acupuncture treatment which is when the healing takes place. Caffeine blocks the production of this neurotransmitter so that’s why it’s not a good idea to have that skinny latte beforehand.

Arrive on time for treatment.

There’s nothing worse than arriving for a treatment late and stressed. Arriving for treatment on time means you get the most out of the acupuncture session, the needles have time to ‘do their work’ and your body has had the chance to relax and release the chemicals needed to improve your health and wellbeing. Do yourself a favour and leave yourself enough time to arrive!

Turn off your mobile phone.

Imagine that you are lying on the treatment table or sitting comfortably in a chair, letting the acupuncture needles do their work, feeling all relaxed and calm almost in a dream like state and your phone goes off! Yes, the day to day demands of life will still be there after treatment but whilst you are in treatment show yourself some consideration and care and turn the phone off. This is your time to focus on yourself without pressure or demands and when was the last time you actually got a chance to do that?

Plan your day so you don’t carry out strenuous activity after treatment.

This doesn’t mean you can’t do anything physical after acupuncture, but it does mean that it is better to do something less strenuous if possible, because during acupuncture treatment you have had your body’s energies directed to specific parts of your body to heal and rebalance. Strenuous activity almost distracts the energies that have been directed elsewhere and so they will not be as effective.

Follow any lifestyle advice given to you by your acupuncturist.

In everyday language I call this ‘lifestyle advice’ but in Chinese Medicine we call this ‘the three free therapies’. What this means is that your acupuncturist will also give you the support and knowledge to make changes in your life. The three therapies are nutrition, exercise and relaxation. Your acupuncturist makes these recommendations from an understanding of the importance of nourishing food, appropriate exercise and personalised relaxation methods, so take their advice, it’s the free bit!

Consider strategic scheduling of acupuncture treatment.

This is simply thinking of acupuncture treatment as a process rather than as individual treatments. As an acupuncturist I always talk about strategic scheduling or a course of sessions over a period of time. Whenever I see someone new I use acupuncture more often, over a shorter period of time, so it can trigger the changes needed in the body to rebalance and heal. As acupuncture continues and the compound effect impacts on the body, I increase the time between treatments and reduce the number of sessions, so as to wean the body off as it improves.

This article was written by Ali Balquees.