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

Acupuncture and Migraine Management

How acupuncture can help

There have now been many controlled trials of acupuncture for migraine, with some large, high-quality ones in recent years. The results of the latest reviews are quite consistent: acupuncture is significantly better than no treatment/basic care for managingmigraine, and appears to be at least as effective as prophylactic drug therapy, with few contraindications or unpleasant side effects (Linde 2009, Wang 2008, Sun 2008, Scott 2008).  Acupuncture has a similar or slightly better effect than sham procedures, which themselves can perform as well as conventional drugs, indicating that sham acupuncture is not an inactive placebo but a contentious alternative intervention. Acupuncture has been found to be cost-effective (Witt 2008; Wonderling 2004). As well as prevention it may also be used to alleviate symptoms in acute attacks (Li 2009). There is preliminary qualitative evidence from patients that acupuncture can increase coping mechanisms as well as relieve migraine symptoms (Rutberg 2009).

Migraine is thought to begin as an electrical phenomenon in the cerebrum that then affects blood vessels, biochemistry, and causes neurogenic inflammation.

Acupuncture can help in the treatment of migraine by:

• Providing pain relief - by stimulating nerves located in muscles and other tissues, acupuncture leads to release of endorphins and other neurochumoral factors and changes the processing of pain in the brain and spinal cord (Zhao 2008, Zijlstra 2003, Pomeranz, 1987)
• Reducing inflammation - by promoting release of vascular and immunomodulatory factors (Kim 2008, Kavoussi 2007, Zijlstra 2003).
• Reducing the degree of cortical spreading depression (an electrical wave in the brain associated with migraine) and plasmalevels of calcitonin gene-related peptide and substance P (both implicated in the pathophysiology of migraine) (Shi 2010).
• Modulating extracranial and intracranial blood flow (Park 2009).
• Affecting serotonin (5-hydroxytriptamine) levels in the brain (Zhong 2007). (Serotonin may be linked to the initiation of migraines; 5-HT agonists (triptans) are used against acute attacks.)
  
  This article originally appeared on acupuncture.org.uk

Meet Our New Acupuncturist: Céline Sandberg

Céline Sandberg, R. Ac. completed MacEwan University’s 3-year acupuncture program, and is registered with the CAAA to practice acupuncture in Alberta. She also completed a 3-week internship at the Beijing Hospital of TCM to study the integration of TCM with Western medicine. Having grown up leading a very active lifestyle being involved in different sports, she has made it her passion to help people return to health after injury. Whether you’re suffering from post-concussion syndrome, other traumatic injuries or a repetitive strain injury to anything in between, she has the training to help your body recover from these injuries. What drew her to TCM acupuncture was the holistic approach to healing; she strongly believes in the power of the mind-body connection and strives to help you achieve mental, emotional, and physical health. 

She has a special interest in treating sports injuries, concussions, migraines and headaches, as well as mental health, gynecological and digestive problems.

Céline is adept with testing and effectively treating your symptoms to produce global effects in the body. She provides strategies for improving your health, consulting you on lifestyle, dietary, and exercise changes. Complimenting tools are integrated in to her treatments to treat specific issues thoroughly:

Myofascial / Fire cupping – same idea as suction cupping, only heat (fire) is used to create the vacuum seal rather than a suction pump. A small flame is inserted to a glass cup long enough to heat the air inside, and then quickly removed before the cup is placed on the skin. As the air cools, a vacuum is created, and the cups are either left stationary, or can be moved around. This technique has both Western and TCM applications.
When used in TCM, the cups are generally used along the acupuncture channels, or on specific points to elicit a certain response. It is beneficial in a multitude of conditions including: pain, digestive disorders. When used with Western ideologies, the cups are often placed around target musculo-skeletal areas. This is perfect for a variety of bone/joint injury or discomfort.

Auricular therapy – this is a type of reflexology using the external ear as a micro system to treat most disorders. This is extremely effective in helping with quitting smoking, and also enhancing and complimenting the treatment done on the rest of the body. Either needles are used, or ear seeds are used in the style of acupressure.

Gua sha – is also known as “skin scraping” or “coining”; either a gua sha tool or a soup spoon is used to “scrape” or massage the skin to remove adhesions and muscle tightness, or can be used along certain acupuncture channels to relieve pain, headaches, and increase mobilization of joints.

IMS/dry needling – are combined with TCM style acupuncture to help treat muscle imbalances. Trigger point and motor point release are used to increase mobility, strength, and flexibility. These techniques are used alongside TCM acupuncture to treat using a more systemic approach. Combining the two results in a prolonged effect due to the reduction of inflammation, the activation of the immune system and a more normalized endocrine system.

Meet the rest of our Reset Wellness Team here.

What Does Acupuncture Treat?

According to the World Health Organization (WHO) acupuncture has been found effective in treating the following conditions:

Musculoskeletal: muscle/joint pain and weakness, sprains, injuries, sciatica pain, arthritis, rheumatism

Circulatory: high blood pressure, angina pectoris, arteriosclerosis, anemia

Gastrointestinal: constipation, diarrhea, abdominal pain, ulcers, nausea, vomiting, colitis, spastic colon, food allergies, hemorrhoids, irritable bowel syndrome (IBS)

Neurological: headaches, migraines, facial paralysis, post operative rehabilitation, multiple sclerosis, neuralgia, bell's palsy, cerebral palsy

Emotional: insomnia, depression, nervousness, anxiety

Dermatological: eczema, psoriasis, acne, herpes zoster, skin rashes

Immune Disorders: candida, chronic fatigue, HIV and AIDS, epstein barr virus, allergies, lupus, hepatitis, rheumatoid arthritis

Gynecological/Genitourinary: menopausal symptoms, PMS, infertility, menstrual irregularities, endometriosis, fibroids, morning sickness, complications in pregnancy, chronic bladder infection, kidney stones, sexual dysfunction, impotence

Respiratory: rhinitis, sinusitis, cold, bronchitis, asthma

Other conditions: addictions, stress management, weight loss, fatigue, chemotherapy/radiation side effects, diabetes.

Acupuncture is a gentle and sophisticated approach for unlocking stress built up in your body. It's application is excellent as preventative care and works in conjunction with other therapies to compliment a wide range of treatment plans.

Céline is available at Reset Wellness Mondays, Thursdays, Fridays and Saturdays. Book Online.

Your Partner in Allergy Relief Strategies: Acupuncture

Acupuncture already helps to relieve pain in some patients, and the latest study hints that it might relieve sneezing and itchy eyes as well.

Most patients plagued with sniffles brought on by seasonal allergies turn to antihistamines for relief, but when they don't get relief, some opt for alternative treatments like acupuncture, in which tiny needles inserted just under the skin at specific points in the body are used to reduce certain symptoms.

In a study published in the journal Annals of Internal Medicine, researchers examined 422 people who tested positive for pollen allergies and had allergic nasal symptoms such as a runny nose. The participants reported their symptoms as well as what medication and doses they used to treat them.

The researchers then divided them into three groups; one received 12 acupuncture treatments and took antihistamines as needed, a second group received 12 fake acupuncture treatments (needles placed at random, non-meaningful points in the body) and took antihistamines as needed, while the final group only took antihistamines for symptoms.

After two months, the researchers asked the patients about their symptoms and how much medication they used. The participants who received the real acupuncture treatments with their antihistamines showed a greater improvement in their allergy symptoms and less use of antihistamines compared to the other groups.

But the fact that even the participants receiving the sham acupuncture therapy reported some relief of their symptoms suggests that a strong placebo effect may be responsible for at least part of the improvement.

That possibility was supported by the fact that after four months of follow-up, the difference between the groups was less pronounced. The researchers speculate that the patients' expectations of how much the acupuncture might help them could have influenced their reports of improved symptoms.

But if the treatments are providing some type of relief, then acupuncture's potential role in treating allergies should be investigated further, the authors say. "The effectiveness of acupuncture for (seasonal allergies) compared with other antiallergic interventions and the possible underlying mechanisms of any effect, including context effects, need to be addressed in further research," they write in the study.

That view is supported by Dr. Remy Coeytaux of the Duke Clinical Research Institute and Dr. Jongbae of the Regional Center for Neurosensory Disorders and University of North Carolina at Chapel Hill, who wrote an editorial accompanying the study.

They note that acupuncture's benefits have started to emerge over the last 15 years and enough high-quality clinical trials support "patient-level meta-analyses for several clinical indications." They suggest that more rigorous research, which would include comparing acupuncture with existing treatments for conditions such as allergies, should be conducted in coming years.

They write: "It may be time to begin asking such questions as: How does acupuncture compare directly with other therapeutic approaches? Which of the many acupuncture traditions or approaches is most effective or appropriate for a given clinical indication? What outcomes or process measures should we be assessing in clinical trials of acupuncture? Is the magnitude of effect, if any, associated with acupuncture for a given clinical indication 'worth it' from the perspective of patients, payers, or policymakers?"

In the meantime, study author Dr. Benno Brinkhaus of the Institute for Social Medicine, Epidemiology and Health Economics at Charité University Medical Center in Berlin wrote in an e-mail response describing the study that "From my experience as a physician and acupuncturist, and as a researcher, I would recommend trying acupuncture if patients are not satisfied with the conventional anti-allergic medication or treatment or they suffer from more or less serious sides effects of the conventional medication. Also because acupuncture is a relative safe treatment."

This article originally appeared on time.com and was written by Alexandra Sifferlin.