I may use this as an adjunctive therapy for pain, based on Kiiko’s Japanese style acupuncture using palpatory diagnosis and practical in-office sessions. This may or may not be covered by your insurance; and patients must be selected appropriately.
What is acupuncture?
Definition: The insertion of fine metallic needles into the body at specific points to treat health problems.
More broadly, acupuncture is a family of procedures involving the stimulation of anatomical locations on or in the skin by a variety of techniques. There are a number of different approaches to diagnosis and treatment in American acupuncture that incorporate medical traditions from China, Japan, Korea, and other countries.
Needles can be manipulated manually or by electrical stimulation. Various heating modalities can be used to warm the needle or skin directly, including: moxibustion, kyotushin, and Tiger Warmer. The use of electroacupuncture, magnets, Diode rings, cupping, acupressure, trigger points, and dry needling may also be used by practitioners.
Who does acupuncture?
- Licensed acupuncturists: The National Commision for the Certification of Acupuncture and Oriental Medicine (NCCAOM) certifies acupuncturists and Chinese herbal practitioners (Dipl. Ac.)
- Medical acupuncturists: Trained M.D.s, therapists, nurses, and other medical professionals may perform limited “medical acupuncture” after taking specialized courses…usually the emphasis is on a more practical approach for pain treatments using a select number of points. State-to-state insurance coverage varies.
Who can get acupuncture and is it safe?
Anybody can get acupuncture. Unlike medications or other procedures, which have a long list of complications and side effects, acupuncture done by certified acupuncturists and trained medical professionals is very safe — even for pregnant women, young children, and the elderly.
For those with bleeding problems/taking anticoagulation, there may be slight bruising (see contraindications).
Does it hurt?
Insertion usually painless/slight prick. Needles may give a feeling of tingling, warmth, heaviness, or ache; some feel “qi” moving up and down the channels.
How is acupuncture done?
Needling techniques and practices vary.
Frequency: Treatments may be daily, weekly, or periodically as needed. Number of sessions is also practitioner-dependent, depending on patient response/need.
Duration: Sometimes needles are inserted and removed immediately after manipulation, some left 15-30 min sessions, some leave needles in until they fall out.Stimulation: Manual, battery operated electrical stimulator, pressure, laser, ultrasound, etc.
Various manual manipulation techniques of the needle à should cause “de Qi” sensation.
What kinds of needles are used?
Individually packed sterile, disposable stainless steel needles are used, so risk of infection is minimal.
Most needles are < hair thickness. (Diameter 0.12-.30 mm; Length 10-75 mm)
ACUPUNCTURE from a Doctor’s Perspective
The variation in acupuncture practice is often disturbing to the scientific mind, which demands certainty and evidence-based medicine, but “acupuncture is a forgiving and extremely flexible science.” (Deadman, et. Al. A Manual of Acupuncture. Jo of Chinese Med Pub., England, 2007).
Acupuncture was adapted and successfully used by millions of practitioners, is practiced throughout the world, and it has survived >2000 years. Perhaps people today seek “alternative medicine” because Western or modern approaches lack the emotional/spiritual component that was and is always part of the healing process. Even the therapeutic power of simple human touch and physical diagnosis is sometimes lost to modern technology and the pressures of time, money, etc.
I believe acupuncture works because it embraces deeper concepts of healing: treating the body as a whole, the idea of the body’s energy in “balance,” and the amazing potential of something as small as a hair-thin needle being able to tap into the body’s own rich resources – stimulating the body to heal itself.
From a physician’s perspective, the best thing about acupuncture is that it is safe and has virtually no risk of serious side effects – which is more than can be said about many medications, procedures, and surgeries that are used on a frequent basis to treat patients. It is also cost-effective in the longterm, especially if it can help people overcome their pain naturally and eliminate the need to use unnecessary diagnostic tests, expensive medications, and invasive procedures.
I am not a licensed acupuncturist, but I am certified to do medical acupuncture. I use it in a very limited fashion and strictly to treat pain, especially back pain and other common musculoskeletal complaints. I was trained in the Kiiko or “Japanese” style of acupuncture, which uses not only specific points, but also the concept of reflection zones and release points to ease pain. A session is 45-60 minutes long, and the patient is treated in both supine and prone positions in the office.
Unfortunately, most insurances will still not cover acupuncture, even when practiced by M.D.s; however, we are trying to change this as patients do well and the medical community accepts acupuncture more and more as a valid treatment for pain (see NIH consensus statement).
The National Institutes of Health (NIH) issued a consensus statement on acupuncture in 1997:
“Acupuncture as a therapeutic intervention is widely practiced in the United States. There have been many studies of its potential usefulness…promising results have emerged, for example, efficacy of acupuncture in adult post-operative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma for which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful…Findings from basic research have begun to elucidate the mechanisms of action of acupuncture, including the release of opioids and other peptides in the central nervous system and the periphery and changes in neuroendocrine function. Although much needs to be accomplished, the emergence of plausible mechanisms for the therapeutic effects of acupuncture is encouraging.”
The NIH concluded: “There is sufficient evidence of acupuncture’s value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value.”
What are the risks?
PRECAUTIONS TO ACUPUNCTURE:
- Patients who are unwilling or very apprehensive
- Bleeding disorders, anticoagulants, antiplatelet drugs (may check PT/INR first)
- Immunocompromised patients (including diabetes mellitus)
- Skin infections at site of needling
- Skin disorders such as psoriasis or eczema (may be infected)
- Pregnancy, esp. in first trimester
- Valvular heart disease (only for indwelling needles)
- Patients who are going to drive or operate machinery
CONTRAINDICATION:
Demand pacemaker (only for electro-acupuncture).
Complications have been reported in the literature, but the incidence is extremely low: from 12 prospective studies (>1,000,000 treatments), the risk of serious adverse events was 0.05 per 10,000 or 0.55 per 10,000 patients*.
- Most common: infection, bleeding, drowsiness-related accidents.
- Most serious is associated with puncturing viscera (pneumothorax and cardiac tamponade),
- Practitioner dependent! (Must have knowledge of anatomy, use sterile needles, etc.
*White, A. A cumulative review of the range and incidence of significant adverse events associated with acupuncture. Acupuncture in Medicine 2004; 22(3)122-133.