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Acupuncture

Acupuncture

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Acupuncture

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  1. Acupuncture Sarah K. Ayers, M.D. Capt, USAF 21 March 2012

  2. Outline Slide • What is Acupuncture? • Indications for Acupuncture • Mechanisms of Action • Evidence • Military Considerations • Resources

  3. Types of Acupuncture • Traditional Chinese • Electrical stimulation • Chinese Scalp • Auricular—Battlefield Acupuncture

  4. Patient #1 • 31yo female s/p MVA • 5 days later, still having 5/10 neck and shoulder pain (L > R) • Ibuprofen insufficient, cyclobenzaprine makes her too sleepy to work • 15-20 needles total, no electricity, pain cut to almost 0/10 • Next day—still mild aches, much better overall

  5. Indications • Chronic Pain/Fatigue Syndromes • Osteoarthritis • Joint disease/back pain • Acute Pain--Sprains, Strains, Post-Operative Pain • Migraines • Fibromyalgia • Depression, Anxiety • PTSD

  6. Indications Continued • Insomnia • Addictions– nicotine, cocaine, heroin • Upper respiratory symptoms • Strokes • Nausea & vomiting

  7. Soo…How does this work? • fMRI with blood oxygen level-dependent (BOLD) measurements • Acupuncture points: rich in neuroreceptors • Modulates pain network via analgesic effects • CNS hormones release in hypothalamus and limbic system • Causes changes in interpretation of pain

  8. Electroacupuncture • Fascia is bath of conductive fluid • General tx (2-8 Hz) • Enkephalin released from periaqueductal gray • Endorphin released from the hypothalamus • May be reversed/blocked by Naloxone • Local tx (above 10 Hz) • Dynorphin released in spinal cord • Activates low-threshold skin and muscle receptors • Serotonin/Norepinephrine released in midbrain

  9. Chronic Issues • Electroacupuncture with exercise vs. exercise alone, 2003 • No changes in objective ROM findings • Quality of life – significantly improved • 2003 Rheumatology paper • over 60yo, >12wk back pain • Quality of life/disability - significantly improved • Some patients able to decrease pain medications

  10. Migraines • Korean Hand Therapy • Study demo’d changes in blood velocity and volume in carotids and vertebrals arteries • Significant efficacy between triptans, acupuncture and control • Auricular acupuncture • Annals of Internal Medicine Jan 2009 • Reduced frequency/pain of primary migraine or tension-type headaches.

  11. Military issues… • Flight Status-Now teaching Battlefield Acupuncture • Allergic rhinitis and sinusitis • Avoids opiate use • Mission Readiness, Capability • Battlefield Conditions • Alternative to sedating medications • Stress/PTSD • TBI/Phantom Pain

  12. Injuries • 2 Battlefield points • 23% reduction of pain in ER patients in initial 24h • Results equivocal after 24h • 5 Battlefield points • 9 chronic pain patients who had no relief with Western therapies • 1st 24h: pain completely relieved • 2nd 24h: pain attenuated from baseline

  13. Deployment Considerations… • Tested at Andrews, Landstuhl, and at Echelon I & II in Al Asad, Iraq • 432 Treatments • Average RTD 2.2 days sooner • $0.06-$0.50 per needle • Relative cost, complication risk of Ibuprofen

  14. Patient #2 • 31yo AD EOD male • Subjected to three blasts where other coworkers died • Now with insomnia/chronic fatigue, TBI, migraines, neck/back pain, inability to run • Chronic narcotic use • About to get a Medical Board (MEB)

  15. Patient 2 Treatment… • Battlefield Acupuncture • Traditional Acupuncture, treated every 2-3wks • Improved headaches/insomnia • Decreased narcotic use • Started hyperbaric oxygen therapy • Now back to running, better concentration, and MEB has been delayed

  16. Summary • Types of acupuncture • Indications • Mechanism of action • Evidence • Clinic/military applications

  17. Questions & Resources • “Acupuncture for Chronic Low Back Pain in Patients: A Randomized, Controlled Trial” CF Meng, Rheumatology, 42: 1508-1517 • “Combining Spatial and Temporal information to explore functionality-guided action of Acupuncture using fMRI” Journal of Magnetic Resonance Imaging, (2009) V30: 41-46 • “An fMRI Study of Somatosensory-Implicated Acupuncture points in stable…stroke pts” Journal of MR Imaging, 24: 1018-1024 (2006) • “Efficacy of Acupuncture for Treating Knee Arthritis” Alternative Medicine Alert Vol 8, p49-60 (May 2005) • “Randomized Control Trial: An Assessment of Acupuncture on Specific Meridian or Specific Acupoint vs sham acupuncture for treatment of functional dyspepsia” Alimentary Pharmacology & Therapeutics (2012) V35: 552-561 • “Traditional Acupuncture in Migraines: A controlled, randomized study” Headache, Mar2008, V48 p398-401 • “The use of Electro-Acupuncture in Conjunction with Exercise for the Treatment of Lower Back Pain” Yeang, Journal of Alternative and Complimentary Medicine, 2003 V9 p 479-490