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Acupuncture. A rough outline. My background. GP; since 1990 BMAS; British Medical Acupuncture Society ( founded 1980); foundation course 1999 Intermediate study days. Used acupuncture since; few basic conditions, predominantly pain control. Origins of acupuncture. Chinese medicine>2000yrs
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Acupuncture A rough outline
My background GP; since 1990 BMAS; British Medical Acupuncture Society ( founded 1980); foundation course 1999 Intermediate study days. Used acupuncture since; few basic conditions, predominantly pain control.
Origins of acupuncture • Chinese medicine>2000yrs • Yellow Emperor’s Classic Internal Medicine; 260BC • Confusianist beliefs; “pulse”diagnosis • Earliest instruments; sharp stones, flints; later wood, bamboo, silver, gold, copper
Yellow emperor Theories of chinese medicine, including acupuncture, and the importance of the balance of life forces
TCM terms • Meridian/channel • Qi ( der chi) • Cun; chinese inch; still used as unit of measurement
Use in modern medicine • Some evidence base developing • BMAS; quarterly journal • Difficulties in performing trials; effects of “sham” acupunctre. • Effects of acupuncture better compared to “usual” treatment or no treatment? • Still a subject of great debate
Western medical approach • Much research into physiology of how acupuncture works • Gate theory of pain;mediated via dorsal columns, ascending influences on CNS • Release endorphins • Changes in connective tissues
Mode of action? • Peripheral nerve stimulation is integral part of mechanism • Increased concentrations neurotransmitters and endorphins measured experimentally • Stimulation A delta fibres; inhibition non myelinated C fibres; ascending connections spinothalamic tract, limbic system. • Connective tissue effects; fibroblast stimulation.
Nice guidance “non specific” low back pain, 2009 • Mentions acupuncture as a cost effective treatment option • ( but guidance heavily criticised by pain specialists; injection treatments not recommended)
Robust clinical evidence • Tension headache/migraine • Pain of osteoarthritis • Chronic low back pain. • Nausea and vomiting
Treatment of nausea and vomiting • Cochrane review 2009; use of acupuncture at PC6 confirmed to be of benefit. • May also be used in palliative care, post operative sickness
Points selection • Traditional acupuncture points • Selection segmental points • Use of trigger points
Modes of treatment • Brief “in and out” needling; often quite superficial • Use of single needle into trigger point • Use of stimulation; manual/electrical • Auricular acupuncture ( Nogier); used in addiction setting • Indwelling “press” needles • Moxa ; Artemis vulgaris. Adds heat
GP acupuncture;pragmatic approach • QUICK • SAFE • CHEAP? • EFFECTIVE? • 10 minute treatment, 5-6 needles, no stimulation usually. Up to 6 sessions • Use of Visual Analogue Score
Audit; 12 months • I have treated 16 patients, total of 57 treatments 9(range 2-7); all in 12.5 minute appointments • Headaches; 1 • Hyperemesis; 5 • Neck and shoulder pain; 8 • Back pain, sciatica; 2
Are there any risks? • Infection; very low; no need for disinfection skin( review; one case in 66,000) • Certain points; pneumothorax • Care in immunosuppressed/anticoagulants • Minor bleeding/bruising common • Care with underlying structures; eg median nerve at PC6.
The acupuncture response • First treatment can make it worse or have no effect • It is estimated that 80% will have a response • Some are “strong reactors”; start gently • Effect tends to be cumulative and after eg 5-6 sessions benefit can be maintained for months • Beware endorphin effects; warn patients
BMAS • The British Medical Acupuncture Society is a registered charity established to encourage the use and scientific understanding of acupuncture within medicine for the public benefit. • Members are regulated healthcare professionals who practice acupuncture within the scope of their professional practice.
Foundation course • Over 2 weekends, cost £580. 24 hours. • Teaching approx 33 points which enable treatment of wide variety of conditions. • COBC; certificate of basic competence; or Diploma.
Practical demonstration Any volunteers?