Acupuncture

The term "acupuncture" describes a family of procedures involving the stimulation of anatomical points on the body using a variety of techniques. The acupuncture technique that has been most often studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.  Acupuncture has been claimed to reduce pain, reduce inflammation, increase blood flow, increase range of motion, decrease the side effect of medication-induced nausea, promote relaxation in an anxious patient, and reduce muscle spasm.  Practitioners believe this process triggers the release of naturally occurring painkilling molecules called peptides

The indications and uses of acupuncture in injury/illness treatment continue to be defined and refined over time. Acupuncture is used as an option when pain medication is reduced or not tolerated, or it may be used as an adjunct to physical rehabilitation and/or surgical intervention to hasten functional recovery.  Physiological effects may include endorphin release for pain relief, reduction of inflammation, increased blood circulation, analgesia through interruption of pain stimulus, and muscle relaxation. Acupuncture is minimally invasive, carries minimal risk for adverse effects, and is moderately costly.  Acupuncture should be considered only after failure of prior treatment NSAIDs, exercise, physical therapy, and chiropractic to effectively limit or resolve symptoms. Acupuncture may be recommended for select use for treatment of chronic moderate to severe low back pain, and neck pain.

Health care providers can be a resource for referral to acupuncturists, and some conventional medical practitioners—including physicians and dentists—practice acupuncture. Ask the practitioner about the estimated number of treatments needed and how much each treatment will cost. Some insurance companies may cover the costs of acupuncture, while others may not.  People experience acupuncture differently, but most feel no or minimal pain as the needles are inserted. Some people feel energized by treatment, while others feel relaxed. Treatment may take place over a period of several weeks or more.

A number of studies have addressed the outcomes of the treatment choices for lumbar disc degeneration and sciatic nerve pathology. The latest study of 472 patients lead by Dartmouth Medical School’s Dr. James Weinstein and supported by the National Institute of Health “for the first time showed very significant improvement in the patients who ended up with nonoperative treatment (exercises and NSAIDS).” This study failed to address the treatment success when standard physical therapy exercises are combined with skilled soft tissue mobilization, acupuncture and herbal prescription, though, and many intelligent patients are choosing to incorporate these therapies into the overall treatment strategy today, utilizing Complementary and Integrative Medicine and the Licensed Acupuncturist with these skills.

Recent studies of the Traditional Chinese Medicine practice of soft tissue mobilization, commonly called ‘acupressure’ but actually called Tuina in Chinese, which literally means mobilization or manipulation of the soft tissue, showed proven benefits. A Taiwanese doctor, Dr. Hsieh published results of a randomized controlled trial showing significant benefit from ‘acupressure and physical therapy’, or Tuina, in 2006, in the treatment of low back pain. The United States congress Office of Technology Assessment concluded in 2005 that “only 10-20% of all procedures currently in use in medical practice have been shown to be efficacious by controlled trial.” Controlled trials have produced consistent evidence of the treatment success from Tuina and acupuncture, though, because of the challenge to prove medical efficacy. Today, most of the proof of efficacy of manual therapies with the standard of double-blinded placebo-controlled human trials concern acupuncture. Surgical costs for lumbar disc repair average more than $10,000, and carry considerable risks, whereas the cost of acupuncture and soft tissue therapies is small, and carries little or no risk of harm. The immediate relief of symptoms when utilizing surgery may be quicker than with conservative therapies, but the long term outcome often involves multiple surgeries and ‘failed back syndrome’, a commonly seen syndrome of chronic debility despite multiple surgeries. This may occur because the patient is not given proper rehabilitative treatment after the surgery. Although the tissue causing the worse symptoms is surgically corrected, the entire problem is not addressed.

A number of recent studies have supported the conservative care approach of acupuncture, physiotherapy, and instruction in targeted stretch and exercise coupled with correction of body mechanics and posture that I utilize in my practice. Increased utilization of this approach could have a significant effect on reducing health care costs in the United States, both reducing the cost of insurance, and saving the government a lot of money. This can only be achieved with patient support. An analysis of clinical trials in 2008 by the Oregon Health and Science University, published in the the Lancet medical journal, found that the typical path of prescription pain medications, X-ray and MRI imaging did not result in improvement over conservative care, but did add a tremendous cost burden to overall health expenditure and the price of health care coverage. To see a BBC report on these studies, click here:http://news.bbc.co.uk/2/hi/health/7872062.stm

It is wise to utilize imaging studies when conservative care strategy has not provided sufficient relief. A short course of conservative care, utilizing acupuncture and soft tissue therapies, should be tried first to evaluate functional improvement. Sometimes the tissue probems are too severe for conservative care alone and surgery is needed. While lumbar surgeries have had a dismal record of success in the past, recent advances in less invasive surgical techniques have proven quite promising. In the past, laminectomies, or full incision of the lumbar lamina, which is the surrounding support tissues, often resulted in chronic tissue problems from incision of so many delicate tissues. Likewise, insertion of metal supports, and disc replacement or removal, also had poor longterm outcomes. Today, many surgeons have become skilled in lumbar surgeries that utilize endoscopy, microsurgery, arthrodesis with small support implants, etc. Studies are finding that it is the quality of comprehensive care after these surgeries that determines ultimate success. It is wise to consider integrating proven conservative care into your strategy no matter whether you choose surgery or not. Improvement in tissue health before surgery, and utilization of acupuncture and soft tissue therapies after surgery, will improve the chances of the best possible outcome. A lasting outcome depends upon correcting all of the problems and not just upon temporary relief of symptoms. Ask me about the package of care that I utilize to help you achieve the best outcome and prevent future problems.

 

References

  • Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002. CDC Advance Data Report #343. 2004.
  • Berman BM, Lao L, Langenberg P, et al. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Annals of Internal Medicine. 2004;141(12):901–910.
  • Eisenberg DM, Cohen MH, Hrbek A, et al. Credentialing complementary and alternative medical providers. Annals of Internal Medicine. 2002;137(12):965–973.
  • Ernst E. Acupuncture—a critical analysis. Journal of Internal Medicine. 2006;259(2):125–137.
  • Kaptchuk, TJ. Acupuncture: theory, efficacy, and practice. Annals of Internal Medicine. 2002;136(5):374–383.
  • Lao L. Safety issues in acupuncture. Journal of Alternative and Complementary Medicine. 1996;2(1):27–31.
  • MacPherson H, Thomas K. Short-term reactions to acupuncture—a cross-sectional survey of patient reports. Acupuncture in Medicine. 2005;23(3):112–120.
  • National Cancer Institute. Acupuncture (PDQ). National Cancer Institute Web site. Accessed at www.cancer.gov/cancertopics/pdq/cam/acupuncture on August 16, 2007.
  • National Institutes of Health Consensus Panel. Acupuncture: National Institutes of Health Consensus Development Conference Statement. National Institutes of Health Web site. Accessed at consensus.nih.gov/1997/1997acupuncture107html.htm on June 22, 2007.
  • Reston J. Now, about my operation in Peking; Now, let me tell you about my appendectomy in Peking…. New York Times. July 26, 1971:1.
  • U.S. Food and Drug Administration. CFR—Code of Federal Regulations Title 21. U.S. Food and Drug Administration Web site. Accessed at www.accessdata.fda.gov/scripts/ cdrh/cfdocs/cfCFR/CFRSearch.cfm?FR=880.5580 on August 2, 2011.
 
Insurance Reimbursement

At this time, Medicaid and Medicare do not provide coverage for acupuncture.  Few insurance companies currently reimburse practitioners for Acupuncture treatments.  Call your provider to determine your eligibility for insurance reimbursement.

 

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