Study showing acupuncture to be superior to morphine in the emergency room

Here’s an article from Apple News outlining the superior efficacy of acupuncture over morphine carried out in 300 emergency departments. This adds to the building evidence supporting the efficacy of acupuncture in the treatment of acute and chronic pain.

 

“Many people are quick to dismiss the power of alternative therapies to cure pain and suffering, as is the case with acupuncture. But with science now saying otherwise, people may have to reevaluate their opinions.

An excellent case in point is a new study published in the American Journal of Emergency Medicine. The study, which was published in July of this year, compared acupuncture against morphine in the management of acute pain.

Researchers randomly selected 300 emergency departments and split them into two even groups. The first group was subjected to acupuncture in order to treat their acute pain, while the second group was given morphine.

The results were even better than researchers imagined. Patients who were treated with acupuncture experienced a whopping 92 percent reduction in their pain, while the morphine group experienced a 78 percent reduction. Not only that, the acupuncture group had a much faster pain recovery time. While the morphine group took an average of 28 minutes to recover from their pain, the acupuncture group recovered from their pain in an average of 16 minutes.

So, the alternative treatment was both more effective in reducing pain and faster. So what’s the catch? There doesn’t appear to be one! Not only did acupuncture blow the conventional medical treatment out of the water on those fronts, it also had fewer drawbacks. Of the one in three patients who experienced adverse side effects from the treatment, 57 percent of these were in the morphine group and just 2.6 percent were in the acupuncture group.

The study went on to suggest that acupuncture “should be considered, especially in today’s increasingly complicated and polymedicated patients, to avoid adverse drug reactions.” Let’s dig a little deeper and find out whether acupuncture really is the better choice for pain treatment in hospitals and ERs.

Morphine and common side effects

Morphine is an opioid (meaning opiate-based) medication used to treat moderate to severe pain. If you’ve ever had to go into the hospital for surgery, chances are you were placed on a strong dose of morphine post-op. After getting my tonsils out when I was 19, I was eased back into the world of the living with a blast of morphine, which left me feeling pretty whacky but largely devoid of pain.

While morphine is undoubtedly effective in alleviating pain, it’s potentially lethal side effects make it a very dangerous drug indeed. In 2014, more than 28,000 Americans died from opioid overdose, with 14,000 of those deaths involving prescription opioids. According to the California Department of Public Health, prescription opioids like morphine were only prescribed for relieving acute pain. Today, however, they’re increasingly being used to treat chronic pain, such as back pain or osteoarthritis. Aside from the addictive nature of morphine, this is putting many people at risk.

The United Kingdom is no better. This article is one of many which highlights the unprecedented number of deaths associated with morphine overdose or side effects under expert supervision in hospitals. The article indicated that three elderly patients in a Portsmouth hospital were killed due to a prescription of lethal doses of morphine, while two other patients in the same hospital died after being administered “suitable” doses of the drug.

More common side effects

When you look at the statistics around morphine, none of this should come as any real surprise. Side effects associated with this opiate are staggering. They are so numerous that I’ll only list a small fraction to give you some idea of just how risky morphine is:

Abdominal pain

Stomach pain

Blurred vision

Bulging soft spot on the head of an infant (I didn’t even know it was legal to prescribe morphine to babies!)

Loss of color in vision

Chest pain

Confusion

Coughing

Reduced urination

Dizziness

Lightheadedness

Fainting

Irregular heartbeat

Headaches

Hives

Rashes

Itching

Nausea

Vomiting

Nervousness

Pounding in the ears

Swelling of the eyelids, lips and tongue

Severe constipation

Shortness of breath

Sweating or chills

Loss of consciousness

Painful urination

Unusual bleeding or bruising

Wow. I for one will never be using morphine again. With such a horrifying list of potential side effects (and that’s certainly not all of them!), I almost think it’d be better to deal with the pain than put that into your body.

What is acupuncture?

Acupuncture is a popular traditional Chinese medicine where thin needles are lightly inserted into the surface of the skin. While it has probably been around for far longer, the first documented utilization of acupuncture dates back to around 100 BCE in ancient China.

Today, acupuncture is receiving something of a revival in the Western world. While many Asian cultures have consistently used acupuncture throughout the past 2,000 or more years, acupuncture was quickly pushed aside in Western cultures with the rise of modern medicine. People began to cast off such traditional treatments in favor of “more effective” aggressively-endorsed medical drugs.

But with an increasing body of evidence showing the dangers and drawbacks of using prescription drugs to treat anything from back pain to migraine headaches, many people are beginning to see the merit in less invasive traditional methods. Acupuncture is now commonly sought out for pain relief, lower back pain, shoulder stiffness and knee problems. Some American physicians prescribe acupuncture treatment in conjunction with conventional medical treatments for improved recovery.

How acupuncture works

Theories as to how acupuncture actually works vary considerably. One major school of thought is that acupuncture operates via neurohormonal pathways. Needles are placed on specific points of the body in order to stimulate certain nerves. These nerves send signals to the brain, which then releases neural hormones such as beta-endorphins. This contributes to feelings of happiness and alleviation of stress, which reduces the pain a patient is feeling.

Another hypothesis is that acupuncture reduces pro-inflammatory markers in the body. Certain studies suggest that acupuncture results in a significant reduction in pro-inflammatory proteins in the body, which decreases inflammation and alleviates pain.

Whatever the reason, the potential side effects of acupuncture are considerably less scary than those of morphine. Listed “side effects” of acupuncture are limited to:

Soreness

Organ injury

Infection

Some people may experience soreness after acupuncture for the first time, but that soreness is from most accounts almost unnoticeable. Both organ injury and infection can occur if the acupuncture practitioner pushes in the needles too deep or doesn’t use new needles each time, respectively. But because the acupuncture practitioners in the United States are closely monitored, this is unlikely to happen.

More acupuncture studies

Aside from the study referenced earlier in this article, there is a huge range of scientific literature validating the claims that acupuncture can alleviate pain. Here are just a few passages from those studies, chosen at random:

“Acupuncture has an intrinsic analgesic (pain relieving) effect in the clinical treatment of tennis elbow pain.” – Journal of Rheumatology, 1993

“Several Cochrane reviews of acupuncture for a wide range of pain conditions have recently been published. All of these reviews were of high quality. Their results suggest that acupuncture is effective for some but not all types of pain.” – Chinese Journal of Integrative Medicine, 2011

“Acupuncture was superior to conventional physical therapy (with regards to chronic back and neck pain).” – Acupuncture and Electro-Therapeutics Research, 1978

“Acupuncture is effective for the treatment of chronic pain and is, therefore, a reasonable referral option.” – Archives of Internal Medicine, 2012

As with everything, keep an open mind and why not give it a go? You might be surprised by the results!

— Liivi HessStruggling with weight problems? Find out why acupuncture might just be that miracle you’ve been hoping for!”

THE STATE OF ACUPUNCTURE EDUCATION

 

Acupuncture is an effective low impact therapy that accesses self healing aspects of the bodies neurohormonal system.

Due to increased research in recent years acupuncture has an evidence base greater than many conventional medical treatments.

The efficacy of acupuncture does not depend on the style used. In other words contemporary acupuncture taught in a short course based almost solely on modern anatomy and physiology works as well as traditional approaches taking 3 or 4 years.* This is a game changing point – acupuncture can be taught in a few weeks to qualified medical professionals.

Most contemporary acupuncture schools subject students to unnecessary ideology and traditional detail resulting in the dual burdens of high debt and low income. Essentially students are being inducted into the belief systems of their teachers at great cost to them. As I have shown previously this has financially ruinous consequences and is an ethical travesty.

Most traditional acupuncture training is of low quality with respect to real world application. Most acupuncture education is at least covertly anti-scientific and anti-evidence. Hence the lack of evident change.

Personally I would dissuade a prospective acupuncture student from attending the usual acupuncture education unless they have another medical license such as NP, PA, MD, PT. Or they have another income source or are independently wealthy. If you have one of the above licenses and live in a State which legally sanctions it then I would recommend a short course such as –https://integrativedryneedling.com/

Finally I’m not in the business of telling others what to believe nor am I personally a capital S skeptic nor by inclination or evidence a materialist. If you are interested in natural medicine find a way to do so that is practical and feasible. Be careful thinking you are going to be different from the others; be super successful and pay off a student debt of $60,000 to $100,000 by practicing acupuncture. If you can, get a standard medical degree and learn natural medicine through continuing education.

Don’t divide medicine into Eastern/Western, Traditional/Naturopathic etc. The best medicine is whatever works with the least amount of toxicity and side effects. Natural medicine is not more spiritual than allopathic medicine. All medicine has the potential to be a practice of compassion. Don’t let yourself be indoctrinated by other people’s beliefs, be your own guide.

 

* Researcher Andrew Vickers quoted in –  Medscape Medical News – Neurology. Acupuncture Superior to Placebo, Usual Care for Chronic Pain, Pauline Anderson, September 10, 2012

See also –  http://www.wellnessclarity.com/?p=283

 

 

Non-deceptive Placebo Study

This study shows that knowingly taking placebo pills reduced pain and pain related disability by about 30%. The effect is likely increased for any medical intervention, whereby just choosing and following through with an intervention helps whether that treatment is effective or not.

 

https://www.sciencedaily.com/releases/2016/10/161014214919.htm.

Animal Acupuncture

The following is a sweet news story  about an Owl undergoing rehabilitation in Spain with acupuncture –

http://news.yahoo.com/acupuncture-helps-sick-owls-return-wild-spain-060256711.html

Also with regard to Veterinary Acupuncture, consistent with my neuro-physiological, contemporary world reinventing of acupuncture, here’s a link to a book review of –Essentials of Western Veterinary Acupuncture, Lindley S, Cummings M. Blackwell Publishing Professional, Ames, Iowa, USA, 2006,

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1780246/

 

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Thomas martin LAc.

More On The Crisis In The Acupuncture Profession

As a followup to my previous post – http://www.wellnessclarity.com/?p=183, I am reposting an essay below I wrote almost 10 years ago called – Toward a Post-Traditional Revision Of Acupuncture. Judging by emails received after the initial posting, acupuncturists in the US and a few other countries found it useful. The essay was also published on the National Guild of Oriental Medicines website in an edited form.

For the reasons summarized below the need for change in the acupuncture profession has become more apparent and more urgent in the intervening 10 years since writing the above article.

The two main concerns are; the failure to thrive financially for the majority of practitioners and continuing isolation of the profession in the contemporary scientific medical environment. Little has changed on these two linked fronts in the past ten years, in fact despite increased research and media attention given acupuncture therapy, the situation has worsened.

Also the high quality research carried out mostly in the West shows that elaborate traditional or neo-traditional acupuncture treatment models and types of acupuncture fail to show better outcomes compared to simple treatment models based on modern anatomy and physiology.

In other words – the sit up and take notice implication is – style or length and complexity of acupuncture training have little effect on clinical outcomes as long as practitioners are trained for contemporary medical competency. As an acupuncturist friend said recently, “I now know this could be taught in a year, not three or four years”.

See Medscape Medical News > Neurology  Acupuncture Superior to Placebo, Usual Care for Chronic Pain, by Pauline Anderson, September 10, 2012 in which Dr Andrew Vickers a seasoned researcher of acupuncture states –

The type of acupuncture didn’t seem to make a difference to the results, said Dr. Vickers. “Some acupuncturists will tell you not to go to such and such a person because that person doesn’t put the needles in the right way, or they don’t use the right theories, or they’re not as well trained, but the particular type of acupuncture you get doesn’t seem to make a large difference.”

Though feared by some practitioners, the wholism and naturalism associated with acupuncture and oriental medicine is not lost with a modern scientific iteration. Nor is this reconfiguring a capitulation to scientific materialism as a final statement on human life, it simply follows from the clear evidence that acupuncture is a neuromuscular mediated treatment that positively modifies physiological functioning.

I have no affinity with the arrogant debunking of acupuncture often featured in contemporary medical editorials. Simply put however acupuncture, by the very best evidence available, is a nervous system mediated treatment, not energy medicine. The continuing wholesale depiction of it as energy medicine does disservice to both acupuncture as a physiological treatment and to authentic practice of healing. This also ignores the central mind-body effect in all medicine, the placebo effect, a strong real world addition to the physiological proven acupuncture effect. An effect that has been poached from, so to speak, by the plethora of acupuncture styles used today, arrogating healing via the placebo effect into their own preferred mystical or quasi scientific theories.

To summarize the main points are –

The Qi/meridian theory is being increasingly abandoned by discerning acupuncturists given lack of evidence for it despite decades of research. (there is a strong movement in this direction even in China according to YunTao Ma)Also for lack of historical support due to poorly translated and misinterpreted traditional texts, and due to failure to cohere with contemporary medical science. And I might add, as many acupuncturists, after years of real-world experience, find themselves outgrowing the belief systems and closed, untestable theories inculcated at acupuncture school.

High quality research shows little or no difference between acupuncture styles/theories and treatment outcomes, suggesting a common physiological basis. Showing that simple contemporary medical acupuncture works at least as well as elaborate, arcane traditional and neo-traditional acupuncture. This also provides an opportunity for cost effective, streamlined training programs that don’t involve learning new, almost religious like, belief systems. As far as I know acupuncture schools have yet to respond whole heartedly to this in transforming their programs. Nor to link their programs and curriculums to the ability of graduates to pay down their loans in 10 years.

As outlined in my previous article http://www.wellnessclarity.com/?p=183, the acupuncture profession is only economically viable for a few. For the vast majority it is essentially a part time profession either requiring financial support from other means or featuring sustained low economic status. Job prospects are close to nil with well over 90% of graduates forced to setup private practices.

Along with this it is usual that acupuncture school graduates start their professional life with high debt burdens ($80,000 to $180,000) they may never repay through professional earnings. It is an open question whether acupuncture schools are abusing the federal student loan system with these facts becoming more established.

Below are some resources that clearly show how acupuncture can be learned, practiced, researched and explained entirely within a contemporary scientific view without downplaying its wholism and the non-quantifiable aspects of the art of practice. You will enjoy the clarity, simplicity and for the most part lack of dogmatism of this evolving approach!

An Introduction To Western Medical Acupuncture – http://www.amazon.com/Introduction-Western-Medical-Acupuncture-1e/dp/0443071772/ref=sr_1_1?s=books&ie=UTF8&qid=1400612651&sr=1-1&keywords=western+medical+acupuncture

Biomedical Acupuncture For Pain – http://www.amazon.com/Biomedical-Acupuncture-Pain-Management-Integrative/dp/0443066590/ref=sr_1_2?s=books&ie=UTF8&qid=1400612808&sr=1-2&keywords=yun+tao+ma

http://www.amazon.com/Gunn-Approach-Treatment-Chronic-Pain/dp/0443054223/ref=sr_1_1?s=books&ie=UTF8&qid=1400612969&sr=1-1&keywords=C+chan+gunn

Acupuncture In Medicine – http://aim.bmj.com

Energy Meridian Misconceptions by D Kendall http://www.tedpriebe.com/documents/Kendall_SJIM_meridians. pdf

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Toward a Post-Traditional Revision Of Acupuncture

by Thomas Martin, MA, LAc.

In recent years numerous researchers, practitioners and commentators of contemporary traditional acupuncture have questioned the validity of central concepts in this practice and therefore the integrity and accuracy of its core theories. The theoretical basis of contemporary traditional acupuncture is thus shown to be not what it has been made to appear like – an extraordinary metaphysical system linking all parts of the body/mind in a subtle energetic system. It is now clear to those who are prepared to think and look beyond the self enclosing loops of traditional dogma, that after four decades of research there is no evidence meridians exist nor that Qi as energy that moves around exists. Even precise acupoints for the most part don’t exist. (See Pomeranz; Ernst & White Ed.; Campbell; Mann; Ma, Ma and Cho; Kendall).

And yet acupuncture is effective, and that it appears to involve a physical interrelatedness of parts of the body via the peripheral and central nervous systems and brain increasingly recognized through scientific study.

Common contemporary usage of terms Qi and Meridian, both central concepts of acupuncture and Chinese medicine are based upon mistranslations (Kendall). Qi is thought to be untranslatable by many Chinese medicine scholars (the Chinese pictogram shows steam over cooking grains). Chinese medicine scholar Paul Unshuld considers the word “vapor” or “subtle influences” as close translations. Others consider “vital strength” or “functional activity” to be approximate meanings. Translation of Qi as energy is widely considered erroneous by scholars of Chinese medicine.

Consider the visual appearance of acupuncture meridians as they are shown in contemporary textbooks. Despite ancient comparisons of meridians with streams, rivers and seas their actual appearance is one of artificial superimposition over the body. Compared with the branching, flowing nature of the nervous system and blood vessels, meridians are depicted with straight lines and zigzags. This glaring discrepancy rarely seems to be questioned by traditionally trained acupuncturists and acupuncture teachers. Instead the implicit assumption seems to be that materialist science could never be privy to such subtle manifestations and that one day their existence will be proven.

Despite the historical evidence that it was originally meant to represent pre-modern shorthand for the vascular system, the meridian system shows up repeatedly in contemporary books and articles as supposed evidence of subtle metaphysical energy in the body. (Long-xiang Huang in Ma, Ma and Cho. Also see p 170 to 171 in Huang Di Nei Jing Su Wen, Chinese medicine scholar Paul Unschuld’s survey of this important classical work where the mai or conduit vessels are described as definite anatomical, tubular structures that carry blood).

Contemporary acupuncture continues to be “explained” to patients and the general public as unblocking energy flowing in the meridians, despite the fact that energy as usable force does not move around in the body but is produced in cellular organelles called mitochondria. Nutrients, oxygen and hormonal substances move around in the blood and nerves conduct signals.

Even the local State Acupuncture Association brochure states, “pain and disease are caused by either an imbalance or a blockage of energy circulating in the body. Acupuncture restores the proper flow of energy, returning the body to good health”. Given that such a statement, which is endemic in the practice of acupuncture, has zero supporting evidence and seems to ignore accumulating proof of a peripheral nervous system-brain connection in acupuncture stimulation, it is small wonder that acupuncturists continue to struggle on the fringes of evidence-based contemporary medicine despite growing public interest.

Doyen of European Medical Acupuncture Felix Mann abandoned the meridian/Qi theory several decades ago after writing some of the first English language textbooks on traditional Chinese medicine and studying in China. Even as a rough imaging guide he points out that acupuncture meridians are clearly as artificial as the meridians around the globe, and that the radiation sensation evoked by acupuncture simply doesn’t conform to meridian pathways. He also abandons precise acupoint location, showing that acupuncture effects can often be obtained by needling fairly large areas and in some cases anywhere on the body. This is frequently borne out in studies that show the efficacy of so called placebo needling at a distance from classical acupoints.

The sheer anatomical precision of contemporary acupuncture meridian charts replete with detailed connections to organs and musculature are clearly a modern construction. The irony here is that these centrally important charts really owe a great deal to modern medical anatomy in that Chinese medicine never had detailed anatomical charts and so certainly could not have had such precisely detailed diagrams of the meridians connected to anatomical organs.

Chinese medicine scholar Paul Unschuld has stated that 95% of books written in the west on Chinese medicine “reflect Western expectations rather than Chinese historical reality.” (Acupuncture Today, July 2004) In other words western literature on this subject (including probably most texts used in acupuncture schools) say more about what westerners would like to have in modern biomedicine than about accurate renditions of Chinese medicine.

The seemingly unified, metaphysically sophisticated traditional system taught to most acupuncture students turns out in fact to be a pastiche of various traditions and theories of both Chinese and Western origin. In many ways the traditional Chinese medicine that has become so popular in contemporary alternative medicine is a fairly confused theoretical construction highly influenced by western New Age vitalist hopes and expectations. Author and longstanding Chinese medicine practitioner D. E. Kendall makes it clear in the introduction to his book The Dao Of Chinese Medicine that for centuries Chinese medical thought has been deeply affected by Western ideas and mistranslations via redaction. The mistranslations of “mai” as meridians and not blood vessels, and of Qi as energy and not as oxygenated blood, are what Kendall considers to be the main confusions driving Chinese medicine into the realm of the metaphysical, and largely alienating it from mainstream medicine.

Even in the history of Chinese medicine, theories have often been retained due to excessive conservatism, and made to coexist with theories more empirically verifiable, thus adding to the current confusion. Professor Long-xiang Huang of the Acupuncture Research Institute of the Academy of Traditional Chinese Medicine in Beijing has, over many years, extensively researched traditional manuscripts. He has concluded that classical medical books such as the Huang Di Nei Jing comprise various channel (meridian) theories from different authors, different historical periods and different areas of medical experience. The tendency was to create an often forcedly integrated theory of acupuncture and Chinese medicine. Long-xiang Huang points out that when clinical facts did not fit the theory they where suppressed in favor of continuance of the theory. The Chinese term for this is “cutting the foot to fit the shoe”. (See the introduction to Biomedical Acupuncture for Pain Management, Ma, Ma and Cho)

A glaring example of disconnection between theoretical description and actual clinical use of meridians is the absence of empirical uses for the Large Intestine and Small Intestine points to treat the anatomical intestines. Apart from the generalized anodyne and anti-infective effects of Li4 and Li11, these meridians don’t treat diseases of the small and large bowels. For any truly empirical theory such glaring discrepancies would mean the questioning of that theory. Why then doesn’t this happen in Chinese medicine? Why does so much of Chinese medical dogma continue to be taught in Western acupuncture colleges without being questioned and abandoned when found wanting? In a recent article in The New York Times (October 22nd 2005) Dr. Xu Tian a Chinese scientist from Zhejiang Province who has made an international breakthrough in cellular genetics stated that his country needs a “new revolution” in order to break free from a “system that teaches people to follow the rules, not to be an innovator”. He adds that thousands of years of tradition would have to be overcome. A tradition “that has always avoided exploring different ways of thinking and exploring, and has emphasized staying within the system.” Why do Westerners tolerate so much dogma, obscurity and unquestioning acceptance at acupuncture school?

As Felix Mann has pointed out in Reinventing Acupuncture, ancient Chinese scholars, like scholars anywhere, were prone to grandiose theoretical elaborations that speak more to the cosmological predilections of the day than to practical efficacy. Those doing the practical work in the messy realities of daily life are more inclined to use what works, with minimal theoretical basis. This is how acupuncture was likely discovered and how it has been practiced over the centuries, not necessarily by the practitioners who wrote books but by those we may never hear about. As Francois Beyens (See White and Ernst, p391 – p407) has put it, throughout the tradition of acupuncture there has always “run a strongly pragmatic approach to treatment” whereby theory has only been used as far as it helps. He adds that initially “the theory of acupuncture was firmly observation based, but the Chinese cultural love for symmetry and order caused the nucleus of practically based observation to be filled out and rounded off, so that it is now difficult to determine in the laws and theories that have been handed down to us by tradition where the scientific logic ends and the fantasy begins.” It appears that even in contemporary practice elaborate theoretical schemes are in a sense still parasitic on this basic efficacy.

My argument for contemporary acupuncture is that it can and does work well with a finely honed empirical skill and virtually no traditional theoretical basis. Acupuncture has complex effects yet is in the end a disarmingly simple technique. I think it is this fact that makes the practice of acupuncture so forgiving in its generosity to enable a plethora of systems and approaches. The theoretical system and its accompanying explanatory mesh can be entirely fanciful, however the fact is that piercing the skin in certain broad areas has complex physiological effects. The simple act of stimulating the peripheral nervous system with a needle defines acupuncture. It is important to note that when nerves supplying acupoint areas are cut or blocked there is no acupuncture effect.

There are some indications that even precise location of needle stimulus is not always essential in producing a healing effect with acupuncture. This is evident with so called placebo needling in modern studies where clinical results can be the same as or close to those using traditional acupiont locations. This fact is graphically demonstrated in fMRI brain studies of acupuncture stimulation where traditional and placebo points produce almost identical brain images of pain amelioration. (P39 Biomedical Acupuncture For Pain Management; Ma, Ma and Cho).

It may also be that acupionts can be virtually created through a kind of neuroplasticity. This effect is suggested in an experiment carried out where volunteers with normal neurological function were given tactile stimulation to the right lower lip and at the same time their right median nerve was painfully stimulated electrically. When the lip was again tactilely stimulated without the electrical pulse to the median nerve the volunteers nevertheless again felt the sensation in the medial nerve. This suggests the creation of a brain map resulting in a conditioned connection between two areas of the body hitherto considered unconnected by a direct neural pathway. (Campbell).

Similarly needling anywhere in the body may re-set the nervous system through connecting the treatment site with a distant area of pain previously not directly connected in the brain. According to Campbell in Acupuncture in Practice patient expectation may prime parts of the limbic system in the brain, which in turn may ready the nervous system for the acupuncture healing effect. Neural conditioning is then deactivated as acupuncture stimulates homeostasis resulting in a return to a healthier nervous system. This effect occurs despite there being no traditionally theoretical connection between the acupoint and the position of the pain.

It may be as suggested by the authors of Biomedical Acupuncture For Pain Management that acupuncture, for the most part is non-specific, the generalized homeostatic stimulation effect is what is important and not the traditional Organ, Meridian, 5 phases or other supposed nature of the acupoint. With further studies such as the fMRI study above this may well be shown. From research it’s clear that the so-called placebo effect in acupuncture is considerable. It’s also apparent from research examples that sham acupuncture points near standard acupoints are frequently as effective.

These facts don’t prove that acupuncture has no independent effect but that the effect of treatment (as with any medical treatment) is often bound up with and dependent upon psychological and other factors. This ‘enmeshing’ makes the practice of acupuncture fluid and somewhat plastic, sustaining a plethora of theories and practices often contradicting each other. As Ma, Ma and Cho point out there are 80 different styles of acupuncture in China alone. Belief/expectation effects will prime certain brain centers in the patient, perhaps at least some of the time, enhancing treatment outcomes. However this effect may well be rooted in the flavor of the day or of the current historical period (anti-materialism for example) so will be at least in part culturally conditioned. The effect may not be as robust when conditions change and are surpassed by new cultural expectations.

In any case the placebo effect tends to wear off over time in the course of a series of treatments, whereas the acupuncture effect increases through the intitial treatment series and frequently remains stable for many months. Additionally acupuncture is an effective treatment in animals.

A contemporary transparent approach to empirical acupuncture will place all theories on hold or at least be cautious and tentative with their use. Anyhow, a simple pragmatic use of empirical acupuncture brings along its own skill and confidence which more than adequately fulfills the non-specific psychological treatment enhancing side of the technique. In addition to this aura of skill and effectiveness the biomedical post-traditional practice of acupuncture (based on current and developing neuro-hormonal understanding) can be more readily explained and communicated to patients and other health professionals in the language of contemporary medicine and science. It is noteworthy that in studies of acupuncture there is little difference in outcomes between acupuncturists practicing different styles – including a modern biomedical approach. All styles achieve about a 75% effectiveness rate. (Campbell) This also suggests that whether acupuncture training is short or the usual 3 to 4 years, results are the same in the hands of an experienced clinician.

All medicine is headed to some degree in the direction of science. Even therapies that are not currently understood scientifically and may even suggest aspects of mind/body functioning that stand outside conventional paradigms need to be tested for effectiveness and appropriate application. A definition of science I find particularly cogent here is that attributed to the late physicist Richard Feynman; “science is a way of trying not to fool ourselves”. This is an important definition for the contemporary practice of Chinese medicine in the West where critical thinking is sorely lacking. As shown above, we are not even practicing traditional Chinese medicine in anywhere near its historical form, and this may in fact be impossible.

For decades Traditional Chinese Medicine practice has been based on central mistranslations and misconceptions pertaining to Qi, Blood and “mai” or channels. The argument that if it’s ancient it must be true does not look as convincing in this light. In the words of Long-xiang Huang it is the task of forward looking practitioners to pick out the “pearls” from the confusion of traditional theory and connect them with a new biomedical “string.” To this end there needs to be more open discussion about clinical efficacy without tying everything back to traditional dogma. Additionally the fostering of careful studies is needed to develop new approaches and to gain evidence for simple theories to replace old theories and approaches. (See Anthony Campbell’s Where To Place the Needles and for How Long for a discussion on modern theoretical approaches to acupuncture practice, as well as his outline of a contemporary atheoretical approach.) There is currently, decades of clinical experience in what could be termed a post-traditional approach to acupuncture especially in England and Europe. The approaches of the following highly accomplished practitioners of this medical art, to name a few, suggest a new beginning: Felix Mann; Anthony Campbell; C. Chan Gunn; Yun-Tao Ma, Mila Ma and Zang Hee Cho; H. C. Dung; P.E.Baldry; Adrian White. Their integrative theories and methodologies can and should be taught, in the very least, as an alternative track in contemporary acupuncture colleges.

In summary, to answer the charge that a modern approach to acupuncture lacks spirituality, it would be fair to say we practice acupuncture primarily to participate in the great medical adventure of relieving suffering and optimizing health and wellness, not simply to satisfy our own need for spiritual/philosophical meaning through grand theories. Is it not spiritual enough to have the capacity to relieve suffering for human beings of all walks of life and animals as well? Also as far as holism goes, acupuncture is inherently holistic without traditional theory, as it stimulates homeostasis and self-healing through the very act of piercing the skin. This probably occurs based upon ancient biological survival responses to wounds, acupuncture being a micro wound. (Ma, Ma, and Cho).

We need to be highly practical and effective yet simple and accessible and to fit the modality of acupuncture and Chinese medicine into the understanding and medical milieu of our times. Acupuncture is essentially a simple and effective technique, which can be taught in a simplified and contemporary manner, refined through experience, and integrated widely into modern biomedicine. It is a method of relieving suffering, inherently holistic in its effect, with minimal side effects. Hence the need of a post–traditional integrative revision.

© Thomas Martin,

Bibliography

Medical Acupuncture – A Western Scientific Approach, Jacpueline Filshie, Adrian White

Acupuncture In Practice – Beyond Points and Meridians, Anthony Campbell

Reinventing Acupuncture – A New Concept Of Ancient Chinese Medicine, Felix Mann

The Gunn Approach to the Treatment of Chronic Pain – Intramuscular Stimulation for Myofascial Pain of Radiculopathic Origin, C Chan Gunn

Biomedical Acupuncture for Pain Management – An Integrative Approach, Yun-Tao Ma, Mila Ma, Zang Hee Cho

Huang Di Nei Jing Su Wen – Nature, Knowledge, Imagery in an Ancient Chinese Medical Text; Paul Unschuld

Problems with the Energy – Meridian Theory (PDF), D. E. Kendall.

Bruce Pomeranz interview by Bonnie Horrigen in Alternative Therapies in Health and Medicine; Nov. 1996, Vol.2, No.6, p.85 – 91

Where to Place the Needles and for How Long? Anthony Campbell

“Time for Acupuncture to Become Part of Standard Care”

The following article by Dr.Lorenzo Cohen, Ph.D., Professor and Director of the Integrative Medicine Program at the University of Texas, MD Anderson Cancer Center appeared in Huffington Post on December 7th, 2013. The article confirms many of the clinical uses for acupuncture in the area of Oncology. These uses are certainly confirmed by myself and other colleagues who have been working in this field utilizing acupuncture and herbal therapy for the past 20 years. Also medical treatment for cancer can easily feel ‘industrial’ and depersonalizing and the care received in acupuncture clinics can help people going through treatment for cancer feel re-empowered, nourished and supported.

In the article the author states that the “mechanisms are not well understood”,  this however is not true any longer with several writers/researchers outlining much of acupuncture’s modes of action in modern scientific understanding. See for example – http://www.amazon.com/Biomedical-Acupuncture-Pain-Management-Integrative/dp/0443066590 and http://www.amazon.com/Introduction-Western-Medical-Acupuncture-1e/dp/0443071772/ref=sr_1_1?s=books&ie=UTF8&qid=1386465583&sr=1-1&keywords=western+acupuncture

Thomas Martin LAc.

See also – http://www.ncbi.nlm.nih.gov/pubmed/23341529

“Acupuncture, the insertion of small, stainless steel needles into points on the body to stimulate specific areas, has been used in recent years by many cancer patients to help with symptom management. Because the mechanisms are not well understood, deciding when and how to safely add acupuncture to one’s treatment plan can be challenging. A recent systematic review conducted by researchers in the Integrative Medicine Program at the MD Anderson Cancer Center can now help patients and their oncologists make more informed choices.

The systematic review, published in the Journal of Clinical Oncology, searched the worldwide literature for randomized, controlled trials evaluating the use of acupuncture for symptom management in cancer patients.[1] Forty-one studies were found for the treatment of eight symptoms (pain — 11, nausea/vomiting — 11, postoperative ileus (constipation) — eight, xerostomia (dry mouth) — four, hot flashes — seven, fatigue — three, anxiety/depression/mood disorders — five, and sleep disturbance — three), and were rated for study quality and whether outcomes were positive or negative.

One well-designed large study undefined for the treatment of chemotherapy-induced nausea and vomiting, found electroacupuncture worked better than anti-nausea medications or sham acupuncture (minimal needling) in women with breast cancer.[2] Although less clear, the evidence also suggests acupuncture is helpful for pain control. None of the identified studies were classified as having a low risk of bias due to study weaknesses, but nine of the 11 pain studies had positive results favoring its use. For the other symptoms assessed, the quality of the studies was lower, but there is reason to believe that with larger more rigorous studies, acupuncture may be found beneficial for some of these conditions as well.

The use of acupuncture for symptom control in oncology is important to consider. Findings from this review and others indicate it is an appropriate treatment alongside conventional care for chemotherapy-induced nausea/vomiting, although additional studies are needed to better understand how it works and which patients might benefit most. For other symptoms, the specific effects of acupuncture remain undetermined, primarily due to weaknesses in the studies. As a low-risk, cost-effective treatment option, acupuncture may be helpful when combined with conventional care for patients suffering from uncontrolled treatment-related side effects or in those for whom other treatment approaches have failed.”

References:

1. Garcia MK, McQuade J, Haddad R, Patel S, Lee R, Palmer JL, Yang P, Cohen L. “Acupuncture in cancer care: a systematic review.” Journal of Clinical Oncology (Published online before print Jan. 22, 2013). doi: 10.1200/JCO.2012.43.5818)

2. Shen J, Wenger N, Glaspy J, Hays RD, Albert PS, Choi C, Shekelle PG. “Electroacupuncture for control of myeloablative chemotherapy-induced emesis: A randomized controlled trial.” JAMA 284:2755-61, 2000.

Oatmeal, Satiety and the Satiety Index

A small study titled “Acute Effect of Oatmeal on Subjective Measures of Appetite and Satiety Compared to Ready-to-Eat Breakfast Cereal: A Randomized Crossover Study” was recently published in the Journal of the American College of Nutrition.

The study showed that a simple low caloric, high satisfaction breakfast primarily of oatmeal “can prolong the period between meals and thus help establish habits conducive to weight loss.”

β-glucan content of the oatmeal, a viscous fiber, seems to result in the high satiety index of oatmeal. Its important to note that the oatmeal be as unprocessed as possible, for example muesli is only half as satisfying as oatmeal using the satiety index.

http://www.tandfonline.com/doi/abs/10.1080/07315724.2013.816614#.UpJMjmTXRk4

 

The Satiety Index of foods was developed by Susanna Holt PhD, and associates at the University Of Sydney. It adds a further refinement to other food indexes such as the Glycemic Index

 http://en.wikipedia.org/wiki/Glycemic_index.

Interestingly even though boiled potatoes are high on the Glycemic Index they are also the highest food on the Satiety Index. Meaning that if you fill up on them (note, not fries) you will stay full for a long time and therefore eat less. If you eat them with other foods, you will eat less.

More on this at http://www.mendosa.com/satiety.htm

 

The Pima Paradox also shows how a high Satiety Index can greatly alter a high Glycemic Index score.

Whereas the Pima Indians have a significant genetic propensity toward diabetes which manifests in those consuming (in Arizona) a modern diet of plentiful refined carbohydrates, animal fat and protein. Their traditional diet (still consumed in Mexico) however comprises large amounts of corn and potatoes as well as activity, resulting in lean body mass and rare incidence of hyperinsulinemia, obesity and type 2 diabetes (NIDDM).

http://foodandhealth.com/cpecourses/giobesity.php

 

Thomas Martin LAc.

Acupuncture for Depression

A small study comparing outcomes for moderate to severe depression in three groups; standard care, counseling and acupuncture was published last this week in PLOS Medicine.

In this pragmatic randomised controlled trial conducted in the North of England, patients with depression were randomised to receive 12 weekly sessions of acupuncture plus usual care (302 patients), or 12 weekly sessions of counselling plus usual care (302 patients), or usual care alone (151 patients).

Both the acupuncture and the counseling groups resulted in significant improvement in depression scores over standard care alone. Improvements were stable at 3 months post treatment. All study groups continued with standard medical treatments such as antidepressants.

Commentary given considered the study as validating acupuncture as an evidence-based treatment for depression in an integrative environment.

A frequent side-benefit of acupuncture treatment for a variety of conditions is improved wellbeing. The study demonstrates this effect to be robust enough to improve moderate to severe depression scores. It seems reasonable to expect an even greater treatment effect in mild to moderate depression.

Clinically I have seen good success in managing bouts of mild to moderate depression combining acupuncture with an Albizzia based Chinese herbal formula.

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001518

 

Thomas Martin LAc.

 

Acupuncture Improves Lung Function and Overall Health in COPD

Sixty-eight of 111 patients from the Kansai region of Japan who were diagnosed as having COPD and were receiving standard medication participated in a randomized, parallel-group, placebo-controlled trial. COPD is considered a non-reversible condition that can severely reduce lung function. It is predicted to be the third leading cause of death worldwide by 2020.

In both groups patients were treated with real or placebo needling at the same acupoints once a week for 12 weeks.The placebo needling involved an apparatus that looked like a real acupuncture needle but only pressed the skin surface.

The primary end point, or study result was the modified Borg scale score evaluated immediately after the 6-minute walk test. This is a scale used to evaluate shortness of breath after exertion.

After 12 weeks, the Borg scale score after the 6-minute walk test was significantly better in the real acupuncture group compared with the placebo acupuncture group. Also improvements in nutritional status, body mass and over-all quality of life was seen in the acupuncture group.

We demonstrated clinically relevant improvements in DOE (Borg scale), nutrition status (including BMI), airflow obstruction, exercise capacity, and health-related quality of life after 3 months of acupuncture treatment 

http://archinte.jamanetwork.com/article.aspx?articleid=1151703

In clinical practice I have often seen improved breathing and voice strength following acupuncture treatment even when the lungs or chest was not the primary focus of treatment. Acupuncture can be a valuable adjunctive treatment for chronic asthma and I have seen it to be of considerable help with breathlessness in people with a cancer diagnosis. Improved wellbeing and functionality is another non-specific outcome often seen following a course of acupuncture.

 

Thomas J Martin LAc.

 

 

Acupuncture For Breast Cancer Related Lymphedema

 

A significant number of breast cancer survivors develop a long-term, difficult to treat, symptom called lymphedema. This involves swelling of the arm, shoulder or breast on the side in which breast tumors and lymph nodes were removed and or radiation treatment performed. The swelling is due to changes in flow of the fluid within lymph vessels in the area, though the exact process is unknown.

Results from a small pilot study led by Barrie r. Cassileth, chief of Memorial Sloan-Kettering’s Integrative Medicine Service, and Clifford a. Hudis, chief of the Breast Cancer Medicine Service, was published April 10 in The Journal Cancer

http://www.ncbi.nlm.nih.gov/pubmed/23576267

Study participants received acupuncture at Memorial Sloan-Kettering twice weekly for four weeks, using a regimen developed by the Integrative Medicine Service.

Researchers measured the participants’ upper-arm circumference before and after the treatments. They found that among the 33 patients who received acupuncture, 11 had a significant reduction in swelling and another 18 had at least a small reduction. When contacted several weeks later for feedback, patients reported lasting improvement in swelling.

Dr. Cassileth stated the study showed that acupuncture as a treatment for lymphedema is safe and well tolerated with no serious side effects.

http://www.mskcc.org/blog/study-shows-acupuncture-may-relieve-chronic-lymphedema-after-breast-treatment

 

These results confirm what I have seen clinically treating this condition in women diagnosed with breast cancer with acupuncture for the past 18 years. One of the main effects of acupuncture being improved blood and lymph flow.

Thomas Martin LAc.