acupuncture past present and practical...pain, frozen shoulder, or various osteoarthritic joint...

Acupuncture:

PastPresent

&Practical

Dr. Nikki Ruse

About Me

1995 Graduated New Jersey Institute of Technology, Honors College:B.S. Engineering Science

1999 M.D. from UMDNJ: New Jersey Medical School,

Major USAF, Medical Corps

Wright-Patterson AFB, OHMcGuire AFB, NJDover AFB, DE

2007Helms Medical Institute, UCLA Stanford

Weight Loss Medicine

Complementary vs Alternative

• If a non-mainstream practice is used together with conventional medicine, it’s considered “complementary.”

• If a non-mainstream practice is used in place of conventional medicine, it’s considered “alternative.”

https://nccih.nih.gov/

Types of Acupuncturists

Licensed Acupuncturists (LAc)

• Master’s level, on-site training at a nationally accredited school or college of acupuncture

• Over 2,000 hrs acupuncture/Oriental med• Required to pass the certification exam,

NCCAOM (National Commission for the Certification of Acupuncture & Oriental Medicine)

Medical Acupuncture • Physicians• Minimum of 220 hours of formal training • Amercian Board of Medical Acupuncture

– Meets/exceeds WHO/WFAS standard– www dabma.org

• Board Certification is NOT required to perform acupuncture, as an MD/DO.

Chiropractic Acupuncture

• 100 or less hours of training• Completed an approved educational

program and an evaluation, including an examination process– American Board of Chiropractic Acupuncture

(ABCA)

History of Acupuncture

• 4000 years old• China, Korea,

Japan, Taiwan, India

Joseph Helms, Acupuncture Energetics, 1995 Chapter 1

China to Europe• Written text: “Huang Di Nei Jing” (or

simply “Nei Jing”) which translates as the “Inner Classic of the Yellow Emperor.” The Nei Jing dates back to approximately 90 BC

• Christian (Jesuit) Missionary Father Placide Harvieu. Upon returning to France from China in 1671, Father Harvieu published the text “Les secrets de la Medicine des Chinois” (“Secrets of Chinese Medicine”).

https://yinyanghouse.com/acupuncture/a-brief-history-of-acupuncture-in-the-west, 4/5/2017

Acupuncture Interest in US

• 1971 James Reston wrote front-page article for New York Times– Reporter in Beijing to cover US-Chinese Ping-Pong

tournament and developed appendicitis– Emergency appendectomy required– Post-op pain alleviated by 3 acupuncture needles

• 1970s, Delegations of US physicians were impressed by major surgery performed in China on awake pts with Acupuncture

Joseph Helms, Acupuncture Energetics, 1995 Chapter 1

Hospitals• Percentage of hospitals offering one or

more complementary and alternative medicine (CAM) increased from 8 % in 1998 to >42% in 2011. Includes:– Acupuncture – Chiropractic – Homeopathy– Massage therapy, etc.

http://www.cbsnews.com/stories/2006/07/20/health/webmd/main1823747.shtmlhttp://www.aha.org/presscenter/pressrel/2011/110907-pr-camsurvey.pdf

American Hospital Assc Survey 2010

• Key reason for offering CAM– 85% indicated Patient Demand– 70% Clinical effectiveness – 58% Reflection Organizational Mission

• Budgetary constraints as the biggest obstacle for implementation of CAM programs.

http://www.cbsnews.com/stories/2006/07/20/health/webmd/main1823747.shtmlhttp://www.aha.org/presscenter/pressrel/2011/110907-pr-camsurvey.pdf

2006 Locations for CAM in hospitals

• Most common in the Midwest (Illinois, Indiana, Michigan, Ohio, and Wisconsin)

• Least common areas in the South (Alabama, Kentucky, Mississippi, and Tennessee).

http://www.cbsnews.com/stories/2006/07/20/health/webmd/main1823747.shtml

19 of 20 hospitals on U.S. News's most recent ‘America's Best Hospitals’ superselective Honor

Roll provide CAM of some type

http://health.usnews.com/articles/health/2008/01/09/embracing-alternative-care.htmlhttp://health.usnews.com/health-care/best-hospitals/slideshows/the-honor-roll-of-best-hospitals-2016-17

DukeMt SinaiCedars SinaiUniversity of MichiganUniversity of ColoradoUCLA StanfordBingham & Women’sUniv of PittsburgBarnes Jewish, Wash U

NYU Langone MCNorthwestern MemorialUCSF Med CenterNY PresbyterianUCLAJohns HopkinsMass GenCleveland ClinicMayo Clinic

• At Nellis Air Force Base, Acus Foundation is creating a standardized training curriculum and clinical model of incorporation for medical acupuncture.

http://acusfoundation.org/programs/the-nellis-project/

Needles• Insert fine (25-36 gauge), solid, blunt-

ended needles in to acupoints.

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Qi (chee)

• Loosely translated as “Life Energy”• Funadamental concept in Eastern ideology

– China: Qi– Japan: Ki– Korea: Gi– India: Prana

Pain-Relief Guide: Acupuncture and Chinese Medicine Jamie Starkey, LAc Lead Acupuncturist, Center for Integrative Medicine Wellness Institute, Cleveland Clinic 11/03/2011

Qi (chee)• Energy in all forms

– Vitality ̶̶ Defensive Qi– Nourishing Qi ̶̶ Generational Qi

• Moving Qi that travels throughout the body along energy lines, call Meridians

• Qi flows w/o obstruction or deficiency, we are in balance, health, wellness

Acupuncture Energetics, Dr Joseph Helms

How does Acupuncture Work?Traditional Chinese Medicine

• 14 Major energy-carrying channels (meridians)

• Imbalances in the channels cause illness, pain, disease

• Acupuncture restore balance and “unblocks” meridians

Meridian Lines• Darras et al. (1987)

– Injected Technitium99 into true and sham acupuncture points, traced with scintillation camera

– At true acupuncture points• Radioisotope diffusion corresponded to

classically described meridians• Inconsistent with either

lymphatic/vascular flow– Sham points

• centrifugal diffusion pattern

Darras, J. C. Visualisation isotopique des meridiens d'acupuncture Cah de Biotherapie Vol.95 Issue pp. 13-22; 1987

How does it work?• Pomerantz et al. shown acupuncture needling

– Affects nociceptive, proprioceptive, and autonomic nerve pathways

– Local release endorphins – Spinal Cord

• Release of enkephalin/dynorphin• Enkephalin releases monoamine neurotransmitters

(serotonin/norepinephrine )• Inhibit spinal pain transmission

– Brain• Endorphins released from hypothalamus-pituitary

region• Inhibit Substance P (involved with

pain/inflammation)Pomeranz & Stux, Scientific Basis of Acupuncture, 1-34, 1986, Springer-Verlag, Quoted from http://www.medicalacupuncture.org/acu_info/priv.html

Acupuncture-Induced Analgesia• Confirmed to be mediated through the

thalamus via Functional MRI, PET and SPECT scans.– Li K, Shan B, Xu J, et al (2006). "Changes in FMRI in the

human brain related to different durations of manual acupuncture needling". Journal of alternative and complementary medicine (New York, N.Y.) 12 (7): 615-23.

– Pariente J, White P, Frackowiak RS, Lewith G (2005). "Expectancy and belief modulate the neuronal substrates of pain treated by acupuncture". Neuroimage 25 (4): 1161-7

– Alavi A et al. Neuroimaging of acupuncture in patients with chronic pain. Journal of Alternative and Complementary Medicine 1997;3:S47-53.

Acupuncture-Induced Analgesia

• Administration of Naloxone prevents acupuncture associated analgesia– Pomeranz B, Chiu D (1976). "Naloxone blockade of

acupuncture analgesia: endorphin implicated". Life Sci. 19 (11): 1757-62.

– Mayer DJ, Price DD, Rafii A (1977). "Antagonism of acupuncture analgesia in man by the narcotic antagonist naloxone". Brain Res. 121 (2): 368-72.

What Medical Conditions can Acupuncture Treatment?

• According to the Chinese . . .

Everything

World Health Organizations / NIH Conditions Appropriate for Acupuncture Therapy

GASTROINTESTINALGastritisPeptic Ulcer painNausea / VomitingDysenteryBiliary Colic

MUSCULOSKELETALRheumatoid ArthBack PainMuscular painNeck PainSciaticaKnee PainEpicondylitis

GYNECOLOGICALFetal Breech PositionInduction of LaborDysmenorrheaMorning Sickness

MISCELLANEOUSDepression HypertensionHypotensionLeukopeniaAdverse Reation to Chemo or RadiationAllergic Rhinitis

ENTFacial PainDental pain

NEUROLOGICALHeadaches Migraines Postoperative painStroke

Source: World Health Organization United Nations. “Acupuncture Review and Analysis of Reports on Controlled Clinical Trials." (2002) & Acupuncture. NIH Consensus Statement 1997 Nov 3-5; 15(5):1-34

Patient c/o

• Low Back Pain• Neck Pain• Osteoarthritis/Knee Pain• Headache• Trigeminal Neuralgia• Fatigue• Phantom Limb Pain• Depression

Contraindications

• Severe bleeding disorders– Blood thinners don’t matter

• Pacemaker is a contraindication to electro-acupuncture

Limited Benefit

• Spinal Cord injuries• Stroke• Neurodegenerative diseases

Major Adverse Events

• 1965-1997: – 10 Cases of internal injuries in US

• Brain damage/stroke• Pneumothorax• Kidney damage• Cardiac tamponade

Common, Minor Adverse Events• Survey by Ernst et al. of over 400 patients

receiving over 3500 acupuncture treatments found– Minor bleeding after removal of the needles, seen

in roughly 3% of patients. – Hematoma, seen in about 2% of patients, which

manifests as bruises.– Dizziness, seen in about 1% of patients. – Conclusion: "Acupuncture has adverse effects,

like any therapeutic approach. If it is used according to established safety rules and carefully at appropriate anatomic regions, it is a safe treatment method."

Ernst G, Strzyz H, Hagmeister H (2003). "Incidence of adverse effects during acupuncture therapy-a multicentre survey". Complementary therapies in medicine 11 (2): 93-7.

https://www.usnews.com/news/best-countries/articles/2016-08-08/fire-cupping-therapy-puts-olympic-rings-on-rio-athletes

Cupping

A technique in which a suction-like force holds cups against the skin for

several minutes.


Cupping

Cupping

• Increases blood flow to the area of pain• Used for lingering pain conditions from old

injuries such as whiplash, low back pain or shoulder pain.

• TCM: stagnation of Qi and blood in the area of discomfort.


Moxibustion

• a technique involving moxa, the herb mugwort (Artemisia vulgaris).

• deeply penetrate the area of discomfort with soothing warmth.

• pain-relieving effect• invigorate the flow of Qi and blood


Moxibustion

• Moxibustion is particularly effective for cases like tight muscle spasms, low back pain, frozen shoulder, or various osteoarthritic joint pains, especially when pain is worsened by damp and cold weather.


Electroacupuncture

Application of a pulsating electrical current to acupuncture needles as a means of stimulating the acupoints

http://www.itmonline.org/arts/electro.htm 4/5/2017

Electro-Acupuncture

• Needles placed in acupuncture points, electrodes are attached from a TENS unit.

• Device turned on, patient will feel small amount of electricity: tinging, burning, etc.

• Intensity of sensation is adjusted to pt tolerance.


Electro-Acupuncture

• Alternating current applied for 10-20 min• Patient becomes adapted to electricity after

first 1-2 min• Cannot use if patient has pacemaker, etc..• Helps with pain and fatigue

Gua shameaning "scraping bruises“Traditional Chinese medical

treatment in which the skin is scraped to produce light bruising.

Wikipedia 4/5/2017

Gua sha

• Like a deep massage with lots of bruising• Massage oil or lubricant is placed on skin• A tool with smooth surface is used• With moderate force, the tool is rubbed

along pt’s skin in long, smooth strokes• Creates redness/bruising. Used to break up

areas of Qi Stagnation or painPain-Relief Guide: Acupuncture and Chinese Medicine Jamie Starkey, LAc Lead Acupuncturist, Center

for Integrative Medicine Wellness Institute, Cleveland Clinic 11/03/2011

Gua Sha tools

Acupuncture Microsystems

http://www.thieme.com/media/samples/pubid-687503961.pdf

A system of particular micro acupoint which constitutes a functional image of the whole organism in a clearly defined partial area.

Auricular Acupuncture

• Auricular model is a microsystem, meaning the entire body is mapped on the ear.

Auricular Acupuncture

• Discovered in 1950s by French doctor, Nogier

• Decoded functional points on the ear.• Points further refined by Chinese and

Russian schools of acupuncture• Used worldwide.

• Palpate areas of the earfor active points that correlate to areas of pain felt in the body. • Needles are placed in points that promote

pain relief and sedation. • All pain-related conditions can be

effectively addressed using this technique.


Battlefield (Auricular) Acupuncture

• Developed: USAF Col. Richard Niemtzow, MD

ASP needle. Single use needles that stay in the ear for 3-4 days

5 Points on each ear

Military Medics

Korean Hand Acupuncture

http://www.thieme.com/media/samples/pubid-687503961.pdf

• Korean Su-Yok• 12 channels and other

reflex points• Points located on palmer

and dorsal sides of the hand

Korean Hand Acupuncture

Scalp Acupuncture

Is Acupuncture right for you?• Don’t postpone seeing a Health Care

Provider about your health problem• Licensing: Not required in Alabama• Check Board Certification groups

– www NCCAOM org– www MedicalAcupuncture.org– www CouncilofChiropracticacupuncture.org

• Check for Insurance coverage or cost of cash pay.

Board Certified Medical Acupuncturists in ALMiller, Melanie MD 159 Main StTrussville, AL 35173(205) 655-2110Family Medicinehttp://www.BirminghamIntegrativeHealth.com

Ruse, Naykala MD, DABMA 1890 Al Hwy 157, #300Cullman, AL 35058(256) 737-8052 Internal Medicinehttp://www.cullmaninternalmedicine.com

Sciacca, Robert MD, FAAMA4501 South Lake Pkwy #200Hoover, AL 35244(205) 985-7393Otolaryngology, Otalaryngic Allergy, Medical Acupuncturehttp://www.alabamaentassociates.com

Summary

• Acupuncture is a 4000 yo practice• Originated in China and other parts of Asia• Widely used in Europe and throughout the

world• Research, training and practice in the US

military• Gaining acceptance in US hospitals

Summary

• How Acupuncture works is not fully understood– Restores balance to Qi (energy,Vitality) – Inhibits spinal pain transmission

• Safe procedure• Find a well trained LAc, Medical

Acupuncturist, etc..

Summary

• There are various modalities that may be used during an acupuncture treatment– Cupping– Moxibustion– Electro-acupuncture

• Different types of acupuncture– Chinese vs Korean vs Japanese, etc.– Microsystems: Ear, Hand, etc.

THANK YOU

It has been my honor to speak with you today!

Questions?

Dr Nikki Ruse256-737-8055

acupuncture past present and practical...pain, frozen shoulder, or various osteoarthritic joint...

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