There has been quite a bit if interest on and off here about acupuncture and I thought this transcript might be helpful.
I am an advocate for the American Pain Foundation and this chat was held last night on their web site.
Enclosed is a copy of the transcript for those of you who either couldn’t make it or came in late.
It will be posted on our website and our discussion boards.
Thank you for joining us and we hope to see you again very soon!
Carolyn aka PA_Carolina
Welcome to American Pain Foundation’s (APF) PainAid chat with Mayssa Sultan, MPA, L.Ac. We’re very pleased to have Mayssa as our guest speaker tonight. The topic for this evening is "Acupuncture: Not Just Needles.”
We will be discussing the subject of acupuncture and its use as part of your pain care plan. Acupuncture and Traditional Chinese Medicine are often used in tandem for pain management. Our goal tonight is to help you learn how acupuncture might help you and what to expect if you decide to pursue acupuncture as part of your pain management plan.
Mayssa is a licensed acupuncturist and herbalist who recently completed her Masters of Public Administration through the National Urban Fellows Program. She was placed at the American Pain Foundation (APF) as part of her fellowship to develop her practical experience in public administration with a focus on health policy.
Following the completion of her degree program, Mayssa was hired to work with APF as a coordinator for the Power Over Pain Action Network’s Western Region and also to work on improving state policies as they relate to pain. She is also the co-founder of Integrative Clinics International, a non-profit organization dedicated to long-term solutions for sustainable health care.
Ok! I’ll turn it over to Mayssa for his presentation. Go ahead, Mayssa.
Hello all! I am excited at the opportunity to share with you a bit about how acupuncture can help you in managing your pain. I think when it comes to something as poorly understood as acupuncture, education is key.
Some of the explanation I will give here will seem a little out there, hang in there with me. Because the mechanism by which acupuncture works is not well understood there are a lot of analogies that go into describing it.
The most important thing to really understand is that acupuncture is a whole body medicine. I called this chat, “Acupuncture, Not Just Needles,” to illustrate that. It is not necessarily that your acupuncturist may use different treatment methods on you, which they may, but more that they will use a whole system of diagnostic questions to find out exactly what “type” of pain you have and treat you based on that.
This means that two people with the exact same disorder may be treated completely differently by their acupuncturist depending on what your acupuncturist comes up with in this diagnostic interview.
How does it work?
From a western biomedical perspective it is thought that acupuncture works through opioid or endorphin release in the body, this is the body’s natural analgesic (pain medicine). It is also thought to speed up the release of certain neurotransmitters and hormones in the brain also helping with pain relief.
Research is still being done to prove these theories. The evidence though that acupuncture provides pain relief is evidenced in the fact that the World Health Organization (WHO) and the National Institutes of Health (NIH) have approved the use of acupuncture for over 27 specific ailments including many forms of pain.
Acupuncture was developed in China over six thousand years ago pretty much through a system of trial and error. Through this, practitioners were able to map channels, like roadways, on the body through which “qi” flows. Now, I don’t want to confuse you right up front.
Qi, pronounced and sometimes spelled chi, is not translated because it there really is no word in English that adequately describes it. I will do my best. Essentially, qi is energy that flows through channels in the body which become blocked when there is pain. The channels are accessed through acupoints which are the places where this energy flows closest to the skin’s surface.
The channels have pathways through the body and connect internally to the organs so manipulation of this qi is able to adjust the body’s systems stimulating the body to heal itself.
These acupoints, about 400 on the body, are accessed through very fine needles, about the width of a strand of hair. These needles are sterile, single use needles and are disposed of after a single insertion. The sensation you will feel is not one of the needle being inserted but more a sense of soreness once the needle accesses the qi.
Besides the fact that the needles are incredibly fine, the acupuncturist is trained to distract your nervous system, by touching a place close to the place of insertion or using an insertion tube so that you don’t feel the needle. The sensation once the acupuncturist has found the qi is as if someone is rubbing a sore muscle.
Acupuncture as a complement
Acupuncture is typically used as a complement to the rest of your pain management program. However, I often found in my acupuncture practice that people waited until they had undergone every other form of treatment to turn to this alternative.
After a number of surgeries, many medications and all the other treatment options, people often expect acupuncture to be the miracle cure. It is not. It will help a person with pain, but the earlier this alternative modality is used the more likely there will be a benefit in a shorter period of time.
I have often helped people who had undergone unsuccessful surgeries, but it often took a long time for the treatments to begin to work. Check with your doctor and do your research as to what treatment modalities you would like or are able to use to treat your pain.
Much of the work we do at the American Pain Foundation is empowering people to have a say in their pain care. Consult your doctor, ask what options may be available to you. They often may not know about acupuncture as an option for pain care, so it will be up to you to find out what your options are.
The key is to note that acupuncture is known to be a complement (an enhancement) to whatever treatment you are undergoing and you should always inform your primary care practitioner as to what treatment you are undergoing.
Acupuncture is a method of treatment which can provide immediate pain relief, but it may take time for the results to be lasting. It will also depend on what you have going on. If you have a herniation in your spine for example, acupuncture can help to ease swelling and inflammation and can help to ease the pain.
But you will also want to visit your doctor regularly to make sure that your pain management program is working for you. Sometimes you may be seeing several practitioners simultaneously for your pain. Make sure someone is managing your care and knows who you are seeing and can evaluate your progress, referring you to appropriate doctors as is necessary.
In states, like California, acupuncturists are primary care practitioners and they can do this for you. This is not necessarily the case in other states and you will want your primary care practitioner, whoever that is, to be aware of all the pain management practices you are undergoing.
People often ask what to expect, how long will the relief last?
This is a very individual experience much as your pain experience is a very individual experience. Some patients will experience complete pain relief, others will only achieve some relief.
Because we are talking here about chronic pain, the chances you have had your pain for quite some time are good. If that is the case, your pain may take some time to treat.
Acupuncture is a system of medicine which deals with the root causes and imbalances in the body. There is typically no quick fix. Again, I must reiterate that some immediate pain relief IS typically achieved. Long lasting relief can take time.
If you have an acute flare-up of your pain condition that may be dealt with quickly, while dealing with the underlying cause of a chronic pain condition may take longer.
In acupuncture, which is a piece of Traditional Chinese Medicine, all conditions are treated by first going through a differential diagnosis.
What does this mean?
This means that your pain will be treated differently depending on how long you have had it, how it feels, sharp stabbing pain, radiating pain, dull aching pain, pain that is worse in the evening or in the morning or according to whatever other conditions you have going on.
Do you have trouble sleeping, frequent colds, or digestive trouble? This all goes into preparing an appropriate diagnosis of your pain which the acupuncturist then uses to treat your pain.
Once a diagnosis has been reached your acupuncturist will choose points and a treatment protocol for you; this means they will decide how often they would like to see you, what modalities they will use and what herbs they may choose to involve in your treatment.
What should you expect?
A treatment takes about 5 to 10 minutes to insert the needles and you will typically sit with the needles in for approximately 20 minutes to a half an hour.
This is typically a very relaxing experience. One I often refer to as the “internal massage.” You will often fall asleep during a treatment awakening feeling very relaxed.
Depending on the training of the practitioner, there are many different schools of thought in treating ailments with Chinese Medicine. A practitioner may treat your pain locally, so in the ankle for ankle pain, or distally, such as treating your wrist to get at your ankle pain.
There is also Korean style acupuncture where the needles are placed almost exclusively in the hands as well as ear acupuncture in which needles are placed in the ears as its own treatment or as part of a treatment where needles are placed in various locations of the body as well.
Korean acupuncture is taught separately from traditional Chinese acupuncture. Ear acupuncture is a part of every practitioners training and is an integral part of acupuncture training.
The whole body both external and internal is represented on the ear and can treat the body very effectively. Some practitioners use only the ears to treat pain conditions. Each of these treatments will last different lengths of time but typically about twenty minutes to a half hour for the treatment itself. The intake or interview part of the session with an acupuncturist can take substantially longer than this.
My initial intakes with a patient can last up to an hour or more. This will involve filling out a health history which may ask questions you don’t feel have anything to do with your pain such as your digestion or sleep habits. However, these questions all go toward helping the acupuncturist assess how they will treat your pain and you as a patient.
As I said, this is not just needles, but whole body medicine. Often your acupuncturist will give you stretches to do, nutritional advice and ask you to journal about your experience both with your pain and in relation to your acupuncture experience.
It is very helpful to track your pain on a daily basis to find what is and is not working for you. There are many different options for treatment with Chinese medicine so if one technique is not working your practitioner has other methods they can use to help you.
In addition to needling, an acupuncturist may employ techniques such as cupping, moxa, massage, electric stimulation and may offer to prescribe you herbs depending on the medications you are taking and the regulations in your state.
Some states do not license acupuncturists to practice herbology. Check with your state’s acupuncture board for more information on this. A simple Google search on acupuncture and state laws should get you to the information you want.
Cupping is a technique in which a glass cup is suctioned to the skin to release some of the stagnation that may exist in that particular part of the body. Cupping can and does often lead to bruising which is not harmful and will resolve in the same amount of time a regular bruise would take to heal. Just be aware that this is normal result of this procedure.
Moxa is the use of an herb, mugwort, which is burned above the point the acupuncturist would like to access in order to warm the point. The moxa looks somewhat like a cigar and is burned above the skin so you only feel a warm sensation. This is another modality acupuncturists use to access your qi. This is especially used with patients whose pain is worse in the cold weather.
What kind of training has my acupuncturist undergone?
Licensed acupuncturists have undergone an extensive three to four year program in traditional Chinese medicine, herbology, as well as extensive training in western medicine, about 3200 hours.
Other persons that may practice acupuncture are doctors, nurses, chiropractors and other practitioners. There are varying degrees of training in acupuncture that these other specialties may undergo, the minimum requirement is typically anywhere from 300 to 800 hours of training.
Some doctors will learn only points and needle you locally, so if you have knee pain they will needle your knee. Others have been trained in the system of Chinese medical diagnosis and will go through the process of identifying a differential diagnosis with you.
Both have benefit, I just wanted to point out that there are various types of practitioners that practice acupuncture.
Is there anything I should be sure to tell my acupuncturist?
Be sure to tell your acupuncturist if you have a history of light headedness or fainting, (this is not a big deal but could impact your practitioner’s choice of points), what medications you may be taking, especially any blood thinners, and if you have a pacemaker, as they are unable to use electric stimulation on you if that is the case.
Access to care
Find out first if your insurance plan covers acupuncture. More and more insurance companies are covering it, often at no additional cost. The important thing is to know to look for it when choosing your plan and select a plan that covers it.
There are limitations often placed by insurance companies on your access to acupuncture. You will typically be allowed 12-24 visits a year. This, from an acupuncturist point of view, is not a lot.
For chronic pain an acupuncturist will want to see you a couple of times a week or at least once a week depending on your practitioner and this could last for a few months. Going to acupuncture is not necessarily a quick fix, although it can be. It is a very individual experience. You will need to be patient with your progress.
Other options are community clinics which often offer acupuncture and have a sliding scale for payment. This is a pay-what-you-are-able-to system and these types of clinics are popping up all over in a response to improving access to acupuncture.
There is also work being done on both a state and federal level to get more support for insurance coverage of acupuncture. Many of these measures are getting support as acupuncture is a cost-effective form of treatment and has been receiving a lot of notice as research is done showing its effectiveness.
For more information:
National Institutes of Health, National Center for Complementary and Alternative Medicine: http://nccam.nih.gov/health/acupuncture/
For comprehensive information on acupuncture and herbs: www.acupuncture.com
To find an acupuncturist near you: www.acufinder.com
You can always refer to the American Pain Foundation’s Treatment Options for more information: http://www.painfoundation.org/Publicati ... ns2006.pdf
Thank you for attending this chat on acupuncture, I hope it was helpful. Our PainAid moderators will now assist with our Question and Answer section of the chat.
Has there been any success with reducing pain and providing relief for idiopathic foot neuropathy?
There has been some success. It would be up to your practitioner to be able to create a differential diagnosis for you and treat you accordingly.
Are there any chances that the needles and the electric current could irritate the feet cause swelling?
Not typically, I haven’t seen it. But, it is true that some people have unexpected reactions. The electrostimulation amps up the acupuncture treatment and could cause extra blood flow in the area.
I have been treated by a MD acupuncturist for three years using most of the mentioned. I have moved from Baltimore to WV near Hagerstown, MD. Do you have a list of your students near here? My treatments did work for me many times, but my body can no longer take pressure in the muscles.
Try using the acupuncturist finder I listed in the section above, www.acufinder.com
, type in your zip code and a list of acupuncturists in your area should come up.
Hi, Mayssa. I know this sounds a bit goofy, but my dog gets acupuncture, and it really works on her. She has arthritis in her neck really badly, to the point that she can’t move and her neck is swollen to the size of her shoulders. She gets 5-7 needles in her head and neck, and within 15-20 minutes, she is back to her old self again. We thought we were going to have to put her down, but have been doing this for a few years now, and it works wonders!
Fantastic! I know many people that swear by acupuncture for their pets.
Five years of CRPS. How can this help me and how can I grow the herbs I use in the house?
Well, according to differential diagnosis I described, your pain is targeted more based on your symptoms than your diagnosis. So, if you have pain in the morning, evening, sharp pain, numbness, whatever ails you, would all be incorporated into a diagnosis that would then inform the acupuncturists decision as to how to treat you. In terms of growing herbs at home, you may want to check with your local herbalist center or an herbalist school in your local area. Your climate will affect what you are able to grow.
I have RSD in my left foot and the needles are painful going in to my body (elsewhere). Sometimes it’s excruciating, even though my practitioner avoids my left food and leg. At times during treatments, my thumb spasms uncontrollably and toes in my left foot are paralyzed. Should I be concerned? And, also, for a couple of days after treatment, my pain is often increased, and then a few days later I get relief. Any thoughts?
Your acupuncturist may try doing ear acupuncture on you. The spasms are probably a result of blocked channels that aren’t getting released. You may need a gentler treatment. Moxa could be a good option for you. Explore options with your acupuncturist. You may also try someone else if you are not getting the results you wish for.
How are the five element acupuncturists different?
Five element acupuncturists diagnose based on the five organ systems in the body and their associated symptoms. So, someone with pain that corresponds to the lung channel may be diagnosed with a wind condition (very esoteric stuff) but can be very effective in treatment. It is just a different lens through which they view the medicine.
Are there instances when or people for which acupuncture is not going to work? How much time should you give acupuncture before coming to the conclusion that it will not work?
Well, from my perspective and, of course, I am biased – I have seen it work for everyone. You may not get the exact relief you want in the timeframe you want, but I have seen it help most people. I typically start my patients on a once a week for 2 months trial and then, reevaluate their progress. Depending on the amount of time you have had your condition, it may take longer.
I am having electric shock type pain in the back of my head that I think is related to the neck surgery I had in 2007, but my neurosurgeon has released me even though I still suffer great pain in the neck and have severe headaches. Can acupuncture be used on the head and neck to treat pain successfully?
Yes, it can be used locally, but there are also points on other parts of the body that can be used to treat this kind of pain. It sounds nerve related.
Is acupuncture effective on individual finger joint pain? Will it aid in the healing process from a dislocation of a proximal joint, for instance? Distal?
It can help with the healing process of a dislocation which often involves quite a bit of swelling. Needles in the fingers do hurt quite a bit, but they are helpful for the pain. In the case of EDS, because it is systemic it would be treated locally and systematically.
Mayssa – Wonderful job explaining acupuncture and its usefulness in a plan of care to treat pain. We are seeing this option being used more and more – particularly for those who have been wounded in combat and suffered multiple traumas. Thanks for presenting this important topic.
Thank you, Brenda.
I use acupuncture for my RSD – left and right shoulder to finger tips – for over 8 years now and now I experience it in my butt and legs. It helps with the combination of meds and acupuncture that lasts for approximately 4 months with maybe 2-3 sessions! Also, I use it for sciatica quite a bit and that’s how I began using acupuncture rather than chiropractic, which I no longer use. My husband suffers from Restless Leg Syndrome. Would he benefit from this technique?
I am glad you are having success with your acupuncture experience. Restless Leg Syndrome can be helped as it would be considered a systemic problem. This would be treated as a full body condition.
IR17;ve had chronic pain for 14 years. Is it too late to start acupuncture? Not sure what you meant by starting treatment earlier rather than later.
Well, it is always better to get started treating something earlier than later, but there is always benefit whenever you begin. The progress may be slower, but the relief will be there. You just won’t see the symptoms melt away quickly.
My practitioner isn’t very familiar with RSD/CRPS. Are there any resources you know of that I can forward?
You could try www.acupuncture.com
or try the NIH site I listed above. They have some condition-specific information. You can also try some of the research institutions that evaluate studies such as the Cochrane Research Center at Johns Hopkins University.
How painful is acupuncture? Do you feel the needles going into the skin, like when they take your blood?
To give you an idea, the gauge of a needle they take your blood with is about 18 gauge needle (It has to be hollow to take the blood). We typically use 34-gauge needles which are very fine. You don’t typically feel the needle going in as the acupuncturist distracts the nervous system. Any “pain” felt during the acupuncture is a soreness that comes once the needle it through the skin.
Are the needles hollow for acupuncture?
No, they aren’t. That is why they can be so thin.
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