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Acupuncture

Acupuncture. Sarah K. Ayers, M.D. Capt, USAF 21 March 2012. Outline Slide. What is Acupuncture? Indications for Acupuncture Mechanisms of Action Evidence Military Considerations Resources. Types of Acupuncture. Traditional Chinese Electrical stimulation Chinese Scalp

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Acupuncture

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  1. Acupuncture Sarah K. Ayers, M.D. Capt, USAF 21 March 2012

  2. Outline Slide • What is Acupuncture? • Indications for Acupuncture • Mechanisms of Action • Evidence • Military Considerations • Resources

  3. Types of Acupuncture • Traditional Chinese • Electrical stimulation • Chinese Scalp • Auricular—Battlefield Acupuncture

  4. Patient #1 • 31yo female s/p MVA • 5 days later, still having 5/10 neck and shoulder pain (L > R) • Ibuprofen insufficient, cyclobenzaprine makes her too sleepy to work • 15-20 needles total, no electricity, pain cut to almost 0/10 • Next day—still mild aches, much better overall

  5. Indications • Chronic Pain/Fatigue Syndromes • Osteoarthritis • Joint disease/back pain • Acute Pain--Sprains, Strains, Post-Operative Pain • Migraines • Fibromyalgia • Depression, Anxiety • PTSD

  6. Indications Continued • Insomnia • Addictions– nicotine, cocaine, heroin • Upper respiratory symptoms • Strokes • Nausea & vomiting

  7. Soo…How does this work? • fMRI with blood oxygen level-dependent (BOLD) measurements • Acupuncture points: rich in neuroreceptors • Modulates pain network via analgesic effects • CNS hormones release in hypothalamus and limbic system • Causes changes in interpretation of pain

  8. Electroacupuncture • Fascia is bath of conductive fluid • General tx (2-8 Hz) • Enkephalin released from periaqueductal gray • Endorphin released from the hypothalamus • May be reversed/blocked by Naloxone • Local tx (above 10 Hz) • Dynorphin released in spinal cord • Activates low-threshold skin and muscle receptors • Serotonin/Norepinephrine released in midbrain

  9. Chronic Issues • Electroacupuncture with exercise vs. exercise alone, 2003 • No changes in objective ROM findings • Quality of life – significantly improved • 2003 Rheumatology paper • over 60yo, >12wk back pain • Quality of life/disability - significantly improved • Some patients able to decrease pain medications

  10. Migraines • Korean Hand Therapy • Study demo’d changes in blood velocity and volume in carotids and vertebrals arteries • Significant efficacy between triptans, acupuncture and control • Auricular acupuncture • Annals of Internal Medicine Jan 2009 • Reduced frequency/pain of primary migraine or tension-type headaches.

  11. Military issues… • Flight Status-Now teaching Battlefield Acupuncture • Allergic rhinitis and sinusitis • Avoids opiate use • Mission Readiness, Capability • Battlefield Conditions • Alternative to sedating medications • Stress/PTSD • TBI/Phantom Pain

  12. Injuries • 2 Battlefield points • 23% reduction of pain in ER patients in initial 24h • Results equivocal after 24h • 5 Battlefield points • 9 chronic pain patients who had no relief with Western therapies • 1st 24h: pain completely relieved • 2nd 24h: pain attenuated from baseline

  13. Deployment Considerations… • Tested at Andrews, Landstuhl, and at Echelon I & II in Al Asad, Iraq • 432 Treatments • Average RTD 2.2 days sooner • $0.06-$0.50 per needle • Relative cost, complication risk of Ibuprofen

  14. Patient #2 • 31yo AD EOD male • Subjected to three blasts where other coworkers died • Now with insomnia/chronic fatigue, TBI, migraines, neck/back pain, inability to run • Chronic narcotic use • About to get a Medical Board (MEB)

  15. Patient 2 Treatment… • Battlefield Acupuncture • Traditional Acupuncture, treated every 2-3wks • Improved headaches/insomnia • Decreased narcotic use • Started hyperbaric oxygen therapy • Now back to running, better concentration, and MEB has been delayed

  16. Summary • Types of acupuncture • Indications • Mechanism of action • Evidence • Clinic/military applications

  17. Questions & Resources • “Acupuncture for Chronic Low Back Pain in Patients: A Randomized, Controlled Trial” CF Meng, Rheumatology, 42: 1508-1517 • “Combining Spatial and Temporal information to explore functionality-guided action of Acupuncture using fMRI” Journal of Magnetic Resonance Imaging, (2009) V30: 41-46 • “An fMRI Study of Somatosensory-Implicated Acupuncture points in stable…stroke pts” Journal of MR Imaging, 24: 1018-1024 (2006) • “Efficacy of Acupuncture for Treating Knee Arthritis” Alternative Medicine Alert Vol 8, p49-60 (May 2005) • “Randomized Control Trial: An Assessment of Acupuncture on Specific Meridian or Specific Acupoint vs sham acupuncture for treatment of functional dyspepsia” Alimentary Pharmacology & Therapeutics (2012) V35: 552-561 • “Traditional Acupuncture in Migraines: A controlled, randomized study” Headache, Mar2008, V48 p398-401 • “The use of Electro-Acupuncture in Conjunction with Exercise for the Treatment of Lower Back Pain” Yeang, Journal of Alternative and Complimentary Medicine, 2003 V9 p 479-490

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