Acupuncture for Headache Relief

acupuncture-forehead

Acupuncture enhances positive patient outcome rates for patients suffering from headaches.

In separate and independent investigations, researchers have determined that acupuncture significantly boosts the effectiveness of occipital nerve stimulation (ONS) and levo-tetrahydropalmatine (l-THP) drug therapy.

Since the late 1970s, neurosurgeons have implanted ONS devices at the base of the skull for the treatment of headaches. An electrical signal is generated by ONS devices to override pain. Researchers from Jilin University Hospital and Changchun Traditional Chinese Medicine University find that administering acupuncture together with ONS is significantly more effective than using only ONS as a standalone therapeutic modality.

Independently, Sichuan Disabled Veterans Hospital researchers have determined that acupuncture combined with levo-tetrahydropalmatine therapy is significantly more effective for the treatment of headaches than using only levo-tetrahydropalmatine as a standalone treatment modality.


Read more.

 

Acupuncture Cuts Postoperative Pain after Neck Surgery

neiguan shousanli

Acupuncture is effective for pain relief after surgery of the cervical spine. Researchers find electroacupuncture applied to acupoints Hegu (LI4) and Neiguan (PC6) safe and effective for achieving significant pain relief. Surgery on the anterior cervical spine is a complex procedure. Analgesics including fentanyl and sufentanil may be used to alleviate postoperative pain. However, due to concerns regarding respiratory depression, they are often prescribed at low dosages leading to only a partial painkilling effect. The results of the perioperative research finds acupuncture effective for pain relief and for stabilizing hemodynamics during surgery. 

Acupuncture point Hegu is traditionally used by licensed acupuncturists to relieve pain and dredge the acupuncture meridians. Neiguan is used by licensed acupuncturists to calm the shen (spirit), which has a tranquillising effect. Neiguan is also used to regulate the heartbeat, alleviate nausea, and to reduce pain. Together, these acupoints may be used to relieve pain in patients undergoing cervical spine surgery. Using electroacupuncture at the acupoint sites has the advantage of providing continuous acupoint stimulation, effectively relieving pain and reducing the required dosage of opioid analgesics. Moreover, it is a straightforward procedure to administer with minimal risk of adverse effects.

Foshan Chinese Medicine Hospital researchers (Zhou et al.) find that electroacupuncture significantly reduces the dosage of remifentanil and propofol required during surgical anaesthesia. The researchers determined that electroacupuncture produces additional benefits during surgery, heart rate and mean arterial blood pressure are more stable when electroacupuncture is applied. Postoperatively, patients in the electroacupuncture study group regained consciousness more quickly and had a shorter extubation (endotracheal tube removal) period compared with the control group that did not receive acupuncture.

Visual analogue scale (VAS) and Ramsay evaluations were used to measure pain and sedation. The evaluations were taken immediately after extubation and again at 2, 4, 8, 12 and 24 hours after extubation. The results showed significant positive patient outcomes for patients receiving electroacupuncture. For example, at 4 hours after extubation, the electroacupuncture group achieved better sedation and pain relief than the control group.

In the control group, 6 patients experienced nausea, vomiting, constipation and other adverse effects while only 1 patient in the electroacupuncture group experienced these issues. Electroacupuncture was applied perioperatively. The frequency of patient controlled analgesic administration was recorded for 24 hours after surgery. The control group self-administered analgesics a total of 116 times while the electroacupuncture group self-administered only 21 times. The researchers note that electroacupuncture stimulation reduced the overall need for pharmaceutical analgesics. The results indicate that electroacupuncture significantly reduces pain following surgery.

Zhou W, Chen YX & Ou JY. (2014). Electroacupuncture on Hegu Point and Neiguan Point to Treat Acute Pain after Surgery on Anterior Cervical Spine. World Journal of TCM. 9(4).

Acupuncture Reduces and Delays the Need for Opioids after TKA(Total Knee Arthroplasty)

knee

Stanford University researchers conclude that acupuncture reduces and delays the need for opioids after total knee replacement surgery. Over 4.7 million people in the United States have had knee replacement surgery. Conventional post-surgical treatment often includes prescription opioids.  The drugs often provide pain relief for patients but are ineffective for some. Further, there is a growing concern that the extended use of prescription opioids leads to addiction, further exacerbating epidemic levels of opiate abuse. As a result, finding drug-free interventions that effectively relieve pain and decrease opiate use has become a public health imperative.

Acupuncture, the insertion of fine filiform needles at specific points on the body, has been used for millennia in China to treat disease, and recently the treatment modality is finding its footing in the schema of conventional medicine in the occident. As formal studies satisfy the burden of proof, acupuncture is increasingly recommended as an alternative to, or adjunct for, pharmaceutical patient care. In the meta-analysis conducted at Stanford University, researchers analyzed the results of 2,391 patients over 39 randomized clinical trials comparing the efficacy of five of the most common drug-free interventions for decreasing pain and opiate use after knee replacement surgery: acupuncture, electrotherapy, cryotherapy, preoperative exercise, and continuous passive motion. Among them, only acupuncture and electrotherapy were associated with reduced and delayed opioid consumption.

Osteoarthritis is a major cause of knee pain and, if severe, it can damage the overall quality of life; chronic pain can diminish functional independence, which may lead to psychological afflictions.  Thus, total knee arthroplasty (TKA) is one of the most common elective surgical procedures worldwide.  Although the goal of surgery is to decrease pain and restore mobility, TKA is associated with intense postoperative pain, and “there is a high prevalence of patients who report persistent chronic pain and some patients who report chronic pain development subsequent to the procedure.” Since acute postoperative pain slows recovery and may lead to chronic pain, adequate pain control is a major concern for patients undergoing joint replacement surgery.

Acupuncture research is promising. Acupuncture is known for its impact on pain relief: in a study conducted at the University of Minnesota School of Public Health on 2,500 patients with total hip or knee replacements, “forty-one percent of patients reported moderate/severe pain prior to receiving acupuncture, while only 15% indicated moderate/severe pain after acupuncture.” Additionally, acupuncture moderates pharmaceutical use: “acupuncture has been shown to reduce the use of opioid analgesics as well as to aid in alleviating post-operative medication side effects including sedation, nausea, vomiting, and dizziness. Of note… was the clinically meaningful finding that acupuncture contributed to lowering pain below the threshold at which patients would receive intravenous narcotics beyond the initial postoperative standard dose.” Since the long-term side effects of opiate use are dose dependent, even a moderate change in acute pain can have a huge impact on long-term care if it tempers early stage opioid use.

The risks of pain mismanagement are extraordinarily high for joint replacement patients. Acupuncture and electrotherapy reduce opioid consumption and improve postoperative pain management outcomes. The results of this study distinguishes acupuncture from a panoply of treatment options. Hopefully, this encourages doctors to include acupuncture in their postsurgical treatment regimens to reduce the incidence of lifelong dependence on opioids.

references

1 Maradit, H., Larson, D. R., Crowson, C. S., Kremers, W. K., Washington, R. E., Steiner, C. A., . . . Berry, D. J. (2015, September 02). Prevalence of Total Hip and Knee Replacement in the United States. Retrieved October 07, 2017, ncbi.nlm.nih.gov/pubmed/26333733.
2 Tedesco D, Gori D, Desai KR, Asch S, Carroll IR, Curtin C, McDonald KM, Fantini MP, Hernandez-Boussard T. Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty: A Systematic Review and Meta-analysis. JAMA Surg. Published online August 16, 2017. doi:10.1001/jamasurg.2017.2872 pg E1.
3 Hinman RS, McCrory P, Pirotta M, Relf I, Forbes A, Crossley KM, Williamson E, Kyriakides M, Novy K, Metcalf BR, Harris A, Reddy P, Conaghan PG, Bennell KL. Acupuncture for Chronic Knee Pain: A Randomized Clinical Trial. JAMA. 2014;312(13):1313–1322. doi:10.1001/jama.2014.12660 pg 1.
4 Crespin, D. J., K. H. Griffin, J. R. Johnson, C. Miller, M. D. Finch, R. L. Rivard, S. Anseth, and J. A. Dusek. “Acupuncture provides short-term pain relief for patients in a total joint replacement program.” Pain medicine (Malden, Mass.). June 2015. Accessed October 07, 2017, pg 9.
5 Tedesco et al, Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty, pg E2.
6 Inacio, Maria C S, Craig Hansen, Nicole L. Pratt, Stephen E. Graves, and Elizabeth E. Roughead. “Risk factors for persistent and new chronic opioid use in patients undergoing total hip arthroplasty: a retrospective cohort study.” BMJ Open. April 01, 2016. Accessed October 07, 2017,  pg 2.
7 Crespin et al, Acupuncture provides short-term pain relief for patients in a total joint replacement program, pg 8.
8 Crespin et al, Acupuncture provides short-term pain relief for patients in a total joint replacement program, pg 2.
9 Ibid, pg 8.
10 Tedesco et al, Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty, pg E10.

Original article: Stanford Acupuncture Opioid Drug Abuse Knee Replacement Finding

Cognitive reserve

cognitive reserve

The term cognitive reserve describes the mind’s resistance to damage of the brain. The mind’s resilience is evaluated behaviorally, whereas the neuropathological damage is evaluated histologically, although damage may be estimated using blood-based markers and imaging methods.

There are two models that can be used when exploring the concept of “reserve”: brain reserve and cognitive reserve. These terms, albeit often used interchangeably in the literature, provide a useful way of discussing the models.

Brain reserve, which refers to actual differences in the brain itself that may increase tolerance of pathology. Cognitive reserve refers to individual differences in how tasks are performed that may allow some people to be more resilient than others.

Using a computer analogy brain reserve can be seen as hardware and cognitive reserve as software. All these factors are currently believed to contribute to global reserve. Cognitive reserve is commonly used to refer to both brain and cognitive reserves in the literature.

You can think of cognitive reserve as your brain’s ability to improvise and find alternate ways of getting a job done. Just like a powerful car that enables you to engage another gear and suddenly accelerate to avoid an obstacle, your brain can change the way it operates and thus make added recourses available to cope with challenges. Cognitive reserve is developed by a lifetime of education and curiosity to help your brain better cope with any failures or declines it faces.

In 1988 a study published in Annals of Neurology reporting findings from post-mortem examinations on 137 elderly persons unexpectedly revealed that there was a discrepancy between the degree of Alzheimer’s disease neuropathology and the clinical manifestations of the disease. This is to say that some participants whose brains had extensive Alzheimer’s disease pathology, clinically had no or very little manifestations of the disease. Furthermore, the study showed that these persons had higher brain weights and greater number of neurons as compared to age-matched controls. The investigators speculated with two possible explanations for this phenomenon: these people may have had incipient Alzheimer’s disease but somehow avoided the loss of large numbers of neurons, or alternatively, started with larger brains and more neurons and thus might be said to have had a greater “reserve”.

Epidemiologic studies suggest that lifetime exposures including educational and occupational attainment, and leisure activities in late life, can increase this reserve.

resources:  What is cognitive reserve? —— Harvard Health Publishing 

Congnitive reserve —— Wikipedia

 

 

Acupuncture And Arthrolysis Ankle Discovery

kunlun-bl60Photograph: HealthCMi, Adobe Images

Researchers investigated the effects of acupuncture combined with joint mobilization on patients with ankle dysfunction. The researchers conclude that acupuncture combined with joint mobilization produces a 59.65% total effective rate.

Ankle dysfunction often occurs as a result of acute ankle sprains, ankle fractures, or due to complications following ankle surgery. Ankle sprains cause damage to the medial or lateral ligaments, which leads to pain and swelling. Some patients are unable to fully recover, affecting their ankle motor functions and increasing the tendency for another sprain. Complications due to surgery and untreated ankles may lead to valgus or an unsteady gait; severe consequences include joint deformity or traumatic arthritis. Also, some patients may experience ankle pain, movement dysfunction, or ankylosis (Zhou et al.).

Ankle dysfunction is mainly caused by tendon or joint injuries; ankle sprains lead to blood stasis, poor blood and qi circulation, and blocked meridians that induce pain. In Traditional Chinese Medicine, ankle dysfunction is in the scope of tendon and muscle injuries (Jin Shang). Acupuncture and moxibustion improve the Yin and Yang balance (Zhang). For ankle dysfunction, common acupoints treated include Shenmai, Zhaohai, Jiexi, Taixi, Kunlun, Yanglingquan, and localized Ashi acupoints. The Taixi (KD3) acupoint is the primary-yuan acupoint on the Kidney Meridian (Foot Shao Yin); this acupoint is traditionally indicated for treating ankle pain. The Jiexi (ST41) acupoint is located on the Leg Yang Ming Stomach Meridian; this acupoint is useful in dredging meridians and promoting the health of joints, the spleen, and the stomach, as well as promoting qi and blood circulation.

The Kunlun (BL60) acupoint is located on the Bladder Channel of Foot Tai Yang; this acupoint helps remove blood stasis, relieves swelling, warm the meridian, expel chills, and promote blood circulation. The Yanglingquan (GB34) acupoint is excellent in treating all diseases related to tendon injuries. The Shenmai (BL62) acupoint is located on the Bladder Channel of Foot Tai Yang. It is also the first acupoint on the Yang Heel Vessel, and this acupoint can be used to treat pronation disorders. The Zhaohai (KD6) acupoint is located on the Kidney Meridian (Foot Shao Yin). It is also the first acupoint on the Yin Heel Vessel, and this acupoint can be used to treat inversion of the foot. The details about treatment methods are as follows:

Acupoints treated include Shenmai (BL62), Zhaohai (KD6), Jiexi (ST41), Taixi (KD3), Kunlun (BL60), Yanglingquan (GB34), and localized Ashi acupoints. Upon disinfection, acupuncture needles (gauge #28, 35 mm length, hao type) were inserted. During each acupuncture session, 3 to 5 acupoints were selected for insertion. Acupuncture needle manipulation techniques used were rotating and reducing (xie) methods. The acupuncture needles were manipulated every 5 to 10 minutes. The needle retention time was 30 minutes. If there was no obvious swelling or the course of disease was more than 10 days, the acupuncture therapy continued without change. If there was significant swelling, pyonex tapping needles were used to release blood stasis, followed by cupping to facilitate removal of blood stasis; this treatment was conducted every other day.

The breakdown of traditional acupoint indications, functions, and channel theory is included in the research analysis. This approach extends acupuncture continuing education throughout the discussion portion of the research article and is consistent with modern standards of reporting. Prevalent across many educational acupuncture investigations is the inclusion of Traditional Chinese Medicine (TCM) theory combined with modern biomedical and scientific data. Medicine is presented in the form of an uninterrupted timeline, wherein ancient principles and modern findings are complementary and serve to shed the light of greater understanding on treatment options and patient outcomes. The polarization of medicine into Eastern and Western schools of thought, or old versus new, falls by the wayside as modern research finds consistency and correlations between varying evolutions in philosophies of medicine.

Specific treatment modalities, often perceived as either traditional, Asian, Western, etc… are in reality ubiquitous both geologically and historically. In this research, arthrolysis joint mobilization (mobility restoration by disruption of adhesions in ankylosed joints) was combined with acupuncture into a comprehensive protocol. The combination of acupuncture and arthrolysis may be seen as a new combination; however, for well over 1,000 years, tui-na bodywork techniques have been incorporated into the canon of Traditional Chinese Medicine. Tui-na encompasses what is understood in the occident as osteopathy, chiropractic manipulations, orthopedics, massage therapy, arthrolysis, and physical therapy. One of the earliest introductions to physical medicine in the form of tui-na was in the Huangdi Neijing (The Yellow Emperor’s Classic of Medicine).

Many scholars document that the great classic text, the Huangdi Neijing, was written circa 300 BCE, although some historical approximations suggest that early forms of the text may date as far back as 2,600 BCE. The exact date of specific sections may vary and is the subject of a great many acupuncture continuing education investigations. That said, many scholars suggest that the Huangdi Neijing may be a compilation, which explains variations on the exact date of authorship. In the text, tui-na is cited as having the ability to promote qi and blood circulation, benefit muscles and tendons, clear the channels and collaterals, and more. Based on a historical perspective, the combination of acupuncture and arthrolysis is a time honored tradition. This research formalizes and tests that long-standing combination.

For the duration of acupuncture therapy, patients were asked to minimize movements of the affected limb (especially the activities of standing and walking for an extended period) as well as moderating rigorous sports activity. When at rest, the patients were instructed to raise the affected limb. Keeping the affected limb warm during cold weather was also important to prevent the disease from becoming chronic or worsening. Acupuncture and arthrolysis therapy was conducted on a daily basis, and one course of treatment lasted for 10 days. Four arthrolysis techniques were applied in addition to acupuncture therapy.

  • Technique 1: The patient’s affected limb was bent at 90 degrees. The doctor held the patient’s affected medial and lateral malleolus with both hands. The doctor’s hand moved upward with force to create separation traction.
  • Technique 2: The patient’s affected limb was bent at 90 degrees. The doctor’s right hand was placed in front of the patient’s talus; the left hand was fixated behind the ankle. The right hand pushed the talus posteriorly. Subsequently, the doctor’s left hand was placed behind the patient’s talus; the right hand was placed in front of the patient’s talus. The left hand pushed the talus toward anteriorly, medially, and laterally to obtain a sliding motion of the talus.
  • Technique 3: The patient was asked to rest in a prone position, his/her affected limb was stretched straight, and the ankle should was suspended in the air while the patient rested on the bed. The doctor’s left hand held the ankle from behind; the right hand held the calcaneus and talus. The right hand pushed the calcaneus and talus medially and laterally.
  • Technique 4: The patient was asked to rest in a supine position. The doctor’s left hand held the patient’s heel from behind; the right hand held the front of the heel. Both hands rotated the heel medially and laterally.

Each of the above techniques were repeated 3 to 4 times; the total treatment time was 15 to 20 minutes per arthrolysis session. Based on the patient’s pain tolerance levels, arthrolysis was conducted once per day or every other day, for 10 days, to complete one course of treatment. The researchers conclude that acupuncture combined with joint mobilization therapy (arthrolysis) produces a 59.65% total effective rate for the treatment of ankle dysfunction.

References
Chen X., Mu J.P., Peng L., Liao H., Zhang Q. (2013). Acupuncture Combined with Joint Mobilization for the Treatment of Ankle Dysfunction. JCAM. 29(10).

Zhang W. (2012). Acupuncture, moxibustion, and physiotherapy in treating ankle sprain. Journal of Traditional Chinese Medicine. (7): 113.

Zhou S., Zhao P.F., Liu Y.X., et al. (2003). Analysis on the causes of ankle dysfunction as a result of ankle fracture. Chinese Journal of Orthopedics and Traumatology. 11(5): 34.

Original article: Acupuncture And Arthrolysis Ankle Discovery

Is gluten-free diet necessary for you or not?

Gluten Free

Gluten is found in many grains like wheat, barley, and rye. People with celiac disease can’t tolerate gluten, not even small amounts. Gluten triggers an immune response that damages the lining of the small intestine. This can interfere with the absorption of nutrients from food, cause many symptoms. A related condition called gluten sensitivity or non-celiac gluten sensitivity can generate symptoms similar to celiac disease but without the intestinal damage.

Gluten-free foods now show up everywhere. An increasing number of people have been switching to gluten-free diets to lose weight, boost energy, treat autism, or generally feel healthier.

Is it because there has been a sudden rise in the number of people with celiac disease? Or is it just the latest diet craze that has turned into a multi-billion-dollar business?

Scientists at Rutgers New Jersey Medical School wanted to find out, so they looked at data on 22,278 people who participated in the National Health and Nutrition Examination Surveys from 2009 to 2014. They found that while the prevalence of celiac disease remained fairly stable over those five years, the number of people who followed a gluten-free diet without having celiac disease more than tripled.

That means that many people who don’t carry the diagnosis of celiac disease are buying gluten-free products. Is is necessary?

Celiac disease can be identified with a blood test for the presence of antibodies against a protein called tissue transglutaminase. A biopsy of the intestine confirms the diagnosis.

Avoiding gluten means more than giving up traditional breads, cereals, pasta, pizza, and beer. Gluten also lurks in many other products, including frozen vegetables in sauces, soy sauce, some foods made with “natural flavorings,” vitamin and mineral supplements, some medications, and even toothpaste. This makes following a gluten-free diet extremely challenging.

If you’re determined to go gluten free, it’s important to know that it can set you up for some nutritional deficiencies. Fortified breads and cereals is a major source of B vitamins and dietary fiber. Taking a gluten-free multivitamin-multimineral supplement is a good idea for anyone trying to avoid gluten.

If you think you might have celiac disease or gluten sensitivity, it’s best to see a doctor before you go gluten free. Once a person has avoided gluten for a while, it becomes difficult to establish if he or she has celiac disease, gluten sensitivity, or neither.

Source: Going gluten-free just because? Here’s what you need to know —— Holly StrawbridgeFormer Editor, Harvard Health

To gluten or not to gluten? —— Mallika Marshall, MDContributing Editor

 

 

Feeling okay about feeling bad is good for your mental health

Feeling okay about feeling bad is good for your mental health

A unique viewpoint from David R. Topor, PhD, MS-HPEd, Contributor, Harvard Health Blog. 

Face and accept your emotions and thoughts, and then get over them, not deny or judge them. 

When you have a negative emotion, are you upset or disappointed in yourself? Do you feel “bad” or “guilty” about this emotion? If so, you may be at risk for poorer longer-term psychological health.

A study in the July 2017 Journal of Personality and Social Psychology looked at the psychological health of people who accept, rather than negatively judge, their emotional experiences. Researchers found that accepting these experiences led to fewer negative emotions when confronted with daily stressors.

The article reported on three separate, but related, studies that explored how accepting negative emotions, rather than reacting to them, affects a person’s psychological health.

The first study aimed to see whether accepting emotions was associated with greater psychological health, and if this association was moderated by several demographic variables. Undergraduate students at the University of California at Berkley completed evaluations to assess acceptance, stress level, and psychological health. The researchers found that accepting mental health experiences was associated with greater psychological health across a range of demographic variables including gender, ethnicity, and socioeconomic status. Further, results indicated that the benefits to psychological health were associated with accepting the emotions associated with a negative event, rather than the situation that triggered those emotions.

In the second study, the authors examined a potential explanation for how the tendency to accept negative emotions is related to psychological health. They explored whether accepting one’s mental experiences helps to decrease negative emotions when experiencing stressors. A consistent reduction in negative emotions should, in time, improve overall psychological health.

Again, a group of undergraduates completed questionnaires related to acceptance and to their emotional responses to a stressful task completed in the lab. Results indicated that by habitually accepting emotions and thoughts, people experienced a lower degree of negative emotion when in stressful situations.

Finally, the authors wanted to see if these results held up for people other than college students. They followed people in a Denver community for a six-month period. These study volunteers completed measures of acceptance, psychological health, and stress, and kept nightly diaries for two weeks identifying the degree of negative emotion felt when experiencing stressors that day.

Results indicated that people who habitually accept their emotional experiences were more likely to report greater psychological health six months later. This was true regardless of gender, ethnicity, or socioeconomic status. Further, people who accepted these emotions were less likely to respond negatively to stressors. That is, people who routinely accept their emotions and thoughts when under stress, experience less daily negative emotion during these times. This in turn is associated with increased psychological health six months later.

Taken together, these three studies highlight the benefits of accepting emotions and thoughts, rather than judging them, on psychological health. It seems like common sense. When a stressful situation causes negative emotions, accepting feelings of frustration or upset — rather than trying to pretend you’re not upset, or beating yourself up for feeling this way — reduces guilt and negative self-image. Over time, this will in turn lead to increased psychological health.

Origional article: Feeling okay about feeling bad is good for your mental health.