Carpal tunnel syndrome

carpal-tunnel-syndrome-nerve-diagram.jpg

Carpal tunnel syndrome is a condition that causes numbness, tingling and other symptoms in the hand and arm. Carpal tunnel syndrome is caused by a compressed nerve in the carpal tunnel, a narrow passageway on the palm side of your wrist.

Common symptoms include:

  • Tingling or numbness. Usually the thumb and index, middle or ring fingers are affected, but not your little finger. Sometimes there is a sensation like an electric shock in these fingers. The sensation may travel from your wrist up your arm.
  • Weakness.

Risk factors include:

  • Anatomic factors. A wrist fracture or dislocation, or arthritis that deforms the small bones in the wrist, can alter the space within the carpal tunnel and put pressure on the median nerve.
  • Sex. Carpal tunnel syndrome is generally more common in women.
  • Nerve-damaging conditions. Such as diabetes.
  • Inflammatory conditions. Such as rheumatoid arthritis.
  • Obesity. Being obese is a significant risk factor for carpal tunnel syndrome.
  • Alterations in the balance of body fluids. Fluid retention may increase the pressure within your carpal tunnel, irritating the median nerve. This is common during pregnancy and menopause. Carpal tunnel syndrome associated with pregnancy generally resolves on its own after pregnancy.
  • Other medical conditions. Certain conditions, such as menopause, obesity, thyroid disorders and kidney failure, may increase your chances of carpal tunnel syndrome.
  • Workplace factors. It’s possible that working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve or worsen existing nerve damage.

Preventions:

  • Reduce your force and relax your grip. If your work involves a cash register or keyboard, for instance, hit the keys softly. For prolonged handwriting, use a big pen with an oversized, soft grip adapter and free-flowing ink.
  • Take frequent breaks. Gently stretch and bend hands and wrists periodically. Alternate tasks when possible. This is especially important if you use equipment that vibrates or that requires you to exert a great amount of force.
  • Watch your form. Avoid bending your wrist all the way up or down. A relaxed middle position is best. Keep your keyboard at elbow height or slightly lower.
  • Improve your posture. Incorrect posture rolls shoulders forward, shortening your neck and shoulder muscles and compressing nerves in your neck. This can affect your wrists, fingers and hands.
  • Change your computer mouse. Make sure that your computer mouse is comfortable and doesn’t strain your wrist.
  • Keep your hands warm. You’re more likely to develop hand pain and stiffness if you work in a cold environment. If you can’t control the temperature at work, put on fingerless gloves that keep your hands and wrists warm.

Treatments:

Nonsurgical therapy

  • Wrist splinting.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Corticosteroids.

Surgery

  • Endoscopic surgery.
  • Open surgery.

carpal tunnel release - mayo—— from Mayo Clinic

Acupuncture and Carpal tunnel syndrome:

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

Acupuncture for treating migraine

migraine

Lately, one of our patients had great result of treating migraine by acupuncture. The patient was in a severe migraine attack when she presented in our clinic one month ago, had instant relief afterwards, and has been migraine-free ever since! 

Here are some information about migraine from National Health Services.

A migraine is usually a moderate or severe headache felt as a throbbing pain on one side of the head. In some cases, the pain can occur on both sides of head and may affect face or neck.

Other symptoms commonly associated with a migraine include:

  • nausea
  • vomiting
  • increased sensitivity to light and sound – which is why many people with a migraine want to rest in a quiet, dark room

Migraine is a common health condition, affecting around 1 in every 5 women and around 1 in every 15 men. They usually begin in early adulthood.

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Click here to see the advices from Harvard Medical Publications regarding migraine prevention.

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Here are some evidence of the effectiveness of acupuncture for migraine: 

With increasing scientific evidence for the effectiveness of acupuncture, the Royal London Homoeopathic Hospital has concentrated on the challenge of providing NHS acupuncture on the scale and frequency required to treat the large number of sufferers with chronic painful conditions including headache and migraine, facial pain, back and neck pain and knee osteoarthritis. —— The Migraine Trust in UK

The available evidence suggests that adding acupuncture to symptomatic treatment of attacks reduces the frequency of headaches. Contrary to the previous findings, the updated evidence also suggests that there is an effect over sham, but this effect is small. The available trials also suggest that acupuncture may be at least similarly effective as treatment with prophylactic drugs. Acupuncture can be considered a treatment option for patients willing to undergo this treatment. As for other migraine treatments, long-term studies, more than one year in duration, are lacking. —— Cochrane Review

A sound body of evidence exists supporting the use of acupuncture for migraine prophylaxis. Acupuncture is at least as effective as prophylactic drug therapy for migraine and it is safe, long-lasting and cost-effective. Although there seems to be little difference between the two, Chinese acupuncture points might be marginally more effective than non-Chinese points. —— The role of acupuncture in the treatment of migraine. CMAJ. 2012 Mar 6; 184(4): 391–392.

The literature reports on the successful treatment of migraine with acupuncture. Although none of the studies made to date fulfil the necessary quality criteria, there is no doubt about the efficacy of acupuncture in the treatment of migraine. —— Value of acupuncture in treatment of migraine. Anaesthesiol Reanim. 1995;20(6):150-2.

Verum acupuncture treatment is more effective than sham acupuncture based on either Chinese or Western nonacupoints in reducing the discomfort of acute migraine. Verum acupuncture is also clearly effective in relieving pain and preventing migraine relapse or aggravation. These findings support the contention that there are specific physiological effects that distinguish genuine acupoints from nonacupoints. —— Acupuncture for treating acute attacks of migraine: a randomized controlled trial. Headache. 2009 Jun;49(6):805-16.

Among patients with migraine without aura, true acupuncture may be associated with long-term reduction in migraine recurrence compared with sham acupuncture or assigned to a waiting list. —— The Long-term Effect of Acupuncture for Migraine ProphylaxisA Randomized Clinical Trial. JAMA Intern Med. 2017;177(4):508-515. 

 

Modern acupuncture linked to constipation relief

Modern acupuncture linked to constipation relief Image: Purestock/Thinkstock

Harvard Health Letter

For some people, constipation is a constant and puzzling struggle.

If a person has no more than two bowel movements per week and there’s no underlying condition or medication responsible, the problem is known as chronic severe functional constipation (CSFC).

A study published online Sept. 12, 2016, by Annals of Internal Medicine, suggests that electroacupuncture may be a treatment option for people with CSFC.

The therapy uses acupuncture needles and tiny amounts of electrical current to stimulate precise points on the body. The study involved about 1,000 people with CSFC. The re-searchers randomly assigned half to electroacupuncture sessions and the other half to fake (sham) acupuncture sessions.

After 28 sessions over eight weeks, 31% of the people in the treatment group had three or more bowel movements per week, compared with 12% in the sham group.

The effects appeared to last an additional 12 weeks for both groups.

About 6% or fewer people in both groups experienced side effects such as pain or bleeding.

The results are encouraging, but the study doesn’t prove that electroacupuncture is effective for CSFC. More studies are needed to confirm the results.

 

Conclusion: Eight weeks of electro-acupuncture increases complete spontaneous bowel movements and is safe for the treatment of chronic severe functional constipation.  —— Annals of Internal Medicine 

Acupuncture is worth a try for chronic pain -from Harvard Medical Publications

Treatment by acupuncture. The doctor uses needles for treatment of the patient.

An international team of experts pooled the results of 29 studies involving nearly 18,000 participants, the research adds to the evidence that acupuncture does provide real relief from common forms of pain. The results were published in Archives of Internal Medicine.

“I think the benefit of acupuncture is clear, and the complications and potential adverse effects of acupuncture are low compared with medication,” says Dr. Lucy Chen, a board-certified anesthesiologist, specialist in pain medicine, and practicing acupuncturist at Harvard-affiliated Massachusetts General Hospital.

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