IAMA Fall 2007  Acupuncture And Pain Management
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IAMA Fall 2007 Acupuncture And Pain Management

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Continuing Medical Education (CME)class notes for Western clinicians on the application of Acupuncture for Pain Management. Sponsor: Indian American Medical Association, Tuality Hospital.

Continuing Medical Education (CME)class notes for Western clinicians on the application of Acupuncture for Pain Management. Sponsor: Indian American Medical Association, Tuality Hospital.

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    IAMA Fall 2007  Acupuncture And Pain Management IAMA Fall 2007 Acupuncture And Pain Management Presentation Transcript

    • Acupuncture and Pain Management: an Integrated Perspective PK Melethil, L. Ac. Melethil Acupuncture Services, LLC Wilsonville, OR 97070
    • OverviewAcupuncture in the context of Traditional Chinese Medicine(TCM)- aWhole Medical system(NIH).Basic TCM theory of pain and diagnostics and therapeutics.Clinical considerations in the use of acupuncture.Headache, Bi (Arthritic) Syndrome for which recent scientific studies (i.e.,Evidence Based Medicine) show the value of acupuncture.Potential applications of acupuncture for surgery and post-surgerytreatments to improve outcomes.3 case studies IAMA Fall 2007 Acupuncture and Pain Management
    • Anthropological RecordArchaeological evidence: 10,000+ years.Ma Wang Dui site: 2,000+ years – clinical tools, philosophical and qigong manuscripts.Written Texts: 2,000-3,000 years old. – Herbal Medicine, Acupuncture, Body workMedicine guided by empiricism Daosim, Confucianism, Buddhism Multiple overlapping and co-existing modelsShared knowledge with Yoga, Ayurveda (India)Greek InfluencesConversations between Huang Di and Chih-Po IAMA Fall 2007 Acupuncture and Pain Management
    • Background• Harmony and Balance• Movement of Qi and Blood 12 Primary Meridians- 6 on each side (symmetry) 8 Secondary (Extraordinary) Meridians• Acupuncture Points (400-500 x 2) Jing-Luo Network of points analogy: a river and its tributaries, a net Variable size, shifting locations Ah-shi points• Mechanism of Action- Contemporary Ideas • Conductivity gradients (Prognos) Electrochemical gradients • Optical/Thermal gradients • Acoustics- variations in visco-elastic properties of tissues IAMA Fall 2007 Acupuncture and Pain Management
    • TCM Zang-Fu (organ networks) and their connectivity based on classical texts such asthe Huang Di Nei Jing- The Yellow Emperor’s Canon of Internal Medicine. In someTCM models, Qi flows through these 12 organ networks every 24 hours with eachorgan being assigned a 2 hour window when its Qi is at its peak. Qi flows out from thetorso to the upper extremity and back followed by a circuit through the lower extremityand the cycle continues again. Yin Yang Comments*Lung Large Intestine Upper Body,(3-5 A.M, Arm-Taiyin) (5-7 A.M., Arm-Yangming) MetalSpleen Stomach Lower Body,(9-11 A.M., Leg-Taiyin) (7-9 A.M., Leg-Yangming) EarthHeart Small Intestine Upper Body,(11 A.M.-1 P.M., Arm-Shaoyin) (1-3 P.M., Arm-Taiyang) FireKidney Urinary Bladder Lower Body,(5-7 P.M., Leg-Shaoyin) (3-5 P.M., Leg-Taiyang) WaterPericardium Triple Warmer Upper Body,(7-9 P.M., Arm-Jueyin) (9-11 P.M., Arm- Shaoyang) FireLiver Gall Bladder Lower Body,(1-3 A.M., Leg-Jueyin) (11P.M–1 A.M., Leg-Shaoyang) Wood* regions of the body associated with the primary channels of the12 Zang-Fu organnetworks and their 5 Phase/Element associations in TCM. IAMA Fall 2007 Acupuncture and Pain Management
    • TCM Models of Pathology- “Disharmony”Models of Pathology Cold Induced Illnesses Progresses from External (Yang) to Internal (Yin) channels- 6 Levels Zang-Fu Theory Based on Organ Disorders (Meridians) Warm-Febrile Diseases Progresses from Outer to Inner layers Models: Triple Burner, 4 LevelsCausative factors External /Environmental Pathogenic Influences Damp, Cold, Heat/Fire, Wind, Dryness, Summer heat ACUTE Internal Pathogenic Influences Emotions (Stagnation) CHRONIC Phlegm << Body Fluids + “Heat” Deficiency Patterns IAMA Fall 2007 Acupuncture and Pain Management
    • Diagnostics & Therapeutics• Diagnostics Interview Palpation Tongue Pulse• Therapeutics Acupuncture TuiNa (Medical Massage) Internal Medicine Diet/Nutrition, Herbs, Minerals, Animal products Qigong, Tai Ji Quan, meditation (Exercises) IAMA Fall 2007 Acupuncture and Pain Management
    • Ma Wang Dui- Ancients Qi Gong IAMA Fall 2007 Acupuncture and Pain Management
    • Pain• Stagnation/Anisotropy Qi, Blood• Bi Syndrome (external pathogen)• Types of pain (paresthesias) Sharp, piercing Dull, throbbing (Heaviness) (Numbness) IAMA Fall 2007 Acupuncture and Pain Management
    • Advantages of AcupunctureSimple, GentlePainless (200-300 mm, single-use needles)Safe, Minimal side effectsReduced use of narcotics & other medicationsEffective, Economical IAMA Fall 2007 Acupuncture and Pain Management
    • Veterinary AcupunctureEquine, etc.No ‘placebo effect’Highly effectiveWell-established veterinary practices in China & US IAMA Fall 2007 Acupuncture and Pain Management
    • Microsystem Acupuncture“Holographic” Models• Ear Developed by French MD (1950s) Paul Nogier• Scalp Jiao, Zhu models• Feet Reflexology TuiNa IAMA Fall 2007 Acupuncture and Pain Management
    • Needle Techniques• Depth of insertion• Angle of insertion• Feeling the Qi• Viscoelastic aspects of tissues• De Qi and propagated sensations• Reinforcing & Reducing techniques• Electro-acupuncture Low frequency ( <10 Hz) and high frequency (~100 Hz) IAMA Fall 2007 Acupuncture and Pain Management
    • Arthritis (“Bi”) Syndromes EARLY STAGE: EXCESS PATTERN >>>>> LATE STAGE: DEFICIENCY PATTERN6 Constitutional Patterns• Wind (Wandering) Bi Migrating pain in muscles, joints• Cold (Painful) Bi Fixed pain, Alleviated by warmth• Damp (Fixed) Bi Marked soreness, numbness, heaviness• Heat Bi Swelling, soreness & pain w local redness• Stagnation of Blood & Phlegm Swelling, rigidity, deformity joints & limited ROM• Liver & Kidney Deficiency alleviated by rest; sore and weak low back, knees “Acupuncture Found To Be of Benefit in Knee Osteoarthritis” http://nccam.nih.gov/news/newsletter/2005_winter/acupuncture.htm Acupuncture for knee osteoarthritis--a randomised trial using a novel sham. Acupunct Med. 2006 Dec;24 Suppl:S7-14. Manheimer E, Lim B, Lao L, Berman B. IAMA Fall 2007 Acupuncture and Pain Management
    • Headache (9 Constitutional patterns)E External, Internal (Stagnation, Deficiency)xte • Wind Heat acute onset, yellow nasal discharge, sore throat, redrna • Wind Cold acute onset, stiff neck, no thirstl • Wind Damp fuzzy head, chest oppression, heavy feelingIn • Liver Yang Rising irritable, restless, insomnia, sore low back/kneeste • Qi Deficiency positional HA, worse with stress or lassitudern • Blood Deficiency dizziness, palpitationsal • Turbid Phlegm nausea, vomit with sputum, dizziness • Blood Stagnation stabbing pain, prolonged & fixed, history of trauma • Kidney Deficiency dizziness, tinnitus, “empty” head feeling IAMA Fall 2007 Acupuncture and Pain Management
    • Acupuncture for Post-operative pain• Differentiation (8 principles, 5 Elements, 4 Levels, 3 Burners)• Before the operation (improve outcomes) Constitutional issues, Shen• After the operation (move Qi & Blood, tonify) External Pathogenic Influences (cold, dryness) Emotions Nature of pain Affected Organs IAMA Fall 2007 Acupuncture and Pain Management
    • Case Studies• Anesthesia (Surgery) Acupuncture was successfully used as the sole means of anesthesia during a surgery for breast reconstruction following cancer, and also substantially facilitated pre-operative procedures. The combination of eastern and western medicines substantially reduced patient disability, hospitalization and cost.• Low back (Lumbar) Pain male, 40 , suffering from low back pain, unable to sit for more than 2 hours at a time. Reported as possible effects of sports injury from 20 years ago. Assess- tight IT band. Dx- Qi/Blood stagnation in GB, Bl channels. Tx- acupuncture and electro-acupuncture, GB and Bl channels. Condition resolved in 4 treatments, include exercise to stretch IT band; follow-up after one month indicated that pain had been resolved completely.• Post-Shingles Paresthesia female, 93, suffering from limited vision, post herpetic uveitis (Western Dx) and paresthesia around L eye. No improvements in 2 months w acyclovir tablets, ciproflaxin eye drops. Dx- Damp Heat-GB channel, Qi/Blood deficiency. Tx: acupuncture (local/distal), GB channel and TuiNa; significant improvement (uveitis) in 4 visits and vision in 9 visits, confirmed by opthalmologist. Patient reports increased energy w ongoing treatment. IAMA Fall 2007 Acupuncture and Pain Management
    • Acupuncture for Breast Reconstruction Surgery Photo provided by Roger Lore, DAOM IAMA Fall 2007 Acupuncture and Pain Management
    • Treatment Approaches• Local and Distal points• Channel based• Complementary (Yin/Yang) Channel based• Microsystem Techniques• External vs Internal Syndromes• Frequency of Treatments IAMA Fall 2007 Acupuncture and Pain Management
    • Other Techniques for Pain• TuiNa Orthopedic massage and muscle alignment techniques• Qigong• Internal Medicine Over 1000 herbs in TCM pharmacopoeia formulas are well-tested, hundreds to thousands of years old Herbs are classified by their flavor and nature the channels/organs they act upon the specific actions on a given organ e.g., Ju Hua (chrysanthemum) is considered to be slightly cold, sweet, bitter, and acrid, enters the Liver channel and soothes the eyes. Its’ found in formulas used to treat Wind Heat- fever w chills, aversion to cold, sore throat. Current herbal products manufactured under cGMP guidelines IAMA Fall 2007 Acupuncture and Pain Management
    • Further Readings• The Web That Has No Weaver, Ted Kaptchuk• Medicine in China, Paul Unschuld• Acupuncture: A Comprehensive Text, John O’Connor, Dan Bensky• The Practice of Chinese Medicine, Giovanni Maciocia• The Management of Post-operative Pain with Acupuncture, Sun Peilin Acupuncture of chronic headache disorders in primary care: randomised controlled trial and economic analysis. Health Technol Assess (UK) 2004;8(48). VickersAJ, Rees RW, Zollman CE, McCarney R, Smith CM, Ellis N, Fisher P,Van Haselen R, Wonderling D and Grieve R. Designing an acupuncture study: the nationwide, randomized, controlled, German acupuncture trials on migraine and tension-type headache. J Altern Complement Med. 2006 Apr;12(3):237-45. Molsberger AF, Boewing G, Diener HC, Endres HG, Kraehmer N, Kronfeld K, Zenz M. IAMA Fall 2007 Acupuncture and Pain Management