Acupunture Treatment

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This is something from my notes I've compiled along the way from articles I've gathered through schooling. In case some of you with back/joint injuries have tried other options and all else has failed, and may be thinking of alternative or complementary therapies.


Acupuncture

Consider This Therapy For

Acupuncture is promoted as a treatment for pain--and there is absolutely no question that it does in fact provide short-term benefit for many of the people who try it. By some estimates, between 50 and 70 percent of patients with chronic pain receive at least temporary relief when treated with acupuncture, and some experience long-term relief as well.
However, doctors are still debating whether this type of therapy has any effect beyond that of a placebo (a fake treatment with no real activity). It's a difficult question to resolve because most placebos are actually quite potent. Dummy pills typically achieve a relief rate of 30 to 35 percent, and a sham procedure, accompanied by suitably impressive instruments and rituals, can be effective more than 50 percent of the time. Indeed, in tests comparing genuine acupuncture with an imitation, patients receiving the fake treatment usually enjoy just about as much relief (50 percent) as those given the real thing.

Of course, if your only concern is pain relief (as opposed to a cure of the underlying problem), it doesn't really matter whether acupuncture's effects are physical or merely psychological, as long as you feel better. And there is, in any event, mounting proof of acupuncture's genuine value. According to an expert consensus panel convened by the National Institutes of Health (NIH) in 1997, well-performed scientific studies have provided evidence of acupuncture's efficacy in relieving pain after dental surgery and in reducing the nausea and vomiting associated with pregnancy ("morning sickness"), chemotherapy, and anesthesia. Other research suggests that acupuncture may be useful--along with other, more conventional therapies--for asthma, osteoarthritis, low back pain, headache (both tension and migraine), menstrual cramps, carpal tunnel syndrome, fibromyalgia, and other conditions that cause chronic pain. Two other intriguing areas are currently under research. One is the use of acupuncture in easing withdrawal from addiction to hard drugs and alcohol; acupuncture, especially of the outer ear, is in use at many detoxification clinics in the United States. (Similar results have not been observed for tobacco addiction, however.) Another possibility is that acupuncture therapy may speed rehabilitation and limit damage after a paralyzing stroke.

How the Treatments Are Done

The "puncture" in acupuncture refers to insertion of tiny needles at certain very specific points on the surface of the body. The treatments vary widely, depending on the individual practitioner and the style of acupuncture. There are several "schools," including Chinese, Korean, Japanese, and a westernized version (based on neurology, not Oriental medical philosophy) called trigger-point therapy. Most practitioners of Oriental-style acupuncture perform at least a partial physical examination at the first visit (including extensive pulse-taking and, possibly, examination of the tongue and palpation of the abdomen). They also tend to take a very detailed medical history, including nutritional habits and other environmental factors.
The actual insertion of the hair-thin, disposable needles has been described as feeling like a mosquito bite. After insertion, the needles may be stimulated by twirling them or connecting them to a mild electrical current (there is no risk of electrical shock). This stimulation may cause a mild tingling or aching sensation referred to as "de qi." The needles may be inserted from a fraction of an inch up to about one inch deep. They can either be withdrawn a few seconds after insertion or kept in place for up to 30 minutes.

Treatment Time: Typically, you should allow 20 minutes to 1 hour per session. The initial visit may take longer.

Treatment Frequency: This varies according to the problem. You may start out with several treatments per week, then taper to weekly or less often. Duration of therapy may range from a few treatments for acute, temporary problems to regularly scheduled treatments over several months for chronic conditions.

What Treatment Hopes to Accomplish

Acupuncture has been practiced in China for several thousand years, although this traditional healing art didn't catch Americans' interest until the early 1970s, when a Western reporter in Beijing received acupuncture for postoperative pain (after undergoing an appendectomy under conventional general anesthesia).
How acupuncture works remains a mystery. According to ancient Chinese medical theory, the life force (called qi or ch'i and pronounced "chee") flows through the body via 14 invisible channels (called meridians), regulating all physical and mental processes. Opposing forces within the body, called yin and yang, must be balanced to keep ch'i flowing properly. The meridians supposedly run deep within the body's tissues and organs, surfacing at some 360 places identified as acupuncture points, sometimes called acupoints. Certain meridians are identified with organs such as the bladder or liver, and the points all along such meridians--even in the hands or feet--are believed capable of affecting the associated internal organ. Stimulating these points is said to balance and restore the flow of ch'i.

An explanation proposed by Western scientists is that acupuncture may trigger the release of natural pain-killing substances within the body called endorphins, thus blunting the perception of pain. It may also alter the body's output of neurotransmitters such as serotonin and norepinephrine, and of inflammation-causing substances such as prostaglandins. Like the manipulation of ch'i, however, this explanation has yet to be conclusively documented.

Whatever the cause may be, the pain-relieving effects of acupuncture seem to have a delayed onset; they increase slowly, even after removal of the needles, and may become more evident after several treatments. The effects may diminish after acupuncture treatments are ended.

Who Should Avoid This Therapy?

In general, there are no medical conditions that rule out the use of acupuncture except, perhaps, a morbid fear of needles. People at risk of easy bruising or excessive bleeding (for example, patients with clotting disorders and those taking a blood-thinning medication) would be prudent to avoid acupuncture, since there is a slight risk of damage to blood vessels. Pregnant women should avoid needle insertion on or near the abdomen.

What Side Effects May Occur?

Acupuncture has no inherent side effects. However, careless application of the technique can present certain hazards. There have been documented cases of hepatitis B transmission and serious bacterial infection due to improperly sterilized needles, a problem that has been controlled by the widespread use of disposable needles. Improperly performed acupuncture can also cause bleeding (if a blood vessel is punctured) or injury to organs, nerves, or tissue, making it important to find a skilled and reputable practitioner.

How to Choose a Therapist

At least 35 states require some form of licensure or certification for the practice of acupuncture. In unregulated states, acupuncture is technically illegal unless performed by a physician, although this ban is rarely enforced.
Educational requirements for licensure vary by state, and this regulatory patchwork makes it difficult to judge an acupuncturist's credentials. Even the titles vary; an acupuncturist may be "licensed," "certified," or "registered," and in a few states may even have the title of "doctor" of acupuncture or Oriental Medicine. Just to make matters more confusing, these titles bear no consistent relationship to educational requirements, which range from 1,300 to 2,600 hours of training (usually in an accredited school or college of acupuncture). Surprisingly, the least qualified practitioners may be physicians, who are permitted to practice acupuncture with no training at all (although most have attended at least a few courses).

There are about 10,000 licensed, registered, or certified acupuncturists in the U.S., and an additional 3,000 medical doctors (MDs) or doctors of osteopathy (DOs) who practice the technique. The Accreditation Commission for Acupuncture and Oriental Medicine sets standards for acupuncture schools throughout the United States, and can send you a list of accredited schools. The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) administers a standardized examination testing theoretical and practical knowledge of acupuncture. Those passing this test must meet continuing education requirements every two years in order to retain certification. There are currently 5,000 practitioners who have achieved certification, and an increasing number of states are using the examination as part of or acupuncture licensure. When choosing a therapist, you should check to see whether he graduated from an accredited school and whether he has received NCCAOM certification.

Unfortunately, no degree or license can reveal the most important variable: skill and talent. Before undergoing treatment, you may also wish to learn more about the practitioner's approach and philosophy. Some practitioners combine acupuncture with other aspects of traditional Chinese medicine, such as the use of traditional herbal remedies and the technique called moxibustion (applying a smoldering cone of herbal material to the skin at an acupuncture point). If your experience with one acupuncturist is negative, remember that it's possible for a different practitioner to produce better results.

When Should Treatment Stop?

According to the NIH panel, if you haven't obtained relief after 10 sessions of acupuncture, the therapy isn't working and should be stopped. In general, chronic pain relief should be perceptible after about six sessions if it's going to happen at all; relief of conditions such as asthma tends to take longer, sometimes months. A responsible acupuncturist will acknowledge when treatment seems to be ineffective and won't pressure you to continue.

See a Conventional Doctor If...

Check with a doctor if you develop any symptoms that might signal a serious illness. Even if traditional Chinese medical theory holds true, and acupuncture has overall health-giving benefits, there are better treatments available for many specific illnesses. Pain, whether chronic or acute, is a red flag for countless medical conditions--some minor, some life-threatening. Any new, persistent, or worsening pain should be evaluated by a medical doctor before you seek relief through acupuncture.
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