Acupuncture Benefits : How it can Improve Your Health

Complementary Medicine

Acupuncture Benefits : How it can Improve Your Health

Acupuncture is a treatment modality in which thin needles are inserted into the various parts of the body. Acupuncture is a key component of Traditional Chinese Medicine. The roots of acupuncture reach deep into ancient China as far back as 2,500 years ago.  There are many styles of acupuncture, each one of them based on slightly different philosophies and techniques, depending on the country's origin. In the United States, Traditional Chinese Acupuncture is probably the most widely practiced system. Although Acupuncture is most often used for pain relief, it is also used for a wide range of other conditions since it is a complete medical system focused on correcting imbalances of energy flow in the body.

What is Acupuncture used for?

 

Acupuncture has been used traditionally to prevent, diagnose and treat disease, as well as to improve overall health. The benefits of acupuncture can extend to a wide variety of conditions.

 

It has been used for the treatment of emotional disorders such as anxiety and depression, as well as digestive complaints including nausea, vomiting, and irritable bowel syndrome. Acupuncture has been used effectively for pain syndromes due to an injury or associated with chronic degenerative diseases such as rheumatoid arthritis.

 

Research has supported the use of acupuncture in the treatment of neurological problems like migraines or Parkinson’s disease, but also as a rehabilitation strategy for individuals who suffered a stroke. Many patients also find relief from conditions such as sinusitis, seasonal allergies or a variety of gynecologic disorders.

 

Acupuncture as part of an overall treatment protocol, has also proved beneficial for reducing fatigue and for promoting overall well-being. Despite all of these potential benefits of acupuncture, in US acupuncture has been used most extensively for the treatment of skeletomuscular disorders and pain management.

How does acupuncture work?

 

The traditional explanation for acupuncture’s effectiveness lies in harmonizing the flow of energy throughout the body. This energy is also known as Qi.

 

According to the ancient Chinese philosophy, for the body to be healthy and to function at its full potential, the Qi has to flow unobstructed. When obstructions in the body form as a result of poor lifestyle choices, improper diet or myriad of other conditions, the flow of Qi becomes obstructed.

 

One can imagine a mountain stream being obstructed by debris. New paths to the flow of the stream have to be created. This leaves, however, everything in the immediate vicinity behind the blockage deprived of the water.

Removing the debris restores the flow and supply of the water. Likewise, inserting needles into specific predetermined acupuncture points around the body is said to restore the natural flow of Qi and health in the affected parts of the body.

 

To this day, however, there is no scientific consensus that this is actually how acupuncture works.  In the United States and many other western countries, acupuncture has been used primarily for pain relief, rather than its traditional role of balancing energy flow to address a wide range of disorders. Much of the research has been therefore focused on explaining the analgesic effect of acupuncture.

 

The rise of acupuncture popularity in the US

 

The first time that Acupuncture gained the attention of the mainstream media was when a senior reporter for The New York Times James Reston reported on his experience with acupuncture while visiting China in preparation for President Nixon’s visit.

 

He experienced the benefit of acupuncture at first hand as part of the recovery process from developing paralytic ileus post appendectomy. Teams of US physicians set for China in hopes of exploring its potential for surgical analgesia.

 

While they eventually concluded that acupuncture was not reliable as a sole analgesic, their reports stimulated a number of research studies, particularly in treating pain. Acupuncture finally gained a certain amount of respectability in the USA after the positive conclusions of an NIH consensus conference (NIH Consensus Development Panel 1998).

 

Dry needling or acupuncture ? 

 

Many patients undergoing physical therapy may be familiar with Dry needling which is also known as "trigger point dry needling". Dry needling uses the same needles that are used for acupuncture, however dry needling is used mainly to treat myofascial trigger points.

 

There is ongoing argument among Acupuncturists and other medical professionals using dry needling whether dry needling is adapted from acupuncture or if dry needling is a variation of trigger point injections. While both therapies can be very beneficial for the right patient, it is important to understand that Dry needling is not the same as Acupuncture.   For more information on dry needling please click the tab “dry Needling".


Optimizing Back Pain Recovery: Best Practices

Musculoskeletal Health with Dr D. 

Optimizing Back Pain Recovery : Best Practices

In this article we will look at the best practices for optimizing back pain recovery. Despite the fact that back pain can cause a significant amount of pain and discomfort, it usually recovers spontaneously on its own. The speed of recovery depends on many variables. There is no one single magic remedy to speed up the recovery process.  However there are certain strategies that can be used for optimizing back pain recovery to help you recover faster. Understanding that you may not have control over certain aspects of your recovery process, will also allow you to create more realistic expectations and avoid undue frustrations.

Physical fitness and age

Individuals who are more physically fit and do not have other major medical conditions, generally tend to recover much faster. The body can fully focus on the healing of the injury when there are no other chronic conditions that also require attention, energy, and resources.

 

The smaller the number of raging fires present at the time of injury, the faster and more efficient the recovery process can be. Since most chronic conditions tend to accumulate over the years, age becomes an important player in the recovery process.

 

For the most part, healing is much faster in younger and healthier individuals. That is not to say, however, that growing old is always plagued with long term recovery process. A healthy and active 60-year-old individual with back strain may recover much faster than a 30-year-old sedentary obese office worker.

Prior injuries

History of prior back pain or the presence of other chronic musculoskeletal injuries plays a significant role in the recovery process. Individuals who suffer from chronic pain which is not well controlled, have gone through a process of so-called sensitization.

 

In other words, their nervous system has become more sensitive to any pain stimulus. Any new injury will, therefore, cause a lot more intense pain and take much longer to subside, despite the fact that the area of injury may be already healed.

 

Importance of early mobilization

When significant acute injury develops, bed rest may be necessary. It should be, however, limited to no more than 24 - 48 hours. Numerous studies have demonstrated the detrimental effect of prolonged bed rest on the recovery process.

 

Motion is the lotion and muscles need to move to heal. While you should not push through the pain to further aggravate your condition, gentle exercises focused on a pain-free range of motion and stretching will allow the muscles to become less stiff and maintain their flexibility.

 

Muscles that are not used, start to deteriorate very rapidly. They lose flexibility, mass, strength and become stiff. Intense pain with even small movements may then result from any attempt to use the stiff muscle since it will be pulling on the injured area.

 

Movement also creates important muscle pump which helps to increase local blood circulation. Increased blood circulation helps to flush out the inflammatory chemicals present at the site of the injury. The accumulated inflammatory chemicals irritate the nerve endings at the site of the injured area.

 

These chemicals are the primary reason for sensation of pain. Increased blood circulation also helps to supply the injured area with nutrients, oxygen and white blood cells that help to heal the injured tissue. Getting an early referral to a physical therapist to start the rehabilitation from acute injury is important for fast recovery and preventing the development of chronic conditions.

 

Application of heat versus cold

Using cold compresses for the injured muscles may be soothing in the first 24 – 48 hrs. This should be, however, followed by the application of heat to promote local blood circulation and to relax the muscle spasm.

 

Moist heat is preferred over dry heat, and moist heating pads, hot showers or baths work great. Heating pads can be applied to the injured area several times a day, but no longer than 20 minutes at a time.

 

You should never sleep on the heating pad. Exposing the injured area to the heat longer than 20 minutes at the time leads to overheating. This will trigger a protective mechanism, which may cause changes in the local vasculature and eventually decrease blood circulation in the injured area.

 

If pain prevents you from getting good night restful sleep, talk to your provider about prescribing short course of pain medication that can decrease the intensity of pain at night, while at the same time help you get better sleep.

 

Taking a muscle relaxant 30 minutes to one hour before sleep is generally a good option. However, your medical provider will be able to make more specific recommendations based on your particular condition.

Sleep and Depression

Getting a sufficient amount of sleep is important for everybody, but it is critical when recovering from an acute injury. The body heals and tissue regenerates when we sleep.

 

Insufficient sleep promotes systemic inflammation within our body, which slows down the healing and contributes to more pain perception. A minimum of seven, but preferably eight hours of sleep is recommended for optimal functioning and recovery.

 

Additionally, an insufficient amount of sleep combined with new intense pain has a strong effect on mood and may lead to depression. Whether depression results from sleep deprivation and pain or the depression has been present prior to the injury, it’s presence further intensifies pain and interferes with sleep, thus creating downward spiral leading to worse outcomes.

Complementary medicine, pain medication, and acute pain

An increasing number of patients do not wish to take any pain medication when they develop acute pain from fear of their side effects. There is an ongoing battle and numerous initiatives to fight the opioid crisis around the world.

 

Additionally, it is also true that every medication carries a risk of side effects. This, however, doesn’t mean that taking pain medication is bad and should be avoided by all means.

 

It is important to understand that there is a role for pain medication in particular when it comes to severe pain. Getting pain under control as soon as possible will prevent altering the way in which our brain deals with pain.

 

Any uncontrolled pain lasting longer than several days can sensitize the brain to pain and lower the pain threshold. This ultimately translates to experiencing painful sensation at much higher intensity with much lover stimulus. A simple gentle touch over the painful area could, therefore, lead to severe pain.

 

Complementary and alternative medicine modalities have been used successfully for the management of pain and injuries for hundreds of years. Many of them have been extensively studied and their effectiveness proven in rigorous trials.

 

Despite their popularity, however, their role is primarily in the management of chronic pain and injuries. This is largely because their main mechanism of action, by which they help to control pain and promote recovery, is through stimulating body own healing processes and pain control.

 

In other words, their primary role is to restore the body homeostasis. The subtle changes they produce over time are sufficient to create a noticeable difference when treating chronic pain or injuries.

 

It is, however, usually not enough to promote lasting pain relief in severe acute pain Click here to read more about the complementary medicine, pain medication and acute pain.

The role of Nutrition

The importance of nutrition cannot be emphasized enough when it comes to recovery from an acute injury. Providing our body with a sufficient amount of lean protein which is important for building tissue, as well as getting enough vitamin C to promote formation of collagen, is the very minimum.

 

Minimizing the intake of vegetable oils by decreasing consumption of fried foods and pastries and replacing them with monounsaturated fats from olive oil, canola oil, and avocados helps to decrease inflammatory process in the body.

 

Eating a wild salmon or other fish high in omega 3 fatty acids at least 2-3 times a week, or taking 1000- 2000 mg of mercury-free omega 3 fatty acids daily in the form of a supplement, has been also shown to decrease systemic inflammation.

 

Having fresh vegetables at least two times a day and eating 2-3 pieces of seasonal fruits will add much-needed vitamins and phytochemicals to act as powerful antioxidants.

Topical analgesic creams

Topical analgesic creams, ointments, and plasters have been used in many traditions to treat injured muscles and bones for millenniums. They have been made from a variety of herbs and other natural substances.

 

Their use not only soothes the pain but also promotes healing. A number of topical analgesic creams have been developed by the pharmaceutical industry based on these old folk remedies.

 

Most of these products contain some combination of menthol, capsaicin and salicylic acid. While these products have been marketed primarily to help to soothe the pain and aches, they also promote local blood circulation by stimulating special receptors on the skin.

 

As mentioned throughout this article, increased blood circulation in the area of pain promotes healing. The use of these products should be therefore encouraged for any musculoskeletal injury where application of topical creams is not contraindicated.

 

Before rubbing any of these products to the skin, try to apply only a small amount to observe for any skin reaction. You should also never apply these creams right before or after hot shower to avoid intense burning sensation.

 

In summary

Recovering from an acute musculoskeletal injury is a complex process. There is no one single recipe since everybody has a unique combination of factors that may either promote or hinder the recovery process.

 

In this article, we have covered only few of the most important aspects that exert a major influence on the recovery process. Optimizing sleep, physical activity, nutrition, and appropriate use of heat/cold and topical creams, can have significant effect on the speed of your recovery.

 

To learn more about complementary therapies that can be used for recovery from acute back pain, visit National Center for Complementary and Integrative Health


Spinal Stenosis: Causes, Symptoms and Treatment

Medicine Corner with Dr D 

Spinal Stenosis

Chronic back pain can be a result of spinal stenosis. Spinal stenosis is usually seen in individuals over the age of 50 who developed significant degenerative changes in their spine from wear and tear. The medical word for these degenerative changes is osteoarthritis. Spinal stenosis is a result of the narrowing of the spaces within the spine where the spinal nerve roots are located. When the spaces get too narrow, excessive pressure on the nerves in the area develops.

Symptoms

People affected by spinal stenosis may experience a variety of symptoms. Some individuals may have no symptoms at all, especially in the initial stages, while others may experience significant amount of pain. It is not known why some people experience more or less pain. Spinal stenosis is a degenerative disease and therefore develops slowly over period of time with gradually worsening symptoms. Most individuals experience tingling and numbness in their buttocks, legs, and calves, especially after prolonged walking. Walking up the hill or up the stairs is particularly painful, but even walking down the stairs can lead to significant amount of pain. In more advanced cases, weakness of the legs, pain, and cramping in one or both legs and feet can present with prolonged standing or walking.  In severe cases, an individual may not be able to walk more than few blocks before severe pain develops.

Urination and bowel movement can also be occasionally affected as a result of the pressure on the spinal nerves that control these two essential physiologic functions, and the individual may develop urinary urgency and incontinence. In general, the back pain from spinal stenosis gets better with sitting down for a few minutes. Sitting flexes the spine and this relieves some of the pressure on the nerves. Many individuals with severe spinal stenosis, therefore, walk stoop forward and keeping their torso slightly flexed to lessen the pain while walking.

Causes

There are several reasons why spinal stenosis may develop. The most common causes include osteoarthritis and bone spurs. Osteoarthritis is one of the forms of arthritis. It is a result of wear and tear that affect the protective cartilage on the ends of the bones. When osteoarthritis is present in the spine, it can cause over time narrowing of the spinal canal, which eventually results in spinal stenosis. When bone spurs develop as a result of long term wear and tear, the spurs may grow inside of the spinal canal and cause pressure on the spinal nerves. Less frequent causes of spinal stenosis include a spinal tumor and a car accident. In both of these cases, there are usually several other prominent symptoms that point out to that diagnosis.

Treatment guidelines

In mild cases of spinal stenosis, a conservative treatment approach is recommended. This may consist of physical therapy and strength training, stretching, short term course of acupuncture, daily stretching, swimming, Tai Chi or Yoga exercises. The goal is to keep the back muscle flexible and relaxed as much as possible. Building core strength is also important to properly distribute the weight and decrease the load on the spine. Losing excessive weight is crucial for the successful management of back pain. Carrying less weight translates to less pressure on the lumbar area of the spine from the excessive forward pull of the abdomen.

 

In more severe cases when the benefits of conservative treatment have been maximized, but pain continues to significantly affect the quality of life, surgery may be necessary. This should be however the last resort since there are inherent risks to any surgical procedure. It has been recommended, that only when all other treatment options have been exhausted, and the individual’s quality of life as it is now is poor, surgery should be considered as a possibility to improve current quality of life.

 

For more information about spinal stenosis you can visit the Mayo Clinic Spinal Stenosis page


Acute Pain Management: A Guide to Complementary Therapies

Complementary Medicine

Acute Pain Management: A Guide to Complementary Therapies

Increasing number of patients do not wish to take any pain medication when they develop acute pain from fear of side effect.  There is an ongoing battle and numerous initiatives to fight the opioid crisis around the world. It is also true that every medication carries a risk of side effects.

 

Complementary medicine such as acupuncture, massage, yoga and meditation has been used to ease the pain and treat acute and chronic injuries long before contemporary medicine became the standard of care. The question arises, should we shy away from conventional pain medication for controlling acute pain and focus primarily on complementary modalities, because they are generally safer and mostly free of side effects?

 

In this post I will try to present unbiased view of  both sides and attempt to come up with the answer that I have found in my practice most successful.

Conventional medicine and acute pain

Conventional pain medication maintains a bad rap in minds of many people. This is especially true for those who are more in tuned with their body and look for complementary medicine as the primary treatment option for their daily maladies.

 

While managing daily aches and pains with stretching, massage, yoga or acupuncture is definitely very reasonable and preferred option, situation slightly changes in case of intense acute pain.

 

It is important to understand that there is a role for pain medication when it comes to severe pain. Getting your pain under control as soon as possible will prevent altering the way your brain deals with pain.

 

Any uncontrolled pain lasting longer than several days can sensitize your brain to pain and lower your pain threshold. This ultimately translates to experiencing pain from similar injury in the future at much lower level than before.

Complementary medicine and acute pain

Complementary medical modalities have been used successfully for management of pain and injuries for hundreds of years. Many of them have been extensively studied and their effectiveness proven in rigorous trials.

 

Despite their popularity, however, their primary role is generally seen in management of chronic conditions. This is largely because their main mechanism of action, by which they help to promote recovery, is through stimulating body’s own healing processes and pain control.

 

In other words, their primary role is to restore the body homeostasis. The subtle changes they produce over time are sufficient to create a noticeable difference when treating chronic pain or injuries.

 

It is, however, usually not enough to promote lasting pain relief in severe acute pain. But that doesn’t mean these modalities cannot be used successfully even in cases of significantly severe pain.

 

There are many practitioners who are quite skillful and capable to accomplish “miraculous” results. This author has treated successfully many patients with significant amount of acute pain in his own private practice with acupuncture and herbal medicine.

 

The problem with using modalities such as acupuncture for treatment of severe acute pain, becomes with the access to these skillful practitioners and the associated cost. In case of acupuncture, it takes years of experience, and additional training in treatment of musculoskeletal injuries to treat patients with severe acute pain, to achieve reliable results.

 

When seeing an acupuncturist for treatment of chronic conditions, weekly sessions are generally sufficient to achieve great results. This is, however, not true in case of significant acute pain.

 

To successfully treat an acute pain, the practitioner will need to see the patient generally up to three times a week for the first two weeks and usually will also prescribe an herbal formula. At the average cost of $70 -$100 per office visit, this can easily add up to $300 - $400 a week x 2.

 

This also does not account for the travel time to and from the office and lost work. Compared to a small co-pay for an office visit with a primary care provider and pain medication if the patient has a medical insurance, this becomes a significant financial burden that majority of patients cannot afford. Just because it is possible, doesn’t therefore mean that it is always feasible and the right thing to do.

Conventional medicine and acute pain

Conventional pain medication works in completely different way. When taking pain medication, the goal is not to restore the body’s homeostasis, or to support the body in its own ability to take care of the pain. The pain medications are designed for one and only purpose. To suppress the pain as fast as possible and as much as possible.

 

There are many different classes of pain medication and they all work in slightly different way. Some of them can be purchased over the counter to suppress mild to moderate pain, but for the severe pain, it is usually necessary to see a medical provider who can write a prescription.

 

While opioid medications are the most powerful tools that we have in our pain arsenal, there are other options which are not classified as opioids, and which your provider can prescribe to control your acute pain.

 

It should be therefore clear, that prescribing pain medication for severe pain, does not necessarily equal prescription for opioids, if that is something that the patient does not feel comfortable with. It is however noteworthy, that taking seven to ten day course of opioid medication is usually sufficient to get even the most severe pain under better control. Different class of pain medication can be prescribed after the initial seven to ten day course of opioid medication, to provide sufficient pain relief.

 

This short course of opioid pain medication is rarely causing any more side effects then some drowsiness and sleepiness. Most individuals with acute severe pain prefer to take this medication only at night when pain becomes more intense, because all the daily distractions are taken away by the silent night.

 

Opioid pain medication is therefore particularly helpful to take before sleep to ease the severe pain and allow for better sleep. To keep the dose of the strong opioid medication as low as possible, the provider usually prescribes one or two other pain medication that work through different mechanism and add to the total pain relieving effect.

Eclectic Approach

An eclectic approach to pain management is in this author’s opinion the best. In the eclectic approach, the patient uses combination of several modalities which complement each other to achieve the best result.

 

Combining one or several complementary modalities such as acupuncture, acupressure, massage, yoga, breathing exercises and meditation along with pain medication, will have much greater effectiveness than using any of them as a standalone modality.

 

This combined approach takes the best from both worlds so to speak. The complementary medical modalities slowly work on helping the body recover faster, while pain medication helps to control the acute pain and allows the patient to focus on the recovery process.

 

Getting sufficient amount of sleep, staying physically active and following an anti-inflammatory diet will further maximize the healing. For more details on how to optimize your recovery process follow this link.

 

To learn more about complementary therapies, visit National Center for Complementary and Integrative Health


Facet Joint Syndrome: A Silent Cause of Chronic Pain

Medicine Corner with Dr D 

Facet Joint Syndrome

Back pain can be caused by degenerative changes and inflammation in the facet joints which is commonly referred to as a Facet Joint Syndrome. The spine is made up of individual vertebral bodies which are stacked one on top of another. On each side of the vertebral bodies are tiny joints called facet joints. Their primary role is to allow the spine to move and make twisting and bending movements. They also keep the individual vertebras from moving too far forward or twisting without limits.  Most facet joint-related pain is seen among individuals over the age of 60 secondary to osteoarthritis. It is, however, not uncommon for younger very active individuals to experience the same pain after engaging for several years in exercises that put lots of stress on the facet joints.

Symptoms

When the facet joints become inflamed because of injury or arthritis, they will generate pain. Acute presentation of facet joint pain may resemble those caused by a herniated disc and at this stage it may be difficult to differentiate between these two. In most case the individual can pinpoint the area of pain indicating involved facet joint. At time, however, the person may experience diffused poorly localized pain in the lower back, hips, and buttocks on both sides. Most patients presenting with pain due to facet joint inflammation have difficulty bending backward which may help to establish the diagnosis. In some cases, the facet joint pain may project pain down to the legs and mimic the sciatic pain. Unlike sciatica, where the pain may project all the way down to the feet, facet joint pain usually terminates at the level of the knees. Only in rare cases the pain may project all the way down to the feet. This is usually seen when osteophyte is causing pressure on the nerve root.

Causes

The major cause for the development of facet joint syndrome appears to be osteoarthritis of the facet joints. Osteoarthritis is generally a consequence of wear and tear. It is characterized by narrowing of joint spaces, loss of joint cartilage and local joint inflammation. This process is similar to the more familiar knee osteoarthritis which is a well-known cause of knee pain among the elderly population. It has been shown that younger individuals suffering from facet joint syndrome tend to have history of strenuous jobs prior to the age of 20 which puts them at high risk for early osteoarthritis of the facet joints.

Diagnosis & Treatment guidelines

Inflammation of the facet joints is generally not well diagnosed by MRI or X-Rays. There is also a poor correlation between the findings on the images, physical exam by the provider and the symptoms that the patient experiences. In most cases injection of an anesthetic medication into the vicinity of the painful facet joint can help to make the diagnosis. If the patient experiences immediate pain relief after the injection, the condition can be diagnosed as facet joint syndrome and steroid injections can then be administered to decrease the local inflammation. The steroid injections are usually administered by pain specialists under fluoroscopy which helps to guide the needle placement. The patient may receive these injections every 3-6 months based on the duration of symptoms relief.

Acupuncture treatment can also be beneficial since needling the musculature in the affected area can improve local blood circulation and decrease the inflammation and muscle tension. Referral to physical therapy to learn appropriate core strengthening and stretching exercise is important in long term management and prevention of further exacerbation.

Avoiding activities that put undue stress on the spine is as important, if not the most important aspect of any long term management of facet joint syndrome. No treatment will be effective if these perpetuating factors are not effectively addressed and appropriate modifications incorporated into daily lifestyle.