REPORT: MB #2847
BACKGROUND: The ancient Chinese art of acupuncture can be traced back to the Stone Age. Stone acupuncture needles from 3000 B.C. were discovered by archaeologists in Mongolia. The art has come a long way from there, but the principles remain the same. Based on the principles of yin and yang, the theory is that the thin needles (0.18 millimeters to 0.51 millimeters thick) create a balance between blood and energy to relieve pain. The technique has been theorized to treat a wide array of ailments, ranging from stress to indigestion to infertility, but there has been little evidence to support these claims, making it a controversial technique in the medical community, but recent clinical studies have produced results convincing some of the world's brightest minds to believe there may be some science behind the technique for certain conditions.
NEEDLES RELIEVING PAIN? During surgery, anesthesia and pain-killing medications are often used to make patients comfortable and make invasive surgery possible. After surgery, patients are often left with post-operative pain requiring additional medication. These drugs, ranging from narcotics to opioids, can cause unpleasant side effects like nausea, vomiting, constipation and hallucinations. A 2007 study out of Duke University Medical Center suggests acupuncture may reduce patients' post-operative pain, therefore reducing the amount of painkillers needed.
After analyzing 15 studies on acupuncture for surgical pain, Duke researchers found performing acupuncture before or during certain operations reported significantly less pain afterwards than patients who did not receive acupuncture. The patients also required less painkillers after surgery, thereby reducing related side effects. Acupuncture patients experienced 1.5 times lower rates of nausea, 1.6 times fewer reports of dizziness and 3.5 times fewer cases of urinary retention compared to the other patients, the study found; however, it was used as a compliment to traditional surgical anesthesia and painkillers -- not a replacement.
CONVINCING FOR SOME: While many will continue to discredit the controversial practice, T.J. Gan, M.D., vice chair of the department of anesthesiology at Duke University School of Medicine, is convinced it's right for some cases. "There has been a fair amount of evidence both in animals and humans that stimulating the acupuncture points can result in the release of body own pain killers systems such endorphins and enkephalins," Dr. Gan told Ivanhoe.
"The acupuncture needs to be inserted about half an hour to 45 minutes before surgery because it typically takes about five or 10 minutes for the body to start releasing some of these pain killing effects of the acupuncture," Dr. Gan explained. "We typically maintain the acupuncture throughout the surgery to the end of surgery. And during that period there is the release of body’s own endorphins."
Acupuncture programs are also in place at Yale, Stanford, Bringham and Women's and Massachusetts General Hospital, among others.
FOR MORE INFORMATION, PLEASE CONTACT:
Melissa Schwarting
Senior Media Relations Strategist
Duke University Medical Center
(919) 660-1303
melissa.schwarting@duke.edu
T.J. Gan, M.D., an anesthesiologist at Duke University Medical Center in Durham, N.C., talks about acupuncture to treat postoperative pain.
How do you believe acupuncture can affect postoperative pain?
Dr. Gan: Acupuncture is a traditional Chinese art and has been practiced for thousands of years. One of the more significant roles is treating pain condition. There has been a fair amount of evidence both in animals and human that stimulating the acupuncture points can result in the release of body own pain killers systems such endorphins and enkephalins.
When you do perform the acupuncture?
Dr. Gan: The acupuncture needs to be inserted about half an hour to 45 minutes before surgery because it typically takes about five or 10 minutes for the body to start releasing some of these pain killing effects of the acupuncture. We typically maintain the acupuncture throughout the surgery to the end of surgery.
In your study, was there any need for follow up acupuncture to treat postoperative pain?
Dr. Gan: In this study, we did not look at that but that pain is a continuing process and certainly having acupuncture after surgery would be very helpful to maintain a good pain control and also reduce the amount of morphine that patients may require after surgery.
How long did the benefits of the acupuncture last?
Dr. Gan: The research we have done, as well as other studies, suggest that acupuncture can last up to about 24 to 48 hours after surgery.
How do you balance the anesthesia drugs and the acupuncture? Is there a decreased need for drugs when you use acupuncture?
Dr. Gan: Certainly during general anesthesia we need to give pain killers as well as the anesthetic to keep a patient asleep and reduce the pain impulses going to the brain. We have found that by using acupuncture, you can potentially reduce the amount of painkillers that you otherwise would need to use during surgery. Some studies suggest that acupuncture can also reduce the amount of anesthetic that you need to provide for the patients.
If a patient is asleep, how do you gauge how much pain medication is needed?
Dr. Gan: That is a very interesting question. In fact, there are some ways we can measure -- not very precisely -- but there are some indications as to how much painkiller we need during surgery. For example, by looking at blood pressure and heart rate as well as patient’s sympathetic response. High blood pressure and high heart rate can both be as a result of inadequate analgesia.
How can pain during surgery affect a patient long-term?
Dr. Gan: There is increasing evidence that the pain following surgery is not just limited to immediately postoperative period. It can actually result in much longer-term pain problems. Let me give you an example: if you have surgery that lasts two hours, there is evidence to suggest that if you control the pain well during the surgery and the recovery period, not only does it benefit a patient immediately postoperatively, but there is also increasing evidence to suggest that this will prevent longer-term pain problems. Studies in humans and in animals demonstrate that poor pain management during the operations and in the recovery period can result in a higher incidence of chronic pain which may be months or years after the initial surgery.
What benefits are there to having an alternative therapy like acupuncture as opposed to drugs?
Dr. Gan: There are many different painkillers that we use, but all the pain killers that we use are associated with side effects. So on the one hand, you want to increase the amount of painkillers you use, but on the other hand, you have to live with the side effects. One strategy is to try and give different pain killers to try to reduce the dose that we need for each pain killer and therefore, reducing the side effects. At the same time, using the non-pharmacological techniques such as acupuncture can reduce the drugs that we need, therefore reducing the side effects.
Since acupuncture affect's the body's chemicals, could that change the way medications work?
Dr. Gan: Yes, with release of endorphins, acupuncture can enhance analgesia. In other words, the patient will be more comfortable with this release of endorphins and as a result, the patient doesn’t need to use as many pain killers -- things like morphine, which have a number of undesirable side effects. So acupuncture does help to reduce the amount of morphine that these patients need.
Is it fair to say acupuncture can enhance the function of other drugs?
Dr. Gan: Absolutely. The use of acupuncture certainly can enhance the pain management and improve patient’s comfort after surgery. By combining acupuncture with some of the other painkillers, it makes the painkillers work better and the patient need less drugs, therefore reducing their side effects.
Did acupuncture have any negative effects on patients in your study?
Dr. Gan: Acupuncture is, in fact, a very safe technique if it is done by qualified professionals, knowing which points to use and avoiding some of the other undesirable points. The needles are very thin; often the patient may not even feel it when the needle is being inserted. So under professional hands and under qualified experienced acupunctures, the side effects are very minimal.
Depending upon the procedure, do you target different areas of the body with acupuncture?
Dr. Gan: In general, there are general and specific points that work well for pain control. So if you’re having shoulder surgery, you may be using some of these points. One of the general points that is effective for pain control is called large intestine (LI) 4, which is just between the thumb and the index finger at the back of the hand. If you are operating on a shoulder, then typically we would also use some local points around the shoulder that would also enhance the analgesic affect of the various acupuncture points. If you are operating on the abdomen, for example, we may be using the same general points for pain, but different local and regional points to enhance the effects.
What is the potential for the use of acupuncture during surgery in conjunction with anesthesia and pain medicine?
Dr. Gan: I think we are increasingly learning more and more about acupuncture and how acupuncture works. The potential is enormous and we are starting to conduct more well controlled clinical trials to help us learn about the effects of acupuncture. We are also increasingly doing more mechanistic studies to show how it works, not only in the area of pain, but also in some of the other areas that haven't been researched as well. There is tremendous potential for integrating this practice into a western mainstreamed medical practice.
So you see it as an adjunct, not as replacement?
Dr. Gan: Yes, I think for most of the conditions, I think we still need powerful drugs to control pain, but I think acupuncture would be a very useful addition to that regimen.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
T.J. Gan, MD
Duke University Medical Center
Durham, NC
melissa.schwarting@duke.edu
http://www.dukehealth.org/
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