Transcript Slide 1

How Acupuncture Plays a Role in
Occupational Medicine
Brent Dauphin, L.Ac., MTCM
Most people’s notion of acupuncture…
History of Acupuncture
Acupuncture has a clearly recorded history of about
2,000 years, but some authorities claim that it has been
practiced in China for some 4,000 years.
The Chinese believe that the practice of acupuncture
began during the Stone Age when stone knives or
sharp edged tools were used to puncture and drain
abscesses.
History of Acupuncture (cont.)
Acupuncture, or needle puncture, is a European term
invented by Willem Ten Rhyne, a Dutch physician
who visited Nagasaki in Japan in the early part of the
seventeenth
century.
The
Chinese
describe
acupuncture by the character 'Zhen/Chen', which
literally means 'to prick with a needle', a graphic
description of this therapeutic technique.
What is Acupuncture?
Acupuncture is a system of medicine that has been
use for thousands of years to promote healing of
injuries and for pain management.
Typical acupuncture treatments involve the insertion of
several surgical grade sterile, single-use disposable
stainless steel needles into specific areas (acupuncture
points) on the body.
Acupuncture Needles
The needles are very thin (about the width of a human
hair.) When acupuncture points are needled, they
work to help move circulation in the body, reduce
pain and improve range of motion at an injured area.
Many people think acupuncture sounds scary – until
they try it!
Is it Painful?
• There is usually a sensation with acupuncture. The
sensations vary in types and intensity depending on
area being treated.
• Typically the sensation is quick and is sometimes
described as a slight rubber band snap.
• This sensation, if experienced, only lasts for about a
second or two and afterwards there is usually only a
sense of a light weight sensation on the skin while
the person rests for about 20 minutes.
Acupuncture Pathways
• A group of points along a longitudinal pathway in the
body is called a meridian. We use points along a
meridian to influence other parts of the body that the
meridian reaches.
• Some meridians reach from head to toe or hand to
head, this helps to explain why an acupuncturist
may use a point on a person’s hand or wrist to treat
a pain they are having in their neck.
Acupuncture Pathways (cont.)
• Patients are often surprised to feel this association
when being treated. When a needle is placed in one
location they frequently remark that they
immediately feel the sensation of pain in the second
location has changed/reduced.
• The reason for the phenomenon is best described by
viewing an acupuncture chart.
Acupuncture Charts
The acupuncture points are organized
Into 14 main channels or meridians that are used to coordinate specific
areas of treatment
Acupuncture and Trigger Points
• Acupuncture charts and pathways were developed
and refined over thousands of years. Most likely it
developed first from massage and acupressure.
What they charted is very similar to what modern
science now calls Trigger Points and uses for
injections. Trigger points are defined as localized
areas in which the muscle and connective tissue are
highly sensitive to pain when compressed. Pressure
on these points can send referred pain to other
specific parts of the body.
Trigger Point Charts
Two Basic Styles of Acupuncture
Local – needles are inserted to an area of injury
• Ex. Putting needles into local points on the
shoulder for a rotator cuff strain.
• Creates a local response to foreign object & kicks
off a reaction of bringing in similar agents to help
heal our body and draw in such things as white
blood cells and other inflammatory reaction
agents.
Two Basic Styles of Acupuncture
(cont.)
Distal – using acupuncture points at locations other
than site of injury.
• Ex. Using an acupuncture point on the hand to treat
a frontal headache.
• Helps to block pain by reducing perception of the
pain signal.
Obstacles of Acupuncture
• I would estimate that at least 90% of the new patients are
apprehensive and reluctant to trying acupuncture. This may be
due to fear of needles, fear of unknown factors such as what is
this acupuncture? Why am I doing this, who is this caucasian
Acupuncturist person? (acupuncturists come in all shapes and
sizes now in America, similar to the population in general.
Chinese is not the majority demographic of acupuncturists
coming out of schools now)
Side Effects of Acupuncture
• SIDE EFFECTS are possible, such as bruising or soreness at the
point of needle insertion. These are usually temporary, however
there have been rare instances of organ injury reported by
incorrect needling technique. Also, just as with any needle
technique fainting is a rare but possible occurrence. Usually this
is due to a patient having skipped a meal and having low blood
sugar at the time or from having extreme needle phobia.
Side Effects of Acupuncture
(cont.)
• Acupuncture is similar to Physical Therapy in that it tends to have
fewer side effects and lesser in severity than other forms of pain
treatment. The function of acupuncture is to create self healing
and is less likely to cause side effects than many other options
such pharmaceuticals which require ingesting a foreign substance
that needs to be absorbed and metabolized by the body.
Treat Yourself
Acupuncture Point on the hand
– Can be use for frontal headaches and sinus pain
– To Find, press the meeting point of bringing the thumb and
first finger together.
– To Use, push on the muscle until you feel a moderate achy
sensation, then continue pushing until the discomfort
diminishes.
Acupuncture Added to WC
• California Adds Acupuncture to Workers' Comp Treatment
Guidelines as of June 15, 2007
• Must be prescribed by medically approved provider
• Inexpensive and conservative treatment for musculoskeletal
injuries promoted by WHO, NIH, Labor Code, and CA Workers
Comp System
• Acupuncture is supported by RAND evidence based treatment
guidelines
ACOEM Guidelines for Acupuncture
• Indications for acupuncture or acupuncture with electrical
stimulation include the following presenting complaints:
– Neck and Upper Back Complaints
– Elbow Complaints
– Forearm, Wrist and Hand Complaints
– Low Back Complaints
– Knee Complaints
– Ankle and Foot Complaints
– Pain, Suffering and the Restoration of Function
ACOEM Guidelines for Acupuncture
(cont.)
• Frequency and duration of acupuncture or acupuncture with
electrical stimulation may be performed as follows:
– Time to produce functional improvement: 3 to 6 treatments.
– Frequency: 1 to 3 times per week
– Optimum duration: 1 to 2 months
– Acupuncture treatments may be extended if functional
improvement is documented as defined in Section
9792.20(e).
Positive Outcomes of Acupuncture
• The positive outcomes of acupuncture in an Injury
Rehabilitation & Post Operative Pain Program in
Workers Compensation include:
– Pain Management
– Decrease in Pre-Operative Anxiety
– Reduction of Inflammation & Swelling after
surgery
Positive Outcomes of Acupuncture
(cont.)
–
–
–
–
–
–
Reduction of Nausea & Vomiting
Regulation of Digestive function
Reduction of Need for Medication
Reduction of Scar Tissue
Decreased Healing Time
Increased Rates of Full Recovery
When is Acupuncture Typically
Referred?
•
Not just when everything else fails! Acupuncture is
a conservative treatment. It is optimal to use
acupuncture earlier in the course of the condition
rather than later. Though acupuncture can be helpful
as far down the line as post-operation recovery.
Some patients have had physical therapy, cortisone
injections and surgeries before they come to see me.
These are considered chronic and are certainly
harder to return to full work capacity…though some
do significantly still improve.
When is Acupuncture Typically
Referred? (cont.)
•
Better results and more commonly referrals occur
after a round of physical therapy has failed to
produce strong enough benefits. Often people have
pain that is very strong and they are not able to
perform rehabilitative exercises. Other referrals are
patients that are either unable or unwilling to take
pain medications, injections or surgery and wish to
try a more “natural” approach to healing.
Use of Acupuncture for CTS
Causation of Carpal Tunnel Syndrome
Painful neuropathies of the
hand and wrist are from
nerve compression, most
often compression of the
median nerve in the carpal
tunnel.
Use of Acupuncture for CTS (cont.)
Etiology of CTS
Median nerve
compression by tendonitis
Usually due to repetitive
motion of the wrist and
hands.
Use of Acupuncture for CTS (cont.)
Carpal Tunnel Release
Surgery:
Carpal
ligament is
incised…
…releasing pressure on median nerve
Studies on Acupuncture
Mechanisms of Acupuncture:
– Stimulates conduction of electromagnetic signals within the
muscle and soft tissue fibers causing a relaxing within the
soft tissue
– Release neurotransmitters and neurohormones that affect
body function such as digestion and breathing.
– Stimulate blood flow in the body, which is helpful in healing
an injury
– Reduces pain by causing a release of endogenous opiods,
which are pain blockers known as endorphins.
Acupuncture Used for Pain
Management
• There are statistically significant benefits for a
variety of types of pain.
– An extensive study was published in the past few years of
1,162 patients with chronic low back pain that were treated
with acupuncture.
– Researcher Heinz Endres, MD concluded, “Patients
experienced not only reduced pain intensity, but also
reported improvements in the disability that often results
from back pain.”
Acupuncture Used for Pain
Management (cont.)
Findings such as these are important in Workers
Compensation because our main goal is to return
the injured employee to work as quick as possible
with the highest capability of function.
Not All Studies Are Conclusively
Positive
• Acupuncture does not cure everything. There is no
one cure all magic bullet or magic acupuncture
point! Just as there is no one perfect pill or surgery
to cure everything.
* Also Note – There are difficulties in conducting studies of
acupuncture as it does not always fit into our western
research model very well due to difficulties in creating a
double blind placebo study.
Placebo Effect
• This is often said of acupuncture because it does not always fit
into a western notion of medicine that can be studied. Pills,
creams, injections, and other medical procedures, such as
ultrasound are also often called placebos. Even the notion of a
physician and the way they interact with a patient have been
noted as a placebo effect, such as a notably increased healing
time when providing a suggestion that the patient, “will be
better in a few days” rather than negatively stating “I am not
sure if the treatment we are giving you will have an effect.” To
that note; many dogs and horses are given acupuncture with
noticeably beneficial improvement in conditions such as
arthritis, this is obviously not due to their expectations in
treatment.
Acupuncture vs. Narcotics
• 2010 analysis by Accident Fund Holdings reported that the cost
of a workplace injury was 9 times higher when a strong
narcotic like OxyContin was prescribed when compared to a
workplace injury treated with conservative care and no narcotic
pain medication.
• Prescription of narcotic pain medication has expanded greatly
in the last decade, prompting a number of laws now requiring
physicians to utilize conservative care in the form of
acupuncture & physiotherapies to reduce narcotic addiction,
overdose injury and death.
Acupuncture vs. Narcotics (cont.)
• Accident Fund Holdings reported that the cost of a
typical workplace injury, averaged about $13,000,
was tripled when a strong narcotic pain medication
was prescribed instead of utilization of conservative
treatment protocols.
• When the strongest narcotic pain medications were
prescribed, the average cost of workplace injury
increased to 9 times the average.
Acupuncture vs. Narcotics (cont.)
• A course of acupuncture and physiotherapy
of 18 visits would cost roughly $2,000, much
less than the $26,000-$114,000 added on
average when patients are treated with
narcotic pain medications instead.
Case Study #1
52 yr. old female process operator developed tennis elbow due to
repetitive tasks. Pain was bilateral in nature. Tylenol and round
of PT not resolving pain. Pt rated pain 6-8 out of 10 at time of
initial acupuncture evaluation with trouble lifting & holding
objects.
Pt treated with distal acupuncture, infrared heat and given topical
herbal patch at each treatment. By 4th tx pt was improving
slowly and by 6th/final was more than 50% improved. Because
patient continued to gain improvement a second set of acu was
requested. By 9th visit pain was reduced drastically. On reevaluation at last appointment (12th) the patient had 0/10 pain
while working full time and had requested release from care. Pt
referred coworker in similar position at work who still had pain
after cortisone injection for lateral epicondyle region pain.
Case Study #2
39 yo M with left Thoracic pain that extended down toward his lumbar area.
Patient was injured when moving a large heavy bag, he performed a lifting
and twisting motion to the left causing the injury. At time of initial
evaluation the patient was very tense and guarded to touch in area from
mid thoracic through upper lumbar, he had palpable spasm in area as
well. Forward bending and walking provoked pain. He was unable to find
a comfortable position to remain in, especially after he finished work as a
maintenance worker. His sleep was provoked as well. Patient was trying
to continue a full 40 hour work week though even with modifications of
reduced lifting, twisting and bending he was having 9/10 pain level. He
had a grade 3 tenderness to palpation at the evaluation.
By treatment number six the patient’s pain reduced even after working a full
day and was sleeping much more comfortably. Objectively I noticed the
tenderness to palpation had subsided a grade 1-2 and the patient was
much less reactive even when given myofascial release over the injury.
By treatment number six he had only slight residual muscle tightness
remaining and active range of movement was now much more functional
with greater comfort overall in the area.
Case Study #3
52 yr F systems analyst injured from keyboarding. Pain at radial wrist.
Limited capability of flexion/extension of thumb at time of evaluation.
Patient was using thumb and wrist splints to prevent movement of
injured area. Swelling at wrist and TTP was at medium high level. After
course of PT the patient had gained some improvement though was still
sore and had limited ROM. Patient declined cortisone injection and
wished to try acupuncture instead.
Patient rapidly felt improvement in range of motion capabilities and pain
reduction. By 3rd tx active range of motion increased to 90%. At fifth tx
the primary physician stated cortisone injection is not warranted and
ordered a second set of acupuncture to help the patient strengthen as
she remains at full duty in workplace. However approximately twice per
year there is a high volume of letter folding and placing into envelopes
which is highly provocative for her thumb and wrist. This period just
occurred and while it was strenuous to the hands in general patient still
has full AROM and much less provocation than the other periods of such
intense wrist and hand usage. The patient was advised to continue to
use the favorable body mechanics and ergonomics she learned during
her treatments to reduce strain in workplace moving forward.
Conclusion
• Acupuncture can be an effective and less costly way to treat
certain work related injuries. Acupuncture can:
– decrease pain
– decrease inflammation
– promote healing
– regulate the immune and endocrine systems.
– may be used as an adjunct to physical rehabilitation and/or
surgical intervention to hasten functional recovery.
Any Questions?
Thank you!
Brent Dauphin, L.Ac., MTCM
Alliance Occupational Medicine
1901 Monterey Rd. Ste 10 San Jose, CA.
2737 Walsh Ave. Santa Clara, CA.
315 S. Abbott Ave. Milpitas, CA.