Posts Tagged ‘chronic pain’
GM, Staten Island
May 13, 2013
I came to Alban Acupuncture a year ago. My major concern was chronic pain in my neck, back and shoulder. I tried physical therapy, chiropractor, massage and acupuncture without lasting results. After a few months of being treated by Joseph, my condition significantly improved. Presently I’m coming once a month to maintain a good shape. I think Joseph’s method is unique because he combines acupuncture with Chinese massage.
Joseph is also helping me with many other problems like palpitations, low energy, stress, seasonal allergies, old knee injury, ankle sprain…
Joseph gives a lot of attention to his patients. His approach is holistic. In the beginning of my visit I tell Joe my current complains and he is addressing them in the same session with my chronic neck/back problems. Overall experience from my visits ( I commute from Staten Island to get there!) is so positive that I’d definitely recommend Alban Acupuncture to my friends.
New Research on Acupuncture for Pain
Sep 12, 2012
Acupuncture is famous for the treatment of chronic pain. Chronic pain is one of the most common health concerns I see in my NYC acupuncture clinic. Back pain, headaches, migraines, shoulder pain, knee pain, neuropathy, arthritis, and other chronic pain conditions. Patients can have profound results.
In the clinic we know acupuncture is effective for pain, but often skeptics are vocal opponents because they believe that there is not enough research.
Recently, a very large analysis of research trials, called a meta-analysis, was published focusing on acupuncture for pain. The meta-analysis shows that acupuncture is effective for the treatment of pain. This was across many pain conditions including back and neck pain, osteoarthritis, chronic headaches, and shoulder pain.
Andrew Vickers PhD, the head author, and his team painstakingly reviewed virtually all of the acupuncture research trials which have focused on pain. They had strict criteria for the quality of the studies to be included in their analysis. In the end, the group used 29 acupuncture studies which included 17922 total patients.
The results of the study showed that acupuncture was much better than no-acupuncture control groups across the studies. The acupuncture was also better than placebo acupuncture across the groups. The difference between real and placebo acupuncture was not as large as the difference between acupuncture and no acupuncture. However, the numbers are large enough to show a real difference between placebo and real acupuncture for pain reduction.
Neck and Shoulder Pain
Jan 23, 2012
Chronic neck and shoulder pain is a very common problem which can occur from overuse, injury, stress, or poor posture. Neck and shoulder pain is often treated with acupuncture (1, 2). Acupuncture treatment often leads to long term pain relief.
For most people, neck and shoulder pain develops over time. At one point, your body was healthy and pain free. However, an injury or chronic stress leads to the development of chronic pain. Acupuncture and Chinese medicine work by bringing the body back to balance. By correcting the imbalance, acupuncture helps the body to heal.
Acupuncture Imbalances Causing Neck and Shoulder Pain
Acupuncture is based on a theory that the pain is caused by an imbalance. When it comes to muscle pain, the acupuncturist must determine if it is a condition of stagnation or deficiency. The treatment will be tailored to that diagnosis.
Stagnation occurs when there is a lack of circulation in the muscles. This impedes the circulation in the acupuncture channels and muscles, which leads to pain. A deficient condition is when there is not enough energy. Then the muscles do not have enough substance to support them, as a result they tense up.
There is an old acupuncture saying which states, “When there is movement, there is no pain. When there is no movement, there is pain.” When there is no circulation and the muscles are tight, pain occurs. This is often caused by stagnation.
Stagnation may develop from an injury, wear and tear, or chronic stress. Chronic stress is one of the most common causes of stagnation, which is why it is easy to develop pain and injuries during periods of high stress.
The other common issue with neck and shoulder pain is qi weakness, or too little energy. In this case, the acupuncture must focus on building up the energy to promote healing.
For an excess condition, your acupuncturist may use a stronger technique, and for a deficient condition, your acupuncturist may use a more gentle technique. If the deficiency is very extreme, then the treatment may be take a longer time.
Acupuncture Treatment for Neck and Shoulder Pain
A successful acupuncture treatment must match the correct identification of an imbalance. Often, the acupuncture treatment will involve acupuncture, electroacupuncture, and tui na.
For the imbalance of stagnation acupuncture points on the neck and shoulders such as Gallbladder 20, Gallbladder 21, Small Intestine 11, and Du 14 may be selected. When the root cause of the shoulder pain is an underlying weakness, then acupuncture points to boost up the qi should be used. These point could be Spleen 6, Kidney 3, and Liver 3. Patients often feel some relief after a few visits. A full treatment course may range from 4-10 visits depending on the severity and complexity of the pain.
Physiological, acupuncture works to reduce pain and inflammation through regulating neural pain pathways, stimulating the release of natural pain relieves in the body, such as opioids, as well as regulating pain relieving opioid receptors. Many studies have also shown acupuncture to have a anti-inflammatory effect, reducing the circulating inflammatory hormones in the blood (3).
Tui Na for Neck and Shoulder Pain
Tui Na, or Chinese medical massage, is also very helpful for treatment of shoulder pain. One of the most powerful and unique techniques in Tui Na is called the rolling technique, called gun fa in Chinese. This technique uses the back of the hand to roll over the muscles. Rolling technique is both soft and strong, allowing it to get deep into the muscle and help with relaxation.
If you push too hard on a muscle, the muscle will rebel. Instead of relaxing, it can become tighter. The rolling technique, because it is smooth, allows the use of strength while avoiding resistance within the muscle.
Treating the Whole Person
Acupuncture will address the whole person, not just the neck and shoulders.
The body is interconnected, tension from one area can create problems in other muscles. Often, trying to target and treat only the location of the pain does not relieve the tension in the surrounding muscle groups. This is particularly true when treating pain in the neck and shoulders. All of the muscles in the region need to be addressed.
Acupuncture helps to relax the body and the mind. Stress and pressure have a profound effect on neck pain development. The stress causes the muscles to become tense. The muscle tension then causes stress, creating a cycle. The acupuncture can help to break this cycle.
References:
1. Sherman KJ, Cherkin DC, Eisenberg DM, et.al. The Practice of Acupuncture: Who Are the Providers and What Do They Do? Ann Fam Med 2005;3:151-158.
2.National Center for Complementary and Alternative Medicine. Acupuncture for Pain. Accessed on 1/23/2012.
3. Napadow V, Ahn A, Longhurst J, et.al. The Status and Future of Acupuncture Mechanism Research. J Altern Complement Med. 2008 September; 14(7): 861–869.
written by: Joseph Alban
Last Edited: 1/23/2012
The Acupuncture Map
Jan 23, 2012
Acupuncture has a powerful ability to address pain all over the body. Often, the acupuncture treatment will focus on areas that are far away from the pain. For example, in Chronic Pelvic Pain Syndrome, the treatment will use many acupuncture points on the arms and legs. This is because the acupuncture channels can be used to reduce pain all along that particular channel.
Acupuncture Channels
I like to think of the acupuncture channels as an map of the body to address pain in specific areas. The acupuncturist will try to locate the area of the pain and determine which acupuncture channel is effected. The most powerful acupuncture treatment will address the acupuncture points for that specific channel.
It is particularly important to focus on the proper acupuncture channel when treating complex chronic pain conditions, such as chronic pelvic pain syndrome. In chronic pelvic pain syndrome, the pain can be located throughout the pelvis, pelvic floor, genitals, hips, lower back, or buttock. Careful examination and precise location of the acupuncture points helps to create a more accurate and effective treatment.
The acupuncture points I select focus on the most effected acupuncture channels. For example, if there is pain and sensitivity on the lower abdomen or near the lower ribs, the GB channel may most effected. In this case, I would uses the acupuncture point GB 34 near the knee. If there is pain in the pelvic floor, the LIV channel is often imbalanced. I may choose points such as LIV 3 or LIV 5 on the lower leg or foot.
Acupuncture points close to the pain
In addition to acupuncture points far from the pain, some powerful acupuncture points will be located close to the pain. For chronic pelvic pain syndrome, many sensitive points are located on the lower abdomen, hips, and pelvis. These acupuncture points may also be used if they are tender or sensitive.
The Body Acupuncture
Jan 17, 2012
Acupuncture can target chronic pain in any location of the body. Sometimes, an acupuncturist will put needles in the place of the pain. But other times an acupuncturist will place needles far away from the location, such as in acupuncture points on the legs and feet for chronic headaches.
The primary way acupuncturists can focus the treatment for chronic pain in specific places because of the acupuncture channels. Acupuncture channels connect different parts of the body and run along different places in the body. The acupuncture channels create a type of map that interconnects different regions of the body.
Large Intesting 4
For example, the Large Intestine acupuncture channel starts on the hand, up the forearm, through the shoulder to the face. This is why LI 4 on the hand can be very effective for frontal and sinus headaches.
On the other hand, the Gall Bladder channel runs from the toes, along the sides of the body, and then to the sides of the head. This is why Gall Bladder 34 near the knee can be effective for headaches on the side or temples.
Auricular acupuncture
Auricular acupuncture, or ear acupuncture, is particularly effective for chronic pain.
In acupuncture, the ear lobe provides a map of the body with points for specific areas and organs.
In ear acupuncture, the best way to target the chronic pain is to find the most sensitive points in the ear for that region and place the needle in that acupuncture point.
Another Look at the Placebo Effect
Dec 12, 2011
For the last 50 years, the placebo effect has been a dirty word. Real interventions make a physiological change in the body. Placebos do nothing but convince the patient that something is different. Reality states otherwise. Ted Katpchuk, an acupuncturist and Chinese medicine doctor who focuses on the placebo effect in his research, wants to change all that.
In last week’s New Yorker, an article focuses on the placebo and the scholars who think about and examine the placebo.
What is a Placebo?
One of the difficult and fundamental questions is what is a placebo? We’ve come to believe a placebo is an inert intervention. A sugar pill.
In most clinical trials of medication, or even with some physical interventions, a group of people with a given condition are given active therapy or medication. The outcomes in this group are compared with a group of people who are given a placebo, but most often are not told which group they are in. Usually both groups improve, even people give the placebo. If the medication is successful, the people on active medication will improve more. The the placebo group improvement is called the placebo effect.
The placebo effect is thought to stem from a belief that a given intervention will help. People convince themselves that the medication is working, and miraculously it does. But the placebo does not change the body physiologically. Or so we thought.
Is the Placebo Inert?
One colossal challenge to the concept of a placebo, is that many studies have shown that a placebo is not inert. Meaning that your body has physiological reactions to taking a placebo. This could mean that belief in a specific drug or intervention actually stimulates your body to heal.
This is particularly true with chronic pain. Early placebo studies have shown that placebo intervention for pain relief actually influence the releases natural pain killers in your brain.
The All Encompassing Placebo
Many of the placebo researchers go further. A placebo is any aspect of a given intervention that may help you feel better, but without a specific physiological interaction with the body. This idea encompasses the whole experience of an individual. The environment of the office, the taste of the pill or tea, and how much the practitioner listens to you. The article even discusses how different colors and shapes of pills have various placebo effects.
A powerful concept in placebo research examines how a given intervention, be it medication, massage, or surgery, is more than simply the intervention itself. For example, my statistics professor at Mount Sinai would often discuss the fact that the clinical trial itself is a placebo. Patients in a clinical trial tend to do better on their medication than the general public. This could be because they feel special, receiving a new medication, being treated by expert doctors with a large staff at their disposal. Then, in the general public, the medications tend to work less well.
Doctor Patient relationship
Kaptchuk would like to explore how best to harness the power of placebos in the healing process. He has focused on the patient doctor interaction as placebo. He even ran a clinical trial of a placebo intervention on IBS where the patients were actually told they were taking a placebo, and that it had clinical efficacy in the past. And amazingly, it worked.
However, this dilemma brings a difficulty with the word placebo. Doctor patient relationship is a skill. A skill that many medical schools have begun to teach, as we loose this skill to technological advances.
Perhaps careful explanation, a caring tone, and an ear to listen can be called a placebo, as it is a non-specific intervention. It is not a chemical pill or an herbal remedy. However, it is also a skill, that can be developed and improved. Kaptchuk would certainly agree with teaching how to wield the healing power of the doctor patient relationship.
Yet, the placebo has a negative tone with the medical establishment, and also much of the population, because we are being fooled into getting better. Perhaps there needs to be a new name for a non-specific intervention.
Placebo: The Social Stigma
What is radical about the placebo idea is that nobody wants to believe that a placebo helps them. And its not just Western medical physicians. Acupuncturists, Chiropractors, and other modalities, as well as patients, fight against the idea that whatever intervention is helping, is a placebo. That means its all in your head.
Kaptchuk and others want to change this stigma. Even if the placebo is all in your head, so what. You feel better. You’re healthier and that’s what counts. But what’s interesting, in some cases, the placebo intervention can actually alter physiology of the body.
A Placebo or Common Sense
A comforting office environment has often be chalked up to placebo. But why would you not want to be comfortable in a doctor’s office with soothing colors and music? It is nerve wrecking enough to go to the doctor. And stress has a real effect on the body. It is just common sense to make the office nice.
I think there is a danger when discussing design of a pill and patient doctor interaction both as placebo because this could reduce the importance of the doctor patient relationship.
Acupuncture itself is an interesting question about the placebo effect. I have a hunch that Kaptchuk believes that acupuncture has a real physiological effect, as he has been involved in many studies comparing acupuncture physiology to placebo physiology, and there is often a difference. But it is not discussed in the article, because the point is that it helps people feel better.
Harnessing the Placebo
The field of studying the placebo itself is young. It questions central tenets to clinical research and shows that our bodies can physically heal ourselves of certain chronic conditions. We do not just react to medication, but also to caring, touch, and the environment.
Like much of good science, these studies bring up more questions than they answer. What is the most important aspect of placebo to focus on. Soft voice, listening to the patient, the examination. Or is it the office lighting, soft colors, and music. As the definition expands, the concept of the placebo can encompass almost anything.
Probably the best way to harness the power of many aspects of the placebo is by not calling it a placebo. Doctor patient relationship, a comforting healing environment, and physical touch are all words that don’t have the placebo stigma. These all help the patient get better, which is what is most important.
Lack of social acceptance in the public and medical community is a challenge that the research will not be able to overcome.
images: erix
Tension Headaches
Nov 28, 2011
Tension headaches are the most common type of headache. Everyone gets them from time to time, but in some it may become chronic. There is no need to suffer, acupuncture can treat your headaches and help you feel better.
You probably know when you have a tension headache. It is usually a dull aching pain that can come from being stressed out, upset, too tired, overworked, or stared at your computer too long.
There is often accompanied with tension of the neck muscles, pressure in the forehead, temples, or base of the skull.
For most people, the headache will last a few minutes to a few hours, but some have chronic headaches which occur for a long time. Severe chronic headache suffers can have it for more than a few days or months. Most cases are not an emergency, but if you experience an abrupt severe headache with a feeling of a snap in you head or if you headache is accompanied by a fever or trauma, you should go to the emergency room.
How does Acupuncture approach headaches?
Acupuncture and Chinese medicine work by addressing imbalances in the body. Once the imbalance is corrected, the body works to heal itself.
Each person’s imbalance can be different. The treatment is tailored specifically to your symptoms and complaints.
When it comes to chronic pain conditions, it is important to consider both the mind and the body, which effect one another. Chinese medicine is quite specific about this, and each organ is effected by different emotions.
Often with headaches, the diagnosis can be associated with imbalances in the body’s energy, or qi. Qi is the body’s energy (Qi is pronounced “chee,” and is sometimes spelled “chi.”).
In Chinese medicine, it is said “When the qi flows there is no pain, when qi stops, there is pain and illness.” When qi circulation is damaged, it is called qi stagnation. This can often happen from stress and anxiety. There can also be too little qi, what we call qi vacuity.
Acupuncture Treatment of Headaches
Acupuncture works to correct the imbalance causing the qi stagnation. An effective acupuncture treatment is based upon a specific and accurate diagnosis. The acupuncture point selection is tailored to the patients imbalance. For example, if there is qi vacuity, we may focus on the acupuncture points Kidney 3, Spleen 9, and Lung 5. But if it is based in qi stagnation, the the acupuncture points liver 3, Large Inesting 4, and Gall Bladder 34 may be selected.
Also combining acupressure with the acupuncture helps to relieve the muscle tension also associated with the tension headaches. Usually people will feel relief after only a few weekly visits.
Physiological, acupuncture works to reduce pain and inflammation through regulating neural pain pathways, stimulating the release of natural pain relievers in the body, such as opioids, as well as regulating pain relieving opioid receptors.
Acupuncture is also very relaxing. Most people feel very calm during the treatment and after the acupuncture treatment. This is because acupuncture does not separate the body and the mind. The mind influences the body, and the body influences the mind. So in treating the body we also relax the mind.
written by Joseph Alban
Last Edited 11/14/2011
Acupuncture for Chronic Pain
Oct 28, 2011
Chronic pain is mysterious. It can come and go. It can get worse, or get better. Often without explanation.
Chronic pain is serious. It interferes with work, school, and relationships. Chronic pain is the most common issue that comes into my acupuncture clinic. Pain can effect almost any place in the body: headaches, back pain, shoulder pain, neck pain, knee pain, and any other location.
Acupuncture for Chronic Pain
Acupuncture is a complex therapy and works in a combination of ways to reduce pain and inflammation.
Acupuncture works to reduce pain and inflammation through regulating neural pain pathways, stimulating the release of natural pain relieves in the body, such as opioids, as well as regulating pain relieving opioid receptors.
Many studies have also shown acupuncture to have a anti-inflammatory effect, reducing the circulating inflammatory hormones in the blood, such as cortisol. Interestingly, many of the hormonal and neural effects last long after the acupuncture treatment has finished, suggesting that acupuncture has both immediate and long term regulatory effective in reducing pain.
What is the acupuncture needle doing?
We also can think about what the acupuncture needle itself is doing. When inserting a needle, the muscles near the acupuncture needle or along the acupuncture channel will often twitch. Many scientists have looked at this “twitch response” which can change the inflammatory mediators in the area of the acupuncture point. This could point to a mechanism related to local pain reduction.
Connective tissue stimulation is another possible mechanisms for pain relief that the acupuncture needle site.
Acupuncturists will twirl the needle many times during the treatment. Researchers have shown that this stimulates subcutaneous loose connective tissue. Helene Langevin, the remarkable researcher who discovered this, writes, “Fibroblasts (the cells) within the loose connective tissue respond to the mechanical stimulation with active cytoskeletal remodeling that may have important downstream effects within connective tissue.”
We do not know the specific clinical effects of the connective tissue responses. But Langevin believes these results may eventually lead to an explanation of the acupuncture channel circulation and connecting the body.
The next steps in acupuncture research will look to understand how these complex mechanisms work together for long lasting pain relief.
References
Napadow V, Ahn A, Longhurst J, et.al. The Status and Future of Acupuncture Mechanism Research. J Altern Complement Med. 2008 September; 14(7): 861–869.
Langevin HM, Churchill DL, Wu J. Et. al. Evidence of Connective Tissue Involvement in Acupuncture. FASEB Journal. April 10, 2002. Published Online.
National Center for Complementary and Alternative Medicine Website. Acupuncture for Pain. Accessed 4/30/2013.
photo: Wikipedia
Back Pain after a Car Accident
Sep 27, 2011
Chronic back pain and neck pain often develops after a car accident. It can happen directly after the accident or gradually over a period of time. Sometimes, people with chronic neck and back pain just doesn’t seem to get better, no matter what they try, even if there are no findings on the x-rays and MRI tests.
Acupuncture is very effective at reducing chronic back pain after a car accident.
In acupuncture and Traditional Chinese Medicine the concept of circulation is unique and can be the reason acupuncture works when other therapies do not.
Acupuncture Channels
Acupuncture Meridians
The body is interconnected by acupuncture channels and meridians. These connect and protect the body. An injury or car accident causes a disruption in the circulation through the acupuncture meridians.
When there is Movement, There is No Pain
Acupuncture and Chinese medicine have a concept called qi and blood stagnation. That means that the accident and injury has lead to lack of circulation in the meridians, as well as the muscles. This lack of circulation causes the pain.
Acupuncture, electro-acupuncture, acupressure, and cupping helps to correct this disruption has to be corrected in order for the body to heal and the pain to recede.
Please note, while acupuncture is very helpful for treating the chronic pain, it is very important to go to a physician or the emergency room after the accident.
If you have questions about acupuncture for chronic back pain, please e-mail or call us 917-887-4946 to make an appointment.
Why the VA should hire Acupuncturists
Mar 18, 2009
Last week on The Brian Leher Show, he interviewed Paul Rieckhoff of Iraqi and Afganistan Veterans of America. It was a powerful and moving discussion about taking care of our veterans as they come back from their experiences overseas.
It got me thinking about how the VA should hire licensed acupuncturist to help these men and women recover mentally and physically. I volunteer with an organization called CRREW which offers low cost acupuncture in the University Settlement in NYC. It began in order to help victims of 9/11.
We only volunteer one evening a week, but it had powerful effects on the community. This needs to be expanded to make a real difference.
Licensed acupuncture are good at treating all types of health problems, and we are inexpensive at that. It would be revolutionary for the VA to hire acupuncturists across the country. This would help people to reduce pain, improve rehabilitation, and mental health.
Ear Acupuncture Model
1. A recent study showed that acupuncture can help in the treatment of PTSD. Incorporating auricular (ear) acupuncture is extremely low cost and effective, and can help a lot of people at the same time in a group treatment.
2. Acupuncture is widely used for chronic pain. Veterans often have chronic pain which is poorly controlled with medications or which can leads to addictions of medications. Acupuncture is safe and non-addictive.
3. Best of all, acupuncture is affordable. We do not use expensive tests or equipment, it really only costs the salary of the acupuncturist and the needles.
Let’s start thinking about public health and provide acupuncture for our Veterans who are returning home.
Follow Up: At the time of writing this, I knew of a few acupuncturists who were volunteering or working with acupuncture students in a VA in Upstate NY, but never a full time or per diem position. Since I published this post, a few people contacted me saying there was an acupuncturist at the VA (I assume in NYC), but they did not provide the contact information. If there is an acupuncturist in the NYC VA, or another VA, please let me know and I will post your contact information.
Photo: Pelikanol
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