Posts Tagged ‘Chronic Pelvic Pain Syndrome’
Mar 6, 2012
I wanted to share recent article in BJUI which I am interviewed about integrative urology and acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome. Acupuncture is gaining acceptance in urology.
Feb 29, 2012
Patients in my New York Acupuncture clinic are always curious how acupuncturists choose the correct acupuncture points. There are a number of ways to choose the acupuncture points.
The basic idea with acupuncture is to correct the underlying imbalance in the body. This can help to stimulate the body to heal itself. We acupuncturists will determine the imbalance by our examination. For example, if there is lack of circulation of the energy, what we call qi stagnation, we’ll choose points to move the qi. A common combination for moving the qi is Liv 3 and LI 4.
I find that acupuncture is most effective by changing the focus of the treatment overtime. At first, we may focus on releasing tension in the muscles, this is called moving qi and blood stagnation. But over time it may become more important to focus on boosting up the qi to support the overall health. This is often true in the acupuncture treatment of chronic prostatitis.
There are also points which are chosen based on the location of the illness. Pain on the urinary bladder channel ,which travels up the back, can be treated with acupuncture points on the urinary bladder channel located on the legs such as UB 40 or UB 60. These points can help with the treatment of chronic pelvic pain syndrome, chronic low back pain, and sciatica.
Acupuncturists will also search out for specifically painful areas at the location of the pain. In Chinese these are called ashi points. In English this means “ouch points.” Often, they may be referred to as trigger points in the West. Acupuncture will help to release these areas of pain to relax the muscle, increase circulation, and reduce pain. Trigger points are very important in the acupuncture treatment of chronic prostatitis/chronic pelvic pain syndrome.
Acupuncturists also may use a specific point because we know that it is clinically effective. For example, using PC 6 acupuncture point for nausea has been shown time and time again to reduce many types of nausea. Because we know this works through clinical experience, we call this an empirical point.
Every acupuncturist has their own style. We develop these through training, our personal interests, and clinical experience.
Feb 6, 2012
The art of electro-acupuncture is in the details of how one uses the therapy. An effective electro-acupuncture treatment comes from what electric stimulation machine is used, proper selection of acupuncture points, how long you use the stimulation, and the proper frequency.
In our New York City Acupuncture clinic, we use the Pantheon Research microstim machine. This is one the highest quality machines ensure a safe and effective treatment. Microstim means that the amplitude of the electric stimulation is much smaller. This is much more comfortable for the patient.
Acupuncture Point Selection
Selecting the best acupuncture points is important when using the electro-acupuncture. The acupuncture points should be chosen based upon the type of pain, the location of pain, and the muscle tightness.
This is particularly important when using acupuncture for shoulder pain. For example, if there is an acute shoulder pain with a tight knot on the corner of the shoulder blade or on the apex of the shoulder, then the leads can be placed on acupuncture points surround the area of pain.
If the spasm is very reactive to pressure, the muscle will resist too much stimulation. In that case, the leads should be placed on the acupuncture points along the effected acupuncture channel a little distance from the pain.
What is the optimal duration for electro-acupuncture?
The optimal time for electro acupuncture pain relief is 20 minutes. My preference is to perform electro acupuncture for 20 minutes. Afterwards, twirl the acupuncture needles to stimulate them and continue with 15 minutes more of regular acupuncture. This helps to get the pain relief and anti-inflammatory effects of both the electro acupuncture and regular acupuncture.
What is the best frequency for electro-acupuncture?
The lower frequencies of electo-acupuncture, such 2hz, 4 hz, or 10hz, can address both pain and inflammation. Most of the time, I use 4hz or 10hz, for most joint pain. These low frequencies can also be useful for insomnia and anxiety in some people.
Is there is chronic muscle tightness that is causing pain, the higher electro-acupuncture frequencies can sometime be effective. In my last post I wrote about electro-acupuncture for a patient with Chronic Pelvic Pain Syndrome.
Jan 30, 2012
Acupuncture is a constantly evolving art. Electro-acupunctrue was only developed within the last 100 years. Electro-acupuncture is used to augment the pain relieving and anti-inflammatory aspects of acupuncture
Electro-acupuncture is very similar to regular acupuncture. That is the acupuncture point selection is generally the same and the treatment time is also similar. Electro-acupuncture provides additional small amount electric stimulation to the acupuncture needles. The electric stimulation enhances muscle relaxation, the release of natural pain killers in the body, as well as decreases inflammation.
Electro-acupuncture is most often used for chronic pain and inflammatory conditions. The pain relief with electro-acupuncture can be so dramatic it has been used for certain types of surgery in China.
History of Electro-acupuncture
Electro-acupuncture for pain, much like other medical discoveries, was somewhat of an accident. In the early 20th century, acupuncture doctors were looking for a way to enhance bone healing by adding electrical current to an acupuncture treatment.
While it did not speed the bone healing, the physicians found it worked wonderfully for pain relief. A new therapy in the long history of acupuncture was born.
How to use Electro-acupuncture
There are many choices when using the electroacupuncture. This is where the art and skill of the acupuncture technique comes into play.
The first is what points to put the leads on. Each lead has 2 clips. You can put them on two acupuncture points that are relatively close together if you want to focus on relaxing a specific region of the body, such as the lower back. Or you can put them farther away if you want to increase circulation in the channels. It is important to place the leads ipsilaterally, that is only one side of the body and not cross the spine.
Then one chooses the frequency. Generally, I use a lower frequency between 4hz and 10hz. This is because the low frequency has been shown to decrease both pain and inflammation (1). The higher frequency, such as 100hz or 200 hz can be powerful for reducing pain, but not as much reduction of inflammation.
After the points and the frequency for electro-acupuncture have been selected I will turn the simulator on. We gradually increase the amplitude of the each lead until the patient gently feels a light tapping. The body generally adjusts and you feel the tapping only for a few minutes.
Success is in the details: How to select frequency
Frequencies can be changed in order to focus on different types of pain. This can be useful for a short stimulation for acute muscle spasm. Or it can help someone who has been experiencing chronic pain with persistent pain or partial relief some lower frequencies, I will use a higher frequencies of electro-acupuncture to stop the pain.
For example, recently I was working with a patient with chronic pelvic pain syndrome. After 2 months of treatment with acupuncture and electro-acupuncture, we were able to reduce the pain to less than half of the initial pain levels. But there was a persistent low level of pain remaining.
I changed from low frequency to high level frequency electro-acupuncture at 200hz on lower back and pelvic regions using acupuncture points such as Bladder 23, Bladder 35, and Gall Bladder 30 for 10 minute treatment. After 3 weeks of this additional treatment, the pain was reduced to almost nothing.
1. Lixin Lao section on electro-acupuncture for pain relief in review article. For full article, please see
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.
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.
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.
Jan 9, 2012
The Meaning of Zhen Jiu ( 针灸)
Acupuncture is not just acupuncture. In fact, the word for acupuncture in Chinese, Zhen Jiu, actually translates to “acupuncture and moxibustion” which shows how central moxibustion is within acupuncture.
Moxibustion is the warming of acupuncture points or needles. Most often, this is done through burning an herb called mugwort. It can also be done with heat lamps as well as herbal lotions.
In my office, we use smokeless moxibustion because it is treated and does not create much smoke.
How does Moxibustion work?
Just like with acupuncture, moxibustion focuses on correcting the underlying imbalance in the body.
Because it is warming, generally moxibustion is used when there is cold in the body. Moxibustion can help to warm the body and add qi as well. The warmth also helps to increase circulation.
Boosting the Qi
There is a tradition that one can use moxibustion on the acupuncture point Stomach 36 for 100 consecutive days in order to boost the body’s qi. I think this therapy is particularly effective for those with poor digestion or asthma due to low energy.
Dec 29, 2011
What does acupuncture treat?
During the past year I have been adding a section to my website focusing on the commonly treated conditions in my clinic. It is not yet comprehensive, but over the next few months I will continue to build this section. Currently, I have a number of in depth articles detailing the acupuncture treatment.
- Acupuncture and Traditional Chinese Medicine for Eczema
- Acupuncture and Traditional Chinese Medicine for Psoriasis
- Acupuncture for Chronic Prostatitis and Chronic Pelvic Pain Syndrome
- Acupuncture for Interstitial Cystitis
Oct 1, 2011
Men with Chronic Pelvic Pain Syndrome (CPPS), or Chronic Prostatitis Category III, suffer from pelvic pain, painful, frequent, urgent, or difficult urination, as well as sexual dysfunction. The pain can be intense or dull and is generally located in the between the testicles and anus, in the penis, scrotum, lower back, or the lower abdomen. These symptoms can be severe and affect all aspects of your life, resulting in depression, lost work and educational opportunities, and trouble in relationships. CPPS is the most common form of chronic prostatitis.
What Causes Chronic Pelvic Pain Syndrome?
The exact cause of Chronic Pelvic Pain Syndrome is not entirely understood. Prostatitis was originally thought to be caused by inflammation caused by a bacterial infection. But many men have symptoms without an infection (1) Some men who have CPPS symptoms do not even have any inflammation. Some physicians believe that CPPS may be caused by referred pain from muscle tightness in the pelvis and back, contracture of smooth muscle such as the bladder, emotional stress, and inflammation after an infection. Intrapelvic congestion of fluids may also be a factor (2).
How does acupuncture help treat Chronic Pelvic Pain Syndrome?
Treating CPPS requires a holistic approach addressing that naturally corrects the underlying cause of the pain and distress. Acupuncture and Chinese medicine provide a holistic approach to healing and are effective treatments to relieve the pain, improve sexual function, and decrease urinary problems, as well as relief depression associated with Chronic Pelvic Pain Syndrome. Acupuncture is also a natural treatment, so as opposed to many of the medications for CPPS, there are very few side effects.
In fact, Chinese medicine’s 2000 years of history could possibly make it the most used treatment for Chronic Pelvic Pain Syndrome of all time. In one of Chinese medicine’s earliest text called Elementary Questions, TCM has described the diagnosis and treatment many syndromes characterized by painful, frequent, and urgent urination with pain and distention of the lower abdomen and pelvis (3). Of course, this syndrome was not called Chronic Pelvic Pain Syndrome or Chronic Prostatitis at the time. But the practice of Chinese medicine has shown that those same principles of diagnosis and treatment are effective when applied to the symptoms caused by Chronic Pelvic Pain Syndrome.
Traditional Chinese Medicine has a holistic approach to diagnosis and treatment, identifying specific imbalances in the body and using acupuncture, Chinese herbs, and acupressure to correct them. Correcting the imbalance does not just treat the symptoms or mask the condition, but rather corrects the root of the problem by encouraging self-healing of the body. Generally, the root cause of painful urination, voiding difficulties, and depression is an imbalance of the body’s vital energy, or qi. The two most common imbalances in qi that cause CPPS are when there is too little qi or when the qi circulation becomes impaired. One way acupuncture and Chinese herbs work is by helping to improve the circulation and the amount of qi.
Those with too little qi may experience the symptoms of poor digestion, bloating, loose and sticky stools, fatigue, shortness of breath, sinus headaches, soft voice, cold limbs, a weak pulse, and pale tongue. Qi stagnation, when the qi is not circulating well, can also cause pain. Those with qi stagnation will often get a cold after a stressful or emotional situation. They also may be prone to headaches, irregular bowel movements, ribside pain, irritability, anger, and depression.
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. Many studies have also shown acupuncture to have a anti-inflammatory effect, reducing the circulating inflammatory hormones in the blood (4).
What is the Acupuncture and Chinese Medicine treatment like for Chronic Pelvic Pain Syndrome?
Chinese medicine works best as a combination therapy that includes acupuncture, tui na (acupressure), and other therapies such as cupping. Chinese herbs are also effective and may be required for certain people. Acupuncture diagnosis and treatment focuses on identifying the specific root imbalance causing the condition and tailoring the treatment for you.
During the first visit, I will complete a medical history and an in depth physical examination, which focuses on an examination of acupuncture points and trigger points of the hips and pelvis. This information creates the picture of the specific imbalance causing the problem.
Acupuncture is most effective through a treatment course. The treatment should decrease pain and urinary complaints, and improvement in sexual function. Many men find rapid relief, within a week or two of beginning the treatment. For others, it may take longer to have an effect. Generally, patients come in for acupuncture once to twice a week depending on the severity, and gradually get acupuncture less frequently. The treatment generally lasts 3-4 months.
The pain and other symptoms are gradually lessened. It is like peeling off the layers of an onion until you correct the root cause of the problem. The results are usually long lasting and patents have few symptoms.
Read More about Acupuncture for Chronic Prostatitis and Chronic Pelvic Pain Syndrome:
- Electro-acupuncture for Chronic Prostatitis
- Chronic Pelvic Pain Syndrome: Chronic Prostatitis without an Infection
- Research on Acupuncture for Chronic Prostatitis
1. Chronic Prostatitis/Chronic Pelvic Pain Syndrome (Current Clinical Urology). Daniel A. Shoskes (ed.) Humama, Totowa, NJ. 2008.
2. Honjo H, Kamoi K., Naya Y, et al. The Effects if Acupuncture for Chronic Pelvic Pain Syndrome with Intravenous Congestion: Preliminary Results. International Journal of Urology. 2004 Aug; 11(8): 607-612.
3. Wiseman N, Feng Y. A Practical Dictionary of Chinese Medicine. Brookline, MA: Paradigm; 1998:583.
4. 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.
Mar 3, 2011
I was taken back a bit. “Yes, I love being an acupuncturist.”
“Why?” She asks.
So I thought about it for a second. I thought about how I love that acupuncture works with the body to heal itself, that it focuses on resetting the body to bring it back to balance, and I love that patients can create their own tool box of techniques to participate in their own healing.
But then I thought for another second. “ I love being an acupuncturist because acupuncture and Chinese medicine can change my patients lives.”
Chronic pain and illness can change your life.
And whether it is a person with terribly itchy and dry skin from eczema, or someone suffering from painful bladder syndrome/chronic pelvic pain syndrome, or with chronic back and shoulder pain, or someone with chronic migraines and headaches, finding relief helps to improve their quality of life.
I love that as an acupuncturist I can help people feel better.
Jan 21, 2011
Integrative urology is essential. The field of integrative medicine is about how to best combine mainstream medicine and alternative medicine. It is essential because many people live with urologic conditions, such as chronic pelvic pain syndrome, chronic prostatitis, interstitial cystitis, and overactive bladder, without help. This impacts their work, education, social life, and overall wellbeing.
I have helped many people with these conditions in my New York acupuncture clinic. The acupuncture and Chinese medicine approach works to correct imbalances that are causing the condition. Mostly, urologic conditions are caused from inhibition of circulation and weakness of energy.
Here are the best posts about how acupuncture can help interstitial cystitis, chronic pelvic pain syndrome, chronic prostatitis, overactive bladder, and recovery from prostate cancer surgery.
- What is Interstitial Cystitis?
- Acupuncture’s Approach for Interstital Cystitis
- Acupuncture for Interstital Cystitis
Chronic Pelvic Pain Syndrome
- More Research on Acupuncture for Chronic Pelvic Pain Syndrome
- Electroacupuncture works for Chronic Pelvic Pain Syndrome
- Chronic Prostatitis Without and Infection
- Acupuncture for Chronic Prostatitis and Chronic Pelvic Pain Syndrome
Incontinence following Prostate Cancer Surgery