This is my story of how I became interested in acupuncture; After I finished medical school in 1983, I studied Family Medicine (FM). Family physicians are on the front line of the Healthcare system. We are taught to be hands-on and use our wits. We systematically take in all the information to arrive at a reasonable diagnosis. Then we follow standard treatment options sanctioned by the medical societies. If the results are not expected we refer to the specialist. The specialists will re-evaluate to confirm or change the diagnosis and modify the treatment plan. The FM doctors and the specialist work together to continue the care plan.
This model of care works for the majority of cases. A small percentage of patients don’t respond appropriately and predictably. I classify these patients as non- responders. These non-responders make obvious the gaps in our understanding of diseases and effective treatments.
In the 1990’s, I was managing a group of patients diagnosed with Fibromyalgia, never really “curing” them just trying to keep them functional in their daily lives. One of these patients tried acupuncture and got great relief from her symptoms. Initially I was shocked that acupuncture out-performed modern medicine. Further investigating piqued my curiosity and I decided to take an acupuncture course.
The acupuncture course was enlightening but also left major gaps in my ability to help patients because of the language barrier. Most of the diagnoses and treatment options were in a foreign language and ideology. For example, a kidney deficiency did not mean the kidneys were failing but rather an “imbalance in the complimenting energies of the body.”
Fortunately I took the pain management module where the text of C. Chan Gunn, MD and 2 volume texts of Travell and Simons were mentioned as must-have references. Upon further study of these doctors, I realized they had taken the ancient languages and myths and translated them into a language I could understand. The circle was complete! Three phenomenal physicians, Janet G. Travell, MD with David G. Simons, MD and C. Chan Gunn, MD had filled the gaps. In the 1940's, Travell/Simons studied to the effects of Lidocaine injections and referred pain. They cataloged the results and published their results in a two volume set of text books. These texts meticulously outline possible treatment options for a multitude of pain syndromes.
All three of these physicians focus their therapy on treating Trigger Points. Trigger Points cause the muscles to shorten pulling joints out of alignment and apply undo pressure on the bone, ligaments, bursas and tendons. The word alignment refers to the natural balance the human body needs and craves. Without balance things don’t work as smoothly, causing stressful points on tissue from bone to muscles and to brain functions.
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What are Myofascial trigger points (TrPs)? TrPs are sick areas of tissue - mostly strands of muscle fibers. You can have TrPs on muscle, tendons and ligaments and even on bone. Any part of the body can be affected, from your scalp causing headaches, to your toes causing bunion pain. Most TrPs will shorten the muscles and cause extra pull on the attachments to the bone and cause arthritic joint changes, spurs, tendonitis and bursitis. TrPs will limit the range of motion of a joint to make one feel stiff and achy. For example, if the quadriceps (the front thigh muscles) are shortened due to TrPs the knee could be pulled out of alignment. This would put added pressures on the patella and the joint itself. The patient would have pain swelling and stiffness. Also, a sick shortened-trigger-point laden muscle will work in a rogue fashion out of step with the other muscles in the group. So the treatment is to rid the muscle of the TrPs. To date there is no medication to treat trigger points. The treatment is a mechanical manipulation of the involved muscles. There are two most common types of TrPs: noisy TrPs and quiet TrPs. The noisy TrPs are always “on,” always singing, always whining giving signals of pain. These are the ones that can awaken you from sleep. The quiet TrPs are most times “off.” They are areas of the muscle that do not like to be moved or touched. They are turned on by a switch or an event. The event can be weather changes, using the muscle, stressful events or just a simple pat on the back. Once turned “on,” the quiet TrPs becomes a noisy TrP. The switch can be turned on for a few seconds to weeks causing a lot of misery.
TrPs can increase in number within muscle tissue and make the muscle behave and feel like belt leather. The leathery muscles will bend needles and not allow penetration. Imagine trying to sew a piece of leather belt. These shortened and stiff muscles make it impossible to bend over or walk without a limp.
How do Trigger Points compare to Tender Points? TrPs are easily with confused “tender points.” Tender points may evolve into TrPs, and TrPs may heal to be less noticeable tender points. Everyone has tender points of some kind. They are the sore areas when mild pressure is applied to them in muscles and bone. Please note that if you push hard enough on bone or muscle, most folks will have pain. The main differences are TrPs cause a pain signal that hurts more and activates muscle activity to cause spasms and shortening. The shortening causes a decrease in the range of motion of the associated joints.
What is Acupuncture? Acupuncture is a word used to describe the use of inserting long, thin needle- like objects in certain points on the body to affect a healing response, coined by the practitioner of Traditional Chinese Medicine (TCM).
What is TCM? A term we give to a strict ancient Chinese medical discipline.
How does acupuncture work? (My personal opinion) It works through two very powerful and simple reproducible processes. 1. When the needle punctures tissue, it causes a minute injury and the tissue bleeds. This injury stirs up the healing or repair cascade/process. The same process as when a scalpel blade cuts through tissue, but on a microscopic scale, so one can think of acupuncture as a type of microscopic "pinhole" surgery. The injured tissue will heal itself. The unhealthy, sick or injured tissue is re-injured to refresh the healing process. The healing process will hopefully purge the tissue of the trigger point laden muscles. It is possible to re-injure the tissue over and over again until the tissue heals correctly without the triggers embedded within the muscles.
2. When the needle enters the muscle, it causes a twitch or reflex response followed by a relaxation and elongation of the muscle. The muscle can elongate anywhere from a few millimeters to inches. This can happen instantaneously, and can often be seen occurring. The twitch and elongation allows the involved muscles relax to perform their job much more smoothly and correctly. Instead of a stiff shortened muscle you have a soft, flexible relaxed muscle working in concert with the other muscles in the group.
2. Simons, Lois S.; Simons, David G.; Travell, Janet G. (1999). Travell & Simons' myofascial pain and dysfunction: the trigger point manual. Baltimore: Williams & Wilkins, 82-86. ISBN 0-683-08363-5.
Why do doctors overlook TrPs as an important cause of pain? Most doctors do not understand trigger points and others do not think TrPs exist. It is not stressed in medical schools or taught in hospital training. So why treat something you do not believe is real and or know anything about. See below the relationship of Trps and Acupuncture points Dorsher's work.
Why don’t these type of acupuncturist order all those fancy tests and scans? Most times, the tests are not necessary and add tremendously to the overall cost of care and add nothing to the treatment process and pain relief. Running tests does buy time to allow the trigger points to heal. But again, this ends up being very expensive time spend waiting.
The same goes for patients with lower back pain, knee pain, or headaches for years, never examined for TrPs!!! This is a grave oversight, that I would consider malpractice.
Why don’t Doctors believe me when I tell them I am in pain? Doctors don’t believe you because of three reasons; lack of time, misunderstanding of TrPs, and an over reliance on tests. To make ends meet, we have to see many more patients than we can really effectively evaluate and manage the patients. So less time is given to an office visit. Remember, the majority of doctors do not believe in TrPs. If physicians don’t believe in TrPs they will not do the appropriate exam. They believe the lab test and the X-ray will prove the diagnosis. They believe that if something is seriously wrong the test will prove it.
Since doctors can not find a problem then their own anxiety and fear pushes them to send their patients to see a more expensive specialist for more costly tests. When the specialist can’t find a treatable cause of the pain, the patient is left with nothing. Patients may have a drawer full of medications that don’t work or cure the pain syndrome.
What is the result of this disbelief? This leads to a war between the patient and the physician. This will lead to the needs of the patients being ignored and unfortunately the physician blames the patients. This victimizes the patients who sink deeper in a pit of despair. Some physicians will think or say: “There is nothing wrong, all your tests are normal”, “this must be in your head” or “what are you doing with all that unnecessary pain medicine? Are you a druggy?” This attitude and ignorance is costing the healthcare system a lot of money and adding to a patient’s misery.
Here is a list of all the things acupuncture can treat: Allergies/Asthma Anxiety/Depression Back/Neck/Shoulder/Knee Pain Arthritis Bladder/Kidney Problems Cough/Bronchitis Gynecological Disorders Headache/Migraine Fatigue High Blood Pressure Sexual Dysfunction Stress/Tension Drug Addiction/Smoking Vision Problems
What makes a good acupuncturist? A good acupuncturist is someone who will listen to understand your unique needs and actually touch you. Not just examine you with the office equipment, but someone who will actually use their hands to examine you.
I was trained to use my ears and hands, the two simplest and most important tools of a physician. The most important tool that a doctor has is his ears, just plain old listening. Most of the time the patient tells me the exact diagnosis! The story of the patient is often all you need to make a diagnosis
A good acupuncturist will actually touch the patient with the second most important physician tool: his hands.
What is Medical acupuncture? Medical Acupuncture is Acupuncture performed by State licensed Medical Doctors.
Traditional Chinese Acupuncture is performed by a State licensed graduate of a School of Acupuncture and are not Medical Doctors. For all practical purpose these two providers are performing a similar procedure. But - they can be 90 degrees differences. The patient will have to decide if they are receiving a benefit toward the resolution of their problem. If they are not, I would advise they try a different provider.
The benefit to me as a licensed MD trained in acupuncture concepts, this allows me and my experiences + the ability to blend in other needling options from the archives of medicine that can break free a stubborn pain case to a cure.
This blending is not just an additional benefit ie 1+1=2. Blending the difference types of needles ie cutting hypodermic needles allows for a multiplying of benefits. 1 + 1 can = 5. Much better than with the thin filament needles.
MDs can use the ultimate therapy tools, The hypodermic needles which have a beveled and cutting tip. Hypodermic intramuscular stimulative needling is the final but most effectiveigniter and activator of natural healing.
The difference in the blunt non-cutting needles and that which can slice through the dense beef-jerky tissues can be a game changer for the patient's recovery.
See prior question.
Why don’t all doctors do acupuncture? Insurance companies do not pay doctors for doing acupuncture. Doctors will rarely do a procedure without getting paid. This becomes a catch 22 for both the insurance company and the patients. Patients pay their insurance premiums in good faith. The insurance companies have learned to get better profits they just limit services. At this point, acupuncture is not a standard covered benefit. Patients pay as much as they can into the health care system and can not afford to pay extra for non-covered services. So patients get worse and see more specialists who order more complicated and expensive tests which cost the insurance company more money.
Why can’t doctors change the system? Doctors are overwhelmed with the day-to-day pressures of running the business of the office, keeping current academically, filling out forms, jumping through the insurance company’s hoops and following the state and local medical board’s regulations. So less time is given to the most important element: our patients and their needs.
How did the medical situation get so far off base? Money and prestige are some reasons. Power and recognition are also involved. The specialists bring in the big dollars to the hospitals, so they are in a better position to control resources. And as such, some specialists view the primary care providers as second-class citizens.
Also, since specialists train the students, interns and residents, the focus is on the specialists. The most important provider is trained to be like a doorman. Say hello, have a quick visit, order a test and punt. Primary care providers are left with only the most basic of care and are programmed to funnel all the high-end care to the specialist.
What is the result of not having an alternative? The result is inappropriate, more expensive care. I have seen patients go to surgery who have NEVER had a thorough muscular-skeletal exam! For example, the correct way to examine the knee is to start at the hip level and check all the way down to just above the ankle. Isn’t that amazing that folks go to surgery on a superficial physical exam and a quick peek at the x-rays!
What is the worst comment the Health Care System (HCS) has told a patient who is in pain? “You have to live with it.” “We have done all that we can do for you.” “It’s all in your head.”
What will change the present system? What may awaken the HCS to this oversight are legal cases and malpractice settlements to patients who are suffering.
How many treatments will I need? It takes about 6 visits to see if this is the right approach, up to 12 to affect a cure. Some patients need a tune-up every so often.
How deep do acupuncture needles go? The needles are inserted anywhere from just barely below the skin in the face to 3 inches in the buttock area.
Why use a needle? Today we use stainless steel needles. In the past, I’m guessing healers used slivers of any material that would penetrate the skin and not harm the tissue. I would imagine healers may have used a sliver of jade, bamboo or ivory from an elephants or whales.
How did these points become known to man? These points were probably well known eons ago by hands-on healers like today’s massage or manipulation therapists. These points have been used and handed down over the course of human existence. Then one of these healers probably used a blunt and then a more pointed/sharper probe to unlock the muscles. Eventually a sharp sliver of material was used to released the muscle and thus affect a healing response.
What about the whole discipline of acupuncture? It is my theory that the whole discipline started from meticulous scientific observation. Practitioners observed therapy and response from needle insertion. Through meticulous documentation, patterns were discovered along with therapeutic results. These findings were cataloged and called Acupuncture. Over time, the findings and results were standardized in such a way that Acupuncture could be taught to the masses.
How were those lines discovered and traced over the body? It's easily observed when doing Acupuncture that patients will say that pain shot this way up or down to another location. The patient noted a connection which the practitioner then cataloged.
Why haven’t modern medicine discovered these relationships? The relationship between acupuncture and trigger points has been studied extensively Peter T. Dorsher, MS, MD, is one on the front lines in this respect. Myofascial Pain: Rediscovery of a 2000-Year-Old Tradition? Peter T. Dorsher, MS, MD (Mayo Clin, Jacksonville, FL), e-mail: email@example.com. Disclosure: P.T. Dorsher, None.
Why is it so hard for modern medicine to disprove or prove Acupuncture? First modern medicine does not want to separate out the "myth" from the raw "science". The myth and mystery of acupuncture will always be open for debate. But even some of the myth really can't be completely disproved because it is about balance, harmony, exercise, nutrition and wellness. The hard science is solid and sound which will not be debunked. The hard science is powerful and it is what I use in my therapy.
How do I choose an acupuncturist? Ask you friends and doctors and make sure the practitioner is certified.
How much does an acupuncture treatment cost? It cost nothing to my patients. Because I am a physician who does acupuncture, it is bundled into the office visit.
Is Acupuncture covered by insurance? Some insurance coverage includes acupuncture, but check with your carrier.
How dangerous is Acupuncture? It is not dangerous at all. In fact, I consider it safer than taking an aspirin!
What do the Acupuncture needles feel like? Do they hurt? Acupuncture needles are very thin, solid and are made from stainless steel. The point is smooth like the nosecone of a rocket (not hollow with cutting edges like a hypodermic needle). Insertion through the skin is not painful like injection or blood sampling. People experience acupuncture needles differently. Most patients feel only minimal pain as the needles are inserted; some feel no pain at all. Once the needles are in place, there is no pain.
Why do I feel the WORSE after a treatment? Mild soreness is common after therapy. An all out flare of the pain is unfortunate and thankfully is not common. Heat, stretching and massage will help to keep the tissue quiet. As the healing process progress, the flaring will be stop. Why does my pain flare up with the least amount of activity? Or …Why does the pain keep coming back after I make such great progress? This means that the tissues are not completely healed and prone to injury. Once the tissues completely heal there will be no flaring of the pain. Depending on how long the tissue has been injured depends on the number of treatments and time it take to complete the healing process.
What about infections? None! It is much safer than getting a shot in the doctor’s office.
Do I have to believe in Acupuncture for it to work? No. Acupuncture is used successfully to treat animals that cannot understand the process or “believe” that it will make them better. A positive attitude towards wellness may reinforce the effects of the treatment received, just as a negative attitude may hinder the effects of Acupuncture or any other treatment. A neutral attitude will not block the treatment results. In fact, Acupuncture works very well for horses, dogs, oxen, and cats, most of who probably don't "believe" in acupuncture, either. It is always beneficial to have confidence in your physician, but faith in a particular technique is not required to obtain results.
Is there side effects? It is quite common with the first couple of treatments to have a sensation of deep relaxation or even mild disorientation immediately following the treatment. These pass within a short time, and never require anything more than a bit of rest to overcome.
Occasionally the original symptoms being treated worsen for a few days, or other general changes in appetite, sleep, bowel or urination patterns, or emotional state may be triggered. These should not cause concern, as they are simply indications that healing is occurring.
What should I do after treatment? It is often helpful to sit quietly following a treatment, and relax. A gentle walk or very mild exercise can also be helpful. Large meals, vigorous exercise, alcohol or excessive aggravation should be avoided.
How should I feel after a treatment? You may feel rather relaxed and calm. If the treatment has been particularly strong, you could feel quite tired or drowsy for a few hours, and you should take this into account if you are planning to drive or use machinery. Occasionally there may be a short-term flair-up of your symptoms as your body balances itself.
What are the risks of Acupuncture? The use of sterile, disposable needles ensures that there is no risk of disease transmission. The needles are very thin and are much smaller than the needles used in the familiar hypodermic injections. The most common complication of treatment is a small bruise or a drop of blood when the needle is removed.
Any medical technique involves some risk. Properly performed, Acupuncture presents minimal hazard when compared to drug regimens or surgical techniques.
Will it be painful? The short answered is no. Acupuncture is not painful but it is not painless. Fifty percent of the time most people don't feel anything. Forty percent of the time they say they feel a little stick. Ten percent of the time people say they feel a little sting. Four percent of the time people may say “ouch.” But only for one out of a hundred needles do some people say that it gave them a zap or zing.
Why are there is zingers? My interpretation of zingers is that the needle activates a super sensitive receptor. These receptors are on high alert for sharp sensation. Once activated they send out a very loud alarm signal…OUCH! Other receptors are on low sensitivity levels. Some receptors may not even fire. Because these receptors are “protectors,” they will alert all the danger or warning symptoms of flight or fight. The pulse rate may increase, hands may get a little clammy, and you may feel dizzy. The patient’s anxiety and fear could prompt me to pause until the patient can relax again.
Is there any relief from this pain of the needle stick and associated anxiety? Yes I have multiple layers of pain relief. First, I have little yellow shot butterfly distractors. These little flat yellow pieces of plastic have low spikes that, when pressed into the skin, give you a sense of pressure which takes away the sting of the needle.
The second layer of comfort comes in the form of a dermal jet, which is an air-fluid injector which injects lidocaine into the skin. It makes a little tiny bump full of numbing medicine and I can place the needle through this little bump. You won't feel a thing.
The third layer of comfort comes is laughing gas. Yes, I have nitrous oxide available to those who are super anxious and need something to calm them down.
Simple Acupuncture is surprisingly comfortable. There is a technique of Intramuscular Injection and/or Intramuscular Stimulation that can be very uncomfortable and in those situations I give pain medicine, tranquilizers, laughing gas, use the air injector, or whatever it might take to make my patients comfortable.
Do you prescribe herbal medicines? I do use a few herbal medicines but I am uncomfortable using them. Herbal medicines are not tested and therefore not regulated. There is no standard of care that one can follow when using herbal medicines. So in these cases, I fall back on my 20 years of experience in modern medicine and I trust the FDA to make sure that quality and safety is monitored.
Is it possible to get better without taking any medications? Yes it is possible in very simple cases but in complex cases we have found that at least some type of medicine is beneficial to the system. In these cases I use traditional medicines like ingredients in recipes. I usually use small amounts chosen specifically for a patient based on the patient’s history, other medications he or she takes, sensitivity and experience.
I don't like taking pills. Why are doctors always suggesting taking pills? If you think of pills as supplements to your diet, then taking them will make sense. Illness is caused by external and internal imbalances. If there is an internal mineral or chemical imbalance that it is necessary for wellness, we must supply it so that your body can incorporate it into the healing process. In that way medicines/pills/herbs are actually foods. Some of my patients think of this food as their daily bread or communion. It is interesting that some of my patients from South East Asia - because of how they use the language - say “I eat the medicine” whereas we say we take the medicine.
Why do insurance companies classify Acupuncture and trigger point injections as surgery? In reality it is like surgery. Surgery is the act of cutting tissue to affect a cure or therapy. The tool we use is not a scalpel but a fine needle. Other terms I might use are: Solid Needle Surgery, Solid Needle Therapy, Fine Needle Surgery, Find Filament Therapy or Find Filament Surgery.
How does acupuncture differ from trigger point injections or cortisone injections? The original reason why physician started doing trigger point injections was to trigger the healing process. Some how the insurance companies would not pay for a simple lidocaine injection some medication had to be injected. And that's when doctors started using steroids. In some cases the steroids can be beneficial. But again somehow in our society we think more is better so that if you inject too much steroids into tissue the tissue will die. It will become atrophied and wither away. I have photographs of areas of the body that have withered away because of steroid use. Can you imagine causing the tissue to wither away around your spine? Your spine will be, very weak and unstable almost guaranteeing the need for some type of stabilizing surgery. Doctors, in my opinion are actually harming patient by injecting steroids in and around the spine.
Why won't Acupuncturists look at my MRI scan? The MRI scans, CAT scans and x-rays are images of internal structures evaluated by specialist with years of training. They are experts and make interpretations in written form. These written reports are then reviewed by the primary physicians who try to make sense of the reports in light of the patient's history and physical. Those expert evaluations can fog judgment and lead one in the wrong direction. That's why it's more important to have first hand information from the patient and from the physician's own hands-on examination. I think this leads to a much more precise diagnosis and plan of action.
My doctor did surgery on me and now he tells me there is nothing left for him to do for me? Some patients have surgery and are not any better and in actuality may be worse. Patients feel as if they have been let down and abandoned. Their spirit and hearts are broken. This is one of the tragedies of the health care system: It victimizes patients and then leaves the patients suffering. The physicians are shocked that they have not cured a problem and have to place blame on the patients for not getting better. When we blame the patients we eliminate any hope of recovering and cause a life to be destroyed.
My orthopedic doctor tells me I will need to get my knee or hip replaced because it is bone on bone. What is this bone on bone arthritis?
The “bone on bone” statement is use by some doctors to interpretation an X-ray meaning that the bones of a joint are rubbing together and thus the joint will require replacement.
In my opinion I consider that a myth. I have not been able to find a corresponding pathological diagnosis in a search of the literature. I do know it is used a lot to prepare patients to have a major orthopedic procedure basis on a simple x-ray. Usually these patients have pain. I advise patients not to have a joint replaced or even back/neck surgery solely because of pain. Pain can be treated with medical acupuncture and thus cured. NOT requiring extensive surgery.
Will you abandon me like the regular health care system? No. My goal is to find the original root of the pain to eliminate that root and thus eliminate the pain. The root is somewhere on your body and we should find it or at the very least keep the pain from growing.
What other tools do you have available to help with my pain? Cold Laser, spray and stretch techniques, massage, range of motion exercises, Acupuncture, trigger point injections, Intramuscular Stimulation, heat therapy, Infrared Heat therapy, electrical stimulation, herbal medicines, and traditional medicines. And last but not least a keen eye, a keen ear and an effective physical exam.
Why are narcotics bad medicines for patients who have chronic non-surgical pain? Three reasons; First it is the problem with dependence to the narcotics. Dependence is the bodies’ ability to tolerate more and more medication until high doses are achieved. In a sense, the medication actually stops controlling the pain. In response to this we increase doses to higher and higher levels. At these levels for long periods the body is more prone to withdraw if the medications are not in the system. The withdrawal can begin in as little as 6-8 hours. So, if a dose of medication is taken at bedtime, by the time the patients eats breakfast the withdrawal start to began, with the shakes, sweats, irritability, nervousness and overwhelming need to take the next dose of medication. The daily withdrawal cycling takes on a life of its own and complicates the entire picture. Doctors then begin to treat the withdrawal symptoms with other medications with additional side effects and within a few months the patients are on 3-4 medication to counter the effects of the narcotics.
Secondly the narcotics distort the exact areas to treat with acupuncture. Again you end up getting distracted by the effects and side effects of the narcotics. So without the narcotics the therapy can be focus and is more effective.
Third, the narcotics shut-down the bodies’ ability to produce its own pain reliever. This natural defense is highly effective and reliable. No side effects, no tolerance and no withdrawals. So once we have made some progress and cooled the hot spots then we will taper off of the narcotics or use on the of the withdrawal blocker like Suboxone or Subutex.
Suboxone and Subutex are given to drug user; won’t the pharmacist think I am a druggy? They might and that is their problem. You can put a little seed into the air by stating your relief at finding a doctor who is willing to treat your pain and move you past the narcotics with this new cutting edge medication. Then give them my card!
What is sham acupuncture?? In my opinion it is impossible to sham or fake acupuncture. The only reason to sham acupuncture is in a clinical trial to prove or disprove the effectiveness. First you would have to test the ineffectiveness of the sham treatment, which is a waste of time. The truth is that it works so it will be around forever!
How can I find a medical acupuncturist in my area to treat me? Search the web for the American Academy of Medical Acupuncture or AAMA.