It’s Official: Acupuncture Doctor Approved

The American College of Physicians formally recommends acupuncture for the treatment of back pain. Published in the prestigious Annals of Internal Medicine, clinical guidelines were developed by the American College of Physicians (ACP) to present recommendations based on evidence. Citing quality evidence in modern research, the ACP notes that nonpharmacologic treatment with acupuncture for the treatment of chronic low back pain is recommended. The official grade by the ACP is a “strong recommendation.” [1]

A major goal of the recommendation is for acupuncture and other nonpharmacological therapies to replace drug therapy as a primary source of pain relief. Treatment with opioids is only recommended, with an official “weak recommendation,” when other modalities do not provide adequate relief. A strong recommendation is also made by the American College of Physicians for the treatment of both acute and subacute lower back pain with heat, massage, acupuncture, and spinal manipulation. [2] The recommendations were approved by the ACP Board of Regents and involves evidence based recommendations from doctors at the Penn Health System (Philadelphia, Pennsylvania), Minneapolis Veterans Affairs Medical Center (Minnesota), and the Yale School of Medicine (New Haven, Connecticut). 

The American College of Physicians notes that approximately 25% of USA adults have had, at the very minimum, a one day lower back pain episode within the past three months. The socioeconomic impact of lower back pain in the USA was approximately $100 billion in the year 2006 . The costs include medical care and indirect costs due to lost wages and declines in productivity. [3] Recommendations for treatment options, including those for the use of acupuncture, include considerations of positive medical patient outcomes, the total number of back pain episodes, duration between episodes, alleviation of lower back pain, improvement in function of the back, and work disability reductions. Recommendations are for both radicular and nonradicular lower back pain.

The target audience for the American College of Physicians recommendations includes all doctors, other clinicians, and the adult population with lower back pain. The ACP notes, “Moderate-quality evidence showed that acupuncture was associated with moderately lower pain intensity and improved function compared with no acupuncture at the end of treatment .” [4] In agreement, the National Institute of Neurological Disorders and Stroke (National Institutes of Health) notes that acupuncture is an effective treatment modality for the relief of chronic lower back pain. [5]

These findings are consistent with those published in Mayo Clinic proceedings finding that acupuncture is effective for the treatment of lower back pain. The same Mayo Clinic report notes that acupuncture does not cause any significant adverse effects. [6] The Mayo Clinic findings apply to both nociceptive and non-nociceptive pain. Nociceptive back pain includes musculoskeletal inflammation and pain involving nerve cells wherein nociceptors are activated. Nociceptors are afferent neurons in the skin, muscles, joints, and other areas. For example, nerve impingement (often referred to as a “pinched nerve”) produces one type of nociceptive pain.

Non-nociceptive pain does not involve inflammation and is more relevant to pain processing in the central nervous system. One type of non-nociceptive pain condition is fibromyalgia and acupuncture has been confirmed as an effective treatment modality for this condition. The Mayo Clinic proceedings note, “Martin et al. found a significant improvement between electroacupuncture vs sham electroacupuncture. Differences were seen on the Fibromyalgia Impact Questionnaire (FIQ) scores for fatigue and anxiety.” [7]

Learn more about how to alleviate fibromyalgia related pain in the acupuncture continuing education course entitled Fibromyalgia Syndrome Treatments. Click the following to learn more:

Fibromyalgia Online Course >
 

The Mayo Clinic and American College of Physicians findings are consistent with additional quality research. Memorial Sloan Kettering Cancer Center (New York) and University of York (United Kingdom) researchers note “We have provided the most robust evidence from high-quality trials on acupuncture for chronic pain. The synthesis of high-quality IPD found that acupuncture was more effective than both usual care and sham acupuncture. Acupuncture is one of the more clinically effective physical therapies for osteoarthritis and is also cost-effective if only high-quality trials are analysed.” [8]

Doctors understand the true need for effective pain management. Nonpharmacological solutions are important for a variety of reasons including prevention of addiction, effective relief of pain, and prevention of adverse effects. This is often of heightened concern during pregnancy and for children. As a result, university hospitals integrate acupuncture into usual care settings to improve patient outcomes. For example, pediatric doctors at the UCSF Benioff Children’s Hospital San Francisco provide acupuncture to children, including non-needle laser acupuncture. At the University of California hospital, acupuncture is made available for both inpatients and outpatients. Dr. Kim notes that acupuncture reduces nausea up to 70%. She adds that acupuncture is also effective for significant reductions in post-surgical pain and chronic headaches. [9]

Recently, researchers have discovered how acupuncture stops pain and provides other forms of relief for patients. Breakthrough research conducted by University of South Florida (Tampa) and Fujian University of Traditional Chinese Medicine (Fuzhou) researchers documents how acupuncture stops pain. The researchers note, “acupuncture exerts a remarkable analgesic effect on SCI [spinal cord injury] by also inhibiting production of microglial cells through attenuation of p38MAPK and ERK activation.” [10]

Microglia are central nervous system immunity cells that secrete proinflammatory and neurotoxic mediators. Acupuncture reduces pain by attenuating this response. The researchers also document that acupuncture provides neuroprotection. The researchers note that acupuncture prevents brain damage in the hippocampus by “preventing microglial activation.” The University of South Florida members of the research team were from the Department of Neurosurgery and Brain Repair and the Department of Pharmaceutical Sciences. Funding was provided by the United States Department of Defense, University of South Florida Neurosurgery and Brain Repair, and the James and Esther King Biomedical Research Foundation.

The aforementioned research reveals an important biochemical mechanism involved in acupuncture’s ability to alleviate pain and reduce harmful inflammation. Researchers focus on other mechanisms activated by administration of acupuncture treatments. For example, laboratory investigations reveal how acupuncture regulates blood pressure.

University of California (Irvine) researchers find acupuncture effective for the treatment of high blood pressure. In a controlled laboratory study, University of California researchers have proven that electroacupuncture at acupoint ST36 (Zusanli) promotes enkephalin production, which dampens proinflammatory excitatory responses from the sympathetic nervous system that cause hypertension. Specifically, electroacupuncture regulates preproenkephalin gene expression, a precursor substance that encodes proenkephalin, which then stimulates the production of enkephalin. [11]

The formal recommendation for the use of acupuncture in cases of lower back pain by the American College of Physicians is based on modern research. Mayo Clinic findings and research from the Memorial Sloan Kettering Cancer Center (New York) and the University of York support this recommendation. In response to the needs of patients, doctors have already implemented acupuncture into several hospitals throughout the USA and both inpatient and outpatient acupuncture treatments are available.

Now, modern scientific investigations reveal how acupuncture works. University of South Florida and Fujian University of Traditional Chinese Medicine researchers confirm acupuncture’s ability to attenuate microglial activation. University of California researchers have quantified acupuncture’s ability to control inflammation by regulating enkephalins. In addition, the NCCAOM (National Certification Commission for Acupuncture and Oriental Medicine) provides professional certification for acupuncturists, which ensures standards of excellence for licensed acupuncturists. Given the large body of supportive research and the administrative support for providing safe and effective acupuncture to the general public, expect to see greater implementation of acupuncture into usual care settings.

Accessibility to care is dependent upon both availability and financial capabilities. Insurance companies have been providing health insurance coverage for acupuncture for decades. Cigna, Blue Cross, Blue Shield, AETNA, United Healthcare, and many other insurance companies provide reimbursement to patients for use of services by licensed acupuncturists. The level of coverage varies, largely dependent upon individual health insurance policy provisions. Licensed acupuncturists can learn more about providing coverage for their patients in the continuing education course entitled Acupuncture Insurance Billing #1. This basic introductory course covers diagnostic requirements, including ICD-10 coding, and other important procedural requirements necessary to obtain reimbursements for patient care.
 

References
1. Qaseem, Amir, Timothy J. Wilt, Robert M. McLean, and Mary Ann Forciea. "Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of PhysiciansNoninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain." Annals of Internal Medicine (2017).
2. Qaseem, et al. Annals of Internal Medicine (2017).

3. Katz J.N. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences.J Bone Joint Surg Am200688 Suppl 2214.
4. Lam M. Galvin R. Curry P. Effectiveness of acupuncture for nonspecific chronic low back pain: a systematic review and meta-analysis.Spine (Philadelphia, Pennsylvania 1976) 201338212438.
5. ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet. Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health.
6. Nahin, Richard L., Robin Boineau, Partap S. Khalsa, Barbara J. Stussman, and Wendy J. Weber. "Evidence-based evaluation of complementary health approaches for pain management in the United States." In Mayo Clinic Proceedings, vol. 91, no. 9, pp. 1292-1306. Elsevier, 2016.
7. Martin DP, Sletten CD, Williams BA, Berger IH. Improvement
in fibromyalgia symptoms with acupuncture: results of a randomized
controlled trial. Mayo Clin Proc. 2006;81(6):749-757.
8. MacPherson, H., A. Vickers, M. Bland, D. Torgerson, M. Corbett, E. Spackman, P. Saramago et al. "Acupuncture for chronic pain and depression in primary care: a programme of research." (2017).

9. Leslie Lingaas. ucsf.edu/news/2014/04/113966/acupuncture-helps-young-patients-manage-pain. Acupuncture Helps Pediatric Patients Manage Pain and Nausea, 2014.
10. Lin, Lili, Nikola Skakavac, Xiaoyang Lin, Dong Lin, Mia C. Borlongan, Cesar V. Borlongan, and Chuanhai Cao. "Acupuncture-induced analgesia: the role of microglial inhibition." Cell transplantation 25, no. 4 (2016): 621-628.
11. Cevic, C and Iseri, SO. The effect of acupuncture on high blood pressure of patients using antihypertensive drugs. Acupuncture & electro-therapeutics research 2013; 38(1-2): 1-15. ncbi.nlm.nih.gov/pubmed/23724695.

This article originally appeared on http://www.healthcmi.com

What Does a Osteopathic Manual Therapist Do?

Soft Tissue Manipulation

The practitioner uses soft tissue manipulation in many different ways. In general, they use it to evaluate the condition of tissues and to help the body’s fluids (such as blood and lymphatic fluid) flow smoothly. Keeping fluids flowing smoothly reduces harmful fluid retention and makes the body’s immune system more effective. Fascia is tissue found in all parts of the body. It connects all of the body’s structures at both superficial and deep levels. Practitioners evaluate the fascia to find areas of restriction, and then use soft tissue manipulation to make sure the length and tension of the fascia are properly balanced. Throughout the treatment, manual osteopaths keep checking on the state of the body’s tissues. If one technique isn’t working to correct a restriction, they use another approach instead. Above all, manual osteopaths try to restore health without over-treating.

Osteopathic Articular Technique

Osteopathic Manual Therapists use this technique to reduce muscle spasms near a joint, ease neurological irritations around a joint, make joints more mobile and to reduce pain and discomfort.  The articular technique involves gently moving 2 joint surfaces.  Before doing this, manual osteopaths carefully prepare the soft tissues around the treatment area.  They also move the patient into a position that will minimize, or eliminate the energy and force needed to perform the manoever.  Many patients find this technique less forceful than joint manipulations.

Cranial Osteopathic Manual Therapy

This is a very gentle osteopathic technique, and it requires the most experience to use effectively. To learn this technique, Manual osteopaths undergo intensive training. Through this training, their hands become sensitive to the cranial mobility and develop great precision in utilizing cranial techniques. Manual osteopaths use this gentle technique to assess and treat the mobility of the skull and its contents. They may also use it to assess and treat the spine, the sacrum, and other parts of the body. The goal of this technique is to adjust the body’s physiology by restoring balance to the circulation of the blood and other body fluids. Manual osteopaths do this by treating the body’s inherent biorhythm. They are able to feel this rhythm in the patient’s head, spinal cord, and in the sacrum and the rest of the body. Manual osteopaths use the biorhythm to assess the patient’s condition, and they may modify it during treatment.

Visceral Manipulation

Osteopathic Manual Therapists use visceral manipulation to treat organs and viscera of the body, including the lungs, heart, liver, spleen, kidneys, stomach, pancreas, intestines, bladder and uterus. Patients may feel pain in one or more of these organs, or the viscera may be less pliable than it should be. Manual osteopaths gently move the structures themselves and the fascia (connective tissue) that surrounds them to restore full movement.

Most patients treated with visceral manipulation feel only the gentle pressure of the manual osteopath’s hand, but the corrections are powerful enough to improve the mobility of an organ, improve blood flow, and help the organ function more effectively.

The above (and many other) osteopathic manual techniques and approaches are used in a coordinated and rational fashion to slowly adjust the patients anatomy and physiology towards normal, so that the patient’s body can heal itself.

This article originally appeared on nmoc.ca

 

5 Reasons You Should Try Acupuncture Right Now

In the West, acupuncture is still sometimes dismissed — even as more western doctors are incorporating the practice into their treatment plans. Nonetheless, acupuncture is becoming increasingly recognized as an effective treatment for relieving pain, easing stress and even combating insomnia. And in the right hands, acupuncture can also be used to treat a wide array of other symptoms and disorders — as it has been in China and many other countries for centuries.

There is nothing magical or superstitious about it. A doctor's office in Shanghai or Hong Kong is not so different from what you'd find in the United States. What is different however, is that acupuncture is a highly respected and frequently used modality for a range of health and medical conditions.

As practitioners and patients in Asia know quite well, the benefits of acupuncture extend much farther, into areas that might even surprise you. Here are five reasons why acupuncture could soon go mainstream as a form of treatment:

1. Allergies

While Western medicine focuses on treating the uncomfortable symptoms of allergies, Traditional Chinese Medicine — using a combination of acupuncture and herbal treatments — treats the whole person from the inside out. This approach works not only to treat the acute symptoms felt during an allergic reaction, but to regulate the immune system. A healthy functioning immune system will improve an individual's health overall, and reduce the severity and frequency of symptoms.

2. Weight Loss

The inability to achieve a healthy weight can be one of the most stubborn problems patients face, and part of the problem lies in the hypothalamus — the part of the brain that regulates hunger, among other things. Acupuncture can be used to stimulate the hypothalamus, quieting its hunger signals and normalizing appetite. And because acupuncture also relieves stress, it inhibits "stress-eating" and rids the body of fat-storing stress hormones like cortisol.

3. Chemotherapy Side-Effects

Chemotherapy uses drugs to inhibit the growth of cancer cells, a critically important action in fighting cancer. But its side effects — nausea, sore joints, dry mouth, hot flashes and fatigue — are tough on the patient. Acupuncture and electro-acupuncture work to activate chemicals in the brain that block pain. This creates relaxing, pleasurable sensations that can provide much-needed relief for patientsundergoing treatment. Patients can also choose acupressure and cold laser acupuncture, which achieve similar results without the use of needles.

4. Infertility

When the body's physiological systems are impaired by stress, or when neurological connectivity is unbalanced and hormones are being triggered in unhealthy ways, infertility can result. Frustratingly, modern fertility treatments are often hampered by these underlying issues. Acupuncture works to help reset neurological circuits. This can reduce hormonal imbalances and overall stress, and boosts the efficacy of fertility treatments.

5. Smoking Cessation

Nicotine is highly addictive, and the symptoms provoked by quitting smoking include intense cravings, irritability, anxiety, poor sleep, headache, increased appetite, fatigue and difficulty concentrating.

Western aids like the nicotine patch merely delay the onset of symptoms. True relief and success in quitting are possible through the use of acupuncture, which can reduce cravings and alleviate withdrawal symptoms. When you add stress relief to the process, quitting smoking can become easier and totally possible. A qualified practitioner will also provide personalized exercise and dietary recommendations, herbal supplements and an analysis of your triggers for smoking and how to avoid them.

Acupuncture has countless applications for patient health. When combined with other modalities from Traditional Chinese Medicine, or in an integrated fashion with western medicine, the results can be highly effective. This ancient discipline treats the whole person, restoring balance, strengthening immunity and helping physiological systems thrive.

This article originally appeared on mindbodygreen.com and was written by Dr. Daniel Hsu

9 Things That Happen To Your Body When You Stretch Everyday

Not many people consider stretching to be a form of exercise, probably because it is something we do a lot without apparent effort, unlike strength training or aerobics. The effects of stretching aren’t all that apparent either; it doesn’t help you break a sweat or lose mega pounds. Stretching doesn’t give you six-pack abs or release growth hormones (HGH) known to have many fitness benefits. However, this relatively gentle form of exercise can keep you staying healthy and fit and is good for both your body and mind. 

1. Stretching increases flexibility

Sports trainers have always insisted that athletes give much importance to stretching, both before and after training sessions. That’s because stretching increased the flexibility of the body and reduced injuries in the field. Cats know that it is not ‘nine lives’ that help them land on their feet, but their great flexibility. And how do they keep their body flexible but by stretching it every now and then in between their long siestas.  In fact, you will see all animals stretching at one time or another during the day. 

2. Stretching exercises help lower blood sugar levels

Stretching definitely makes you more flexible, but the number one reason to stretch actually comes from an exciting new study which has found that it reduces blood sugar levels. You might already know that intense exercise increases insulin production and the utilization of the hormone to push glucose from the blood into tissues.

Contrary to expectations, a 30-second stretch and hold routine has been found to be just as effective in lowering glucose levels in the blood. Surprisingly, the effect doesn’t come from increased insulin production, but from capillaries in the muscle tissue opening up, facilitating the movement of glucose into the cells.

People with diabetes have a perennial problem with high blood sugar either because their pancreas gland is not producing insulin, as in Type I Diabetes, or because their insulin production has reduced over the years, as in Type II Diabetes. In people with insulin resistance, the hormone is present, but it cannot be utilized due to the insensitivity of insulin receptors.

Elevated sugar levels can damage blood vessels and nerves and adversely affect almost all other organ systems of the body, severely damaging kidneys, liver, heart, and the nervous system. Diabetes is rated as the no. 7 killer, but it is an underlying cause of many other potentially fatal diseases, including high blood pressure, atherosclerosis, heart disease, and stroke.  

High blood glucose level is not a problem exclusive to diabetics. In non-diabetics, high carbohydrate diet can cause high blood sugar for 1-2 hours after a meal. Although their insulin production will eventually bring down the sugar levels, frequent episodes of elevated blood sugar can do almost as much damage as full blown diabetes.

Elevated blood sugar can also cause overproduction of insulin, which gradually desensitizes the insulin receptors, resulting in insulin resistance. This can set into motion a series of metabolic problems that can potentially lead to Type II Diabetes.

Stretching helps reduce blood sugar by increasing the flexibility of the blood vessels supplying the muscles, which in turn allows more blood flow to the muscle tissue where the glucose can be utilized.  

3. Stretching helps reduce high blood pressure and its ill effects

Blood pressure is the force exerted on the arteries as the blood gets pumped through them. There may be several reasons such as obesity, diabetes, mineral imbalances, and stress hormones that may elevate a person’s blood pressure above the normal of 120/80.

The stress-busting effect of gentle, slow-paced stretching exercises can contribute directly to the lowering of blood pressure. It is not surprising since we already know that the stress hormone cortisol can raise blood pressure.

Increased pressure on the arterial walls damages them and makes them stiffer. But stretching can counteract the artery-stiffening effect of hypertension and protect you from many life-threatening conditions associated with high blood pressure, including atherosclerosis, kidney failure, and heart disease.

4. Regular stretching routine can reverse atherosclerosis

Atherosclerosis is another progressive disease condition which, like diabetes, has a wide-ranging effect on several organ systems. It starts with the buildup of plaque on the inner walls of the arteries that carry oxygenated blood from the heart to different organs and tissues of the body such as kidneys and heart muscle.

Plaque consists  mainly of cholesterol and calcium, and their accumulation on the arterial walls results in the narrowing of these blood vessels. This naturally reduces the blood flow to the respective organs, lowering their efficiency. For example, atherosclerosis in the coronary artery supplying the heart muscles can result in partial blocks that causes heart pain or angina, or a complete block that can result in a heart attack.

Atherosclerosis in the carotid artery that carries blood to the brain increases the risk of stroke. Narrowing of peripheral arteries reduces the blood supply to the hands and legs, causing pain and numbness. When renal arteries are affected, chronic kidney disease develops, which eventually culminates in kidney failure.

Besides narrowing the lumen of the blood vessels, atherosclerosis stiffens the arteries. We have seen that stretching exercises can increase the flexibility of blood vessels and improve blood flow. It has also been observed that regular practice can gradually reduce the plaque in the affected arteries.

5. Stretching exercises keep the muscles healthy

Muscles develop or atrophy based on the use and disuse theory. Those muscles we work more often become well developed while the least used ones tend to breakdown. When you sit around for extended periods, your thigh and calf muscles and glutes remain inactive, while certain other muscles in the lower back and around the knees become overstrained and sore. Stretching can prevent muscular atrophy of the glutes and other underused muscles and relieve pain in the strained ones.

We have seen how stretching improves blood circulation to the muscles. With increased blood supply comes extra oxygen and other nutrients to the muscles. Removal of metabolic waste from the tissues also becomes more efficient.

6. Stretching can increase the range of motion (ROM) of joints

Muscles are attached to the bone joints by tough, yet flexible, tendons. A similar type of tissue between the bones in a joint allows joint flexibility. Unless these tissues are kept in good condition with frequent stretching movements, the connective tissue protein collagen weaves a network of fibers. It causes them to stiffen up, reducing their capacity to remain flexible. When that happens, the range of motion (ROM) of the joints becomes greatly reduced. Stretching helps break up the collagen network and keeps the tissues flexible, allowing greater ROM.  

Aging naturally stiffens the tissues and reduces ROM, but in diabetic people, high blood sugar levels cause collagen to become glycated, forming a tougher, much less flexible tissue. That is one reason why ‘frozen shoulder’ is a common problem in diabetics. Along with aerobic exercises and resistance training, stretching exercises hold extra importance for diabetics.

7. Stretching helps correct structural imbalances and improves posture

Our body has a bilateral symmetry in the musculoskeletal framework, and the S-shaped curvature of the spine helps with balance. When we repeatedly do tasks that cause imbalances, such as carrying weight––a baby or a shoulder bag––on one side, some muscles gets over stretched while their counterparts remain contracted. The same thing happens when we use one hand or one leg exclusively for heavy and repetitive work or activity.

Similarly, when we spend a lot of time crouched in front of the computer screens, our shoulder muscles overstretch inwards, while the chest muscles remain contracted. You can see the opposite condition in pregnant women who bend backward in an effort to balance the weight of the enlarged tummy.

Stretching exercises help relieve the tension in both the overstretched and  contracted muscles and restore the structural integrity of the body.  

8. Regular stretching keeps your back safe

Back problems can be triggered by lifting heavy weights or by sudden twisting movements, especially in those who have not been maintaining the flexibility of their spine with sufficient stretching activities.

The vertebrae that form the spine are held in place by the surrounding muscles. 23 pairs of vertebral discs made of cartilaginous tissue keep the bony vertebrae separated from each other and from the spinal cord that runs through the spine. Their slightest displacement can injure the spinal cord, resulting in mild to acute pain.

Lack of exercise can make the cartilage tissue stiff and inflexible. When that happens, sudden twisting and straining can cause tears in the cartilage. Sitting for long hours without stretching makes the spine stiff and cause backache. Tight hamstrings also can cause low back pain.

Stretching exercises involving bending and rotational movements help strengthen the core muscles surrounding the spine and keep the discs flexible. Exercises stretching the hamstrings as well as getting up from the seat every 20-30 minutes for a few minutes of general stretching can keep your back in good condition. And don’t wait for any back pain to get you started on this. 

9. Stretching improves mental health

We’re not stretching the facts here, but people who do stretching exercises regularly report improvement in sleep quality, mood, and self-esteem. Don’t dismiss it as subjective data because there are plenty of sound scientific reasons to support their claim. For one, stretching triggers the release of dopamine, the feel-good neurotransmitter associated with positive feelings and good sleep. Dopamine can improve attention, learning and memory too.

The positive effects stretching have on blood sugar levels, blood pressure, and general cardiovascular health also can improve mental wellbeing because the above conditions are associated with depression and mood swings.

Stretching should be ideally done at an easy pace, accompanied by correct breathing techniques. A stretched position should be held for a minimum of 20-30 seconds to derive optimum results. Yoga and Pilates can be good stretching routines, but make sure that you involve all muscle groups, repeating it 4-5 times a week.

This article originally appeared on naturallivingideas.com and was written by Sierra Bright.