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How Acupuncture Plays a Role in
Occupational Medicine
Brent Dauphin, L.Ac., MTCM
Most people’s notion of acupuncture…
Education
Brent Dauphin, MTCM, L.Ac.
I am a California Board licensed acupuncturist and pain
management specialist. California leads the way
nationally for education and licensing requirements. CA
State board requirements make it a four year doctoral
level program. I received my degree in Traditional
Chinese Medicine from Five Branches University where I
completed over 3,200 hours of comprehensive clinical
and theoretical training in acupuncture and herbology.
Additional Training & Education
During the course of my education I traveled to
Zhejiang University in Hangzhou, China for extended
studies in traditional Chinese medicine. There I
studied acupuncture in the major hospitals of the
area. Prior to studying acupuncture I studied at the
University of California at San Diego and received an
undergraduate
degree
in
psychology
with
neuropsychology emphasis.
I currently treat
hundreds of people every month for pain relief at
several different clinics in the Bay Area.
History of Acupuncture
Acupuncture has a clearly recorded history of about
2,000 years, but some authorities claim that it has been
practiced in China for some 4,000 years.
The Chinese believe that the practice of acupuncture
began during the Stone Age when stone knives or
sharp edged tools were used to puncture and drain
abscesses.
History of Acupuncture (cont.)
Acupuncture, or needle puncture, is a European term
invented by Willem Ten Rhyne, a Dutch physician
who visited Nagasaki in Japan in the early part of the
seventeenth
century.
The
Chinese
describe
acupuncture by the character 'Zhen/Chen', which
literally means 'to prick with a needle', a graphic
description of this therapeutic technique.
What is Acupuncture?
Acupuncture is a system of medicine that is used
around the world by millions of people to promote
healing naturally.
Typical acupuncture treatments involve the insertion of
several surgical grade sterile, single-use disposable
stainless steel needles into specific areas (acupuncture
points) on the body.
Acupuncture Needles
The needles are very thin (about the width of a human
hair.) When acupuncture points are needled, they
work to help move circulation in the body, reduce
pain and improve range of motion at an injured area.
Many people think acupuncture sounds scary – until
they try it! The needles are typically only inserted a
half inch or less.
Is it Painful?
• There is usually a sensation with acupuncture. The
sensations vary in types and intensity depending on
area being treated.
• Typically the sensation is quick and is sometimes
described as a slight rubber band snap.
• This sensation, if experienced, only lasts for about a
second or two and afterwards there is usually only a
sense of a light weight sensation on the skin while
the person rests for about 20 minutes.
Acupuncture Pathways
• Acupuncture is systematized and utilizes 361 points
on the body. Each point is studied extensively for its
indication and contraindications as well as the
proper location, needling depth and angle of
insertion.
• A group of points along a longitudinal pathway in the
body make up what is called a meridian. We use
points along a meridian to influence other parts of
the body that the meridian reaches.
Acupuncture Pathways (cont.)
• Some meridian pathways reach from head to toe or
hand to head. This helps to explain why an
acupuncturist may use a point on a person’s hand or
wrist to treat a pain they are having in their neck.
Patients are often surprised to experience this
association when being treated. When a needle is
placed in one location they frequently remark that
they immediately feel the sensation of pain in the
second location has changed/reduced.
• The reason for the phenomenon is best described by
viewing an acupuncture chart.
Acupuncture Charts
The acupuncture points are organized into 14 main channels or
meridians, that are used to coordinate specific areas of treatment
Acupuncture Channels & Trigger
Points Similarities
Acupuncture channels and pathways were developed
and refined over thousands of years. Most likely it
developed first from massage and acupressure. What
they charted is very similar to what modern science
now calls Trigger Points and uses for injections.
Trigger points are defined as localized areas in which
the muscle and connective tissue are highly sensitive
to pain when compressed. Pressure on trigger points
will send referred pain to other parts of the body.
Trigger Point Charts
Shaded Areas Indicate Trigger Point Zones
Compared Patterns
VS
TAI YANG CHANNEL
(One of the 14 channels)
Similar TRIGGER POINT Zone
Two Basic Styles of Acupuncture
Local – needles are inserted to the an area of injury
• Ex. Putting needles into local points on the
shoulder at location of a rotator cuff strain.
• Creates a local response to foreign object in the
area to help the body heal that location. This kicks
off a reaction of bringing in similar agents as
when we get a cut and draws in such things as
white blood cells and other inflammatory reaction
agents in our body.
Two Basic Styles of Acupuncture
(cont.)
Distal – using acupuncture points at locations other
than site of injury.
• Ex. Using an acupuncture point on the hand to treat
the shoulder pain.
• Helps to block pain by reducing perception of the
pain signal in the channel.
Treat Yourself
Acupuncture Point on the hand
– Can be use for frontal headaches and sinus pain
– To Find, press the meeting point of bringing the thumb and
first finger together.
– To Use, push on the muscle until you feel a moderate achy
sensation, then continue pushing until the discomfort
diminishes.
Acupuncture Added to WC
• California Adds Acupuncture to Workers' Comp Treatment
Guidelines as of June 15, 2007
• Must be prescribed by medically approved provider
• Inexpensive and conservative treatment for musculoskeletal
injuries promoted by WHO, NIH, Labor Code, and CA Workers
Comp System
• Acupuncture is supported by RAND evidence based treatment
guidelines
ACOEM Guidelines for Acupuncture
• Indications for acupuncture or acupuncture with electrical
stimulation include the following presenting complaints:
– Neck and Upper Back Complaints
– Elbow Complaints
– Forearm, Wrist and Hand Complaints
– Low Back Complaints
– Knee Complaints
– Ankle and Foot Complaints
– Pain, Suffering and the Restoration of Function
ACOEM Guidelines for Acupuncture
(cont.)
• Frequency and duration of acupuncture or acupuncture with
electrical stimulation may be performed as follows:
– Time to produce functional improvement: 3 to 6 treatments.
– Frequency: 1 to 3 times per week
– Optimum duration: 1 to 2 months
– Acupuncture treatments may be extended if functional
improvement is documented as defined in Section
9792.20(e).
*Treatments are typically authorized in a group of six sessions
Positive Outcomes of Acupuncture
• The positive outcomes of acupuncture in Workers
Compensation Injury Rehabilitation:
–
–
–
–
–
Pain Management
Reduction of Need for Medication
Reduction of Inflammation & Swelling
Improvemed Active Ranges of Motion
Improved capacity of Activities of Daily Living
Positive Outcomes of Acupuncture
(cont.)
• Positive outcomes of a Pre/Post Operative Program
in Workers Compensation include:
–
–
–
–
–
–
Reduction of Nausea & Vomiting
Regulation of Digestive Function
Decrease in Pre-Operative Anxiety
Reduction of Scar Tissue
Decreased Healing Time
Increased Rates of Full Recovery
When is Acupuncture Typically
Referred?
• Not just when everything else fails!
• Acupuncture is a conservative treatment. It is optimal
to use acupuncture earlier in the course of the
condition rather than later. Though acupuncture can be
helpful as far down the line as post-operation recovery.
Some patients have had physical therapy, cortisone
injections and surgeries before they come to see me.
These are considered chronic and certainly can be
harder to return to full work capacity…though some do
significantly still improve.
When is Acupuncture Typically
Referred? (cont.)
Acupuncture referrals in Workers Compensation
commonly occur after a round of physical therapy has
failed to produce strong enough benefits. Often people
have pain that is very strong and they are not able to
perform rehabilitative exercises. Other referrals are
patients that are either unable or unwilling to take pain
medications, injections or surgery and wish to try a
more “natural” approach to healing.
Example of Acupuncture
Referral for CTS
Etiology of CTS
Median nerve
compression by tendonitis
Usually due to repetitive
motion of the wrist and
hands.
Use of Acupuncture for CTS (cont.)
Progression Signs & Symptoms
Painful neuropathies of the hand
and wrist are from nerve
compression,
most
often
compression of the median nerve
in the carpal tunnel.
Severity
1. Pain
2. Tingling
3. Numbness & Lack of Sensation
4. Loss of Strength
Use of Acupuncture for CTS (cont.)
Carpal Tunnel Release Surgery
Carpal
ligament
incised
…releasing pressure on median nerve
Other Modalities Provided
During Acupuncture Treatments
Electro-Acupuncture
TENS unit are connected with acupuncture via small clips
to the needle. This delivers the same current as when
used in Physical Therapy. However instead of the electric
pulse being on top of the skin it instead goes directly to
the depth of the muscle.
This serves to
stimulate the
muscles into
relaxing and
enhance
acupuncture’
s effect.
Tuina
Tuina - is a form of medical massage or myofascial release
that is used in conjunction with acupuncture to help a
person return to their previous range of motion and
movement capability.
There are various techniques that
form tuina. Often it is a
combination of moving an area
through its range of motion while
adding a combination of gliding,
stroking, pushing or other
movements over the muscle and
soft tissue to help facilitate
circulation and healing of the
area.
Qi Gong
Acupuncturists may provide simple exercises bases in
a longstanding restorative therapy known as Qi Gong.
This is used by many millions of people in Asia as
range of motion exercises to improve healing and
overall well being.
These exercises are similar to Yoga and Tai Chi and
can be tailored specifically to different body parts.
They are usually performed at a moderately slow speed
and meant to increase ranges of movement and
proprioception.
Acupuncture is Not Passive
I provide patients with at home or at work exercises to
perform in addition to their acupuncture. We also work
on understanding body mechanics, ergonomics and
origins of their pain so they reduce workplace strain in
the future. Performing Qi Gong exercises or working
on self care strategies help workers stay active in their
healing.
Studies on Acupuncture’s Effect
Mechanisms of Acupuncture:
– Stimulates conduction of electromagnetic signals within the
muscle and soft tissue fibers causing a relaxing within the
soft tissue
– Release neurotransmitters and neurohormones that affect
body function such as digestion and breathing.
– Stimulate blood flow in the body, which is helpful in healing
an injury
– Reduces pain by causing a release of endogenous opiods,
which are pain blockers known as endorphins.
Acupuncture Studies for Pain
Management
• There are many studies that have found statistically
significant benefits for a variety of types of pain.
– An extensive study was published in the past few years of
1,162 patients with chronic low back pain that were treated
with acupuncture.
– Researcher Heinz Endres, MD concluded, “Patients
experienced not only reduced pain intensity, but also
reported improvements in the disability that often results
from back pain.”
Acupuncture Used for Pain
Management (cont.)
Findings such as these are important in Workers
Compensation because our main goal is to return
the injured employee to work as quick as possible
with the highest capability of function.
Variables in Outcomes
• There are many studies with positive results indicating
acupuncture is an effective treatment modality for
treating pain. However not all studies are conclusively
positive for all types and conditions of pain.
• Acupuncture does not cure everything. There is no one
cure all magic bullet or magic acupuncture point! Just as
there is no one perfect pill or surgery to cure everything.
* Also Note – There are difficulties in conducting
studies of acupuncture as it does not always fit into
our western research model very well due to
difficulties in creating a double blind placebo study.
Placebo Effect
• This is often said of acupuncture because it does not always fit
into a western notion of medicine that can be studied. Pills,
creams, injections, and other medical procedures, such as
ultrasound are also often called placebos. Even the notion of a
physician and the way they interact with a patient have been
noted as a placebo effect, such as an increased healing time
when providing a suggestion that the patient, “will be better in
a few days” rather than negatively stating “I am not sure if the
treatment we are giving you will have an effect.” To that note;
many dogs and horses are given acupuncture with noticeably
beneficial improvement in conditions such as arthritis, this is
obviously not due to their expectations in treatment.
Obstacles of Acupuncture
• I would estimate that at least 90% of the new patients are
apprehensive and reluctant to trying acupuncture. This may be
due to fear of needles, fear of unknown factors such as what is
this acupuncture? Why am I doing this, who is this caucasian
Acupuncturist person? (acupuncturists come in all shapes and
sizes now in America, similar to the population in general.
Chinese is not the majority demographic of acupuncturists
coming out of schools now)
Side Effects of Acupuncture
• SIDE EFFECTS are possible, such as bruising or soreness at the
point of needle insertion. These are usually temporary, however
there have been rare instances of organ injury reported by
incorrect needling technique. Also, just as with any needle
technique fainting is a rare but possible occurrence. Usually this
is due to a patient having skipped a meal and having low blood
sugar at the time or from having extreme needle phobia.
Side Effects of Acupuncture
(cont.)
• Acupuncture is similar to Physical Therapy in that it tends to have
fewer side effects and lesser in severity than other forms of pain
treatment. The function of acupuncture is to create self healing
and is less likely to cause side effects than many other options
such pharmaceuticals which require ingesting a foreign substance
that needs to be absorbed and metabolized by the body.
Acupuncture vs. Narcotics
• 2010 analysis by Accident Fund Holdings reported that the cost
of a workplace injury was 9 times higher when a strong
narcotic like OxyContin was prescribed when compared to a
workplace injury treated with conservative care and no narcotic
pain medication.
• Prescription of narcotic pain medication has expanded greatly
in the last decade, prompting a number of laws now requiring
physicians to utilize conservative care in the form of
acupuncture & physiotherapies to reduce narcotic addiction,
overdose injury and death.
Acupuncture vs. Narcotics (cont.)
• Accident Fund Holdings reported that the cost of a
typical workplace injury, averaged about $13,000,
was tripled when a strong narcotic pain medication
was prescribed instead of utilization of conservative
treatment protocols.
• When the strongest narcotic pain medications were
prescribed, the average cost of workplace injury
increased to 9 times the average.
Acupuncture vs. Narcotics (cont.)
• A course of acupuncture and physiotherapy
of 18 visits would cost roughly $2,000, much
less than the $26,000-$114,000 added on
average when patients are treated with
narcotic pain medications instead.
Case Study #1
52 yr. old female process operator developed tennis elbow due to
repetitive tasks. Pain was bilateral in nature. Tylenol and round
of PT not resolving pain. Pt rated pain 6-8 out of 10 at time of
initial acupuncture evaluation with trouble lifting & holding
objects.
Pt treated with distal acupuncture, infrared heat and given topical
herbal patch at each treatment. By 4th tx pt was improving
slowly and by 6th/final was more than 50% improved. Because
patient continued to gain improvement a second set of acu was
requested. By 9th visit pain was reduced drastically. On reevaluation at last appointment (12th) the patient had 0/10 pain
while working full time and had requested release from care. Pt
referred coworker in similar position at work who still had pain
after cortisone injection for lateral epicondyle region pain.
Case Study #2
39 yo M with left Thoracic pain that extended down toward his lumbar area.
Patient was injured when moving a large heavy bag, he performed a lifting
and twisting motion to the left causing the injury. At time of initial
evaluation the patient was very tense and guarded to touch in area from
mid thoracic through upper lumbar, he had palpable spasm in area as
well. Forward bending and walking provoked pain. He was unable to find
a comfortable position to remain in, especially after he finished work as a
maintenance worker. His sleep was provoked as well. Patient was trying
to continue a full 40 hour work week though even with modifications of
reduced lifting, twisting and bending he was having 9/10 pain level. He
had a grade 3 tenderness to palpation at the evaluation.
By treatment number six the patient’s pain reduced even after working a full
day and was sleeping much more comfortably. Objectively I noticed the
tenderness to palpation had subsided a grade 1-2 and the patient was
much less reactive even when given myofascial release over the injury.
By treatment number six he had only slight residual muscle tightness
remaining and active range of movement was now much more functional
with greater comfort overall in the area.
Case Study #3
52 yr F systems analyst injured from keyboarding. Pain at radial wrist.
Limited capability of flexion/extension of thumb at time of evaluation.
Patient was using thumb and wrist splints to prevent movement of
injured area. Swelling at wrist and TTP was at medium high level. After
course of PT the patient had gained some improvement though was still
sore and had limited ROM. Patient declined cortisone injection and
wished to try acupuncture instead.
Patient rapidly felt improvement in range of motion capabilities and pain
reduction. By 3rd tx active range of motion increased to 90%. At fifth tx
the primary physician stated cortisone injection is not warranted and
ordered a second set of acupuncture to help the patient strengthen as
she remains at full duty in workplace. However approximately twice per
year there is a high volume of letter folding and placing into envelopes
which is highly provocative for her thumb and wrist. This period just
occurred and while it was strenuous to the hands in general patient still
has full AROM and much less provocation than the other periods of such
intense wrist and hand usage. The patient was advised to continue to
use the favorable body mechanics and ergonomics she learned during
her treatments to reduce strain in workplace moving forward.
Conclusion
• Acupuncture can be an effective and less costly way to treat
certain work related injuries. Acupuncture can:
– decrease pain
– decrease inflammation
– promote healing
– regulate the immune and endocrine systems.
– may be used as an adjunct to physical rehabilitation and/or
surgical intervention to hasten functional recovery.
Any Questions?
Thank you!
Brent Dauphin, L.Ac., MTCM
Alliance Occupational Medicine
1901 Monterey Rd. Ste 10 San Jose, CA.
2737 Walsh Ave. Santa Clara, CA.
315 S. Abbott Ave. Milpitas, CA.