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Acupuncture
Sarah K. Ayers, M.D.
Capt, USAF
21 March 2012
Outline Slide
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What is Acupuncture?
Indications for Acupuncture
Mechanisms of Action
Evidence
Military Considerations
Resources
Types of Acupuncture
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Traditional Chinese
Electrical stimulation
Chinese Scalp
Auricular—Battlefield
Acupuncture
Patient #1
 31yo female s/p MVA
 5 days later, still having 5/10 neck and
shoulder pain (L > R)
 Ibuprofen insufficient, cyclobenzaprine
makes her too sleepy to work
 15-20 needles total, no electricity, pain cut
to almost 0/10
 Next day—still mild aches, much better
overall
Indications
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Chronic Pain/Fatigue Syndromes
Osteoarthritis
Joint disease/back pain
Acute Pain--Sprains, Strains, PostOperative Pain
Migraines
Fibromyalgia
Depression, Anxiety
PTSD
Indications Continued
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Insomnia
Addictions– nicotine, cocaine, heroin
Upper respiratory symptoms
Strokes
Nausea & vomiting
Soo…How does this work?
 fMRI with blood oxygen level-dependent
(BOLD) measurements
 Acupuncture points: rich in neuroreceptors
 Modulates pain network via analgesic effects
 CNS hormones release in hypothalamus and
limbic system
 Causes changes in interpretation of pain
Electroacupuncture
 Fascia is bath of conductive fluid
 General tx (2-8 Hz)
 Enkephalin released from periaqueductal gray
 Endorphin released from the hypothalamus
 May be reversed/blocked by Naloxone
 Local tx (above 10 Hz)
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Dynorphin released in spinal cord
Activates low-threshold skin and muscle receptors
Serotonin/Norepinephrine released in midbrain
Chronic Issues
 Electroacupuncture with exercise vs.
exercise alone, 2003
 No changes in objective ROM findings
 Quality of life – significantly improved
 2003 Rheumatology paper
 over 60yo, >12wk back pain
 Quality of life/disability - significantly improved
 Some patients able to decrease pain medications
Migraines
 Korean Hand Therapy
 Study demo’d changes in blood velocity and
volume in carotids and vertebrals arteries
 Significant efficacy between triptans,
acupuncture and control
 Auricular acupuncture
 Annals of Internal Medicine Jan 2009
 Reduced frequency/pain of primary migraine or
tension-type headaches.
Military issues…
 Flight Status-Now teaching Battlefield
Acupuncture
 Allergic rhinitis and sinusitis
 Avoids opiate use
 Mission Readiness, Capability
 Battlefield Conditions
 Alternative to sedating medications
 Stress/PTSD
 TBI/Phantom Pain
Injuries
 2 Battlefield points
 23% reduction of pain in ER patients in initial 24h
 Results equivocal after 24h
 5 Battlefield points
 9 chronic pain patients who had no relief with
Western therapies
 1st 24h: pain completely relieved
 2nd 24h: pain attenuated from baseline
Deployment Considerations…
 Tested at Andrews, Landstuhl, and at
Echelon I & II in Al Asad, Iraq
 432 Treatments
 Average RTD 2.2 days sooner
 $0.06-$0.50 per needle
 Relative cost, complication risk of Ibuprofen
Patient #2
 31yo AD EOD male
 Subjected to three blasts where other
coworkers died
 Now with insomnia/chronic fatigue, TBI,
migraines, neck/back pain, inability to run
 Chronic narcotic use
 About to get a Medical Board (MEB)
Patient 2 Treatment…
 Battlefield Acupuncture
 Traditional Acupuncture, treated every 2-3wks
 Improved headaches/insomnia
 Decreased narcotic use
 Started hyperbaric oxygen therapy
 Now back to running, better concentration,
and MEB has been delayed
Summary
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Types of acupuncture
Indications
Mechanism of action
Evidence
Clinic/military applications
Questions & Resources
 “Acupuncture for Chronic Low Back Pain in Patients: A Randomized,
Controlled Trial” CF Meng, Rheumatology, 42: 1508-1517
 “Combining Spatial and Temporal information to explore functionalityguided action of Acupuncture using fMRI” Journal of Magnetic
Resonance Imaging, (2009) V30: 41-46
 “An fMRI Study of Somatosensory-Implicated Acupuncture points in
stable…stroke pts” Journal of MR Imaging, 24: 1018-1024 (2006)
 “Efficacy of Acupuncture for Treating Knee Arthritis” Alternative
Medicine Alert Vol 8, p49-60 (May 2005)
 “Randomized Control Trial: An Assessment of Acupuncture on
Specific Meridian or Specific Acupoint vs sham acupuncture for
treatment of functional dyspepsia” Alimentary Pharmacology &
Therapeutics (2012) V35: 552-561
 “Traditional Acupuncture in Migraines: A controlled, randomized
study” Headache, Mar2008, V48 p398-401
 “The use of Electro-Acupuncture in Conjunction with Exercise for the
Treatment of Lower Back Pain” Yeang, Journal of Alternative and
Complimentary Medicine, 2003 V9 p 479-490