August 2018 - Acupuncture of Iowa
Wahl Protocol Certified Health Professional
LauraUncategorized
Laura Christensen, MA, MAc, LAc has just been certified in The Wahls Protocol. This is a system of dietary intervention for the reversal of auto-immune disease and chronic illness. Laura attended a 3 day seminar during the summer of 2018 where she was trained and certified by Dr. Terry Wahls MD in her approach.
Laura is eager to share her new understandings, as well as her own experiments in healthy cooking and eating with her patients and the general public.
Acupuncture Carpal Tunnel Relief Confirmed
LauraAcupuncture, Affordable Acupuncture, Asian Medicine, Community Acupuncture, ConditionsAcupuncture, carpal tunnel, Iowa City
Acupuncture Carpal Tunnel Syndrome Relief Confirmed
Researchers find acupuncture effective for the treatment of carpal tunnel syndrome (CTS), a local entrapment neuropathy affecting the wrist and hand that causes pain, numbness, and dysfunction. The research team documents acupuncture's beneficial influence on the morphology of the median nerve and improvement of clinical symptoms.
According to researchers conducting the investigation, "while previous studies investigated the effect of acupuncture on clinical symptoms and electromyographic studies, to the best of our knowledge, its effect on median nerve morphology was not investigated before." [1] This study demonstrates that acupuncture influences morphology of the median nerve, which opens up a host of possible future studies that may build upon this foundation of knowledge.
Median nerve compression in the carpal tunnel region of the wrist results in pain, numbness, and tingling in the fingers or hand, as well as possible weakness and atrophy of the hand muscles innervated by the median nerve. [2] More prevalent among women, it is correlated with overuse, diabetes mellitus, rheumatoid arthritis, hypothyroidism, and pregnancy. [3]
Diagnostically and prognostically, musculoskeletal ultrasound imaging has been growing in popularity for monitoring this condition because of its ease and cost effectiveness. Musculoskeletal ultrasound shows the cross-sectional area (CSA) in the wrist level of the median nerve and this study documents correlations between median nerve cross-sectional areas and electrophysiological changes within the CTS affected limb.
A total of 27 female patients (45 limbs) with CTS were diagnosed with electromyographic tests for the purposes of this investigation. The patients were similar in age, BMI (body mass index), duration of disease, and severity of CTS. Exclusionary criteria were the following: radicular pain, polyneuropathy, radial or ulnar nerve diseases, severe CTS, trauma history, prior hand surgery.
In patients with bilateral CTS, both extremities were included in the same group. All patients were informed about the study and provided consent. They were randomly divided into two groups (acupuncture and control). The mean duration of the disease was 18.3 months and 19.3 months respectively. Both groups used night wrist splints for CTS for 4 weeks, while only the acupuncture group received acupuncture treatments. The following nine acupoints were selected for the study:
Daling (PC7)
Ximen (PC4)
Neiguan (PC6)
Laogong (PC8)
Qingling (HT2)
Shenmen (HT7)
Shaofu (HT8)
Taiyuan (LU9)
Quchi (LI11)
The median nerve cross-sectional area was measured at the proximal carpal tunnel with musculoskeletal ultrasound, with the scaphoid and pisiform bones used as bony landmarks for the proximal tunnel where the cross section was measured. [4] Needles of size 0.25 × 25 mm were inserted into the points and were retained for 25 minutes per acupuncture session. Treatments were conducted two or three days per week for four weeks, totaling ten sessions.
The median nerve cross-sectional area was measured by using musculoskeletal ultrasound on the patients while seated and positioned similarly (elbow at 90 degree flexion with the forearm in supination position). Cross-sectional areas of size 9 mm or greater had previously been determined as a possible diagnostic measure for CTS. [5]
Pain severity, hand function, and musculoskeletal ultrasound measurements were taken before and after treatments. The visual analog scale (VAS: 0–10 cm) measured pain severity. The Duruoz Hand Index (DHI) and Quick Disabilities of the Arm, Shoulder and Hand (DASH) scores were used to assess hand functions and disability. All electrophysiological tests were performed by using a Nihon Cohden Neuropack machine.
Compound muscle action potential (CMAP: normal >6.8 mV) measured the reaction of the abductor pollicis brevis muscle to stimulation at the wrist and elbow. Sensory nerve action potential (SNAP: normal >10 uV) measured the reaction of wrist stimulation to signals traveling in the opposite direction of normal signals in the nerve fiber (antidromic) of the second finger. Motor distal latency (normal <3.8 ms), sensory nerve conduction velocity (SNCV: normal >40.4 m/sec), and motor nerve conduction velocity (M-NCV: normal >49.4 m/sec) were also measured before and after treatment.
Acupuncture group positive outcomes proved significant. The median nerve cross-sectional area decreased from 11.6 to10.6 mm, motor distal latency decreased from 4.3 to 4.1 ms, and SNAP increased from 16.7 to17.6 uV. Also in the acupuncture group, VAS decreased from 9 to 4.8, CMAP increased from 12.9 to 14.8 mV, DHI decreased from 47 to 37, Quick DASH decreased from 67.2 to 56.8, S-NCV increased from 31 to 33.2 m/sec, and motor nerve velocity increased from 57.4 to 59 m/sec.
The improvement within the acupuncture group when comparing baseline values with the results highlights the success of acupuncture in decreasing clinical symptoms of CTS. It also highlights its ability to transform median nerve morphology such that acupuncture can reduce the cross-sectional area. The results within the control group were not as significant as the acupuncture group, highlighting the efficacy of acupuncture in treating neuropathic disorders compared with night splint monotherapy.
The researchers cited several investigations showing acupuncture's positive influence on CTS. Recent studies have used magnetic resonance imaging to show how acupuncture may alter brain activity and the limbic system of CTS patients. [6,7,8] Acupuncture produces anti-inflammatory effects in the median nerve within the carpal tunnel, as well as effects that can be compared to ibuprofen, night splints, and oral or injected steroids. [9,10,11]
Acupuncture generates beneficial morphological changes in the median nerve of patients with carpal tunnel syndrome and reduces or eliminates symptoms. Based on the scientific evidence, acupuncture is a reasonable treatment option. Consult with a local licensed acupuncturist to learn more.
1 Ural, Fatma Gülçin, and Gökhan Tuna Öztürk. "The acupuncture effect on median nerve morphology in patients with carpal tunnel syndrome: an ultrasonographic study." Evidence-Based Complementary and Alternative Medicine 2017 (2017).
2. S. Tanaka, D. K. Wild, P. J. Seligman, V. Behrens, L. Cameron, and V. Putz-Anderson, "The US [musculoskeletal ultrasound] prevalence of self-reported carpal tunnel syndrome: 1988 national health interview survey data,"American Journal of Public Health, vol. 84, no. 11, pp. 1846– 1848, 1994.
3. R. J. Spinner, J. W. Bachman, and P. C. Amadio, "The many faces of carpal tunnel syndrome," Mayo Clinic Proceedings, vol. 64, no. 7, pp. 829–836, 1989.
4. Ural, Fatma Gülçin, and Gökhan Tuna Öztürk. "The acupuncture effect on median nerve morphology in patients with carpal tunnel syndrome: an ultrasonographic study." Evidence-Based Complementary and Alternative Medicine 2017 (2017).
5. J. T. Mhoon, V. C. Juel, and L. D. Hobson-Webb, "Median nerve ultrasound as a screening tool in carpal tunnel syndrome: correlation of cross-sectional area measures with electrodiagnostic abnormality," Muscle and Nerve, vol. 46, no. 6, pp. 871–878, 2012.
6. A. U. Asghar, G. Green, M. F. Lythgoe, G. Lewith, and H. MacPherson, "Acupuncture needling sensation: the neural correlates of deqi using fMRI," Brain Research, vol. 1315, pp. 111–118, 2010.
7. V. Napadow, J. Liu, M. Li et al., "Somatosensory cortical plasticity in carpal tunnel syndrome treated by acupuncture," Human Brain Mapping, vol. 28, no. 3, pp. 159–171, 2007.
8. V. Napadow, N. Kettner, J. Liu et al., "Hypothalamus and amygdala response to acupuncture stimuli in carpal tunnel syndrome," Pain, vol. 130, no. 3, pp. 254–266, 2007.
9. M. Hadianfard, E. Bazrafshan, H. Momeninejad, and N. Jahani, "Efficacies of acupuncture and anti-inflammatory treatment for carpal tunnel syndrome," Journal of Acupuncture and Meridian Studies, vol. 8, no. 5, pp. 229–235, 2015.
10. Ho, Chien-Yi, Hsiu-Chen Lin, Yu-Chen Lee, Li-Wei Chou, Ta-Wei Kuo, Heng-Wei Chang, Yueh-Sheng Chen, and Sui-Foon Lo. "Clinical effectiveness of acupuncture for carpal tunnel syndrome." The American journal of Chinese medicine 42, no. 02 (2014): 303-314.
11. Yang, Chun-Pai, Nai-Hwei Wang, Tsai-Chung Li, Ching-Liang Hsieh, Hen-Hong Chang, Kai-Lin Hwang, Wang-Sheng Ko, and Ming-Hong Chang. "A randomized clinical trial of acupuncture versus oral steroids for carpal tunnel syndrome: a long-term follow-up." The Journal of Pain 12, no. 2 (2011): 272-279.
Acupuncture Relieves Pregnancy Pain
LauraAcupuncture, Community Acupuncture, Conditions, Iowa City, Oriental Medicine Theory
Acupuncture and cupping are safe and effective treatments for lumbopelvic pain during pregnancy. Researchers conducted an observational study at a hospital-based community antenatal clinic in New Zealand and determined that acupuncture produces significant positive patient outcomes, including reductions in lumbopelvic pain levels. [1] Lumbopelvic pain is in the lower torso, lower back, and pelvic girdle and is frequently experienced by pregnant women. Acupuncture provides an important alternative treatment option because many common prescription drugs and over-the-counter analgesics are not recommended during pregnancy.
During the study period, a total of 245 pregnant women attended the clinic, 144 (56.5%) of whom reported lumbopelvic pain as their primary or secondary complaint. Sixty-three women were excluded from the study as they either did not complete a baseline assessment or did not complete a post-treatment follow-up. Data from 81 women were included in the results. Of the women involved in the study, 45 were nulliparous (55.5%). The majority of women were in the third trimester of pregnancy (49.3%), 31 were in the second trimester (38.2%), and 10 were in the first trimester (12.3%). Most of the women were referred to the clinic by a midwife (72%).
Acupuncture and cupping treatments were provided according to the principles of traditional Chinese medicine (TCM). Points were selected on an individual basis and not all points were used on all of the women. The most commonly used points were Yanglingquan (GB34) and Zulinqi (GB41), which were used in over 50% of all women. Ashi points on the lower back were used in 25–50% of the women, excluding direct needling of Ciliao (BL32) and Zhongliao (BL33). Ashi points surrounding Huantiao (GB30) and ashi points on, near, or between Qiuxu (GB40), Shenmai (BL62), and Taichong (LV3) were also used in 25–50% of women. Ashi points between Neiting (ST44) and Lidui (ST45) and ashi points on, near, or between Chengshan (BL57), Feiyang (BL58), Yintang (MHN3), Baihui (GV20), Kunlun (BL60), Fengshi (GB31), and Waiguan (TB5) were used in fewer than 25% of women. Additionally, cupping therapy to the lower back was provided to over 50% of women in taking part in the study. This is an interesting selection given that cupping is ordinarily contraindicated on the abdomen and lower back during pregnancy.
Upon insertion of the needles, deqi was obtained manually and needles were retained for 20 minutes. Treatment was given once weekly, with each woman receiving a minimum of three treatments. The mean number of treatments was 3.85. Ear press needles were also offered to the women to place on the foot acupoints if desired. They were advised to retain these for 2–3 days and to remove them if they became uncomfortable or itchy.
All women taking part in the study completed the Measure Yourself Medical Outcome Profile (MYMOP) questionnaires prior to and after acupuncture treatments. The MYMOP questionnaire allowed the participants to describe their symptoms in their own words and to rate them using a scale of 0–6. They were also allowed to give additional information about other symptoms, especially those related to functional impairment and general well-being. Symptomatic changes were calculated by subtracting the post-treatment score from the pre-treatment score, and a reduction of one point or more was considered clinically significant.
Of the 81 women included in this study, 18 reported an improvement in symptoms of 1–1.99 points (22.2%), 30 reported an improvement of 2 –2.99 points (37.0%), 15 reported an improvement of 3 –3.99 points (18.5%), and 9 reported an improvement of 4 points or more (11.1%). A total of 72 women (88.9%) reported clinically significant improvements following treatments with acupuncture and cupping. The data demonstrates that acupuncture and cupping are effective treatment options.
In a prior study conducted at Yale-New Haven Hospital, researchers find auricular acupuncture effective for the treatment of pregnancy-related lower back and posterior pelvic pain. [2] A total of 152 pregnant women completed the study. They were randomized to receive auricular acupuncture, sham auricular acupuncture, or no treatment. All women were 25–38 weeks pregnant and had no prior experience with acupuncture.
Auricular press needles were administered at three points (kidney, analgesia, and Shenmen) and were secured with tape. These points were selected for their location close to the hip and lumbar spine areas on the auricular somatotopic map. The participants were instructed to keep these press needles in place continuously for one week without pressing or stimulating them in any way. If they experienced any redness or irritation, they were instructed to return to the clinic to have the needles inspected, adjusted, or removed if necessary.
Sham Auricular Acupuncture
The above procedure was also followed for the sham auricular acupuncture group, with the exception that three non-specific auricular points (shoulder, wrist, extra-auricular) were selected.
Pain and functional status were measured using a Visual Analogue Scale (VAS) with measurements taken at baseline, on day 7, and on day 14. On day 7, all participants reported improvements in pain, with the acupuncture group experiencing the greatest improvements compared to sham and control. In the acupuncture group, 81% of participants experienced significant improvements compared with 59% and 47% in the sham and control groups respectively. Additionally, 37% of women in the acupuncture group were pain-free at the 7-day mark, compared with 22% and 9% in the sham and control groups respectively. One limitation of the study design is that the data may indicate and active sham control, with the shoulder, wrist, and extra-auricular ear acupuncture points potentially providing clinically significant contributions to symptomatic relief.
At the 14 day follow-up, 68% of women in the acupuncture group reported significant improvements in pain levels, with 16% being entirely pain-free. In the sham group, 32% of women saw improvements in pain, with 9% being pain-free. In the control group, 18% had improvements, with 6% being pain-free. The results indicate that auricular acupuncture provides significant clinical benefits.
1. Department of Human Development, Washington State University Vancouver, Vancouver, Washington, USA.
2. National Institute of Complementary Medicine at University of Western Sydney, Sydney, Australia.
3. New Zealand School of Acupuncture and Traditional Chinese Medicine, Wellington, New Zealand.
4. Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut.
5. Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Connecticut.
6. Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
7. Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, Connecticut.
8. Women's Education and Life Learning Center, Yale-New Haven Hospital, New Haven, Connecticut
9. Departments of Anesthesiology, Pediatrics, Psychiatry, and Human Behavior, University of California School of Medicine, Irvine, California.
1. Soliday E. Betts D. "Treating Pain in Pregnancy with Acupuncture: Observational Study Results from a Free Clinic in New Zealand" Journal of Acupuncture and Meridian Studies 2018;11(1):25e30.
2. Wang S.M. et al. "Auricular acupuncture as a treatment for pregnant women who have low back and posterior pelvic pain: a pilot study" American Journal of Obstetrics & Gynecology September 2009.
Acupuncture Fibromyalgia Relief Confirmed
LauraAcupuncture, Affordable Acupuncture, Community Acupuncture, Iowa City
Acupuncture is an effective treatment modality for the alleviation of fibromyalgia. Researchers at the Physical Medicine and Rehabilitation Department of Ataturk University conclude that acupuncture improves two biochemical markers and clinical outcomes for patients with fibromyalgia. Objective measures show that acupuncture increases serum serotonin levels while simultaneously reducing Substance P levels. For subjectives, the researchers document lasting subjective improvements including less pain, fatigue, and anxiety. [i]
Fibromyalgia is a chronic condition with a variety of symptoms including widespread pain, sleep problems, fatigue, and cognitive difficulties. Fibromyalgia is frequently comorbid with depression and anxiety. The exact mechanism of the disease is has not been fully identified within allopathic and hospital medicine, but it is thought that serotonin and Substance P play an important role.
Serotonin is a neurotransmitter involved with mood, sleep, sexual behaviour, and pain regulation. Independent research confirms that fibromyalgia patients have lower serum serotonin levels compared with healthy individuals. Substance P is a neuropeptide involved in pain sensitivity, depression, and peripheral neurogenic inflammation. [ii] Excess levels of Substance P may play a role in the pathology of fibromyalgia, especially since Substance P has an active role in pain perception.
The study measures levels of these two biochemical markers along with several clinical parameters, both before and after treatment with acupuncture. A total of 75 female participants were recruited for the study. Exclusion criteria included usage of non-steroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors, tricyclic antidepressants, and other antidepressant drugs within the past 15 days. Those who had smoked tobacco, suffered from bleeding diathesis, or had painful conditions other than fibromyalgia were also excluded.
The patients were randomized into three groups; acupuncture, sham acupuncture, and simulated acupuncture. All three groups were similar in terms of mean age and body mass index. The mean duration of disease was 4.44 years, 3.94 years, and 5.09 years respectively. The following acupuncture points were selected for the study:
Dazhui (GV14)
Jianzhongshu (SI15)
Hegu (LI4)
Qihai (CV6)
Taichong (LV3)
Zusanli (ST36)
Sanyinjiao (SP6)
The points were needled bilaterally using 0.25 × 25mm sterile stainless steel filiform acupuncture needles. The needles were retained for 30 minutes per acupuncture session, without manual manipulation during needle retention.
The sham acupuncture group was included to act as a control and to identify the physiological effects of inserting needles into the skin at non-acupuncture points. Sham points were selected within an approximate 1–2cm radius of the true acupoints used in the acupuncture study group. These were identified using an electronic acupuncture point detector to find areas with a weaker signal compared with the genuine acupuncture points.
The simulated acupuncture group was included as a control and to identify the psychological effects of acupuncture treatment. Small, round adhesive bandages were applied to the same points as those used in the acupuncture group. Small needles (0.25 × 15mm) were inserted shallowly into the bandages, but were not allowed to penetrate the skin.
The three groups were blinded using a three section folding hospital screen with the bottom of one of the sections detached allowing the screen to be rolled up. A treatment couch was pushed into this space, and with the patient in position, the screen was dropped over the neck area to block their view. The needles at Dazhui and Jianzhongshu were inserted first, with patients in a seated position. Patients were then asked to recline in a supine position, safely resting in the space between the foldable head and body sections of the couch while the remaining needles were inserted. For all three groups, treatment was administered twice weekly for a total of four weeks.
Serum serotonin and Substance P levels were monitored before and after treatments using a commercial enzyme immunoassay kit, along with several other clinical parameters. A Visual Analogue Scale (VAS) was used to measure widespread pain. The Fibromyalgia Impact Questionnaire (FIQ) was used to measure work status, depression, anxiety, morning tiredness, pain, stiffness, fatigue, and well-being. The Nottingham Health Profile (NHP) was used to measure quality of life including pain, energy, physical mobility, emotional reactions, social isolation, and sleep. Finally, the Beck Depression Inventory (BDI) was used to measure a total of 21 different items including mood, social withdrawal, insomnia, and fatigue. The number of tender points (NTP) for each patient was also taken into account. All parameters were measured at baseline and after treatment. Follow-up visits were performed one month and three months after completion of treatment.
Patients in the acupuncture group experienced significant improvements in VAS (p<0.001), FIQ (p<0.001), BDI (p<0.001), NTP (p<0.001), and some aspects of NHP following treatment. Most of these improvements continued at the three month follow-up. Patients in the sham acupuncture group experienced significant improvements in VAS (p<0.01), FIQ (p<0.05), BDI (p<0.01), and NTP (p=0.001) following treatment. However, only the improvements in FIQ and NTP continued at the three month follow-up. Patients in the simulated acupuncture group experienced significant improvements in VAS (p=0.001), BDI (p<0.01), and NTP (p=0.01), but these improvements discontinued by the three month follow-up.
These findings indicate that sham acupuncture and simulated acupuncture provide a short-term placebo effect but do not provide long-term results. True acupuncture produced greater short-term results and also produced long-term positive patient outcomes. This indicates that the effective action of true acupuncture is not due to the placebo effect.
Serum serotonin levels increased significantly in the acupuncture and sham acupuncture groups (p<0.001 and p<0.01 respectively), with the increase in the acupuncture group being significantly greater than both sham and simulated acupuncture (p<0.01). Serum Substance P levels significantly decreased in the acupuncture group (p=0.001). There were no significant changes in serum Substance P in the sham group, and there was a significant increase (p=0.001) in the simulated group.
This study suggests that acupuncture is an effective treatment for patients with fibromyalgia, with the ability to improve a wide variety of symptoms, increase serum serotonin levels, and reduce serum Substance P levels. Genuine acupuncture treatment is superior to sham or simulated acupuncture, with improvements in symptoms lasting for several months after completion of all treatments. Contact your local licensed acupuncturist to learn more.
[i] Wolfe F. et al "Serotonin levels, pain threshold, and fibromyalgia symptoms in the general population." The Journal of Rheumatology [01 Mar 1997, 24(3):555-559].
[ii] Harrison S. Geppetti P. "Substance P" The International Journal of Biochemistry & Cell Biology Volume 33, Issue 6, June 2001, Pages 555-576.