Acupuncture gaining acceptance, even at high-tech Lancaster cancer center

Inside the artfully curving, steel-and-glass Ann B. Barshinger Cancer Institute, home to a robotic CyberKnife, linear accelerator and other whiz-bang devices, Nick Dower treats patients with a simple tool Confucius would recognize.

Telling cancer patient Karen Wenrich, 60, to take a deep breath, Dower deftly taps an acupuncture needle into her leg, the fine steel point reaching muscle near the shin.

Over the next five minutes, he inserts 27 more needles. Wenrich says she hardly felt a thing.

Originating in China more than three millennia ago, acupuncture has slowly gained acceptance in the United States. The National Institutes of Health now recognizes its value in easing chronic back, knee and head pain.

Medicare does not cover acupuncture, but if requested, some insurers, including Aetna, Capital Blue Cross and Highmark, will cover physician-applied acupuncture for such problems as chronic pain or nausea.

Even in Lancaster County, acupuncture is going mainstream. A total of 12 licensed acupuncturists practice here, including at least three doctors, according to state records. That’s up from 10 in 2009. Across Pennsylvania, there are 705 acupuncturists, up from 638 in 2009.

“There’s increasing evidence that this is not just hocus-pocus or a placebo, but rather there’s something to it,” said Dr. Keith Wright, of Georgetown Family Health in Bart Township. “It adds another tool in my bag to help promote healing.”

Acupuncture involves the placement of slender needles at specific points of the body associated with electrical conductivity. Some acupuncturists attach the needles to a low-intensity electric current.

Supportive research

Research suggests the needles trigger responses in the body that influence pain, anxiety, circulation and other processes, according to the Mayo Foundation for Medical Education and Research.

Exactly how acupuncture works is not understood, but evidence is mounting that it does work, particularly for pain management, said Dr. Tony Ton-That, a rehabilitation physician with Lancaster Neuroscience & Spine Associates.

Ton-That predicts acupuncture will take off when more consumers and insurers see it as a cost-effective alternative to surgery and drugs for chronic neck and back pain.

He said about 40 percent of his practice involves acupuncture, up from 10 percent when he started offering the treatment 10 years ago.

“I was skeptical,” said Jason Nauman, 31, of Leola, a Marine Corps veteran who has suffered from debilitating back pain since surviving a roadside bomb explosion in Iraq in 2004.

But Nauman said he experienced immediate pain relief and improved range of motion after his first acupuncture treatment by Dr. Wright. He returns about every other week to keep the pain in check.

“This is the only thing that has worked,” Nauman said.

Fatigue treated

On a recent afternoon in a quiet, softly lit treatment room at Lancaster General Health’s Barshinger Cancer Institute, Dower inserted 28 needles into Wenrich’s skin — seven in each leg, three in each arm, three in the upper chest, two in each ear and one above the nose.

Wenrich rested on a treatment couch with eyes closed, her legs slightly elevated on cylindrical pillows.

“There’s very specific reasons for every point I choose,” said Dower, a Millersville University graduate who earned a master’s in acupuncture and became licensed after three years at the Won Institute of Graduate Studies in Montgomery County.

He was treating Wenrich for the lack of energy she feels after more than 30 radiation treatments over six weeks at the cancer institute this fall.

“I was thrilled, actually, that an institution like this would even offer acupuncture,” said Wenrich, of Manheim Township, a former massage therapist. “I came in eager, ready to go. But I can see where people would have a reservation.”

With each insertion, Dower first pressed a guide tube against Wenrich’s skin, then tapped the top of the encased needle, setting the point into the skin.

“Deep breath,” he said with each insertion. Wenrich said she experienced no discomfort and sometimes didn’t feel a needle going in. She rested alone for 20 minutes after Dower had set the needles.

Wenrich calls the $60 she pays for a 45-minute session several times a month money well spent. She said she sleeps better, has more energy and feels less anxious.

Acupuncture in Public Health: County in West Virginia Considers integrating an Acupuncture Program

Journal photo by Jenni Vincent

Dr. Virginia Hisghman, a licensed acupuncturist, enlists the help of Jefferson County Health Department board member Willis Nowell as she explains the benefits of auricular therapy (also known as ear acupuncture). Nowell said he didn’t experience any pain as she placed the thin needles in various spots on the outside of his ear.

KEARNEYSVILLE, WV - Since Jefferson County Health Department officials and board members are looking to serve more patients, they have also been discussing new services that could help achieve that goal - including possibly offering acupuncture as part of a pilot program dealing with mental health and abuse problems.

As a result, county health officer Dr. David Didden, along with board chairman Tom Trumble and member Willis Nowell, recently met with Dr. Virginia Hisghman to discuss the various ways acupuncture can be used in a public health agency setting.

A licensed acupuncturist for 18 years, Hisghman works at Shenandoah Health Associates in Winchester. She has a masters in oriental medicine and received her doctorate from the University of Virginia in research methodologies. She also worked as an National Institutes of Health research fellow focusing on using acupuncture for sleep in adults.

Dr. Virginia Hisghman, a licensed acupuncturist, enlists the help of Jefferson County Health Department board member Willis Nowell as she explains the benefits of auricular therapy (also known as ear acupuncture). Nowell said he didn’t experience any pain as she placed the thin needles in various spots on the outside of his ear.

Didden, who has a family medicine practice in Shepherdstown -Potomac Integrative Health - also serves on the five-member West Virginia Acupuncture Board. His term ends June 30, 2016.

He has suggested the county health department consider helping deal with various community needs, using an integrated approach to mental and behavioral health, as well as substance abuse.

A pilot project is being considered that would be "non-pharmaceutical centered" and eventually might include modalities such as acupuncture, nutrition counseling and mindful stress reduction, Didden said.

"One idea is to initially become a clearing house of information for community members seeking additional information about substance abuse and mental health services," he said.

"This would have to be grant funded, but we could look at having a pilot program during which we would contract with some licensed professionals, including a counselor and social worker, to staff an on-call phone line and also have some web-based resources to refer to so that if someone is interested in getting into treatment or various programs, they would be able to call one central line," Didden said.

He credited Dr. David Baltierra at Harpers Ferry Medicine for this idea, explaining, "When we talked to him about an integrated substance abuse treatment program and how we might link with his operation, he said he really needs a central location to refer people when they are struggling with an issue."

"Since we're talking about providing help with the recovery process, I think this is something that public health is perfectly positioned to do. We can offer this service and help people when they don't know where to turn," he said.

No direct patient intervention would be involved with this broader, more general approach, Didden said, but it may also eventually be possible to provide some services to individuals interested in a holistic approach to mental health and substance abuse.

That's why he and Hisghman have been talking about her work and who can benefit from it, Didden said.

Depending on funding, it may be possible "to have licensed acupuncturists come into our program, with the possible long-term goal of having an opportunity to train some other staffers," he said.

Hisghman said this type of cooperative venture is a possibility, especially since acupuncture can be used to treat a variety of problems, including addiction issues.

Acupuncture can treat a lot of people effectively and safely, she said, adding that needles required for the various procedures are relatively inexpensive.

"The No. 1 priority is to always focus on safety," Hisghman said.

Working with other medical professionals is not new since she's also a nationally-certified National Acupuncture Detoxification Association trainer and focuses on auricular therapy (or ear acupuncture).

"We train groups at Yale University when they first introduce this particular protocol to all of their incoming psychiatrists in their rotation. It's been used for more than 30 years and has had extensive research done on it," she said.

"The theory is that we can treat the entire body just using the outside of the ear," Hisghman said, adding that she'd recently attended the first international conference at Johns Hopkins University on auricular medicine.

"It is gaining ground because there is excellent research on it, and it works. Many consider it a beneficial way for helping deal with addiction issues," she said.

-Staff writer Jenni Vincent can be reached at 304-263-8931, ext. 131.

© Copyright 2014 Journal News. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

The Human Brain On Acupuncture: Chinese Traditional Medicine, Visualized

Acupuncture needles inserted in the body produce a rapid sedative effect that stimulates multiple regions of the brain. Photo courtesy of Shutterstock

Lying down on an exam table, spreading your arms and legs apart, and closing your eyes as fine needles are inserted into your skin sounds counterintuitive to pain relief. The ultra-thin stainless-steel acupuncture needles are strategically placed into your skin at acupuncture points to evoke "deqi" sensations that can lead to a relaxed and healthier you. The tiny sensations caused by the pricks on your skin actually activate the nervous system and the brain, but how does this all work?

The “qi” sensation that is widely discussed in acupuncture is produced when a needle is inserted. The aching, tingling sensation generates responses in different brain regions as acupoints are needled. In fact, specific acupuncture points have distinct deqi characteristics that have a consistent and unique ability to stimulate specific brain regions.

Stimulating acupuncture points leads to overlapping brain responses in a number of cortical and subcortical brain regions. This includes the insula, thalamus, anterior cingulate cortex and primary and secondary somatosensory cortices — all part of the sensorimotor cortical network, according to Medscape. At the same time, there is a deactivation in the limbic-paralimbic-neocortical network, which includes the medial prefrontal cortex, caudate, amygdala, posterior cingulate cortex, and parahippocampus. These brain areas are associated with a pain matrix that is responsible for modulating both the sensation of pain and affective pain perception.

In the YouTube video, “This Is Your Brain On Acupuncture,” user James Whittle, an acupuncturist in Asheville, N.C., shows the difference in brain activity during superficial needling and deep needling. Unlike superficial needling, deep needling has been shown to be more effective than the superficial one for the treatment of pain associated with myofascial (pressure) on trigger (sensitive) points. However, the superficial technique is more apt for treating areas with potential risk of significant adverse effects, such as lungs and large blood vessels.

A group of researchers in the video sought to delve deeper into the effects of both techniques on the brain. First, an MRI scan was taken of the brain at base line, meaning at rest, to observe the activity taking place. Then, the research team scanned the brain when the needles were inserted into the participant’s body using superficial and deep needling techniques, respectively.

In the superficial needling MRI, the researchers found there was an increase in blood flow in front of the brain. This is just the brain’s normal response to the needle being lightly inserted. The deqi sensation in deep needling was actually found to lead to a deactivation in areas of the brain further back. Scientific analysis has shown deqi can deactivate areas within the brain that are associated with the processing of pain. “That reinforces the idea that something quite special is happening, something unique to acupuncture, something physiological,” said Dr. George Lewith of the University of Southampton in the video.

MRI images of two acupuncture techniques.

MRI images of brain activity in superficial needling (L) and deep needling (R).

A 2005 study published in the journal NeuroImage found acupuncture increased activity in a different brain area called the insula, which is part of the cerebral cortex. Although the researchers admit they don’t know what this activity means, it indicates acupuncture does have some real effect on the brain. "What we have demonstrated is that acupuncture is partially modulated by expectation but is probably also modulated by a real treatment effect," Lewith said in the press release.

These studies add evidence that the already proven beneficial practice in Traditional Chinese Medicine does have a mysterious, unexplained effect on the brain. Acupuncture does cause an activation/deactivation of cerebral functional regions. However, there are those who believe much of the relief of acupuncture is simply due to a placebo effect.

In the U.S., there are more than 3,000 physicians who integrate acupuncture into their clinical practice, according to the Cleveland Clinic. Currently, chiropractors and acupuncturists are struggling to gain acceptance from the health insurance industry since acupuncture’s efficacy has yet to be confirmed in scientific studies. Traditional Chinese Medicine, such as acupuncture, still has a long way to go in the U.S. to be considered in the same caliber as other Western medical treatments.

Looking for relief from hot flashes or night sweats?

If you’re a woman in the throes of menopause who is experiencing any of the telltale symptoms — hot flashes, night sweats, irritability, insomnia, vaginal dryness, libido changes — you might have explored a variety of treatments for relief.

 

Some women try to get more phytoestrogens naturally in their diet, others try a combination of exercise and herbal formulas, and some find hormone replace therapy necessary. For others, acupuncture could be the answer.

 

Some studies show that acupuncture may provide relief from menopausal symptoms such as hot flashes. The National Center for Complementary and Alternative Medicine (NCCAM) from the National Institutes of Health agrees that there are likely some benefits to alternative therapies such as acupuncture to ease the symptoms of menopause. However, because studies are often small, NCCAM suggests that more research is necessary.

 

How much of this could be due to the placebo effect? In at least one study, women who were given a placebo needle had less relief than women who were given real acupuncture needles. In other studies, however, women felt no difference between real and fake needles. Another study surmised that acupuncture could be effective against hot flashes because it boosts the production of endorphins, which may stabilize the body's temperature controls.

 

Scientists may be undecided about the positive effects of acupuncture, but practitioners are convinced of its healing powers.

 

“The beautiful thing about acupuncture and Chinese medicine is people say, ‘Oh I have this. Does acupuncture treat that?’ Well, yes, it treats everything,” says Lauren Buckley, a licensed acupuncturist at South Philly Community Acupuncture in Philadelphia.

 

“What we are doing is treating a pattern imbalance in the body,” she says. “And the way we treat a pattern imbalance in the body is by gathering all the symptoms you have that should be comprehensive of all systems in your body — respiratory, gynecological, digestion, cardiology, skin, hair, nails, bowel movements — all the data from your body systems. And the data is then consolidated into imbalances in chi and blood, yin and yang, interior and exterior, and hot and cold — those are the eight principals in acupuncture.”

 

Buckley says that women come to here, wanting to know if acupuncture can treat insomnia, night sweats or vaginal dryness. She tells them it can, but what it’s really treating is the root imbalance in the body. “Once we get to the root imbalance in chi and blood flow, then we are able to fix the symptoms. So I tell people, yeah, I’m fixing their irregular cycle, but really I am fixing a liver/spleen/blood imbalance,” she says.

 

Sometimes women combine acupuncture treatments with Chinese medicine — herbal medicinal formulas that may be a combination of many herbs tailored specifically to that woman’s symptoms.

 

Not every woman who comes in for acupuncture is 100 percent relieved of her menopausal symptoms, but people rarely leave without some type of improvement, Buckley says. The remedy isn’t a one-time gig, either, but takes eight to 12 sessions — twice a week at first then tapering off, depending on how it goes. They may have to return occasionally if symptoms flare.

Baseball’s Oldest Player Reveals His Secret – Acupuncture

Jason Giambi says he got some teasing at first, but now even his younger teammates are giving this ancient healing art a try.

The team doctor for the Cleveland Indians says he can’t think of any other baseball team with an in-house acupuncturist. That may be because the Cleveland Indians also boast the oldest player currently in the major leagues.

Designated hitter Jason Giambi is 43. He started in the majors 20 years ago, when some of his teammates were still in diapers. He says he was looking for anything to help him keep up.

“I’m older and traveling a lot and not sleeping so much,” he says. “We got on this routine of doing acupuncture…and it’s really made a huge difference for me.”

Jamie Starkey is the lead acupuncturist at the Center for Integrative Medicine at the Cleveland Clinic. She is also the Cleveland Indians’ team acupuncturist.

“I can go in and actually release some of the muscles that may be tight and that would actually prevent injury down the road,” she says.

She also offers yoga and Reiki massage. “It’s wonderful in terms of supporting the immune system and to promote sleep and overall wellness and stress management,” she says. “All of those things in combination – both eastern and western medicines – will help prolong a player’s shelf life.”

Giambi says at first his teammates made fun of him, but not anymore. “Now they’re like, ‘Hey, he’s still playing. He’s 43. I might give that a shot,’" he says. "And before you know it, there’s five or six guys that do it now.”

Acupuncture Helps Boost Drugs Used to Treat Depression

Acupuncture enhances the therapeutic effects of paroxetine, a drug often given the trade name Paxil, Aropax or Seroxat. Patients receiving acupuncture plus paroxetine showed greater clinical improvements in obsessive-compulsive symptoms, depression and anxiety than patients receiving only paroxetine. Researchers discovered the synergistic effects of acupuncture combined with paroxetine plus another important advantage of adding acupuncture to paroxetine intake. Yin Tang and othe acupoints are needled here. Acupuncture sped up the effective action of therapeutic benefits. The researchers note, “acupuncture/electroacupuncture has a rapid onset of therapeutic effect and produces a noticeable improvement in obsessive-compulsive, depressive and anxiety symptoms.”

Acupuncture and electroacupuncture were found equally beneficial in overall therapeutic results. Scores in individual areas of improvement varied between acupuncture and electroacupuncture therapy when combined with paroxetine. Importantly, electroacupuncture showed significant improvements over manual acupuncture in reducing recurrent and multiple medical symptoms of no known organic cause. Electroacupuncture also demonstrated significant efficacy over manual acupuncture in reducing depression related hostility and phobic anxiety. Both manual acupuncture and electroacupuncture showed significant clinical benefits in reducing primary unipolar depression when combined with paroxetine with significant improvements over and above those of paroxetine only.

The researchers cite several important findings as the basis for the investigation. Roschke, et al. published in the Journal of Affective Disorders, “Acupuncture is more effective than oral antidepressants in improving depressive symptoms.” Yeung et al. document that acupuncture is effective for patients with “poor outcomes after antidepressant medications.” Zhang et al. confirm that acupuncture is both safe and effective for treating depression.

The study confirms three major findings. Acupuncture, electroacupuncture and paroxetine are effective in the treatment of primary unipolar depression. Acupuncture and electroacupuncture combined with paroxetine has a “rapid onset of therapeutic effect.” Additionally, acupuncture and electroacupuncture combined with paroxetine synergistically improves conditions of obsessive-compulsive behavior and anxiety in patients with depression. The results are better for patients combining acupuncture or electroacupuncture with paroxetine than those only taking paroxetine. The researchers also note that acupuncture and electroacupuncture combined with paroxetine “is a safe treatment for primary unipolar depression.”

The researchers used a standard set of acupuncture points with minor modifications for all patients in the study. This varies from customized clinical care wherein a licensed acupuncturist has more flexibility in the acupuncture point prescription based on differential diagnostics. Although the approach of using one set of acupuncture points for all patients is common in many research models, it is considered a variation from the norm according to Traditional Chinese Medicine (TCM) principles wherein each patient receives a custom acupuncture point prescription based on an exact presentation of conditions.

The research team cited several studies finding the governing, pericardium, spleen, liver and stomach meridians effective for the treatment of depression. These findings combined with a presentation of Chinese medicine principles for the treatment of depression were given as the reasoning for the acupuncture point choices. The primary acupuncture points used in the study were Baihui (DU20), Yintang (EX-HN3), Fengfu (DU16), Fengchi (GB20), Dazhui (DU14), Neiguan (PC6) and Sanyinjiao (SP6). Minor customizations based on some indications were added. Zusanli (ST36) was added for cases involving poor appetite or fatigue. Shenmen (HT7) was added for patients with sleep disturbances. Shuaigu (GB8) was added for patients with headaches. Zhigou (TB6) was added for patients with constipation.

Wang, et al. confirm that acupuncture combined with SSRIs (serotonin reuptake inhibitors) is more effective than using SSRI medications alone. The additional research also confirms that acupuncture potentially reduces the “delay before the onset of the therapeutic action of SSRIs.” Wang, et al. note, “Acupuncture combined with SSRIs shows a statistically significant benefit over a 6-week period compared with SSRI administration only.” The research team notes that acupuncture is safe and produces no adverse effects. Wang, et al. add that acupuncture may allow for “the reduction of the dose of antidepressants and their associated adverse clinical outcome.”

The researchers note, “We showed that acupuncture combined with SSRIs produces statistically significantly larger reductions of HDRS (Hamilton Depression Rating Scale) values than SSRIs alone. This additional benefit was evident from the first week and continued throughout 6 weeks of treatment.” The investigators note that these findings are consistent with another body of research including a 6 week controlled, randomized trial of acupuncture combined with paroxetine.

Psychiatrists prescribed SSRIs to each patient in this randomized, controlled study. The acupuncture group received SSRIs plus acupuncture therapy. The control group received SSRIs only. A differential diagnosis was made for each patient by a China Association of Acupuncture and Moxibustion certified acupuncturist with a minimum of 15 years of clinical experience. The standard of care was protocolized to a given set of primary and secondary acupuncture point prescriptions. Between 6 and 10 needles were applied to each patient at each office visit. The acupuncture needles were 0.25 × 40 mm and the depth of insertion was 10 – 30 mm. Needles were stimulated until deqi arrived. The dao qi acupuncture technique was applied to the primary acupuncture points. Dao qi is lifting, thrusting and rotating the acupuncture needle with gentle and smooth stimulation.

Several back points are inserted here.

GV14 and GV4 were needled in the seated position with a 5 minute retention time prior to removal of the needles. Next, patients were in the supine position for additional acupuncture care for 30 minutes. Treatment was applied once per day in the morning at a rate of 5 days per week for a total of 6 weeks.

The primary acupuncture points were GV24 (Shenting), GV20 (Baihui), GV14 (Dazhui) and GV4 (Mingmen). Secondary points were:

LR3 (Taichong), SP9 (Yinlingquan) for liver depression & spleen deficiency
LR3, LR14 (Qimen) for liver qi stagnation
HT7 (Shenmen), ST36 (Zusanli) for heart and spleen deficiency
KI3 (Taixi), LR3 for liver and kidney yin deficiency
CV4, CV6 for spleen and kidney yang deficiency
HT7 and Anmian for insomnia and forgetfulness
PC6 (Neiguan) for palpitations and chest tightness
ST25 (Tianshu), ST37 (Shangjuxu) for constipation
Mental illness is a serious individual and societal issue. Working towards more effective treatment protocols and greater access to care will help in the treatment of depression. Given the increasing body of evidence that acupuncture enhances the clinical benefits of paroxetine, an integrative medicine approach seems more rational than a medication only approach. Let’s look forward to acupuncture treatments becoming recommended and available to patients needing care in the treatment of depression.


References:
Chen, Junqi, Weirong Lin, Shengxu Wang, Chongqi Wang, Ganlong Li, Shanshan Qu, Yong Huang, Zhangjin Zhang, and Wei Xiao. "Acupuncture/electroacupuncture enhances anti-depressant effect of Seroxat: the Symptom Checklist-90 scores." Neural Regeneration Research 9, no. 2 (2014): 213.

Wang, Tianjun, Lingling Wang, Wenjian Tao, and Li Chen. "Acupuncture combined with an antidepressant for patients with depression in hospital: a pragmatic randomised controlled trial." Acupuncture in Medicine (2014): acupmed-2013.

Qu SS, Huang Y, Zhang ZJ, et al. A 6-week randomized controlled trial with 4-week follow-up of acupuncture combined with paroxetine in patients with major depressive disorder. J Psychiat Res 2013;47:726–32.

- See more at: http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1398-acupuncture-boosts-drugs-for-depression#sthash.6BUuSqHS.dpuf

When Beauty Sleep’s Elusive, Try Acupuncture

Sleep. It sounds so simple. But for the millions of Americans that suffer from sleep deprivation, it’s a very complex issue.

With a job, two kids and living a life at the breakneck pace that is New York City, I never thought I’d have trouble sleeping. And the truth is, I have no trouble falling asleep. But I can’t stay asleep. So I decided to give acupuncture a try.

“After acupuncture, there’s a change in the brain that’s visible on a MRI,” said Dr. Yemeng Chen, the president of the New York College of Traditional Chinese Medicine.

With campuses in New York City and Long Island, the school has graduated more than 500 acupuncturists. Chen said that even traditional medical doctors seek out acupuncture training to complement their expertise.

But won’t it hurt? Chen said that one of the acupuncture points related to sleep issues is in the ear. He proposes putting two needles in my ear. Inside my ear.

“For sure, no one likes needles," Chen said. "But this is thin and tiny. We insert in acupuncture points, those related to nerve endings. The patient won’t feel severe pain.”

So maybe a little pain.

The first thing Chen ordered me to do was stick out my tongue. He said I was dehydrated, which was a shock to me. I drink about 70 ounces of water every day. But interestingly, I do feel thirsty much of the time.

Chen then put about 20 needles on me, from my ears to my forehead to my wrists and ankles. The only one that made me truly uncomfortable was the one in my left ankle, which Chen said was indicative of some sort of blockage that is affecting my sleep, probably in my liver. When I told him I typically wake up every night 45 minutes after initially falling asleep, he was further convinced of circulatory system block.

Some find the road to sleep is immediate. One patient in Chen’s waiting room said, “When I’m here, I fall asleep very easily. It’s a nice nap, very refreshing.”

I didn’t fall asleep during my session, but was relaxed, though it was difficult to say whether that was because of the well-placed needles or being separated from my iPhone in a dimly-lit room for 20 minutes. Even if this is my only go at acupuncture, I learned a valuable lesson: Don't take my phone to bed.