Acupunture: worth learning?

Discussion in 'Pain Medicine' started by Paindoc13, Dec 29, 2008.

  1. Paindoc13

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    Hi all, I'm new to the forum. I have been reading lots of good stuff on here. I just got accepted for a Pain fellowship and I'm looking into preparation and had a few questions on acupuncture.

    I was wondering if any of the attendings do or don't do acupuncture in their office?

    Would it be worthwhile for me to take the courses? Compensation, usefulness, patient satisfaction?? I was thinking if I did it, I would do it prior to fellowship.

    Thanks again,

    Patrick
     
  2. Tenesma

    Tenesma Senior Member
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    you could do it during fellowship --- there are night/weekend courses that can be completed within a year.

    it would be an asset to have a non-western-allopathic approach to pain medicine as part of your armamentarium...

    don't do it for income purposes, but rather because of personal interest.
     
  3. lobelsteve

    lobelsteve SDN Lifetime Donor
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    Acupuncture is incompatible with allopathic training. There is no science behind it. Unless my Netter was missing pages...


    www.quackcast.com

    Listen to Mark Crislip's podcasts and decide if you want to be a physician scientist or just another excuse for a pain doc.
     
  4. Tenesma

    Tenesma Senior Member
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    wow...

    i think it behooves us to think outside of the box for our chronic pain patients (who for the most part have a huge anxiety/musculoskeletal component to their pain)....

    while i don't practice acupuncture, I dare not refuse it to patients who have tried everything...

    while I can't explain how it works nor have I seen miracles with it, I believe being a doctor is being part scientist and part artist...

    as long as it doesn't hurt the patient, or expose the patient to further harm down the line, as long as it doesn't burn any bridges, as long as patients get some type of relief that allows for less meds/more function, then by all means - keep on doing it...

    and if you are going to be a REAL physician scientist then please show me the data on most of what we do? so far... the ONLY thing with some scientific support (at least according to Bogduk et al) are cervical medial branch neurotomies...
     
  5. PMR 4 MSK

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    I don't do accupuncture, but periodically suggest it to those who fail everything else. If they ask about it, I tell them it's basically safe, with rare exceptions, but may or may not help. The worst damage is usually to their checkbook. We do have a physiatrist in town who does it, along with a lot of prolotherapy.
     
  6. teri78

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    I completely agree with what Tenesma said. Although I don't consider it a first line therapy, I don't see the harm in trying it in patients who don't respond to conventional tx or who want to try it. In fact, I myself was thinking about taking a course sometime during my training just to add another tool in my arsenal.
     
  7. lobelsteve

    lobelsteve SDN Lifetime Donor
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    A fundamental problem in this line of thought is that becuase we do not have a tremendous amount of favorable evidence to support what we do, this in no way changes the fundamental and immutable laws of physics, biology, and chemistry. Explaining acupunture in those terms is not possible. Everything I do can be explained in terms of science, and when the science is advanced at the molecular level in regards to the CNS, our tools will change. But suggesting acupunture is somehow either art or science is ludicrous.

    That being said, if a patient asks about acupuncture, I have no problem with them trying out an unproven (all articles published regarding pain and acupuncture to date lack scientific voracity). As long as they understand the financial consequences. I get a little angrier at the practitioners marketing an unproven modality and then making ourageous claims as to its efficacy. We have some butthole in Georgia (just south of Atl) who provides a guarantee and charges $150 pe session.

    I may start using an ancient american indian or mayan technique for pain management- it will be non-invasive, completely illogical, highly mystical, scientifically undefinable, terribly costly, and secretive. I'll make my patients sign a consent not to discuss the actual treatment, but free to discuss the miracle cure of their pain. I'll then advertise in the paper, see a few hundred dolts, umm err, patients- strike that--- clients....and then when I get enough folks better I'll start training other dos in my miracle cure for all pain.

    I think you see where I am going...:D
     
  8. QofQuimica

    QofQuimica Seriously, dude, I think you're overreacting....
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    I agree with Tenesma too, for two reasons:

    1) Just because we don't currently understand how something works, doesn't mean that it can't work. I'll agree with people who doubt the existence of Qi energy as a rationale for acupuncture, but that doesn't mean there isn't a rational explanation for why being poked in certain places with needles can relieve pain. Someone may come up with a scientific theory to explain acupuncture in the future; in the meantime, there's no reason not to use a modality if it is empirically helpful and not harmful. There is some evidence in the literature that acupuncture does help some people.

    2) Even if we could prove without a doubt that acupuncture had no effect whatsoever, we know for a fact that the placebo effect is extremely powerful. Figuring out how to harness it and use it to help patients help themselves should not be pooh-poohed as "unscientific".

    OP, I think if you want to learn acupuncture, you should go for it. It's not unreasonable that there might be some situations where using it is appropriate. Researchers at Mayo have done some work on using acupuncture to treat fibromyalgia, and they even figured out a way to blind their study by performing "sham acupuncture." If you're interested, here's the link.
     
  9. Josh L.Ac.

    Josh L.Ac. MSA/LAc & BSN/RN --> AA-S
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    All of your patient are belong to us.
     
  10. Tenesma

    Tenesma Senior Member
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    there are no fundamental or immutable laws of physics, biology or chemistry... there are theories that are borne out with scientific experiments, and then become laws, only to be un-done by newer laws and theories...

    quackery, snake oils, etc... that will always exist... and as long as nobody gets hurt, and it doesn't empty their wallets then I am all for it.

    i have had patients swear that Reiki cured their back pain
    i have had patients swear that glucosamine/chondroitin helped them get off narcotics for their cervical radiculopathy

    i'd much rather they pursue something like that versus a fusion...
     
  11. pmrmd

    pmrmd SDN Lifetime Donor
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    i agree with steve. no science in acupuncture and, in my experience around here, it is done by a D.C. just trying to get a few extra bucks before the patient leaves their care.
     
  12. Intubate

    Intubate ASA Member
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    if acupuncture doesnt work, try those kinoki pads.
     
  13. lobelsteve

    lobelsteve SDN Lifetime Donor
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    I drank the SCIENCE Kool-Aid.

    It tastes like C6-H12-O6.

    Saying that chem,phys,bio are theories is illogical and does a disservice to the scientific method we use to evaluate attempts at legitimate care. It is convenient to have modalities that defy all 3 using energy fields that cannot be quantified or measured.

    There is science, there is art, there is the unknown. Everything else is Cleveland.
     
  14. ampaphb

    ampaphb Interventional Spine
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    1) Invasive placebos are more effective than non-invasive ones.
    2) Qi energy seems to be equally able to be therapeutic whether you put the needle in Liver3, the tip of the patient's nose, or the soles of their feet
    3) Do you also write for sugar pills? Magnets? Prolo? Chiropractic? Shark fin?

    I think there is a HUGE difference between ADVOCATING these modalities, and holding your tongue. I don't discourage their use, but I certainly would never advise they be tried till there is reasonable scientific documentation that they work.

    As for the Bogdukian reference? What he said was that there is Class A evidence for RF. But extrapolating from that comment to conclude that other interventional procedures are the equivalent of accupuncture is simply wrong. It presumes the absence of evidence IS evidence of absence, and we know it isn't.


    German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups.


    Haake M, Müller HH, Schade-Brittinger C, Basler HD, Schäfer H, Maier C, Endres HG, Trampisch HJ, Molsberger A.
    Orthopaedic Department, University of Regensburg, Bad Abbach, Germany.

    BACKGROUND: To our knowledge, verum acupuncture has never been directly compared with sham acupuncture and guideline-based conventional therapy in patients with chronic low back pain. METHODS: A patient- and observer-blinded randomized controlled trial conducted in Germany involving 340 outpatient practices, including 1162 patients aged 18 to 86 years (mean +/- SD age, 50 +/- 15 years) with a history of chronic low back pain for a mean of 8 years. Patients underwent ten 30-minute sessions, generally 2 sessions per week, of verum acupuncture (n = 387) according to principles of traditional Chinese medicine; sham acupuncture (n = 387) consisting of superficial needling at nonacupuncture points; or conventional therapy, a combination of drugs, physical therapy, and exercise (n = 388). Five additional sessions were offered to patients who had a partial response to treatment (10%-50% reduction in pain intensity). Primary outcome was response after 6 months, defined as 33% improvement or better on 3 pain-related items on the Von Korff Chronic Pain Grade Scale questionnaire or 12% improvement or better on the back-specific Hanover Functional Ability Questionnaire. Patients who were unblinded or had recourse to other than permitted concomitant therapies during follow-up were classified as nonresponders regardless of symptom improvement.

    RESULTS: At 6 months, response rate was 47.6% in the verum acupuncture group, 44.2% in the sham acupuncture group, and 27.4% in the conventional therapy group. Differences among groups were as follows: verum vs sham, 3.4% (95% confidence interval, -3.7% to 10.3%; P = .39); verum vs conventional therapy, 20.2% (95% confidence interval, 13.4% to 26.7%; P < .001); and sham vs conventional therapy, 16.8% (95% confidence interval, 10.1% to 23.4%; P < .001.

    CONCLUSIONS: Low back pain improved after acupuncture treatment for at least 6 months. Effectiveness of acupuncture, either verum or sham, was almost twice that of conventional therapy.

    Arch Intern Med. 2007 Sep 24;167(17):1892-8
    PMID: 17893311
     
  15. Tenesma

    Tenesma Senior Member
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    poor cleveland :D
     
  16. Paindoc13

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    Thanks for the replies!

    It just seems like quite a few pain docs do Acupuncture, so that is why I asked.

    I'll have to give it some more thought.
     
  17. lobelsteve

    lobelsteve SDN Lifetime Donor
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    A bigger problem... anybody can call themselves a pain doc. The FP drug dealer, the DC moneymaker, the PT PhD entrepreneur, the ACGME BC Anes or PMR Pain Medicine Specialist, the ND hippie holistic healer in a van down by the river. No definite standard makes variable, ineffective, and often unsafe care.
     
  18. PMR 4 MSK

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    Don't forget the CRNA practicing independently...
     
  19. Josh L.Ac.

    Josh L.Ac. MSA/LAc & BSN/RN --> AA-S
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    When reading the research coming out of Germany, pay close attention to the background and training of the researchers. In the case of the study that was posted (and most of the research coming out of Germany), the protocols were designed and administered by the loose German equivalent of Medical Acupuncturists. But instead of being an anesthesiologist or PM&R doc --> pain doc, most are family practice docs with 100 hours of training (versus 300 hours for America Medical Acupuncturists).


    While I will completely side-step the debate on American Medical Acupuncturists 300 hours of training versus master's or doctorate prepared acupuncturists with 2800-3500+ hours of training, it is very significant to note that the average German physician acupuncturist does not have acupuncture training that is equivalent to their American counterpart. Plus, I've met some German physician acupuncturists and there style is different from what is taught in the US in terms of "traditional diagnosis" and point selection.

    I'm not going to say what us Amerikans do is inherently better, I'm just saying that it is difficult to take the results done in the German studies and apply them here.
     
  20. ampaphb

    ampaphb Interventional Spine
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    Simply false

    Acupuncture was administered in 340 outpatient practices by physicians of various specializations who had at least 140 hours of acupuncture training: 55% had undergone basic training (mean, 213 hours) and 45% had advanced training (mean, 376 hours). The study physicians had practiced acupuncture for 2 to 36 years (median, 8.0 years). All took part in a 1-day training session with emphasis on acupuncture methods and study design. Each patient in the study practices was seen by the same physician-acupuncturist at each session. Independent telephone interviewers assessed outcome measures.

    ...

    Patients were randomized to receive verum acupuncture, sham acupuncture, or guideline-based conventional therapy. All interventions comprised ten 30-minute sessions, generally 2 sessions per week, and 5 additional sessions if, after the tenth session, patients experienced a 10% to 50% reduction in pain intensity (Von Korff Chronic Pain Grade Scale). Interviewers and patients were blinded to this criterion. In all telephone interviews, patients were asked specifically about use of medication and physical therapy.

    The sterile, disposable needles (Asiamed, Pullach near Munich, Germany) used for verum and sham acupuncture were identical and were either 0.25x40mm or 0.35x50 mm. Only body needle acupuncture, without electrical stimulation or moxibustion, was allowed. Verum acupuncture consisted of needling fixed points and additional points (from a prescribed list) chosen individually on the basis of traditional Chinese medicine diagnosis, including tongue diagnosis. Fourteen to 20 needles were inserted to a depth of 5 to 40 mm depending on location. Induction of de Qi (the sensation felt when an acupuncturist reaches the level of Qi [numb radiating sensation indicative of effective needling] in the body) was elicited by manual stimulation. Sham acupuncture on either side of the lateral part of the back and on the lower limbs was also standardized, avoiding all known verum points or meridians. As with verum acupuncture, 14 to 20 needles were inserted, but superficially (1-3 mm) and without stimulation.

    The methods of acupuncture and Chinese diagnosis were established on the basis of the international literature and a consensus process with international experts. The exact method of acupuncture has been published. (Haake M, Mu¨ller HH, Schade-Brittinger C, et al. The German multicenter, randomized, partially blinded, prospective trial of acupuncture for chronic lowback pain: a preliminary report on the rationale and design of the trial. J Altern Complement Med. 2003;9(5):763-770; Molsberger AF, Streitberger K, Kraemer J, et al. Designing an acupuncture study, II: the nationwide, randomized, controlled German acupuncture trials on lowback pain and gonarthrosis. J Altern Complement Med. 2006;12(8):733-742.) For acute episodes of pain, only rescue medication was permitted in both acupuncture groups. This was strictly defined as nonsteroidal antiinflammatory drugs to be taken on no more than 2 days per week up to the maximum daily dose during the therapy period and only 1 day per week during follow-up. Use of any additional therapies for pain during the entire study period was prohibited

    Patients in the conventional therapy group received a multimodal treatment program according to German guidelines. (AKDA. Empfehlungen zur Therapie von Kreuzschmerzen. 2 ed. Dusseldorf, Germany: Nexus GmbH; 2000.). The guidelines provide the treating physician with recommendations about the treatment algorithm and assess the various therapy forms according to the degree of evidence based on a literature search and recommendations of the specialist associations.

    Conventional therapy included 10 sessions with personal contact with a physician or physiotherapist who administered physiotherapy, exercise, and such. Physiotherapies were supported by nonsteroidal antiinflammatory drugs or pain medication up to the maximum daily dose during the therapy period. Rescue medication was identical to that for the acupuncture groups.

    During acupuncture treatment, communication with the patient was limited to necessary explanations to avoid unblinding the patient by suggestive remarks. Patients in all 3 groups were informed before randomization that acupuncture would be offered after completion of the trial.
     
  21. chauffeur

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    If you're interested in Medical Acupuncture, look into the Helms Course, which was previously through UCLA and is now through Stanford. Do your own research. There is a ton of evidence out there. Many of the review articles group poorly designed studies together with others. I've been pleasantly suprised with my patients who've recieved acupuncture, particularly after they have failed many other more expensive and invasive interventions.

    You don't have to explain acupuncture in terms of cold invasion or yin/yang exess, read about Percutaneous Electrical Nerve Stimulation (PENS) and other variations. Functional MRI studies are also interesting and promising. There is a chapter on acupuncture in most pain textbooks. Before I new more about acupuncture, I thought this is was odd.
     
  22. Josh L.Ac.

    Josh L.Ac. MSA/LAc & BSN/RN --> AA-S
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    I've actually been in China when groups of medical acupuncturists from both Germany and America were finishing up the their hours and it was ridiculous. Both groups received credit for patient treatments when all they did was stick a needle at a location pointed out by one of the TCM docs. No diagnosis, no interview, not even a full treatment.

    Even if the physicians in this study were to have high-quality training of 376 hours (the mean of all the physicians was still less than the 300 required for medical acupuncturists in this country), it still pales in comparison to someone training full-time. As part of my master's degree program, I spent almost 200 hours practicing needling before I even touched a patient whereas the American medical acupuncturists I met in China (they were from a program in New York state) had never even used an acupuncture needle before.

    It showed.

    Now I'm going to preempt the whole "physicians are smarter than acupuncturists" by conceding that in general, a pain doc is going to have the ability to learn acupuncture faster than the average master's / doctorate degree acupuncture student.

    But still 8-10X the hours is 8-10X the hours, I don't care if you are Doogie Howser or not.

    I've actually read the article that group published that outlined their protocols. First of all, developing standardized protocols are lame. While it might be important in order to standardize methodology for research, pretty much the only people that actually used treatment protocols in practice are acupuncture students, chiropractors with a 100 hour training certificate, medical acupuncturists (in the study - the ones I actually know in the real world don't use protocols anymore either), and master's / doctorate-prepared acupuncturists that suck.

    If you don't modify your treatment protocol based off of the reactions you get from the first few needles you put in, then you aren't doing acupuncture; you're pretending (and billing).
     
  23. ampaphb

    ampaphb Interventional Spine
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    So ... since it would be impossible to design study with a standardized treatment protocol, it is impossible to test the scientific validity of the treatment?
     
  24. ampaphb

    ampaphb Interventional Spine
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    The Archives of Internal Medicine study does show a good response, but it also showed that you could place the needles anywhere, and get similar efficacy.

    They therefore concluded that "the unexpected finding of similar effectiveness of sham and verum acupuncture forces us to question the underlying action mechanism of acupuncture and to ask whether the emphasis placed on learning the traditional Chinese acupuncture points may be superfluous ... This can not be explained solely by positing the existence of additional, previously unknown acupuncture points or regions because in the sham acupuncture, needles were inserted only very shallowly and without elicitation of de Qi. Several other hypotheses must
    be considered instead: (1) there are no specific acupuncture effects at all; (2) the specific acupuncture effect is very small and is overlaid by nonspecific effects; and (3) there exist specific acupuncture effects, the nature of which is still unknown,that lead to symptom improvement independent of point selection and depth of needling."
     
  25. Josh L.Ac.

    Josh L.Ac. MSA/LAc & BSN/RN --> AA-S
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    No, you could either use a standardized treatment and through interview determine that all of the patients involved should respond to that treatment (which would be next to impossible to recruit enough subjects and the results would have to be evaluated under the context of "this is a standardized treatment"), or you could test "real acupuncture" as being an intervention that is tailored on the fly to each patient.


    Once somebody figures out how to solve this problem, hopefully they will jump on the issue of a proper control.
     
  26. lobelsteve

    lobelsteve SDN Lifetime Donor
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  27. Josh L.Ac.

    Josh L.Ac. MSA/LAc & BSN/RN --> AA-S
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    Can you give a cliff notes review of those podcasts, I have a party to get to.


    KTHXBYE.



     
  28. ostensibly

    ostensibly Junior Member
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    I vaguely remember hearing about acupuncture used in certain surgeries for local anesthesia intraoperatively in China. Anyone able to elaborate ?
     
  29. brori

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    This brings up several topics, including the sham multibillion unregulated herbal/vitamin/plant root market. How does this continue to thrive in 21st century America. What is the AMA doing about this?

    Granted, some herbal remedies might work for some, but going unregulated, privatized industries will take "proprietary formula" on the label to the extreme. ie lots of cheap fillers and "unsterile" conditions during manufacturing.
     
    #29 brori, Dec 31, 2008
    Last edited: Dec 31, 2008
  30. ostensibly

    ostensibly Junior Member
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  31. ostensibly

    ostensibly Junior Member
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  32. Green Mountains

    Green Mountains New Member
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    I find lobelsteve comments on acupuncture quiet disturbiing. I also find it amazing just how someone with really no expertise in something can be so quick to say it does not work or is for quacks. That is not a true scientist.

    If you google youtube and look for Dr. Rosenthal a hematologist and oncologist from Dana Farber and medical director you will find a total diff view point.

    The studies do exist that show acupuncture is effective for pain.

    Dr. Rosenthal also states that acupuncture is for more than just pain and they are now discovering that acupuncture is EVIDENCE BASED medicine.

    Please for future ref make sure you get your facts strait before making a recomendation on something. I was always under the impression that as a medical physician you should not comment on something you know very little about? That type of behavior is dangerous, then you have physicians making a diagnosis when they really don't know what is actually going on.

    If acupuncture can help a person with pain or a cancer patient with the side effects of chemo, and it is safe and when delivered by a qualified person (licensed acupuncturist), then why not? If you want scientific evidence then look for it because it exists.

    I hope I never have the unfortunate event of being in an emergency situation and having to see a physician that is going to treat me when they don't actually know whats wrong with me but are willing to act like they do and as a result risk my life.

    Get some training and do some research before making or giving professional opinions regarding subjects you know very little about.

    As for the person who asked about acupuncture and training, Go for it, it will only benefit your patients. After all, is that not what the ultimate goal is for a physician.

    Look acupuncture up on pubmed and you will find, at least 13,000 articles published!

    Best of luck to you.
     
  33. lobelsteve

    lobelsteve SDN Lifetime Donor
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    A critical review of the most discussed articles on Acupuncture reveals they are poop. Take your 8 posts (current count) and go to quackcast and listen to Dr. Crislip's critique of the methodology, results, and conclusions that do not follow from the results in regards to these articles. Quackcasts 7,8,21,27

    If a patient wants to do acupuncture, I have no problem with them exploring this avenue. If I have to pay for it via higher taxes, then we have a major problem. Could you recommend a good phrenologist?
     
  34. ampaphb

    ampaphb Interventional Spine
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    Could you please provide us with citations for a few Prospective, Double-blind, Controlled trials amongst those 13000 articles that specifically document acupuncture's efficacy in addressing pain? That would probably bolster your argument far better than making reference to a You Tube video.
     
  35. Tenesma

    Tenesma Senior Member
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    green mountains.... i hope by the time you finish your medical training that your insight into critical review of literature expands beyond youtube and google and pubmed searches... please read the articles instead of the abstracts... then you will see where a lot of us come from (scientifically)... even though, non-scientifically i still recommend acupuncture (just like i would recommend reiki) for conditions that i don't understand, can't understand, don't respond to normal medicine/imaging, and the patient has worn through all western medical approaches.
     
  36. SSdoc33

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  37. Green Mountains

    Green Mountains New Member
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    My medical training in AOM is does not involve youtube, I only made a ref to it. If you want to see some really good evidence based studies on acupuncture they do exist. Checkout what Dana Farber and MD Anderson are currently doing. I do not claim to have the medical training of a MD/DO nor will I ever claim that. So you guys have me beat with this.

    I decided to change my career after my life experiences with family members who became terminally ill and WM medicine failed them. But the doctors did the best they could for them.

    Most of my professors in AOM school are medical doctors and I enjoy having the opportunity to learn from them.


    What I have learned is that the delivery of healthcare works best with a team approach to it. Everyone has a place, not just MD/DO. Even acupuncturists can and do contribute.

    For someone to make comments like (quack) is totally not fair, to a medicine that has stood the greatest test of them all :The test of time".

    Also to suggest that my medical training is limited to pubmed and youtube is quiet insulting.

    Most of the MD/DO that I have met are quiet open to AOM as a whole and many tell me that they like it due to the fact that it is safe and has a proven long history.

    As someone who grew up, looking up to MD/DO, I guess I would expect more from the responses I have recieved here.

    TCM has been around longer than us all and I am sure it will still be here long after we are gone.

    Also my 8 posts now 9, are not all based on acupunture. I decided to choose this career path after having some western training and back ground.

    I will say that I am happy to hear that at least for now many of you are willing to consider AOM for patients. That is at least a start, hopefully as time goes on, you will see the studies you are looking for.

    I will say that I have seen some amazing things as a student in AOM. For myself, I use to get sinus infections and now I am free of them. My ENT is happy due to not wanting to keep giving me antibiotics. Also I use to get migraines pretty badly, in my previous career, I was a VP in corporate america and lived on pain meds. Now I am free of them. So I know it does work and my ENT and other family doctors are also quiet impressed and happy I am doing better.

    For myself I hope to work with a Oncologist after graduation, help with the side effects of chemo.

    I guess that is enough from me for now, don't want to bore anyone.

    Live life to the fullest, its way to short not too.

    Best Regards to all.
     
  38. ampaphb

    ampaphb Interventional Spine
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    We subject our claims to evidence-based rigor. If you venture into our world, you should expect to be treated as an equal, and have your claims subjected to similar scrutiny.

    Lots of old wives tales have been disproven when subjected to the unforgiving glare of the light Evidence-Based Medicine sheds. "The test of time" is no substitute for the scientific method.

    Anyone can make claims, get testimonials, and report those magical words "in my experience". Until you subject your data to the same methodology current medicine demands, you are, indeed, in the realm of quackery.
     
  39. Green Mountains

    Green Mountains New Member
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    OK I bite

    I may not be a medical doctor but I am not an idiot and do not enjoy the sarcastic remarks about my posts. I will say that I am quite offended. If you want research please read the following.

    As for the earlier comment about not having tax dollars pay for it. Well don't be surprised The Federal Acupuncture Act, when it does finally pass. Maybe after I graduate. I will enter the realm of politics, I have always passed on this. Even thought my Uncle is a retired US Senator and another was in congress. When I find myself being talked down to like this and the apparent anti anything besides your views, I do find myself wondering if I should get involved more?

    Maybe you guys can call all of these doctors and tell them they are quacks?
    Here is just some of what I have personally read. They are long so please enjoy.

    I wonder what Dr. House thinks? That would be a good one.

    Some pretty big names I might add. MD Anderson, Havard, Duke. On no I better call the Attourney Generals in those states, because there are quacks treating patients. Oh, I forgot, I also know one a very prominent AG

    ENJOY

    Anesth Analg 2008; 107:2038-2047
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    Pain


    ________________________________________
    ANALGESIA
    Acupuncture for the Management of Chronic Headache: A Systematic Review
    Yanxia Sun, MD, and Tong J. Gan, MB, FRCA
    From the Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
    Address correspondence and reprint requests to Tong J. Gan, Duke University Medical Center, Department of Anesthesiology, Box 3094, Durham, NC 27710. Address e-mail to [email protected] .
    Abstract
    OBJECTIVE: The objective of this review was to evaluate the efficacy of acupuncture for treatment of chronic headache.
    METHODS: We searched the databases of Medline (1966–2007), CINAHL, The Cochrane Central Register of Controlled Trials (2006), and Scopus for randomized controlled trials investigating the use of acupuncture for chronic headache. Studies were included in which adults with chronic headache, including migraine, tension-type headache or both, were randomized to receive needling acupuncture treatment or control consisting of sham acupuncture, medication therapy, and other nonpharmacological treatments. We extracted the data on headache intensity, headache frequency, and response rate assessed at early and late follow-up periods.
    RESULTS: Thirty-one studies were included in this review. The majority of included trials comparing true acupuncture and sham acupuncture showed a trend in favor of acupuncture. The combined response rate in the acupuncture group was significantly higher compared with sham acupuncture either at the early follow-up period (risk ratio [RR]: 1.19, 95% confidence interval [CI]: 1.08, 1.30) or late follow-up period (RR: 1.22, 95% CI: 1.04, 1.43). Combined data also showed acupuncture was superior to medication therapy for headache intensity (weighted mean difference: –8.54 mm, 95% CI: –15.52, –1.57), headache frequency (standard mean difference: –0.70, 95% CI: –1.38, –0.02), physical function (weighted mean difference: 4.16, 95% CI: 1.33, 6.98), and response rate (RR: 1.49, 95% CI: 1.02, 2.17).
    CONCLUSION: Needling acupuncture is superior to sham acupuncture and medication therapy in improving headache intensity, frequency, and response rate.

    Acupuncture Becoming More Mainstream in Western Medicine
    December 26, 2008
    Dear Mayo Clinic:
    What do you think of acupuncture as a treatment for various ailments? How does it work?
    Answer:
    Acupuncture, which has been used and studied throughout the world for more than 4,000 years, can be utilized to rebalance the flow of energy (Qi) in the body and effectively treat many conditions. At Mayo Clinic, acupuncture has been used successfully for pain management, postoperative nausea, anxiety relief, drug addiction, insomnia and headaches, to name a few.
    Acupuncture is administered by inserting up to a dozen or more tiny needles into very precise locations (points) determined by symptoms. The needle insertion points are based on a series of points along meridians or channels that interconnect throughout the body, each with a different function. There are twelve principle meridians within the body, containing almost 400 acupuncture points.
    Patients rarely have any discomfort with needle insertion. Needles remain in place for 15 to 45 minutes. During a treatment, the acupuncturist may gently stimulate the needles manually, apply heat with a ceramic lamp at a safe distance, or attach low-frequency electrical stimulation. The goal is to improve energy flow in the body, thus relieving pain and other symptoms, allowing people to sleep better and improve their quality of life.
    For some conditions, one treatment provides rapid relief. Other situations, such as chronic pain management, may require a series of treatments. In some cases, symptom relief is not always immediate and may require a period of two to three days for the positive effects to be noted. This is in part related to delayed secretion of endorphins.
    While some patients and providers remain skeptical of its therapeutic value, acupuncture is becoming more mainstream in Western medicine as a stand-alone treatment or as one element of a comprehensive treatment plan.
    As a practicing neurosurgeon, I can cite several examples of acupuncture's beneficial effects. These stories from our patients illustrate the scope of acupuncture's benefits:
    Post-surgery nausea: Nausea and vomiting after surgery can be a serious side effect of anesthesia for some patients. It can slow recovery and require some patients to remain in the hospital for weeks on IV fluids. Potential complications of extended bed rest include increased risk of pneumonia and blood clots. One acupuncture treatment can abate the nausea, as shown in this case:
    A colleague of mine needed neck surgery and had a lifelong history of postoperative nausea that resulted in prolonged hospital stays. We performed acupuncture within an hour of surgery. At that point, she was already developing nausea. Following one acupuncture treatment, she didn't need anti-nausea medication, slept well and sailed through the rest of her recovery. She and her husband considered the benefit dramatic. We also have seen dramatic results in liver and heart transplant patients with relief of nausea and quicker recovery.
    Tennis and golf elbow (epicondylitis): Another patient, who is an avid tennis player, believed he was permanently sidelined because of elbow pain. Aggressive physical therapy and steroid injections hadn't helped. With one acupuncture session, his pain was eliminated, and several days later he played in a doubles match — and won. Studies have shown that, for this type of pain, acupuncture can be more effective than steroid injections or physical therapy alone.
    Cancer recovery: Another patient had difficulty bouncing back after surgery — an esophagus resection to treat cancer. Like many patients who undergo this procedure, he had problems with eating, lost weight and wasn't able to work or exercise. After he had lost almost 50 pounds and nothing else helped, he tried a series of acupuncture treatments. He says the acupuncture gave him his life back. He has returned to work and more normal activities, has gained needed weight, and works out regularly with a trainer.
    Granted, these are anecdotes. Not everyone will experience similar results, nor might everyone even be a candidate for acupuncture. Acupuncture has an excellent safety profile, with negligible risk of infection or bleeding. It can safely be performed on patients who are on blood thinners, unlike many other pain management modalities. Patients should seek treatment by physicians who have received extensive training in the art and science of acupuncture.
    Overall, an ever-growing body of research confirms the benefits of acupuncture. One treatment can cost from $100 to $200, and most insurance companies do not cover acupuncture. Coverage is slowly becoming more common, however, as insurers see that acupuncture can help reduce health care costs when fewer pain medications are needed and patients can be discharged more quickly from the hospital.
    — Ronald Reimer, M.D., Neurosurgery, Mayo Clinic, Jacksonville, Fla.
    A combined [11C]diprenorphine PET study and fMRI study of acupuncture analgesia




    References and further reading may be available for this article. To view references and further reading you must purchase this article.
    Darin D. Doughertya, b, 1, , , Jian Konga, b, 1, Megan Webba, Ali A. Bonabc, Alan J. Fischmanc and Randy L. Golluba, b
    aPsychiatric Neuroimaging Research Program, Department of Psychiatry, Massachusetts General Hospital (MGH), Harvard Medical School, MA 02129, USA
    bAthinoula A. Martinos Center for Biomedical Imaging, and Nuclear Magnetic Resonance Center, MGH, Charlestown, MA 02129, USA
    cDepartment of Nuclear Medicine, Massachusetts General Hospital, Boston, MA 02114, USA

    Received 11 February 2008;
    revised 22 April 2008;
    accepted 24 April 2008.
    Available online 2 May 2008.

    Abstract
    Functional neuroimaging studies suggest that a lateral network in the brain is associated with the sensory aspects of pain perception while a medial network is associated with affective aspects. The highest concentration of opioid receptors is in the medial network. There is significant evidence that endogenous opioids are central to the experience of pain and analgesia. We applied an integrative multimodal imaging approach during acupuncture. We found functional magnetic resonance imaging signal changes in the orbitofrontal cortex, insula, and pons and [11C]diprenorphine positron emission tomography signal changes in the orbitofrontal cortex, medial prefrontal cortex, insula, thalamus, and anterior cingulate cortex. These findings include brain regions within both the lateral and medial pain networks.
    Keywords: Acupuncture; Placebo; Analgesia; Opioid; PET; fMRI; 11C-diprenorphine
    Article Outline
    1. Introduction
    2. Materials and methods
    2.1. Human subjects
    2.2. Experimental procedures
    2.2.1. Session 1
    2.2.2. Session 2
    2.2.3. Sessions 3 and 4
    2.2.4. fMRI session
    2.2.5. PET session
    2.3. Acupuncture administration
    2.3.1. Verum acupuncture
    2.3.2. Sham/placebo acupuncture administration
    2.4. Data analysis
    2.4.1. Behavioral data analysis
    2.4.2. fMRI data analysis
    2.4.3. PET data analysis
    3. Results
    4. Discussion
    Acknowledgements
    References



    Fig. 1. Acupuncture administration procedure. S indicates verum (placebo) acupuncture stimulation at LI4; R indicates rest without stimulation with acupuncture needle still in place. During the fMRI scanning session, imaging data was collected from t = 0 to t = 29 min. During the PET scanning session, tracer injection and imaging acquisition began at t = 2.
    View Within Article



    Fig. 2. Greater fMRI signal change increases were found during verum acupuncture when compared to sham acupuncture and greater [11C]diprenorphine PET binding potential decreases (suggesting increased endogenous opioid release) were found during verum acupuncture when compared to sham acupuncture.
    View Within Article

    Table 1.
    Real and placebo acupuncture subjective SASS ratings during fMRI and PET sessions (mean ± S.D.)

    View Within Article
    Table 2.
    fMRI signal change differences evoked by real and placebo acupuncture treatment

    Peak coordinates are in Montreal Neurological Institute (MNI) space. Threshold was set at P < 0.005 with 5 continuous voxels.
    View Within Article
    Table 3.
    Greater [11C]diprenorphine PET binding potential decreases (corresponding with greater endogenous opioid release) during real and placebo acupuncture treatment

    Peak coordinates are in Montreal Neurological Institute (MNI) space. Threshold was set at P < 0.05 with 5 continuous voxels. Italics represent a priori regions.
    View Within Article

    Corresponding author at: Massachusetts General Hospital, CNY 2612, Building 149, 13th Street, Charlestown, MA 02129, USA. Tel.: +1 617 724 6143; fax: +1 617 726 4078.
    1 Drs. Dougherty and Kong are co-first authors.
    M. D. Anderson's Cohen honored for contributions to traditional Chinese medicine



    IMAGE: Lorenzo Cohen, Ph.D., is the director of the integrative medicine program at the University of Texas M. D. Anderson Cancer Center.
    Click here for more information.



    HOUSTON - Lorenzo Cohen, Ph.D., Director of the Integrative Medicine Program at The University of Texas M. D. Anderson Cancer Center is the recipient of the 2007 International Scientific and Technological Cooperation Award of Shanghai Municipality (ISTCASM) and the 2008 Magnolia Memorial Award for his contributions in furthering research into the use of traditional Chinese medicine in cancer therapies.
    The prestigious awards, established by the Shanghai Municipality People's Government, recognize individuals and international organizations that make outstanding contributions to the city. The ISTCASM award has been presented since 2006 to those who advance scientific and technological development in Shanghai. The Magnolia Memorial Award, named after the city's official flower, was created by the municipal government in 1989 to show appreciation to expatriates who live in Shanghai and contribute to the city's economic performance, international relations, business environment, management standards and community development. Cohen was selected based on the merit of his scientific collaboration with faculty from Fudan University Cancer Hospital in Shanghai.
    Cohen and his M. D. Anderson colleagues have worked closely with researchers in the Department of Integrative Oncology at Fudan University Cancer Hospital over the past five years, and in 2005 the teams were awarded a $2.15 million grant from the National Cancer Institute to expand ongoing laboratory and clinical research studies of herbal and natural-based products as sources for new cancer therapies. M. D. Anderson and Fudan University Cancer Hospital signed a sister-institution agreement in 2003 that formalized a framework for educational, clinical and research exchange programs.
    "I am extremely honored to accept these awards and extend my deep appreciation to my colleagues at Fudan University and the city of Shanghai for making this partnership possible," said Cohen. "Together, we continue to make important strides in understanding traditional Chinese medicine and its potential to advance the science of cancer research and patient care."
    According to Luming Liu, M. D., chair and Zhiqiang Meng, deputy-chair of the Department of Integrative Medicine at Fudan University Cancer Hospital, the ongoing collaboration with Cohen and M. D. Anderson has opened multiple avenues for research training. Currently faculty and staff from both institutions are supporting the collaboration through work on several research projects.
    Joint clinical studies currently underway include examining the ability of HuaChanSu (a form of dried toad venom) to treat advanced pancreatic, liver and lung cancer. Energy-based practices such as qigong are also being investigated as a way to promote relaxation among breast cancer patients undergoing radiation therapy.
    "Dr. Cohen and the researchers in Shanghai have championed a 21st century research program dedicated to studying the mainstays of traditional Chinese medicine and its application to cancer," said John Mendelsohn, M.D., president of M. D. Anderson. "Their continued work in this area exemplifies our commitment to the exchange of knowledge across continents to benefit cancer research and treatment."
    Traditional Chinese medicine dates back up to 5,000 years ago and in China is accepted as standard of care. The majority of chemotherapies used today originated from natural plants and many popular drugs, such as morphine and aspirin were derived from plants, according to Cohen.
    At M. D. Anderson, Cohen said that over 50 percent of patients report that they use ingestible complementary therapies. "Growing numbers of patients globally are integrating complementary therapies into their cancer care, especially cancer survivors who are looking to Eastern medicine to manage side effects and even prevent recurrence," Cohen said. "It is important for medical teams to understand fully the potential benefits, risks and safety precautions associated with therapies such as traditional Chinese medicine, as we would any regimen."
    Director of the Shanghai Ministry of Science and Technology of Shanghai, Shou Ziqi, presented the awards to Cohen in an official ceremony in Shanghai last week. Dutch horticulturist Co Buschman was also honored for his work with Sino-Dutch agricultural projects in Shanghai since 1997.
    A Yale researcher and expert in the practice of acupuncture is conducting a three-year study on the effectiveness of this ancient Chinese practice in reducing low back pain during pregnancy.

    The study is funded with a $400,000 grant from the National Institutes of Health and will include 150 women who are at least 24 weeks pregnant. The lead researcher, Shu-Ming Wang, M.D., associate professor of anesthesiology at Yale School of Medicine, was approached by a colleague three years ago who was suffering from severe low back pain and sciatica in the final months of her pregnancy.

    "She asked if I could do anything to help," said Wang, who inserted three, two-millimeter needles into her colleague's ear. "She recovered immediately." A subsequent survey of more than 1,000 pregnant women in New Haven County showed that 65 percent suffered from low back pain and sciatica. The survey was conducted by Yale-New Haven Hospital in conjunction with Wang, who is an attending anesthesiologist at the hospital.

    Acupuncture involves stimulation of anatomical points on the body by a variety of techniques, including penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation. In this study each of two groups of women will receive slightly varying acupuncture treatment. The remaining group will receive no treatment and serve as a basis of comparison. Wang said those women who do not receive treatment and those who do not improve with assigned group interventions will be invited to return for additional treatment at no cost after the study is completed.

    The treatment consists of three tiny needles inserted on one side of the ear. The women will be asked to remove the needles after one week and the results will be measured two weeks after the treatment was initiated. "They can sleep, and shower, and forget about the needles, other than when they answer the telephone," Wang said.

    Co-investigators include Michael Berman, M.D., James Yue, M.D., Ferne Braveman, M.D., Zeev Kain, M.D., and Haiqun Lin, M.D.

    Persons interested in participating in the study should call Wang's office at 203-737-1149 and leave their name and contact information.

    Jacqueline Weaver - [email protected]
    Yale University
     
  40. ampaphb

    ampaphb Interventional Spine
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    A study that shows a trend? Really? That's the best you can do?

    See a testimonial of "here's how we do it at Mayo Jacksonville" is an appeal to authority.

    fMRI data is interesting, but is more HOW it works that IF it works.

    And your vaunted MD Anderson study is an announcement that they are preparing to START a study - please feel free to keep us apprised 5 years from now when the RESULTS are published
     
  41. PMR 4 MSK

    PMR 4 MSK Large Member
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    From what I've seen, many/most of the accupunture studies appear to be on patients with highly somatic complaints - headache, abdominal pain, endometriosis, etc. These are subject to powerful placebo effect, and sham accupunture automatically removes the possibility of being double-blind. Accupuncture, by it's very nature, is very difficult to study under the rigors of modern science.

    I'm not opposed to insurance covering it, as long as the limits are similar to those for PT. It's not likely to cause harm, and may benefit some. Not sure if their have been any studies looking at it from a financial efficacy standpoint. Much of what we do has minimal EBM.
     
  42. Josh L.Ac.

    Josh L.Ac. MSA/LAc & BSN/RN --> AA-S
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    There have been several studies that looked into the savings that acupuncture vs. conventional therapy can generate but they [all the ones that I am aware of] were done in England and Germany.

    Personally I'm fine with limited insurance coverage for acupuncture - my wife and I would rather not deal with taking it. Once the medicare for acupuncture bill finally passes, there will be an even greater influx of under-qualified practitioners scrambling into the field to make $35 a patient.


    Wonderful.
     
  43. teri78

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    Now I realize that the person who this comment was addressed to had a very inappropriate tone in his first post. However can you give us a few prospective, Double-blind, Controlled trials for all of the injections you do on a daily basis?

    Very few of the txs pain physicians offer to patients have this kind of support.
     
  44. lobelsteve

    lobelsteve SDN Lifetime Donor
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    The propoganda technique of shifting the subject does not alter the current topic.

    His injections are based in science and not Meridians and mythical energy fields.
    Netter goofed a bit on the cervical epidural venous plexus, but to miss meridians entirely that run over the entire body? Hmm.
     
  45. Josh L.Ac.

    Josh L.Ac. MSA/LAc & BSN/RN --> AA-S
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    "Internets, how do conceptual models?"
     
  46. teri78

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    How I am changing the topic? I just don't see why you think acupuncture needs to have more EBM than some other tx's you use everyday.

    I am not trying to say acupuncture is some great tx. I just don't understand the double standard, or maybe I do and I just don't want to say it.

    Personally, I don't really believe that sticking needles in ones face will specifically help their leg or back pain. However, I do think it is at least possible that there is some generalized process, maybe endorphin realease, that may explain the relief some patients get. There are lots of tx's and medications used that the actual mechanism of action is unknown, and there maybe some real physiological reason acupuncture works in some people that just isn't known yet.

    I really am not someone who is pro-acupuncture. I've acutually tried acupuncture myself once, and all I got out of it was a lighter wallet. However, I don't discount it simply because it didn't work for me, or doesn't have double-blind controlled trials. It seems safe, and some people do seem to benefit, so I just don't quite see why think it is such a sham.
     
  47. chauffeur

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    There is a good article this month on mechanisms of analgesia - Acupuncture analgesia: I. The scientific basis. Wang SM, Kain ZN, White P. Anesth Analg. 2008 Feb;106(2):602-10. Review.

    We don't even know how Acetaminophen works.

    Acetaminophen has similar analgesic and antipyretic properties to NSAIDs. However, the mechanism by which acetaminophen exerts its therapeutic action is still being clarified.

    I think there is something to it, but study designs have been poor. Also, acupuncture is so broad. There is Classical Chinese, Traditional Chinese, Japenese, Korean, and many other variations. What is even "true" acupuncture is debatable. Most studies lump all this together.
     
    #47 chauffeur, Feb 4, 2009
    Last edited: Feb 4, 2009
  48. chauffeur

    chauffeur Member
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    It's at least as effective as prophylactic drugs for migraine and may also benefit some patients with frequent tension-type headache, 2 large reviews conclude. :confused:

    http://www.medscape.com/viewarticle/587243

    If sham needling works nearly as good as the real acupuncture points, needle me. I'd rather do that than take a TCA on which I can't function.
     
  49. DrJosephKim

    DrJosephKim Advisor
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    More and more patients are seeking alternative therapies these days. Learning acupuncture is an invaluable skill.
     
  50. lobelsteve

    lobelsteve SDN Lifetime Donor
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    Just because patients are acting stupid doesn't mean we should encourage them. How many people get reactions from supplements (renal failure), have VB strokes from chiros, or spend several thousand cash out of pocket for acupuncture because they hurt so bad they'll do anything- and the darvon from their lacking pcp isn't effective.

    And whose acupuncture should I learn, chinese, modified, electric, sham, etc.
    Go to 12 acupouncturists and get 12 very different meridian and point selections.

    Go to 12 differernt pain specialists with an S1 radic, and you'll get 1 or 2 oddballs going at L5-S1 IL vs S1 TFESI. But htey are all going after the same target.
     

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