All this talk of sharks for some reason reminded me of a cartoon some of you may remember from the Foundation Course (I know there were lots) of the “organic acupuncture” and the patient speared by numerous swordfish. The cartoon was used to illustrate the point that one of the difficulties with acupuncture research is that acupuncture is not the same the world over, or even between practitioners taught in the same way. There is no specific “dose” of acupuncture as there is a dose of aspirin or meloxicam, and different techniques may even be almost unrecognizable as acupuncture (“laser” acupuncture, swordfish acupuncture). This means that unless acupuncture is defined for a given study and, further than this, what techniques were used (“robust” needling, electroacupuncture, superficial needling) judging the study or report, and being able to repeat its effects, will be impossible.
But how does this relate to practical, clinical acupuncture? It is just that it is worth remembering the factors that contribute to the “dose” of acupuncture a patient receives. Firstly, the patient is a factor –whether they are a “good responder” or not (I defined this in a recent blog). A few needles, placed moderately deeply and stimulated a couple of times may turn out to be a big dose for a good responder who may be worse initially before improving dramatically. For most normal responders such an approach would probably have little or no effect. Then there is what the acupuncturist does with the needles – depth of placement; diameter of needles; the use of “lift and thrust” movements to stimulate; targeting of myofascial trigger points; the addition of electrical stimulation. Additionally, our veterinary patients tend to move about much more than do human patients, thus stimulating the points further as the needle tips alter position.
There may be other, subtler factors: if the clinician is a good responder themselves or very sensitive to the needles (i.e. feels a lot when the needles are inserted) it seems possible that they may be more likely to “under dose” their patients by using finer needles, fewer needles and less stimulation, because of, perhaps misplaced, empathetic feelings. Those who feel very little from needle insertion may have a tendency to take a more robust approach to needling.
All these considerations and judgements are part of what makes acupuncture so fascinating. Many of the positive studies of acupuncture use electroacupuncture as the stimulus, ie a potent stimulation, but so called “sham” (or what would look like rather feeble needling) acupuncture for migraines may be superior to standard treatment.
So it is worth remembering all this if your patients are not responding in the way you think they ought to, and examine the aspects of your technique that contribute to the dose of acupuncture delivered.
Oh, yes, and that the swordfish bit was a joke…