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A good dose of acupuncture…

15/12/2010

3 Comments

 
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…

3 Comments
Acupuncture in Leeds link
30/3/2011 03:09:37 am

I like the fact that acupuncture works on animals - does this not undermine the myth that acupuncture is all just a load of placebo?

Just a quick comment on needling away from the affected area - i.e. distill points. I have seen some amazing acupuncture by Kiko Matsumoto, who nearly always uses distal points, and has very good results.

Thanks fpr the article - you have a follower!

Reply
Samantha Lindley
30/3/2011 11:29:10 am

Thanks for your input.
Placebo is a complex subject and is a real neurophysiological response that can be targeted, and can be both blocked and enhanced by certain agents. Acupuncture has part of its effects through "placebo" (increasingly it is becoming clear that it is not an especially helpful term), which is one reason why its specific effects have been tricky to ascertain.
Placebo effects are seen in animals - this has been established and must be accounted for in clinical trials so unfortunately the fact that acupuncture appears to work so well in animals is no proof of a specific effect of needle insertion. We have a way to go with that one in the clinical setting, although there are many experimental studies of acupuncture in animals.
Regarding distant points- the animals I would refer to as good responders (and although we have no proof of this it would seem that prey species and cats are better responders overall than dogs and humans, probably because they are physiologically more reactive to incoming stimuli) would respond well to needling of any points. This is via what we would call a heterosegmental effect - and is potent in good responders. The other point about distal points is that they may be in the same spinal segment as the pain and therefore be closer to the source of the problem than first appears by their anatomical position. It is also possible that they work well for reasons we have not yet ascertained!

Reply
Bobbi M link
15/12/2020 07:50:36 am

Thaank you

Reply



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