By Capt. Elwood W. Hopkins, Neurologist, Naval Hospital Bremerton, Wash.
This blog is part two of a three part series. Part one was posted on Dec. 22.
Most of us in the class were respectful of the information but remained skeptical. Could the clinical effects just be another placebo effect? Certainly if subjective measures are the outcome to be expected, then a placebo effect could not be discounted. There is no honest way to perform a placebo-controlled double blind randomized study of acupuncture, especially if pain is the primary endpoint being measured. In fact, it was emphasized that functional outcome measures are what we should be striving for when treating patients with acupuncture. Dr. Claraco repeatedly wanted to know what a patient could not do because of the condition to be treated, and did not care what number they chose on the pain scale. His measure of success was an objective improvement of function.
Becoming a believer. There is nothing like personal experience to convince one of an effect. It is a bit like not requiring a double blind placebo controlled cross-over study to establish that an open parachute is more effective than a closed one. After the introductory lectures and our first practical session of learning the proper technique of painless needle insertions (the first needles are always placed by the student in their own leg – a great motivator for learning the difference between painless and not-so needle insertions), Dr. Claraco asked if any members of the class had conditions that might be treated with acupuncture.
Not believing that anything could be done to change my 30-plus years of Raynaud’s, I volunteered this information and was surprised when “The Matador” raised one eyebrow, smiled and beckoned me to sit facing the class while he examined my neck, and not my peripheral pulses. Finding what he was looking for, he inquired about my past history of trauma (motor vehicle, motorcycle, football, etc), consistent with what his exam had revealed and believing that my Raynaud’s was due to prior cervical injury (especially to posterior rami) as the pathophysiologic basis for the dysfunctional sympathetic tone in the hands and fingers (which in retrospect make sense as the Raynaud’s did not effect my feet or toes).
I was then placed prone on the treatment table (standard portable chiropractic/massage type) while four needles were inserted in the paraspinous regions of T2-T6 (where the sympathetics exit from the intermediolateral column of the spinal cord) to which electrical stimuli were applied for about 10 minutes. I felt no immediate changes in my hands or fingers (which were asymptomatic in the warm classroom), but my neck certainly was more supple and had a greater range of motion than I had experienced in the past few decades. The next morning (this was in December) I went for my usual run, during which my Raynaud’s characteristically announces its presence at about 10 minutes into the run and persists throughout the run (another 30-40 minutes) and remains for an hour or so after, even after showering and otherwise feeling warm. But this morning nothing happened to my fingers. They did not become pale, lifeless, nor did they sting or make it difficult for me to unlace my shoes or insert the key card and turn the door knob of the room to the Navy Lodge. The benefits of this one treatment persisted for the next two months, then gradually the Raynaud’s returned, but only to the tips of a few fingers. I received a second acupuncture treatment five months after the first and now, nearly a year later, have continued to be almost totally free of symptoms, except in the coldest of conditions and then only after a long exposure.
Many other of my classmates were treated for various conditions (radiculopathies, interstitial cystitis, arthritic joints, etc.) and virtually all benefitted from the treatments, making even the few cynics and skeptics believers in the value of this simple, safe and inexpensive tool that has been time-tested for several thousand years.
Part three will run on Thursday, Jan. 5.