By Capt. Elwood W. Hopkins, Neurologist, Naval Hospital Bremerton, Wash.
This blog is part three of a three part series. Part one was posted on Dec. 22 and part two posted on Dec. 29.
Upon return to my neurology practice at Naval Hospital Bremerton, Wash. in December 2009 I immediately began treating several of my own patients with acupuncture. And, as the other more experienced acupuncturist at our hospital, Dr. Son told me, once you learn how to use acupuncture, it will transform the way you practice medicine. Indeed, he was correct.
I now have provided more than 1,000 acupuncture treatments and have treated a variety of conditions: headaches, TMJ Syndrome, plantar fasciitis, prostatitis, IBS, acute and chronic joint problems, vertigo, post-operative pains, nerve root, chronic and acute back and neck problems, myofascial pain syndromes, fibromyalgia, athletes with focal maladaptive musculoskeletal problems, chronic fatigue, depression, painful peripheral neuropathies, and as an aid for smoking cessation, weight control, and detoxing opioid-dependent patients.
About 90% of patients get a good result and many a spectacular benefit. One 70-year old man with 30 years of painful diabetic neuropathy returned after the first treatment describing his benefits as “a miracle,” enabling him to do a full day of yard work with repeated lifting, bending and stooping; things he had not been able to do for decades. Another patient with spinal stenosis and chronic sciatica has, after four treatments, remained asymptomatic and able to pursue his classic car restoration projects, which require stooping and bending over fenders in engine bays, etc., for the last three months. Some patients don’t respond, and it is never clear why, at least not to me. Although a single treatment can provide lasting relief, we were trained to expect that for chronic problems, an initial course of about six treatments, ideally once or twice a week, would be best, after which the condition might need “tune up” treatments at various intervals, or not at all. Acute problems typically respond to just one treatment.
Although there are many different acupuncture courses, I was especially pleased with the scientific principles that formed the basis for the “Contemporary Medical Acupuncture” course provided by the team from Macmaster University in Toronto that guided our patient evaluations, enhanced our understanding of the musculoskeletal and neuromuscular pathophysiology, and assisted us in designing effective acupuncture treatment plans. The three other neurologist in my class concurred and we all graduated with an expanded appreciation and enthusiasm for putting this fabulous tool to work.
Our class of 27 students also included psychiatrists, a gastroenterologist, chiropractor, rheumatologist, podiatrist, gynecologist, endocrinologist, sports medicine physician, a few residents and several family medicine physicians. Clearly, anyone caring for patients should consider adding this tool to their kit.
The acupuncture needles are actually rounded at the ends, unlike bevelled “cutting needles” and insert between tissues rather than cutting through and damaging fibers. Non-nociceptive pressure is applied by one hand of the acupuncturist as the needles are advanced to the desired depth with the other hand. The pressure is a more robust and faster-conducted sensation, thus blocking any pain that might be felt as the needle is inserted. Needles are of stainless steel, individually wrapped, sterile and disposed of after each use. Although the adverse effect rate of acupuncture is 1/50,000 treatments, all of these (infection, pneumothorax) are preventable with proper technique.
There are no contraindications to acupuncture including treating patients on anticoagulants. Some patients may have punctate areas of bleeding when needles are removed and these are readily stemmed with a cue tip. I have treated adolescents and nonagenerians but would not recommend treating children who might find the experience intimidating and frightening, especially if unable to understand what is being done and why. The only other patient I would not treat would be one who did not want acupuncture. I have treated two patients who felt the acupuncture made them worse, so like everything else in medicine, you can’t always have a successful outcome.
Treatments take about 30-45 minutes, including patient assessment, explanation of the process and placement of needles, application of electrical stimulator and completion of the treatment. Some patients may become light-headed from treatment, especially if they arrive dehydrated. This is caused by both vagal reactions for first time treatments and the vasodilatory effects of the treatment (it is a good treatment for hypertension, especially a hypertensive emergency). Treatments are performed with patients recumbent or in a massage chair. Many patients I have treated have been able to reduce or eliminate the use of analgesics, including opioids, as well as antihypertensive medications and several of the patients who have diabetes have found it easier to control their blood sugars, often with fewer medications. Fewer antidepressant, tranquilizing and sleep medication needs are other benefits about which patients have commented. I have one patient who was about to undergo surgery as a last resort for cervical radiculopathy, but cancelled his surgery after a few acupuncture treatments and has remained asymptomatic for several months.
It is now evident to me that there truly is a great benefit to acupuncture. If you have ever received acupuncture, share you stories in our comments section.