Acupuncture

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Alternative medicine in chronic pain control
Science or Fiction?
Presented by Jinni Demine, the big lover of sea
turtles
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Case of the year German Shepherd, 10 yo,
female (very cute)

• Apple in the owners eye (mine)
• Hip dysplasia grade II-III, degenerative joint
  disease, osteoarthritis
• Lame, very painful hips
• Climb up stairs with great difficulties, etc.,
  etc.
• Has been on meloxicam for the past 7 months
• Cannot reduce the dose
• Is she still painful???

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Therapies

• NSAIDs
• Corticosteroids
• Chondroprotectives
• Surgery
• Alternative medicine

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Alternative Therapies

• Acupuncture
• Homeopathy
• Herbal therapy
• Chiropractic therapy
• Essential fatty acids

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It matter not whether medicine is old or new, so
long as it brings about a cure, It matters not
whether theories are eastern or western, so long
as they prove to be true
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What is homeopathy?

• Homeopathy is the selection of the minimal dose
  of substance to cure a disease by the knowledge
  that the same substance could cause the symptoms
  seen in the patient.

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Homeopathy

• Hundreds and hundreds of drugs name, but
• No double-blinded studies were conducted on
  animals
• Many veterinary homeopathists are not even DVM!!!
• Can we believe panacea effects of homeopathy
  authors describe us???

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Herbal therapy

• No clinical studies evaluating chronic pain
  control in small animals were conducted before
  1997
• Our colleague at OVC (Marie C. Poland, 1997)
  conducted double-blinded, placebo-controlled
  clinical trial of aspirin and two herbal
  therapies for treatment of canine osteoarthrities

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Results of the study conducted by M. Polland
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Acupuncture

• Being integrated as a valid therapeutic modality
  in
• Equine medicine
• Large animals medicine
• Exotic animals medicine
• Small animal medicine

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1988, AVMA declared

• Veterinary acupuncture and acutherapy are
  considered valid modalities, but the potential
  for abuse exists. These techniques should be
  regarded as surgical and or medical procedures
  under state and practice acts

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History of Acupuncture

• Long, long, long History
• Originated in China, but there is some evidence
  that acupuncture was practiced earlier in
  elementary way in the North of India and in Tibet
• Very little demand for small animal acupuncture
  as it is very rare for Chinese to own pets

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Acupuncture History (contd)

• Legend says that veterinary acupuncture was
  discovered by chance, on the battlefield, when
  lame horses were found to be sound after being
  hit by arrows at distinct points (at the butt??)

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Acupuncture its not Acute Puncture, but...

• Acus - needle, Latin
• Pungare - pierce, Latin
• Insertion of a special type of needle in precise
  location in the body, called acupuncture points
  with the purpose of preventing and treating
  disease

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Traditional Chinese concepts

• Yin and Yang represent the dynamic nature of
  the life in all its interrelationships
• Yang is male yin is female
• Yang is heaven yin is earth
• Yang is hot, yin is cold

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Traditional Chinese concepts contd

• Black represents darkness or night, or female
  energy
• White represents brightness or daytime, or male
  energy
• All of this is relative as is symbolized by the
  small dots located inside the larger space
• Within every woman there are male traits and vice
  versa
• The entire symbol also implies movement (day into
  night, v.v..)
• Important to determine if a diagnosis is yin or
  yang so one can choose the proper yin or yang
  treatment

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I am lost, tell me in a simple vet words.

• Yin parasympathetic nervous system and
  endorphins
• Yang the sympathetic nervous system and
  epinephrine
• Therefore the disease will eventually manifest
  when the body is in a state of imbalance, the
  causes of which can be multiple

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In other Chinese words...

• The body shows signs of illness when there is an
  imbalance in the rhythmic cycling of Yin and Yang

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QI - vital energy

• The interaction of the opposing forces, yin and
  yang, gives rise to the flow of vital energy Qi
• Any stagnation of Qi leads to impairment or
  blockage of energy flow that manifest as pain or
  as a disease process
• Complete standstill of Qi means death

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Meridians

• Qi accumulates in the organs and flows in
  pathways that are known as meridians or channels
• Think of river that extends to all parts of the
  country
• Acupuncture points are situated along the channel
  like buds
• By stimulating these points with needles, heat or
  massage, a therapeutic influence can be exerted

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Meridians contd

• 12 meridians, named according to the organ on
  which they have primary influence.
• Broken down into yin or yang functions
• Yin liver (LV), Heart (HT), Lung (LU), Kidney
  (KI), Pericardium (PC)
• Yang Gall Bladder (GB), Small Intestine (SI),
  Stomach (ST), Large Intestine (LI), Bladder (BL)
• Two extra meridians Conception Vessel (CV) and
  Governing Vessel (GV) run up the ventral and
  dorsal midline of the animal
• Acupuncture points are usually found in small
  depressions (or valleys as Chinese say).

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Five phases

• Wood Liver/Gall Bladder
• Fire Heart/Small Intestine
• Earth Spleen/Stomach
• Metal Lung/Large Intestine
• Water Kidney/Bladder

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What are the involved mechanisms?
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Anyway, how does it work?

• Many Theories
• The neural nonopiate mechanism (Gate theory)
• The hormonal opiate mechanism
• The trigger point mechanism
• The stimulation of local vasodilation

• To make long story short
• Acupuncture effects result primarily from the
  nervous system effects. Nerves are stimulated,
  blood circulation increases, muscle spasms are
  relieved, and hormones, such as endorphins and
  endogenous cortisol, are released

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Gate Theory
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Acupuncture Techniques
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Acupuncture today

• Some studies concluded that three types of
  acupuncture (laser, saline injection and no
  injection) were equally useful for treating
  horses with chronic back pain
• However unblinded subjective outcome lack of a
  comparison group makes the conclusion
  questionable
• In dogs, clinical reports on the successful
  treatment of IVDD, musculoskeletal
  problems, pain therapy have been
  published but how accurate are they is
  unknown, therefore decide for
  yourself

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When would you use acupuncture?

• 1. The client finds Sx too expensive and out of
  question
• 2. Geriatric patient or preexisting illness
  possess high risk for anesthesia
• 3. Client prefers alternative therapy (aunt,
  friend, etc.)
• 4. Side effects from long-term medications

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How can acupuncture be used?

• Have correct diagnosis!!!!
• Try it before choosing Sx, if the choice of Sx is
  not clear-cut
• In the post-op period to accelerate convalescence
• With medications to decreased the frequency of Tx
  or to decrease the dosage needed to control the
  problem

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Side-effects

• The most common is over-acupuncturing which can
  lead to exacerbation of the problem being
  treated, especially an animal being treated for
  pain
• Bent or broken needles

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Dos and donts in Acupuncture Therapy

• Donts
• If possible avoid acupuncture
• immediately after the patient has eaten a heavy
  meal
• after exertion or in fatigued animal
• in animals that are extremely frightened, enraged
  or agitated
• in pregnant animals
• if injections of atropine, narcotics, narcotic
  antagonists or corticosteroids have been used
• if animals cannot be comfortably restrained and
  observed throughout the treatment period
• in animals with bleeding abnormalities or in
  areas where local malignancies or skin infections
  are present

• Dos
• Always be aware of the anatomy of the area being
  punctured to avoid traumatizing underlying
  internal structures
• Exercise care to avoid electric burns with
  Electroacupuncture

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Protocol

• For chronic problems
• Once weekly Txs during a period of 4 to 8 weeks
• Once the condition under control decrease the
  frequency of Txs to once biweekly and then
  stretch out to every 3-6 months
• The session usually lasts 15 min once the needles
  are in place

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Summary

• Musculoskeletal chronic pain is the most common
  condition in small animals
• Many treatments can be used to correct the pain
• Some alternative therapies efficacy is very
  questionable
• Acupuncture is a good Tx alternative to control
  certain musculoskeletal conditions
• It can be used in some special circumstances when
  traditional therapies dont work for this patient
• Its relatively safe and effective

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The End