accupuncture

Re: accupuncture

Rajat — Wed, 14 Nov 2012 18:38:17 GMT

Hi all

Bit of a follow up

These are a few veterinary acupuncture papers and general material HERE that were on my google drive- including a good presentation on it by another acupuncturist which delves into the science of how it helps alleviate pain a fair bit, and one presentation by me to members of public/clientele done a few years ago.

I'll try to get the rest together, I think its on my hard drive at home so will have to search for the papers I meant to quote...there are so many on acu tho, and many of the older studies conducted from China are sometimes less than rigorous...now there are many newer ones too but worth remembering the West only really became interested in acupuncture circa 1970-ish...

So for the fMRI stuff- s a cheeky link to a google search, plenty of reading material here - http://scholar.google.co.uk/scholar?q=acupuncture+%2B+functional+MRI+%2B+analgesia&btnG=&hl=en&as_sdt=0%2C5

Some choice extracts from the above

1 - http://onlinelibrary.wiley.com/doi/10.1002/hbm.20081/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false

2- http://www.sciencedirect.com/science/article/pii/S1053811902911456

3- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1193550/

4 -http://www.ncbi.nlm.nih.gov/pmc/articles/PMC227035/

PS the cat w BPA in the simple presentation I did was a classic Pavlovian - he would fall asleep under e-acu and after 3- 4sessions of this, he would lie down on the table once out of the carrier and and promptly pass out prior to ANY intervention at all- just the sight of the needles/me/the machine/being in the room elicited this response! It was quite hilarious, needless to say...

And the pointer w/shoulder pain - lovely dog- massive trigger point- conked out literally within 10-20 seconds of single needle insertion. Owners couldn't believe it when I showed them the pic!

Also OA in the knee for people ( there is evidence for efficacy in back and neck pain and strong anti emetic effects especially in chemo patients) :

http://rootandbranchom.com/References/References-Acupuncture-in-patients-with-osteoarthritis-of-the-knee.pdf

http://aim.bmj.com/content/30/3/187.short

http://rheumatology.oxfordjournals.org/content/38/4/346.short

http://www.ncbi.nlm.nih.gov/pubmed/22588814

http://www.sciencedirect.com/science/article/pii/S0304395912002886

There's more info on my comp - and there are negative studies out there too. Worth remembering while reading that in many older studies it was considered that 'sham' acu was needling at a non acupuncture point. Now non penetrating needles are used in preference as it is recognised a needle entering the body anywhere is acupuncture and exerts a neurophysiological effect

That's me out

Cheers

Rajat

Re: accupuncture

Rajat — Tue, 13 Nov 2012 20:09:21 GMT

Hmm not heard of TSE but TENS I have- while some people find benefit from TENS it is actully a bit uncomfy, and is now superceded by both manual and electro acupuncture. The voltage required for TENS is about 100x that for e-acupuncture (if I remember correctly from my lectures) as skin is a poor conductor of electricity. The boss bought a TENS machine to play around with. I used it on myself and never on a dog or cat after that- I didn't see how they would tolerate it. It did hurt a bit.

E- acu on the other hand is much much gentler. I have had it myself several times. And done it to many many dogs and cats and rabbits. Most will tell you when they can feel the sensation, one stops there, and it doesn't hurt or cause reactions the vast majority of times in my experience..

Re: accupuncture

Rajat — Tue, 13 Nov 2012 20:05:34 GMT

To those who want some links , please give me a day or 2 as am on holiday and being Diwali, its like Xmas for me, just a bit busy, not to say inebriated!! . I will forward some interesting studies on to you.

Re dangers of acu- it is substantially more dangerous with things like indwelling needles, or needling of certain points or around the thorax. It is otherwise immensely safe.

Re: accupuncture

james herriot lied — Tue, 13 Nov 2012 19:53:47 GMT

[quote user="Niall Taylor"]

Never underestimate the power of expectation bias - just sayin'

[/quote]

Oooooooooohhhhhhh.

Should we just move along to the RMB bucket controversial thread category now?

Re: accupuncture

Niall Taylor — Tue, 13 Nov 2012 19:05:17 GMT

[quote user="Rajat"]There is actually a wealth of EBM and scientific evidence in support of acupuncture now, including very interesting FMRI studies and so on. I can forward or link some if anyone is interested as a taster.[/quote]

Here's a couple from me in the meantime:

Conzemius, M.G., and Evans, R.B., (2012) Caregiver placebo effect for dogs with lameness from osteoarthritis J Am Vet Med Assoc Vol. 241 pp. 1314–1319

http://avmajournals.avma.org/doi/pdf/10.2460/javma.241.10.1314

A caregiver placebo effect for owners evaluating their dog’s lameness occurred 39.7% of the time. A caregiver placebo effect occurred 44.8% of the time when veterinarians examined dogs for lameness at a walk, 44.8% of the time when veterinarians examined dogs for lameness at a trot, and 43.1% of the time when veterinarians evaluated dogs for signs of pain on palpation of the joint. This effect was significantly enhanced with time. Mean ground reaction forces (GRFs) remained unchanged for dogs during treatment with the placebo. Individually, of 58 dogs, 5 had GRFs that worsened by # 5% over 42 days, 7 had GRFs that improved by # 5% over 42 days, and 46 had GRFs that remained unchanged.

Conclusions and Clinical Relevance—A caregiver placebo effect was common in the evaluation of patient response to treatment for osteoarthritis by both pet owners and veterinarians. Force platform gait analysis was an unbiased outcome measure for dogs with lameness from osteoarthritis. A caregiver placebo effect should be considered when interpreting owner and veterinary reports of patient response to treatment.

also...

Ernst, E., Lee, M.S., Choi, T.Y., (2011) Acupuncture: does it alleviate pain and are there serious risks? A review of reviews Pain. Vol. 152, no. 4, pp. 755-764

http://www.ncbi.nlm.nih.gov/pubmed/21440191

Acupuncture is commonly used for pain control, but doubts about its effectiveness and safety remain. This review was aimed at critically evaluating systematic reviews of acupuncture as a treatment of pain and at summarizing reports of serious adverse effects published since 2000. Literature searches were carried out in 11 databases without language restrictions. Systematic reviews were considered for the evaluation of effectiveness and case series or case reports for summarizing adverse events. Data were extracted according to predefined criteria. Fifty-seven systematic reviews met the inclusion criteria. Four were of excellent methodological quality. Numerous contradictions and caveats emerged. Unanimously positive conclusions from more than one high-quality systematic review existed only for neck pain. Ninety-five cases of severe adverse effects including 5 fatalities were included. Pneumothorax and infections were the most frequently reported adverse effects. In conclusion, numerous systematic reviews have generated little truly convincing evidence that acupuncture is effective in reducing pain. Serious adverse effects continue to be reported. Numerous reviews have produced little convincing evidence that acupuncture is effective in reducing pain. Serious adverse events, including deaths, continue to be reported.

Never underestimate the power of expectation bias - just sayin'

Cheers,

Niall

Re: accupuncture

Evelyn Barbour-Hill — Tue, 13 Nov 2012 14:41:38 GMT

[quote user="Liz white"]TSE is for Transcutaneous Spinal Electroanalgesia. It was invented by Alex MacDonald, who helped run one of the ABVA courses. It's supposed to be like a powerful TENS machine, the advantage being that owners can use it more frequently than they may see an acupuncturist.( if I remember correctly) .

[/quote]

I was firmly corrected when I suggested it was a sort of TENS machine. Whatever it is, it was completely ineffective and useless. Utter waste of money and expectations.

Re: accupuncture

Sarah Mark — Tue, 13 Nov 2012 11:51:06 GMT

I'd be very interested to see these studies too, could you send me the link or reference? Thanks Rajat.

Re: accupuncture

Liz w — Tue, 13 Nov 2012 11:17:49 GMT

TSE is for Transcutaneous Spinal Electroanalgesia. It was invented by Alex MacDonald, who helped run one of the ABVA courses. It's supposed to be like a powerful TENS machine, the advantage being that owners can use it more frequently than they may see an acupuncturist.( if I remember correctly) .

Re: accupuncture

Evelyn Barbour-Hill — Tue, 13 Nov 2012 11:02:49 GMT

[quote user="Rajat"]Not sure the machine you mention, is it TENS or electro-acupuncture?I use the Cefar acus which I believe is now out of production but the pros ll rated it highly.[/quote]

No, it was TSE. I can't remember what TSE stands for: Trans Spinal Electro-something? SL recommended it strongly for pain but it was completely useless. I imagine everyone else found the same as I haven't heard anything of it for years.

[quote user="Rajat"]I haven't read K+ K ;)[/quote]

Don't bother.

Thanks for an interesting post, Rajat. It looks as if almost everything about acupuncture has changed dramatically in the last twenty years.

Re: accupuncture

Niall Taylor — Tue, 13 Nov 2012 08:18:04 GMT

I'd be interested to see the links if you don't mind, or you could forward them by email if they're not on-line.

Niall

Re: accupuncture

Rajat — Tue, 13 Nov 2012 01:26:54 GMT

Hi Evelyn

I can see why you re disillusioned- I stopped my subscription to a veterinary acupuncture group when I realised the way it was going a year or 2 back. Not a grievance but a personal preference. I can see why people would come away feeling less than impressed from certain courses.

I admire and rate Sam Lindley very highly, was taught by her and Mike Cummings (who is amazing- he is editor or co editor of the acupuncture in medicine journal his knowledge of human anatomy and acupuncture in general is amazing having been a military doctor and treating physical injuries as a background) I have sent him many human clients (pet owners mainly!) who have been very impressed alongwith improving substantially too.

Not a plug as I have nothing to gain, but I would suggest anyone interested in this field to go for a short course with the WVAG (western veterinary acupuncture group). The tutors are refreshingly honest, and go to pains to highlight the shortcomings and limitations of the technique and our knowledge in certain areas.

Not sure the machine you mention, is it TENS or electro-acupuncture?I use the Cefar acus which I believe is now out of production but the pros ll rated it highly.

I had the good fortune to go for the electro-acupucnture meet which was about 70% human medics and 30% vets it was very informative and is held every year. Great to compre notes cross species and see some live demos by Mike et al!

Re needling time, what I learnt and have seen from needling myself other people as well as animals is that you dont need to have them in for 20-30 minutes to have n effect. Some studies show different endorphin types and levels if left in for this time, but thats not to say it will not be efficacious if inserted for say a minute. Other things I learnt is it shouldn't hurt, the vast majority of the time. Also, needles re single use, and the better quality needles you use the less it hurts - I only use Seirin or S needle.

I think acupuncture does not need to be dogmatic or steeped in a foreign language or different type of medical system to work. I think we need to question it just like any other intervention and re-evaluate regularly. It is quite a useful tool for more than pain - it has stopped my persistent non responsive hangover nausea and emesis on more than 2 occasions when nothing else worked, and also helped a parvo puppies nausea and allowed them to eat straight after electro-acu ..have a great picture somewhere I can show you if you want!

Re nsaids - I think often acu works better or is complementary to reduce the dose. Some ppl won't see these benefits in their pets (clients) and others will want only acupuncture and no drugs. I often see benefits with client's pets already on polypharmacy. It is amazing for muscular pain in my experience over a short 4 years.

I think a lot of your questions could be answered by those 2 books above. I bought Schoens acupuncture, and though the main thrust is TCM he does cover WMA too. I haven't read K+ K ;)

There is actually a wealth of EBM and scientific evidence in support of acupuncture now, including very interesting FMRI studies and so on. I can forward or link some if anyone is interested as a taster.

Just some thoughts from my limited 5 year experience using this technique. I know I would struggle with the TCM system. Narda Robinson at Colorado state is a major proponent of approaching acupuncture as a neuro-physiological intervention than anything else and has written some very interesting articles. She has a book coming out soon (as of 6-8 mos ago when I emailed her)

Best

Rajat.

Re: accupuncture

Evelyn Barbour-Hill — Mon, 12 Nov 2012 23:57:28 GMT

[quote user="Liz white"]

The incidental spondylosis was in a dog I was already needling long term for a forelimb problem, with long intervals between sesssions, and it was picked up during an abdominal xray. When I next saw the dog I treated the spine as well with some shorter interval follow-up sessionsand its demeanour improved substantially over the course of treatments.

The other dog I was thinking of had been diagnosed with osteoarthritis in multiple sites and also had spondylosis. After his initial treatment he was climbing on furniture again, barking at cars out the window, playing with his toys- all activities that he hadnt done for several years prior to the acupuncture.

Both these dogs were on tramadol and Nsaids prior to me even seeing them.

[/quote]

That's interesting. I really mean it. I think you would agree though that you were treating back pain, and the ventral spondylosis did not necessarily represent the cause.

It doesn't alter my opinion of the course I went on, and its organiser, though.

By the way, taking the discussion along: how do you sterilise your needles? Autoclave?

Re: accupuncture

Liz w — Mon, 12 Nov 2012 23:04:38 GMT

You know why people go Anon.....

Just looked back through my files to get the facts for you, and it seems my previous claim was in fact a combination of different cases.

Both these dogs were on tramadol and Nsaids prior to me even seeing them.

I'm not in general practice at the moment - I just see acupuncture cases for other vets, so I'm not involved in any of the work up of cases, or medication side of things. I treat animals in their own home, so they are usually relaxed, and they really don't seem to mind it. They are usually excited to see me despite previous treatments, and generally just become drowsy and relaxed during treatment.

Re: accupuncture

Evelyn Barbour-Hill — Mon, 12 Nov 2012 21:42:21 GMT

[quote user="Liz white"]When X-rays for other reasons have shown spondylosis.

[/quote]

OK – I am not criticising but I want to get to the bottom of this – this is quite a realistic situation: you radiograph the abdomen to rule out an intestinal foreign body, and incidentally you find ventral spondylosis. The dog was not complaining before of back pain. You apply an acupuncture prescription for.... back pain? And the next day the dog is showing behaviours it hasn't for years.

Or would it be more the case that you are investigating back pain, and your only radiographic findings are ventral spondylosis, and when you apply acupuncture for back pain the dog is much improved?

Please believe me, I am not attacking you. I have related my own experience and the word "disillusioned" was carefully chosen. I might add, that in various conditions where acupuncture might have been very effective, a NSAID was also effective and somehow seemed preferable to both owners and me to sticking several needles at a time into sensitive bits of the patient and having it sit still for half an hour.

Re: accupuncture

Liz w — Mon, 12 Nov 2012 20:55:07 GMT

When X-rays for other reasons have shown spondylosis.

Re: accupuncture

Evelyn Barbour-Hill — Mon, 12 Nov 2012 19:26:51 GMT

[quote user="Liz white"]By treating a dog with an incidental radiographic finding, and getting a happier dog the next day, showing behaviours that it hasn't done for years.[/quote]

OK, but what were you treating it for?

Re: accupuncture

Liz w — Mon, 12 Nov 2012 18:10:57 GMT

By treating a dog with an incidental radiographic finding, and getting a happier dog the next day, showing behaviours that it hasn't done for years.

Re: accupuncture

Martin Atkinson — Mon, 12 Nov 2012 17:56:17 GMT

[quote user="patrick murphy"]I also did a search of forums for a thread re. accupuncture in general and cmae up negative. is there one?[/quote] Erm....the one you already started?! http://www.vetsurgeon.org/forums/t/13389.aspx

Re: accupuncture

Evelyn Barbour-Hill — Mon, 12 Nov 2012 17:51:37 GMT

[quote user="Liz white"] I've had some great results with it, that cannot be accounted for by anything other than the acupuncture.[/quote]

I don't doubt you, I'm sure it can work.

But I don't follow this bit;

[quote user="Liz white"] Even in dogs with conditions supposed to be symptomless.[/quote]

Sorry, if there's nothing wrong with the dog, how, except in the imagination, can you get a great result by treating it?

Re: accupuncture

Liz w — Mon, 12 Nov 2012 17:33:44 GMT

[quote user="Evelyn Barbour-Hill"]

Rajat, thanks for the book suggestions. I may buy one or the other. I have some faith in Samantha Lindley (though I haven't forgotten that she sold me the completely useless TSE machine).

I was interested in acupuncture since first hearing of it as a schoolboy. I talked to Allen Klide and I bought the Klide and Kung book (which was rubbish). So naturally I was really keen when that course came up. I had misgivings during the course: that horse was one cause; another was that the lecturer claimed relief of conditions I knew to be symptomless; another was that said lecturer was somehow quite unable to describe the points in anatomical terms ("It's up the back of the paw" "I'm sorry, what exactly do you mean by that?" "Well, it's up the back of the paw".) Then there was the remote point location........ we looked at a greyhound with a genuine hip problem. "Now, you'll find if you palpate his spine there's an uncomfortable spot right up there............" and we all gasped and said "ooh, so there is" . Then I came home and palpated many fit healthy greyhounds, and found I could always demonstrate a tender spot just up there....

What finally disillusioned me:

a) It's painful.

b) It didn't work.

[/quote] I've had some great results with it, that cannot be accounted for by anything other than the acupuncture. Even in dogs with conditions supposed to be symptomless.

Re: accupuncture

Mark Holmes — Mon, 12 Nov 2012 06:56:42 GMT

It was a greyhound they have uncomfortable spots everywhere!

Re: accupuncture

Evelyn Barbour-Hill — Sun, 11 Nov 2012 19:05:41 GMT

Rajat, thanks for the book suggestions. I may buy one or the other. I have some faith in Samantha Lindley (though I haven't forgotten that she sold me the completely useless TSE machine).

What finally disillusioned me:

a) It's painful.

b) It didn't work.

Re: accupuncture

Rajat — Sun, 11 Nov 2012 17:46:26 GMT

Hi Evelyn

There is such a chasm between TCM and Western medical acupuncture that I feel to learn the chinese system one has to learn TCM s an entirety...it can be done but tkes a long time. I believe the course is 4 years long - more or less like a medical degree...

I think I know the one you mean

I studied western medical acupuncture (WMA) and as it is primarily based on science, and understandable western concepts of cause and effect and neurophysiology, I find it much easier to understand.

May I suggest a couple of books?

1) Acupuncture in practice- beyond points and meridians (Anthony Campbell)

2)Essentials of western medical acupuncture (Lindley and Cummings)

I can mail them to you for a read if you want to borrow them, if you haven't completely lost faith

You re very right in your last statement, I recall some studies comparing western vs TCM point selections and found them largely similar between practitioners looking at the same patients. The theory doesn't really matter as long as the effect is there, but it is much easier, I find, to select the points and understand the point selection process with WMA compared to TCM

Re: accupuncture

Evelyn Barbour-Hill — Sun, 11 Nov 2012 17:25:52 GMT

[quote user="Rajat"]

[quote user="Evelyn Barbour-Hill"]I'm afraid that after going on an acupuncture course, full of enthusiasm, I came home very cynical. Perhaps I chose the wrong course.[/quote]

Out of interest, Evelyn, which organization did you do the course with?

[/quote]

I believe the organiser is still in practice, so I don't think I should say. I can tell you however that it was based on "traditional Chinese" concepts so that may give you a clue. (It wasn't the "traditional Chinese" theory that made me cynical however. I thought the theory was b****x, but I reckoned that didn't matter as long as it led you to the correct prescription).

Re: accupuncture

Rajat — Sun, 11 Nov 2012 17:16:56 GMT

[quote user="Evelyn Barbour-Hill"]I'm afraid that after going on an acupuncture course, full of enthusiasm, I came home very cynical. Perhaps I chose the wrong course.[/quote]

Out of interest, Evelyn, which organization did you do the course with?

You re correct, in that Laser needling of acupuncture points, is not acupuncture per se. Needles need to penetrate skin. I think there is more evidence for the use of laser, I have no knowledge of it beyond the meager bits I have read from companies and some research. The biggest stumbling block is the cost or I'd give it a go.

Having said that, I'm pretty happy with the way most of my patients respond to needling alone.