What is Acupuncture?
The Chinese understanding of anatomy and physiology was provided in the Huangdi Neijing (Yellow Emperor’s Internal Classic) (ca.200-100 BCE). The ancient Chinese were possibly the first to develop a standardized method for precisely classifiying body locations. Needling Therapy (Acupuncture in the west) is the most well recognized component of this complete system of Chinese medicine known. In California, Licensed Acupuncturists are Primary Care Providers, with a scope of practice that includes Herbal medicine, diet therapy and physical rehabilitation.
How exactly does Needling Therapy (Acupuncture) Work?
Needling therapy (Acupuncture) brings about restorative processes involving superficial tissue reactions (Skin), nocioceptive (also called pain receptors) that can detect mechanical, thermal or chemical changes, above a set threshold, and proprioceptive (muscle static load, length and position; meaning "one's own" and perception) sensory systems, the vascular (circulatory) system and related nerves, viscerosomatic (organ/body) relationships and the central nervous system (CNS).
How exactly does Needling Therapy (Acupuncture) Work?
Needling therapy (Acupuncture) brings about restorative processes involving superficial tissue reactions (Skin), nocioceptive (also called pain receptors) that can detect mechanical, thermal or chemical changes, above a set threshold, and proprioceptive (muscle static load, length and position; meaning "one's own" and perception) sensory systems, the vascular (circulatory) system and related nerves, viscerosomatic (organ/body) relationships and the central nervous system (CNS).
Inflammation is a local, protective response to microbial invasion or injury. The nervous system reflexively regulates the inflammatory response, just as it controls heart rate and other vital functions. There is evidence showing that the neural control of acute inflammation is reflexive, directly interconnected and controllable. Both laboratory and clinical evidence have recently shown the existence of a negative feedback loop between the autonomic nervous system and the immune system.
Special emphasis is placed on cholinergic anti-inflammatory mechanisms that inhibit the activation of macrophages and the release of cytokines (activating and recruiting further immune cells). There is evidence indicating that stimulation of the vagus nerve, by either Needling Therapy, electrical or pharmacological means, prevents inflammation and inhibits the release of cytokines that are clinically relevant drug targets for treating inflammatory disease
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The most important CNS response is to provide control to regions of the spinal cord that mediate inhibition of pain, relaxation of muscular tissue, normalization of vascular tone and the restoration of visceral homeostasis. Control processes are directed to those regions of the body activated by specific neurovascular nodes (previously known as acupuncture points). Nodes are selected located in the main area of the complaint (local and adjacent), along with proximal and distal nodes along the affected muscular distribution. This approach assures that needling, mediated by the CNS, is directed to relieve pain, reduce muscular contractions, promote healing and restore blood flow to specifically address the presenting problem.
Why is Needling Therapy (Acupuncture) appropriate for pain?
Based on known and established anatomical, physiological, and medical principles, Needling Therapy (Acupuncture) has an evidence base that is consistent with the historic foundations and present understanding of Western and Chinese/oriental medicine.
Effective and appropriate treatment is essential in preventing chronic pain and is rehabilitating those that progress to a chronic and costly pain conditions. The bio-psychosocial model of pain(recently adopted in California pain guidelines) recognizes that pain is the sum of the patient’s biology, psychological state, cultural background/belief system, and relationship/interactions with the environment (workplace, home, disability system, and health care providers).
Acupuncture blocks A-delta (Ad fibers) and C fibers in order to decrease sympathetic efferent outflow and allows the patient to voluntarily control hyper-tonic muscles as a method of controlling the patient's pain, impairment and disability. The principal effect of this control is to restore autonomic balance, reduce pain and increase function (range of motion, strength and endurance).
How do you know if you're getting better?
Practicing evidence-based medicine requires the utilization of measurable outcomes. A recommendation for continued treatment is indicated in cases when patient's condition of affected body regions is improving in one or more of the following subjective and objective assessments. These factors identify structural and functional improvement:
Special emphasis is placed on cholinergic anti-inflammatory mechanisms that inhibit the activation of macrophages and the release of cytokines (activating and recruiting further immune cells). There is evidence indicating that stimulation of the vagus nerve, by either Needling Therapy, electrical or pharmacological means, prevents inflammation and inhibits the release of cytokines that are clinically relevant drug targets for treating inflammatory disease
.
The most important CNS response is to provide control to regions of the spinal cord that mediate inhibition of pain, relaxation of muscular tissue, normalization of vascular tone and the restoration of visceral homeostasis. Control processes are directed to those regions of the body activated by specific neurovascular nodes (previously known as acupuncture points). Nodes are selected located in the main area of the complaint (local and adjacent), along with proximal and distal nodes along the affected muscular distribution. This approach assures that needling, mediated by the CNS, is directed to relieve pain, reduce muscular contractions, promote healing and restore blood flow to specifically address the presenting problem.
Why is Needling Therapy (Acupuncture) appropriate for pain?
Based on known and established anatomical, physiological, and medical principles, Needling Therapy (Acupuncture) has an evidence base that is consistent with the historic foundations and present understanding of Western and Chinese/oriental medicine.
Effective and appropriate treatment is essential in preventing chronic pain and is rehabilitating those that progress to a chronic and costly pain conditions. The bio-psychosocial model of pain(recently adopted in California pain guidelines) recognizes that pain is the sum of the patient’s biology, psychological state, cultural background/belief system, and relationship/interactions with the environment (workplace, home, disability system, and health care providers).
Acupuncture blocks A-delta (Ad fibers) and C fibers in order to decrease sympathetic efferent outflow and allows the patient to voluntarily control hyper-tonic muscles as a method of controlling the patient's pain, impairment and disability. The principal effect of this control is to restore autonomic balance, reduce pain and increase function (range of motion, strength and endurance).
How do you know if you're getting better?
Practicing evidence-based medicine requires the utilization of measurable outcomes. A recommendation for continued treatment is indicated in cases when patient's condition of affected body regions is improving in one or more of the following subjective and objective assessments. These factors identify structural and functional improvement:
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Subjective
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Objective
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Treatment Outcome Assessment
Treatment outcome assessment measures and documents the patient's functional and symptomatic response to the treatment provided. The comparison of these measurements before and after treatment enables the practitioner to evaluate the patient's progress in an objective manner. A positive result of the treatment outcome assessment, accompanied by a determination that maximum medical improvement has not been achieved would validate the need for additional treatment.
Acupuncture and electroacupuncture therapy have been utilized to treat a broad spectrum of illnesses and injuries, and are particularly effective at treating anatomically localized neuromusculoskeletal (NMS) injuries caused by repetitive stress or trauma. The anatomical NMS injuries that are most typically treated by acupuncture and electroacupuncture are due to trauma, sports injuries, auto accidents, and work-related repetitive stress injuries of the tendon, ligament, and bursa, and injuries in and around joint areas and the soft tissues (muscles, ligaments, etc) surrounding the spine. Acupuncture and electroacupuncture are also commonly used to treat chronic or post-operative pain, headaches, nausea and menstrual-related pain.
A. Severity and Duration of Conditions
Conditions of illness and injury are generally classified into three or more categories, depending upon severity and duration. The commonly used descriptions of the stages of illness and injuries are acute, sub-acute, chronic, and recurrent.
B. Treatment Frequency and Duration
The effects of acupuncture are generally cumulative. Acupuncture initiates physiologic tissue restorative and regenerative mechanisms. (See Physiological Mechanisms of Action) Frequency and duration of treatment are based on several factors including severity of condition, chronicity (duration of condition), previous episodes and pre-existing conditions. Complicating factors present inherent difficulties in recovery, therefore, extra time and treatment is appropriate in order to observe a therapeutic response. The therapeutic effects of treatment should be assessed by subjective and objective assessments after each course of treatment. (See Measurable Outcomes) Normally an initial course of treatment consists of 12-18 treatments over a 4-6 week period, depending on complicating factors. For acute conditions, fewer treatments may be necessary to observe a therapeutic effect and to obtain complete recovery.
For chronic conditions, and conditions with complicating factors, extended treatment is recommended to observe response to treatment. As in most types of therapy, the earlier the patient receives treatment, the greater the probability of recovery, and the shorter the time to recovery. Acupuncture is commonly utilized in chronic conditions because of effectiveness in pain management and limited treatment options. However, it should be noted that acupuncture and electroacupuncture can lead to complete recovery in many NMS conditions when it is offered in the acute and sub-acute stages of injury, particularly when used in conjunction with other therapeutic interventions, such as ROM and strengthening exercises and manual manipulation of the soft tissue.
Acupuncture or electroacupuncture are rarely performed as a single treatment, but are usually prescribed and performed as a series, or “course of treatments.” Thus, treatment planning requires a recommendation for the number, frequency, and duration of treatments that is appropriately based upon the nature and extent of the injuries and the prognosis for a progressive and timely recovery from those injuries. Severe injuries, multiple injuries, metabolic disorders, and other complicating factors may require more frequent treatments over a longer duration of time. For example, while some multiple injuries can be treated simultaneously, others must be treated independently and sequentially, requiring increased treatment frequency.
The following recommendations for the frequency and duration of treatment are based upon moderate to severe injuries in an otherwise healthy patient. Individual case recommendations should be scaled accordingly.
Treatment outcome assessment measures and documents the patient's functional and symptomatic response to the treatment provided. The comparison of these measurements before and after treatment enables the practitioner to evaluate the patient's progress in an objective manner. A positive result of the treatment outcome assessment, accompanied by a determination that maximum medical improvement has not been achieved would validate the need for additional treatment.
Acupuncture and electroacupuncture therapy have been utilized to treat a broad spectrum of illnesses and injuries, and are particularly effective at treating anatomically localized neuromusculoskeletal (NMS) injuries caused by repetitive stress or trauma. The anatomical NMS injuries that are most typically treated by acupuncture and electroacupuncture are due to trauma, sports injuries, auto accidents, and work-related repetitive stress injuries of the tendon, ligament, and bursa, and injuries in and around joint areas and the soft tissues (muscles, ligaments, etc) surrounding the spine. Acupuncture and electroacupuncture are also commonly used to treat chronic or post-operative pain, headaches, nausea and menstrual-related pain.
A. Severity and Duration of Conditions
Conditions of illness and injury are generally classified into three or more categories, depending upon severity and duration. The commonly used descriptions of the stages of illness and injuries are acute, sub-acute, chronic, and recurrent.
- Acute • Having rapid onset, relatively brief duration, and often severe symptoms; which have a duration within four weeks of onset.
- Sub-Acute • Somewhat less than acute in severity, intermediate in character between acute and chronic symptoms within a three months duration from onset of symptoms.
- Chronic • Injury of long duration and/or frequent recurrence of longer than three months duration.
- Recurrent/ Flare-Up -- Return of symptoms of original injury at intervals or as a result of aggravating factors.
B. Treatment Frequency and Duration
The effects of acupuncture are generally cumulative. Acupuncture initiates physiologic tissue restorative and regenerative mechanisms. (See Physiological Mechanisms of Action) Frequency and duration of treatment are based on several factors including severity of condition, chronicity (duration of condition), previous episodes and pre-existing conditions. Complicating factors present inherent difficulties in recovery, therefore, extra time and treatment is appropriate in order to observe a therapeutic response. The therapeutic effects of treatment should be assessed by subjective and objective assessments after each course of treatment. (See Measurable Outcomes) Normally an initial course of treatment consists of 12-18 treatments over a 4-6 week period, depending on complicating factors. For acute conditions, fewer treatments may be necessary to observe a therapeutic effect and to obtain complete recovery.
For chronic conditions, and conditions with complicating factors, extended treatment is recommended to observe response to treatment. As in most types of therapy, the earlier the patient receives treatment, the greater the probability of recovery, and the shorter the time to recovery. Acupuncture is commonly utilized in chronic conditions because of effectiveness in pain management and limited treatment options. However, it should be noted that acupuncture and electroacupuncture can lead to complete recovery in many NMS conditions when it is offered in the acute and sub-acute stages of injury, particularly when used in conjunction with other therapeutic interventions, such as ROM and strengthening exercises and manual manipulation of the soft tissue.
Acupuncture or electroacupuncture are rarely performed as a single treatment, but are usually prescribed and performed as a series, or “course of treatments.” Thus, treatment planning requires a recommendation for the number, frequency, and duration of treatments that is appropriately based upon the nature and extent of the injuries and the prognosis for a progressive and timely recovery from those injuries. Severe injuries, multiple injuries, metabolic disorders, and other complicating factors may require more frequent treatments over a longer duration of time. For example, while some multiple injuries can be treated simultaneously, others must be treated independently and sequentially, requiring increased treatment frequency.
The following recommendations for the frequency and duration of treatment are based upon moderate to severe injuries in an otherwise healthy patient. Individual case recommendations should be scaled accordingly.
- Acute • 3 treatments per week, decreasing frequency as symptoms resolve and are reduced.
- Sub-Acute • 3 treatments per week, for up to four weeks. 2 treatments per week thereafter. This is also the time when a rehabilitation exercise program is usually introduced.
- Chronic • 2-3 treatments per week for up to eight weeks as an initial course of treatment, and 1-2 treatment per week thereafter.
- Recurrent/ Flare-Up -- 8-12 visits as needed over a 2 month period
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1. Initial Course of Treatments A detailed or focused re-evaluation designed to determine the patient’s progress and response to treatment should be conducted at the end of each course of treatment. Additionally, a brief assessment of the patients response to each treatment should be noted after each treatment is completed, and again before the next one is started, and recorded in progress notes (e.g, SOAP notes). When a patient’s condition is not responding to treatment for a period of 2-3 weeks, a more thorough re-evaluation should be conducted immediately to determine if the condition is different or more serious than the initial diagnosis had indicated and/or whether the condition requires further diagnostic testing and/or referral to other diagnostic or treatment specialists. 2. Re-Evaluation and Re-examination After an initial course of treatment has been concluded, the detailed or focused re-evaluation should determine whether the objectives of the initial treatment plan have been fulfilled, and the extent to which they have been fulfilled by the documentation of subjective and objective assessments. A determination and recommendation must be made as to whether an additional course of treatment would continue to contribute to the patient’s recovery or not. 3. Continuing Course of Treatments Follow-up courses of treatment may be similar in frequency and duration to the initial course of treatment. However, one of the goals of any treatment plan should be to reduce the frequency of treatments to the point where maximum therapeutic benefit continues to be achieved while encouraging more active self-therapy, such as strengthening and ROM exercises, and rehabilitative exercises. The frequency of continued treatment generally depends upon the severity and duration of the condition; treatment benefits are generally stronger and last longer as a condition moves from acute towards complete resolution and as the patient takes a more active role in his or her recovery. When the patient’s condition stabilizes, or no longer shows improvement from the therapy, a decision must be made on whether to continue treatment in order to stabilize and maintain the patient’s progress, or to discontinue therapy. In some cases of chronic pain, it may be appropriate to utilize acupuncture for pain management, for example, for patients who have adverse reactions to pain medications or when the prescribed pain medications are not sufficient to manage the patient’s chronic pain. This decision is based on a number of factors, including the potential benefit of the therapy and the potential risks involved in that therapy. |
C. Patient Health and Safety
Identification and diagnosis of a condition/disorder is substantiated through historical data related to the chief complaint, onset of the condition, type of symptoms and their character, and previous history related to the condition. In addition, findings from the physical examination assist in defining the severity of involvement and the specific diagnosis.
In order to protect the health and safety of patients, quality of care strategies for reducing clinical errors and improving patient safety should be observed. These strategies include encouraging practitioners to adopt evidence-based health care approaches to patient care, maintain their clinical skills at or above broadly accepted professional standards of care, and follow applicable case management guidelines.
Evidence based healthcare, provided by properly trained providers, is one of the most conservative, least invasive, and safest types of health care. This being said, it is important to note that all forms of treatment carry some risk of harm to the patient and acupuncture and electroacupuncture are no exception. Therefore, implementing basic risk management procedures that recognize, avoid, and manage actual or alleged adverse outcomes, can help clinicians minimize the risk of harm or injury to patients.
Acupuncture and Electroacupuncture: Evidence-Based Treatment Guidelines © CAOMA 2004
Identification and diagnosis of a condition/disorder is substantiated through historical data related to the chief complaint, onset of the condition, type of symptoms and their character, and previous history related to the condition. In addition, findings from the physical examination assist in defining the severity of involvement and the specific diagnosis.
In order to protect the health and safety of patients, quality of care strategies for reducing clinical errors and improving patient safety should be observed. These strategies include encouraging practitioners to adopt evidence-based health care approaches to patient care, maintain their clinical skills at or above broadly accepted professional standards of care, and follow applicable case management guidelines.
Evidence based healthcare, provided by properly trained providers, is one of the most conservative, least invasive, and safest types of health care. This being said, it is important to note that all forms of treatment carry some risk of harm to the patient and acupuncture and electroacupuncture are no exception. Therefore, implementing basic risk management procedures that recognize, avoid, and manage actual or alleged adverse outcomes, can help clinicians minimize the risk of harm or injury to patients.
Acupuncture and Electroacupuncture: Evidence-Based Treatment Guidelines © CAOMA 2004