What to do if Acupuncture Fails

... in NECK PAIN

1.Needle/laser Lung7

2.Manually move head to end point in each direction and palpate over the cervical transverse processes. Acupuncture any tender (Ah-shi) points you find. Treat each point as you find it with laser or single needle (insert, achieve Qi then remove)

Dr Ian Relf

This was one of the excellent “Meet the Experts” sessions at the Brisbane meeting. If you were there you would have learnt some amazing tips on how to use acupuncture in sciatica, oncology; how to use some newly discovered acupuncture points for upper and lower limb pain; how to analyse the tongue to aid diagnosis; how to incorporate periosteal pecking into your treatment plan and the latest update on neurophysiology.

.... for Bunions

Eliminate excessive carbohydrates/sugar from the diet.

I n Japanese acupuncture, a bunion is called a “sugar toe”. They believe the Spleen Channel includes the pancreas(and thus controls insulin production). In many people excessive intake of carbs leads initially to Spleen-pancreas overstimulation (hyper-insulinemia/hypoglycemia) and eventually to Spleen-pancreas failure (stagnation or insulin resistance/glucose intolerance). This causes “dampness” leading to “phlegm” which solidifies as bony deposits.

WHAT TO DO WHEN ACUPUNCTURE FAILS

Use the Mirror Technique

(or the upside- down, opposite side technique):

Match the yin or yang channel but on the opposite side and opposite end of the body. e.g.

Fingers = opposite toes

Wrist = opposite ankle

Elbow = opposite knee

Shoulder = opposite hip

and vice-versa.

If the problem is on the lateral side of the right wrist (e.g. near LI5, a yang channel) choose a point on a yang channel on the left ankle (e.g. ST41). If a patient has gout in his left hallux, instead of using SP1 on either foot, choose a point on a yin channel at the right thumb (e.g. LU11).

Neck Pain:

Next time a patient with neck pain does not respond as well as you would like, consider adding:

(1) Roberta Chow's spinous process stimulation...use a laser over each of the cervical spinous processes.. this affects pain relief via a positive sympathetic nervous system response.

(2)Follow the transverse skin crease lines. Where they end or where two intersect is usually a tender point that is worth needling or lasering. Since these points usually also overlie a cervical transverse process it is worth “periosteal pecking” this point ( the injured perioisteum takes 3-5 days to heal ).

(3)Use D,L Phenylalanine, one tablet two or three times daily. This amino acid is converted into Noradrenaline and Dopamine, two of the CNS neurotransmitters, and blocks the breakdown of that person's Endorphins, thus enhancing the acupuncture effect.

It Could Never Happen (to Me)

I found a timely reminder of the care and responsibility a medical acupuncturist owes to a patient in Dr James Rotchford's article on adverse effects of acupuncture(see www.medicalacupuncture.org/journal/Vol11/ ). He lists 13 points to help avoid adverse events:

•  Use appropriate sterile technique.

1. Over the sternum, angulate the needle to avoid passing through congenital foramens overlying the heart.
2. If the patient has a significant risk factor for infection, i.e., advanced age, diabetes, immunosuppressive therapy, artificial joints, heart murmurs, prosthetic valves, active cancer, etc., avoid using implanted needles. Generally, implanted needles imply greater risk to the patient.
3. Based on personal experience and stories from patients, if cellulitis occurs in the context of acupuncture, take appropriate cultures and consider immediate parenteral antibiotics.
4. If a patient is taking anticoagulants, consider superficial needling and in all cases, apply firm pressure after removing a needle. (The author believes that electrical acupuncture in this context implies greater risk to the patient.)
5. To avoid pneumothorax, consider patients at greater risk to be smokers, tall males, patients with emphysema, patients who are or have been taking corticosteroids, patients with active cancer, and patients who are emaciated for any reason. (Any point overlying pleura can be risky but especially LR 14, GB 21, 23, 25, and SP 21 are vulnerable. Electrical stimulation of these points implies greater risk.)
6. Be cautious and hesitant to assume that acupuncture is the only therapy indicated for your patients. Physicians are legally held to higher standards than lay acupuncturists with regard to missed conventional diagnoses and/or therapeutic options.
7. Elderly and new patients are preferably supine during acupuncture treatments.
8. Significant insomnia predating acupuncture generally is associated with significantly more discomfort and pain during and after an acupuncture session.
9. Be alert for metal allergy.
10. Warn patients, especially after the first treatment, to be more cautious in driving. A half-hour recovery period for new patients would be considered prudent.
11. Be vigilant and informed about possible adverse events.
12. Facilitate a systematic approach toward reducing barriers that interfere with improving patient care and safety.