Pregnancy and Acupuncture

While a large part of my practice involves the treatment of infertiliy, once the client has conceived she may opt to continue therapy. There are many reasons that clients who have used Chinese medicine to conceive will continue to work with us through the beginning of their pregnancy, to seek treatment toward the end of term, or use us to help them throughout the entire gestation. In the beginning of the pregnancy, usually through the first trimester, acupuncture can be very useful to minimize the chances of miscarriage due to uterine insufficiency. For women who have had previous miscarriages or who worry that they may carry a risk of such an occurrence may opt for this careful approach by using Chinese medicine. Additionally, acupuncture may be used to minimize or eliminate uncomfortable effects of pregnancy such as morning sickness, digestive problems, lowered energy and musculoskeletal pain - for which it can be extraordinarily effective.

Some women, by virtue of their age, risk factors or general health may opt to work with an acupuncturist throughout the entire pregnancy to ensure that her body remains as strong as possible and to minimize risk to the baby. The added bonus of this type of ongoing work is that labor and delivery is often quite a bit easier as a result.

Finally, many women will use an acupuncturist's services in the last month of pregnancy in order to help with a breach presentation of the baby, induce labor if the child is past term and the mother wants to avoid using chemical means of inducement or Caesarian section; or simply to ease the delivery.

All of these strategies can be very useful for a pregnant woman. Below I've included a few western medical studies demonstrate that the scientific community is beginning to recognize these benefits:

Research:

From the journal, Pain and Symptom Management, and summarized in Acupuncture Today, comes a study which demonstrates dramatic reduction in morning sickness in women receiving acupuncture versus placebo. 

The Journal of Complementary Medicine, 2009 published a study in which it was showed that women who used acupuncture during their pregnancy and labor had much lower rates of Caesarian section and a subjectively higher rate of comfort during the actual labor process.

From the US Pharmacists journal comes a compendium of many other studies demonstrating the utillity of acupuncture for morning sickness.

From the  Scandinavian journal, Acta Obstetricia et Gynecologica Scandinavica comes a study evaluating the treatment of pelvic and low back pain with acupuncture, during preganancy. Not only did the study conclude that acupuncture was very effective at treating this type of pregnancy related pain, but it also found that it obtained a superior result to using physical therapy as the sole treatment for this type of discomfort.

Using acupuncture to treat pregancy and/or post-partum related depression often yields powerful results. And we see this quite often in our clinic. In The Journal of Affective Disorders, there is a study which demonstrates this positive effect.

In the Journal Obstetric and Gynecologic Investigation, a rat model is used to investigate the potential chemical basis for acupuncture's effect in preventing one type of miscarriage.

From an Austrian Obstetrics journal, Wien Klin Wochenschr, comes a study on the effectiveness of using acupuncture to induce labor and ripen the cervix.

A small study in the journal, Acupuncture Medicine, demonstrates the effectiveness of using acupuncture to treat the insomnia which can be connected to pregnancy in many women.

From Science comes this French study on the successful management of  pelvic pain in pregnant women.

Acid Reflux and Chinese Medicine

Acid reflux is a problem which we see in the clinic frequently and it responds very well to acupuncture and herbal therapy.

Gastrointestinal Reflux Disease (GIRD or GERD) occurs when stomach acid inappropriately flows backward into the esophagus. Many people will experience this occasionally. However, for about 25 to 35 percent of the people in the United States, this may become a chronic condition that can dramatically impact their enjoyment of life. The western medical treatment for GERD is to administer pharmaceuticals which either neutralize excessive stomach acid or decrease it's secretion. In the short term, this can be very useful and for occassional heartburn relatively safe. However, over the longer term side effects can become quite problematic. As an example, antacids are generally composed of calcium; aluminum hydroxide; sodium compounds and/or magnesium hydroxide. Side effects from these compounds may include: 

• Carbonate: regular high doses may cause alkalosis, which in turn may result in altered excretion of other drugs, and kidney stones. A chemical reaction between the carbonate and hydrochloric acid may produce carbon dioxide gas. This causes gastric distension which may not be well tolerated. Carbon dioxide formation can also lead to headaches and decreased muscle flexibility.
• Aluminum hydroxide: may lead to the formation of insoluble aluminium-phosphate-complexes, with a risk for hypophosphatemia and osteomalacia. Although aluminium has a low gastrointestinal absorption, accumulation may occur in the presence of renal insufficiency. Aluminium-containing drugs may cause constipation.
• Magnesium hydroxide: has laxative properties. Magnesium may accumulate in patients with renal failure leading to hypermagnesemia, with cardiovascular and neurological complications. See Milk of magnesia.
• Sodium: increased intake of sodium may be deleterious for arterial hypertension, heart failure and many renal diseases.

 For the proton pump class of drugs, including Nexium, Prilosec, Aciphex, Protonix and several others, acute side effects may include:

• Constipation
• Diarrhoea
• Flatulence
• Headaches
• Nausea
• Abdominal pain
• Vomiting
• Rarely, breast enlargement in men and anemia.

Perhaps more concerning is the long term use of these drugs may potentially lead to more signficiant problems including an increased likelihood of infections, nutritional deficiencies and a greater propensity toward dementia.

Acupuncture in the treatment of Acid Reflux:

Acupuncture and Chinese herbology are extremely useful in both managing and effectively treating acid reflux, frequently eliminating it altogether. As in so many situations like this one, an acupuncturist will evaluate the patient on basis of how their body manifests both the disease as well as other health markers. From this evaluation we create a treatment which is tailored to the individual. It is this tailoring which makes for such an effective treatment. 

Research/Articles

• A recent Japanese article found that acupuncture was extremely effective in eliminating many of the causes of reflux and GERD. The study, which can be read here, found that,

... acupuncture relieves digestive impairment due to stress. This finding suggests that acupuncture is an effective modality for the treatment of functional dyspepsia (indigestion). Dyspepsia usually involves pain of the upper abdomen, bloating and sometimes nausea, heartburn and belching. Dyspepsia is also linked to GERD, gastroesophageal reflux disease.

• An NIH funded study, published in the journal, Aliment Pharmacol Therapy, demonstrated that acupuncture was more effective than doubling the proton pump dose in the patient population studied.

• The American Journal of Physiology-Gastrointestinal and Liver Physiology published a study in which it was demonstrated that acupuncture decreased the stomach sphincter relaxation, which leads to reflux by 40%.
• An interesting research study which demonstrates that GIRD/GERD and chronic sinusitis will often coexist in the same patient. Chinese medicine has long posited the same relationship and we frequently see that in our patients who have one of these problems experience an improvement in the second simultaneously.
• A recent study published in Alimentary Pharmacology & Therapeutics (and which can be read here):

. . . concludes that acupuncture is effective in the treatment of dyspepsia.

Researchers examined a total sample size of 712 patients. They were randomly assigned to 6 groups. Group 1 received specific acupuncture points on the stomach (Leg Yangming) meridian. Group 2 received non-specific acupoints on the stomach meridian. Group 3 received acupuncture on alarm points and transport points. Group 4 received acupuncture on the gallbladder (Leg Shaoyang) meridan. Group 5 received sham acupuncture, which uses acupuncture needles applied to non-acupuncture points. Group 6 was administered itopride. Itopride is a drug made for the treatment of dyspepsia and many gastrointestinal disorders. It is a prokinetic benzamide.

Patients received 5 acupuncture treatments per week for a period of 4 weeks. Follow-up was documented 12 weeks following the treatment period. All groups improved, however, Group 1 had over a 70 percent success rate. Group 1 received specific acupuncture points on the stomach meridian. The group with the lowest success rate was the sham acupuncture group with only a 34.75 percent improvement. The researchers concluded, “Acupuncture is effective in the treatment of functional dyspepsia, and is superior to non-acupoint puncture. The benefit of acupuncture relies on acupoint specificity.”

Back Pain and Acupuncture

Treating back pain is a substantial part of my day at the clinic, constituting around 15% of a typical day's patient load. I realized that I had given short shrift to this topic when three back pain patients who read this blog regularly asked why so many of the topics covered by this site deal with internal medicine-related issues like fertility or immunity and not musculo-skeletal pain. The reason is simple, and perhaps wrong-headed of me: I have always presumed that most people already are aware of the dramatic effect that acupuncture can have on back pain and it's multiple causes but less knowledgeable about it's many other uses.

 

Back pain can have an astonishing number of origins, in broad brush these range from muscular to spinal with many types of pain originating from an interplay between both the muscles and the nerves exiting the spine.The most frequent types of back pain that we see in the clinic are from herniation, spinal stenosis and muscular impingement on spinal nerves. In clinic, the most rapid response to acupuncture therapy tend to be with muscular impingement; while spinal stenosis and herniation can require more gradual and focused treatment in order to begin to see favorable results. Very frequently, however, we can help our patients avoid more aggressive  therapies such as surgery.

With an acute back spasm we can usually have the person feeling much better within 1-2  treatments, while with chronic back problem I usually tell patients that they will feel a measurable improvement with 3-4 treatments which will indicate that we are on the right track. From that point forward, we will continue to treat until the problem is gone and the clients returned to full functioning.

Research and Articles about Back Pain and Acupuncture

Pain expert Dr. Scott Fishman answers questions about back pain . Partially excerpted from DiscoveryHealth.com

Q: My doctor has recently suggested acupuncture. Is acupuncture safe and will it really help?

A: Acupuncture is one of the most time-tested treatments known to mankind. If the value of a treatment were based solely on how long it has been around, and how long people have thought that it was helpful, then acupuncture would probably be the most effective treatment known to humankind.

Typically, acupuncture is performed with a very thin needle that causes gentle sensations. It is usually not painful. Classically, acupuncture involves using a needle — although sometimes electricity is passed through the needle, and sometimes the burning of traditional Chinese herbs is employed as well. Burning these herbs is called "moxabustion."

The points that are used for the needle insertions often are at a distance from the actual area of symptoms. So, if someone has pain in their back, they may be getting needles in their feet, their ears or somewhere else distant from the actual site of the pain.

Taken all together, acupuncture is an ancient, time-tested form of therapy that seems to have exceptionally few side effects and appears to be safe for pain management. . . In my experience, many patients have found relief from pain through acupuncture. For those of my patients who have not found relief with standard medical therapies, I am always open-minded to any kind of treatment that will help, particularly those that have the fewest side effects. Thus, I embrace acupuncture. I look forward to revelations through science that better explain how it works and how it may be best applied to fight the war on pain.

 Excerpted from the University of Maryland Medical Center:

STUDY ANALYSIS SHOWS ACUPUNCTURE EFFECTIVE FOR TREATING CHRONIC LOW BACK PAIN

With the acupuncture needles in place, the back pain patient rests for several minutes. The wires are part of the electrical stimulation used in the treatment. Most patients say the needles are painless and they find the treatment very relaxing.

Millions of people suffer with low back pain, and it is one of the top reasons people seek medical treatment. Back problems are also, by far, the primary reason for appointments with acupuncturists. But does acupuncture really help these patients? Researchers from the University of Maryland School of Medicine and the Peninsula Medical School, Plymouth, U.K., analyzed dozens of studies from around the world on acupuncture for low back pain.

“For people with chronic low back pain, this analysis shows that acupuncture is clearly effective in providing considerable pain relief,” says Eric Manheimer, study author and director of database and evaluation for the University of Maryland Center for Integrative Medicine. “The research also showed that acupuncture provided true pain relief. The benefit was not just due to the placebo effect.”

The reviewers scoured the medical literature for all studies involving acupuncture for treating low back pain. To minimize bias, the American and British teams developed explicit criteria for evaluating the studies and did the evaluations independently. Their analysis included only randomized controlled trials, the gold standard study design for evaluating medical procedures.

Thirty-three studies covering more than 2,100 patients met the criteria for review. In the end, the researchers used 22 of these studies for their analysis. All 22 evaluated Chinese-style acupuncture for chronic low back pain, defined as pain that has been on-going for more than three months. The other 11 studies were excluded because they either only reported data that could not be combined statistically, they only included patients with acute back pain or pregnancy-related back pain or they involved forms of acupuncture other than traditional Chinese acupuncture.

Manheimer says, “We wanted the studies for the analysis to meet the highest scientific standards. As a way to account for a possible placebo effect, we looked at many studies that used ‘sham acupuncture’ as a control group, where acupuncture needles were inserted only superficially or in the wrong place.”

The sham acupuncture studies were double-blinded, meaning neither the researchers nor the participants knew who was receiving the real or the sham treatment. When looking at those studies, the reviewers found the differences in pain ratings showed a significant difference between the real acupuncture and the sham acupuncture groups, indicating that the benefit was not just due to the placebo effect.

“From our analysis, the message for people with chronic low back pain is that acupuncture is a truly effective therapy that provides significant pain relief,” says Manheimer. “Patients with low back pain have many options for treatment including medication, chiropractic care, physical therapy and back exercises. However, these treatments do not always help, and scientific evidence indicates that they have only modest effectiveness.”

The researchers evaluated the effects of acupuncture both in the short-term (defined as three weeks after the last acupuncture treatment) as well as in the longer term. They found acupuncture provided definite pain relief in the short-term, and this relief appeared to be sustained over the longer term. However, they say it’s too early to be certain of longer term effects, and more studies are underway.

Previous attempts to synthesize information on acupuncture and chronic low back pain provided mixed results. But since 1999, the publication of five high quality, large-scale studies has added new evidence for the analysis. The current analysis includes these newer studies as well as earlier research not included in previous reviews.

In all, this analysis contains more than twice as many studies as earlier reviews and includes reports in English, Chinese, Japanese, Korean as well as Germanic and Romance languages. For this study, the reviewers received funding from the National Center for Complementary and Alternative Medicine, a part of the National Institutes of Health.

Mesothelioma and Acupuncture

I was contacted yesterday by the Mesolthelioma Center who asked if I wouldn't mind creating a link to their noteworthy foundation. I am all too glad to do so given the often horrific after effects of asbestos exposure in the form of mesothelioma.

Mesothelioma is a cancer of the mesothelium - the lining covering many parts of the inside of the body, in particular the outer covering of the lungs, chest wall and abdomen.  It is almost always caused by exposure to asbestos although other risk factors, such as smoking, can increase risk for disease and worsen the prognosis. Symptoms may not appear until decades after the exposure, which can often obscure the origin of the symptoms that the individual is experiencing and make the eventual diagnosis more difficult to achieve.

Symptoms of mesothelioma depend upon the area of the body affected. I have lifted the following directly from wikipedia.com since the symptoms possible are so lengthy. However, see the Mesothelioma Center's page here for a more in-depth breakdown of the parts of the body affected and the ways in which the disease can manifest.

Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

These symptoms may be caused by mesothelioma or by other, less serious conditions.

Mesothelioma that affects the pleura can cause these signs and symptoms:

• Chest wall pain
• Pleural effusion, or fluid surrounding the lung
• Shortness of breath
• Fatigue or anemia
• Wheezing, hoarseness, or cough
• Blood in the sputum (fluid) coughed up (hemoptysis)

In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body.

Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:

• Abdominal pain
• Ascites, or an abnormal buildup of fluid in the abdomen
• A mass in the abdomen
• Problems with bowel function
• Weight loss

In severe cases of the disease, the following signs and symptoms may be present:

• Blood clots in the veins, which may cause thrombophlebitis
• Disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs
• Jaundice, or yellowing of the eyes and skin
• Low blood sugar level
• Pleural effusion

• Pulmonary emboli, or blood clots in the arteries of the lungs
  Severe ascites

 As I have described in other parts of this website, I often work with people with cancer - for the management of the side effects and symptoms of the chemotherapy, surgeries, and radiation therapies, as well as for immune system regulation. As such, I have seen many people going through the treatments associated with mesothelioma at the Northside Holistic Center. What the Mesothelioma Center asked me to do was to print the following code block below, which I am happy to do. Please contact them for additional information on this disease and it's associated symptoms. I would be happy to serve as an information and treatment source on the acupuncture and Chinese medical side of the equation.

Acupuncture has been linked to alleviating the nausea associated with chemotherapy and the pain incurred from the constant surgeries that cancer patients undergo. The Mesothelioma Center offers the most comprehensive and current information on asbestos exposure and a complete list of mesothelioma causes.

Another great resource is the website Mesothelioma Symptoms which gives a good sense of symptoms, treatments and resources for those working through mesothelioma.

Children and Allergies

I treat a lot of children's issues at the Northside Holistic Center and allergies are one of the frequent complaints that children, as well as adults present with. Frequently, my pediatric patients present with a variety of allergy related issues such as asthma, eczema, and digestive problems. This kind of work is very satisfying to most acupuncturists for, while most allergies respond to what we do quite well, children will often appear to be almost magical in their ability to rapidly get well from our work.

The first question that many parents have about using acupuncture as a modality is, "How can you persuade a child to lay still for the placement of the acupuncture filaments?"

The child's parents are usually relieved to find that this is usually much easier than it sounds. Unlike the treatment of adults, children usually only need to retain the filaments for a few minutes per point. This makes keeping them interested much easier. For toddlers and infants, the mother or father can simply hold the child or read them a story. For older kids a toy can be used as a distraction tool while the treatment is proceeding. Most of my clients under fifteen come to enjoy acupuncture therapy as much as adults and parents are surprised to find that many children look forward to their treatment - gratifying to all parties involved!

Links for Other Resources:

This link is from a mother dedicated to helping other parents' with their childrens' allergy issues. Her meetup link allows members to share information about their children's health, recipes, and techniques to help parents cope with and treat their kids.

http://www.meetup.com/no-nutz-mamas/

Research Links and Articles

• From ABC News comes both an article and a video covering the use of acupuncture for seasonal allergies. The entire article can be read and the video viewed here. An excerpt is below:

 Aniko Foldi and Marty Rudolph said they have battled severe allergy symptoms for years with no relief. "You name it, I have every kind of symptom," Aniko said.

"I have had surgery, I've gone to an allergist's office two times a week for shots," Marty said. Both of them desperate for help they turned to acupuncture as a last resort and both said it worked. "It absolutely mitigates the impact," Marty said.

"It's just amazing to me it's like a 100% improvement," said Aniko.

Dr. Marshall Sager in Bala Cynwyd, Montgomery County practiced traditional medicine for years before becoming a certified acupuncturist. He said he's seen great success treating allergies with the ancient technique.

Aniko said Cheryl's treatments have been life changing. "I'm not taking any meds at all," Aniko said. "I would say that she saved my life."

Aniko Foldi and Marty Rudolph said they have battled severe allergy symptoms for years with no relief. "You name it, I have every kind of symptom," Aniko said."I have had surgery, I've gone to an allergist's office two times a week for shots," Marty said.

Both of them desperate for help they turned to acupuncture as a last resort and both said it worked."It absolutely mitigates the impact," Marty said."It's just amazing to me it's like a 100% improvement," said Aniko.

Dr. Marshall Sager in Bala Cynwyd, Montgomery County practiced traditional medicine for years before becoming a certified acupuncturist. He said he's seen great success treating allergies with the ancient technique.Aniko said Cheryl's treatments have been life changing."I'm not taking any meds at all," Aniko said. "I would say that she saved my life."

• From the journal Pediatrics:  A double-blind, randomized, placebo-controlled trial of acupuncture for the treatment of childhood persistent allergic rhinitis.

Department of Paediatrics, Kwong Wah Hospital, 25 Waterloo Rd, Kowloon, SAR, Hong Kong. dkkng@ha.org.hk

OBJECTIVE: To compare active acupuncture with sham acupuncture for the treatment of persistent allergic rhinitis among children. METHODS: Subjects with persistent allergic rhinitis were recruited from the pediatric outpatient clinic. They were randomized to receive either active acupuncture or sham acupuncture. Main outcome measures included daily rhinitis scores, symptom-free days, visual analog scale scores for immediate effects of acupuncture, daily relief medication scores, blood eosinophil counts, serum IgE levels, nasal eosinophil counts, patients' and parents' preferences for treatment modalities, and adverse effects. RESULTS: Eighty-five patients were recruited from the pediatric outpatient clinic at Kwong Wah Hospital, in Hong Kong. Thirteen patients withdrew before randomization; 35 patients (mean age: 11.7 +/- 3.2 years) were randomized to receive active acupuncture for 8 weeks, and 37 patients (mean age: 11 +/- 3.8 years) were randomized to receive sham acupuncture for 8 weeks. Acupuncture was performed twice per week for both groups. Both the assessing pediatricians and the patients were blinded. There were significantly lower daily rhinitis scores and more symptom-free days for the group receiving active acupuncture, during both the treatment and follow-up periods. The visual analog scale scores for immediate improvement after acupuncture were also significantly better for the active acupuncture group. There was no significant difference in the following outcome measures between the active and sham acupuncture groups: daily relief medication scores, blood eosinophil counts, serum IgE levels, and nasal eosinophil counts, except for the IgE levels before and 2 months after acupuncture in the sham acupuncture group. No severe adverse effects were encountered. Numbness, headache, and dizziness were found in both the active and sham acupuncture groups, with no difference in incidence, and the effects were self-limiting.

CONCLUSIONS: This study showed that active acupuncture was more effective than sham acupuncture in decreasing the symptom scores for persistent allergic rhinitis and increasing the symptom-free days. No serious adverse effect was identified.

• From SeatlePi.com comes an article on pediatric acupuncture: www.seattlepi.com: It describes a few practitioners experience with treating children.

• While not specifically child-oriented, but applicable come a study from the International Journal of Immunopharmacology comes a study of more than one hundred Taiwanese patients treated with an herbal formula that we commonly use for allergies:

Xin Yi San reduces nasal symptoms in patients with perennial allergic rhinitis (AR) due to its diverse immunomodulatory effects. One hundred and eight Taiwanese patients with AR received either XYS or a placebo for three months. The investigators found that XYS attenuated the nasal symptoms of sneezing, rhinorrhoea and nasal congestion through reduction of nasal airflow resistance and increase in the cross-sectional area of nostrils. They also observed that XYS exerted diverse in vitro immunomodulatory effects, including suppression of serum IgE levels and increased production of the cytokines IL-10, sICAM-1 and IL-8. (Traditional Chinese medicine, Xin-yi-san, reduces nasal symptoms of patients with perennial allergic rhinitis by its diverse immunomodulatory effects. Int Immunopharmacol. 2010 Aug;10(8):951-8)."

A global study in the prestigious journal Pediatrics, evaluating the saftey of acupuncture with children, found that:

Treating kids with acupuncture is a common practice and generally safe, according to a new study.

“Like adults, acupuncture is very safe when applied to the children’s population,” said Jamie Starkey, an acupuncturist from the Cleveland Clinic, who did not take part in the study. “And so it basically mimics exactly what is seen in the adult population.”

“Any of the serious side effects that they found were definitely due in part to the clinician’s malpractice,” Starkey said. “So, it was certainly somebody who was not necessarily the most trained. The take-home message is that it is absolutely safe in both the adult and pediatric world, but you have to go to somebody who is trained.” [italics mine]

 An article about the study is readable here.