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Acupuncture and Arthritis

Below is a copy of handouts given to attendees at a lecture Dr Chernish gave for the Arthritis Society of Canada. We hope that you will find it informative.

What is arthritis and acupuncture?

Arthritis is the inflammation of a joint on a rheumatic, degenerative, or infectious basis.

Acupuncture is the use of solid needles inserted into the body to treat and prevent illness.

There are three goals of acupuncture:

  1. Return the patient to a healthy state.
  2. Prevent recurrence of illness.
  3. Develop maximum vitality.

History of Acupuncture

Acupuncture has an extensive history in China, with an archeological history dating back 5,000 years and a written history dating back 2,000 years.

It took a little longer for acupuncture to travel to the western hemisphere, with the first use in Europe being in the 1600s, and in the 1700s in North America.

Current Usage

Acupuncture is now used world-wide for the treatment of pain, stroke, infertility, psychiatric disorders, orthopedics, obstetrical conditions, and the treatment of infectious diseases.

In China, acupuncture is an integral, rather than an alternative, part of the healthcare system.

How Does It Work?

Traditional Theory of acupuncture views a patient in a traditional manner with emphasis on:

  • Meridians
  • Qi
  • Acupuncture points
  • Yin/Yang balance

Traditionally, pain has been felt to be caused by blocked energy flow in a meridian, which causes an imbalance of yin and yang and an imbalance of tender or reactive acupuncture points.

The goal of acupuncture treatment is to unblock the body’s natural tendency toward balance and health.

Physiology

Science has shown us that there are local, generalized, immediate, and long-term physiological effects of acupuncture. These include effects on:

  • Pain (via endorphin release)
  • Inflammation (possibly via ACTH release)
  • Mood (via serotonin and norepinephrine release)
  • Hormones (testosterone, estrogen etc.)
  • Autonomic tone
  • Muscle relaxation
  • Neuromuscular patterning

Acupuncture Treatment

Acupuncture treatment is always individualized to treat the patient’s symptoms AND constitution. This means that every patient will receive an individual treatment and the treatment will be different at each visit according to the patient’s symptoms. Treatment of the symptoms and constitution is sometimes referred to as “treating the root and the branch”.

Each treatment will involve an individualized number of needles, usually from 2 – 25 or more. These needles are placed at sites close to and distant from the areas of pain and inflammation.  Needles may be placed above and below the troubled area, and on the same side or the opposite side of the body as the affected area.

Depth of insertion of needles is dependent on the constitution of the patient, the symptoms, and the location on the body. Needles are inserted sometimes as little as 1-2mm, and sometimes more than 6 inches.

Needles are usually left in place for 20 minutes or more, and can receive stimulation either by hand or with an electrical current.

The points to treat are chosen on the basis of the patient’s constitution and symptoms.

The number of treatments will vary according to the patient’s symptoms and constitution. This could mean as little as 1 – 2 treatments for an acute problem, such as gout in a healthy person, 5 – 10 treatments for a more entrenched problem like a flare-up of rheumatoid arthritis, and ongoing treatment for chronic arthritic problems.

Frequency of treatments may be daily or every few days for an acute problem, and weekly or every several weeks for more chronic problems.

The diameter of the needle may vary from as small as 0.12 mm – 0.3 mm or more, and its length can range from 10mm – 100mm. The diameter of the needle is chosen according to where the needle must be placed (smaller needles on the face, etc.) and the degree of stimulation required. The needles that are used are solid, non-cutting, and flexible.

Does it Hurt?

Generally speaking, acupuncture is painless and is often accompanied with a sense of deep relaxation following treatments.

Acupuncture is a very safe process. Pain, bruising, and fainting are rare occurrences. Infections are extremely uncommon, and puncturing an organ is exceedingly rare.

Efficacy

Since acupuncture treatment must always be individualized, and each treatment for a single patient will be different from previous treatments, acupuncture is not easily adaptable to the standard Western double-blind scientific study.

Nonetheless, there is reasonably good scientific evidence for efficacy of acupuncture treatment for nausea and various pain syndromes, including one recent study showing good results for the treatment of osteoarthritis of the knee.

Practically speaking, excellent results can be seen in the treatment of:

  1. Osteoarthritis
  2. Thumbs, hands, and feet often respond within 2 – 3 treatments with a decrease in pain and inflammation and improved function. The treatment may have to be repeated in  6 – 12 months, in some cases.
  3. Knee and hip arthritis may require 5 – 10 treatments for initial response.
  4. Hallux rigidus responds extremely well to minimal treatment resulting in a prolonged remission.
  5. Acute gout generally responds to 1 or 2 acupuncture treatments with an elimination of pain and swelling.
  6. Rheumatoid arthritis usually requires treatment on an ongoing basis; flare-ups often respond to 2 – 3 treatments, spaced a day or two apart.

Some General Principles about Acupuncture Treatments of Arthritis:

  • Acupuncture can reduce inflammation within the first week or two.
  • Acupuncture can reduce muscle pain and spasm that accompanies joint inflammation.
  • Acupuncture can help improve muscle function across joints that have been rendered inactive by pain or inflammation.
  • Acute problems respond quicker than chronic problems.
  • Younger patients usually respond quicker than older patients.
  • Response is generally quicker and more profound in those who are taking less medications.
  • Acupuncture will not interfere with other treatments.
  • Acupuncture can be very helpful in pain control in those awaiting surgery.
  • Acupuncture can be helpful in those who still suffer pain after joint replacement surgery.
  • The goal of acupuncture treatment for arthritic pain is a remission of the pain and inflammation for weeks, months, or even permanently.

Quality

There is no regulation of acupuncture practice in Manitoba. This means that anyone can practice acupuncture in Manitoba, regardless of qualifications or lack of qualifications.