Acupuncture as a Last Resort
Can we change the paradigm?
I have the pleasure of practicing acupuncture two to four days a week in my outpatient clinic. Since obtaining my certification as a medical acupuncturist via the Helm’s Medical Institute in 2013, I have incorporated acupuncture as part of my clinical practice. As a board-certified physical medicine and rehabilitation physician, I primarily treat patients with acute and chronic pain. Most of my patient referrals come from specialists who have exhausted all their treatment tools and have placed their patients in the “untreatable” box. Or they come from primary care providers who do not want to start opioids and have done all that they could to manage their patients’ pain. The patients often say to me, “Acupuncture is my last resort.”
I have found that acupuncture, if used alone for the management of chronic pain, is weakly effective. It does wonders, however, if combined with other modalities including diet modification (removal of foods that are inflammatory to the GI system and joints), targeted use of nutritional supplements, weight loss that preserves muscle mass, initiation of an individualized exercise program, use of personalized stress-relieving techniques that the patient can easily incorporate in their daily routine, smoking cessation, and/or limiting alcohol intake. What if this approach was applied from the time of onset of pain? Could many surgeries have been avoided with the subsequent development of post-laminectomy syndrome? Would fibromyalgia be an actual diagnosis? Would we be facing an opioid epidemic?
The practice of medicine has morphed over the years with the advent of technology and the growth of the pharmaceutical industry. It is my clinical opinion that we have gotten away from the art of touch, a skill necessary to practice acupuncture. Not to mention that in our current culture, results, including the complete elimination of pain, are expected to occur immediately. For those patients who are looking for a quick fix for the management of their chronic pain, most are disappointed by acupuncture. However, they are often the ones who have no intention of modifying their toxic lifestyles; these are the patients who have signed off acupuncture completely, never to use it again. The patients who recognize that it will take time and are willing to make the changes to improve their health while simultaneously using acupuncture are the ones who get better and give me hope that perhaps the paradigm can change.
The eternal optimist that I am hopes that by the time I retire from the practice of acupuncture and medicine it will be customary for the patient presenting with acute pain to have acupuncture as part of their initial treatment plan, which will automatically include a lifestyle assessment, lab testing for nutritional deficiencies and/or pairing with a health coach, nutritionist and physiotherapist to help them make the necessary lifestyle modifications. What do you think?
Janice Brown, MD, DABMA
AAMA Board of Directors, Membership Committee Chair