Child study a turning point for therapy
Acceptance of acupuncture as a has turned a corner, according to a report published last month in the American Academy of Pediatrics' journal, Pediatrics, which concluded that the ancient Chinese needle therapy is safe for use on children, provided that it is performed by 'appropriately trained practitioners'.
The study is the first large-scale systematic review reflecting the growing trend in paediatrics worldwide of using acupuncture on children and adolescents suffering from pain such as migraines. The researchers, from the University of Alberta in Canada, pooled data from more than 37 international studies, randomised trials and single case reports. They focused on the adverse effects associated with using the therapy in children and teenagers.
Out of the 1,422 children and teens in the study, 168 experienced mild side effects (pain, bruising, bleeding), one had a moderate side effect (infection), and 25 were listed as severe (overnight hospitalisation, reversible coma and intestinal obstruction). The report indicated that the severe adverse effects were the result of substandard practice.
It was great news for someone like me, who has always been fearful of acupuncture. If the therapy is considered safe enough for children, then nothing should prevent me - a middle-aged adult - from giving it a try.
Acupuncture had been recommended on many occasions over the past two years as a therapeutic solution for my chronic and acute shoulder pain symptomatic of adhesive capsulitis, or frozen shoulder. The disorder is a chronic and inflammatory disease of the shoulder joint capsule and the surrounding soft tissue, manifesting as pain, soreness, dysfunction and loss of mobility.
However, I had rejected acupuncture - and was also a bit of a sceptic - because of possible pain or bruising, hygienic safety and risk of infection. But the Canadian study gave me some assurance that as long as I sought treatment from a professional who met appropriate standards, my risks would be minimal.
Throughout its 8,000-year history, acupuncture has survived periods of robustness and suppression, but remains an important element in today's traditional Chinese medicine as well as its modernisation as a primary component of Complementary and Alternative Medicine (CAM). Before the Iron Age, acupuncture was initially administered with stone instruments or bian stone, as recorded by ancient literature. The Huangdi Neijing, compiled about 2,200 years ago and regarded as the earliest book written on Chinese medicine, contains the first description of acupuncture.
From the start of the Qing dynasty in 1644 to the opium wars around 1840, herbal medicine was perceived as superior to acupuncture in practice, but during the Long March (1934-35), acupuncture was used as the primary tool to help maintain the health of the army. Mao Zedong officially united traditional Chinese medicine with Western medicine in 1950, with acupuncture utilised as the primary application in Chinese hospitals.
Today, acupuncture is used to as a therapeutic tool to help restore health and minimise pain for people suffering from osteoarthritis, digestive disorders including diarrhoea and constipation, migraines, autism, infertility, depression, labour pains in childbirth, chemotherapy and musculoskeletal disorders or injuries, such as frozen shoulder.
Donna Sutton, a physiotherapist at Peak Performance in Central who was educated in New Zealand and Hong Kong, has administered physiotherapy and acupuncture to many, including Hong Kong rugby team members with sports injuries. She has seen a variety of outcomes: some patients have noted relief after only one or two treatments; others have required four to six visits before any benefits are realised, and still others have felt no effect and stopped the therapy altogether.
Sutton says acupuncture is most effective for musculoskeletal problems such as plantar fasciitis, tendinopathies including tennis elbow, achilles tendinosis, rotator cuff tendinitis and frozen shoulder.
Two years ago, I tore my rotator cuff playing tennis and within two weeks was diagnosed with a mild case of frozen shoulder. My mobility range hovered around 45 per cent, but the pain and swelling in the shoulder and back area was acute. In the past 24 months I have had four steroid injections, more than 10 appointments with orthopaedic surgical specialists for shoulder, back and neck examinations, two magnetic resonance imaging, physical therapy, osteopathy and therapeutic massage.
The cost and time spent on managing the disorder have been overwhelming, with little success or sustainable relief, and in the past two years I haven't experienced one pain-free night of sleep.
According to acupuncture etiology, I have wind and cold invading my taiying and yangming meridians, causing pain in my shoulder, radiating to the neck and back; constant yin deficiency, which disrupts the exuberance of my yang; and qi stagnation and blood stasis, among a host of other ailments.
Sutton inserted seven sterile, prepackaged 50 millimetre acupuncture needles into my right shoulder, arm, hand, upper calf and lower calf, which correspond to points of the large intestine, small intestine, gall bladder and stomach meridians. All insertions were four millimetres deep and relatively painless, except the needle just below my thumb and the point near my ankle. I had aching sensations with referral pain on the corresponding left side of my body and mild throbbing in my head. The session lasted for about 20 minutes. When the needles were removed, my right arm felt heavy and I felt tired, with some mild discomfort in my abdomen, which subsided after two hours. There were no marks on my arm, no bleeding and no apparent bruising. It had gone well.
Later in the day, it became apparent that something had significantly changed. As I got ready for bed in the evening, I was stunned by how comfortable and relaxed I felt. When I woke up the following morning, I felt rested and relieved. For the first time in nearly two years, I had experienced a pain-free night's sleep.
When I returned to the physiotherapy office for my second appointment, Sutton measured my range of mobility, which had improved by almost 20 per cent. I had not expected such improved conditions from a treatment I had rejected as suspicious. I was stunned. My improved mobility was evidence reflecting more than just a placebo effect.
When I asked Sutton how such a huge difference was possible after only one appointment, she smiled and said simply: 'Don't second-guess it. For some patients, acupuncture just works.'
Needle and no damage done
According to the Centre for Health Protection's Guidelines on Infection Control Related to Acupuncture, published in June, acupuncture-associated infections are extremely rare when done under good management by a qualified practitioner. Here are a few things to keep in mind when seeking treatment:
1. The treatment room should be clean, dry, well ventilated and well lit.
2. There should be facilities for hand hygiene and the practitioner should perform hand hygiene before and after patient contact to prevent infections.
3. All work surfaces should be smooth and impervious so they can be disinfected thoroughly, and bed linen should be clean and changed after each patient.
4. The practitioner should review client information and pay attention to potential risk factors regarding medical history (skin infections, chronic illness); drug history (steroid or anticoagulant, such as warfarin); allergy history (drugs or alcohol allergy); and lab results (microbiology and viriology reports).
5. The practitioner should use pre-packaged, disposable sterile acupuncture needles and guide tubes. Package should be opened just before use.
6. In preparation for treatment, skin should be swabbed with 70 per cent alcohol or povidone-iodine or chlorhexidine-in-alcohol to disinfect the penetration site. Once the practitioner has disinfected the penetration site, bare hands should not touch the area again.
7. Acupuncturist should hold the handle of the needle upon insertion and never the area near the needle shaft.
8. Needles, after removal, should be discarded immediately into a sharps box as clinical waste.