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What's the "Point": Acupuncture

April 2, 2018

 

During my twice weekly shifts at the local small animal general practice I often have opportunity to mention and recommend integrative medicine - acupuncture, low level laser therapy, joint mobilization, nutritional therapy, etc. Similar to the aging Baby Boomer generational tide we are experiencing in the United States, a large percentage of our pet population is aging into seniority as well. With this maturation comes degenerative conditions such as kidney and liver disease, osteoarthritis, dental disease, muscle wasting, neurologic disorders, and cognitive dysfunction.

 

It was partly out of frustration dealing with these degenerative conditions that I sought out integrative medical training - acupuncture above all else has the potential to affect great positive change in these conditions that would otherwise run amok in the lives of our furry companions.

Despite living in a very forward-thinking and “crunchy” area of

the country, I still often receive incredulous disbelief and even abject resistance towards medical acupuncture for animals. The objections range from simply not believing acupuncture works to the fact that I am talking about placing multiple needles in their dog who already hates getting annual vaccines. My goal with this article is to allay many of these concerns and provide some simple albeit convincing evidences concerning the efficacy of acupuncture.

 

Acupuncture accomplishes four main physical and biochemical changes:

 

  • Communicates with the nervous system, a process called neuromodulation.

  • Increases blood flow; this helps deliver oxygen and medications to the site, as well as aid in removal of metabolic waste

  • Stimulates the body to release its own natural chemicals including pain relievers, endorphins, and anti-inflammatory substances

  • Helps relax tight or knotted muscle, further reducing pain and symptoms.

 

1. Neuromodulation


The body’s biomechanical scaffold is composed of bone, muscle, connective tissue, and nerves. Each of these components has parts that are deep within our bodies and parts that rise close to the surface. We have all discovered how superficial our ulnar nerve is when we strike our funny bone on the edge of the stairway banister. This is important because acupuncture works mainly through a process called neuromodulation - affecting the nervous system by stimulating nerves and blood vessels that are easily accessible. The stimulation, however, does not end there.

 

Local acupuncture-induced signals ascend up the nerves all the way to their sources in the dorsal horn of the spinal cord and in multiple regions of the brain (2,3). Here, shifts in the tone of the autonomic nervous system (see figure) are induced, leading to changes in the cardiopulmonary and digestive systems (5).

 

The sympathetic nervous system is responsible for “fight or flight”, whether that involves fleeing from danger or trying to cope with an internal disease. Chronic pain or disease can result in this system consistently being over-active, leading to impaired digestion, elevated heart rate, high blood pressure, anxiety, and stress on the liver, pancreas, kidneys, and brain. Reducing this sympathetic overdrive can reduce symptoms of disease.

 

Conversely, if a nerve is not functioning, such as in paralysis, we can use acupuncture to wake these nerves up. 

 

 

2. Improved Blood Flow


Acupuncture locally stimulates the release of a substance called Nitric Oxide (1). Nitric Oxide is a key regulator of blood circulation and is responsible for dilation of local blood vessels in times of increased oxygen demand, strenuous activity, or inflammation. By increasing blood flow to an area of dysfunction or disease, oxygen and medications can be better delivered to the site, as well as aid in removal of metabolic waste (lactic acid, free radicals, etc.).

 

3. Release of Beneficial Endogenous Chemicals


Local stimulation of nerves via acupuncture needles begins a cascade of signaling that ascends all the way to the spinal cord and brain. Subsequently, it causes the release of opioid peptides such as endorphins and serotonin (6). Opioid peptides bind to opioid receptors in the brain, exerting the same effect as if we had administered morphine, a synthetic opioid. Serotonin is a neurotransmitter responsible for regulating mood, appetite and digestion, sleep, and memory (7).

 

4. Relaxation of Muscular Trigger Points


Over half of the documented acupuncture points lie over muscle bellies (4). Dysfunction or disuse of a muscle leads to hypertonicity and in chronic cases trigger points (see Box 1). Insertion of an acupuncture needle at this location, along with some stimulatory movements of the needle, can induce the trigger point to relax and provide pain relief and improved range of motion (8). This is similar to what is described as “dry needling” by chiropractors and physical therapy practitioners.

 

As you can see, a lot can be said for the effectiveness and utilization of acupuncture. New studies are coming out every week detailing how acupuncture is successfully being used to treat conditions ranging from constipation to spinal cord injury to headaches to Alzheimer's to insomnia (9,10,11,12,13). 

 

 

One question I get fairly often is how often a veterinary patient needs treatment. In short, that depends on the condition. Dogs who are paralyzed will need daily treatments. Pets in pain can start 1 to 3 times weekly and taper to monthly acupuncture treatments. Preventative acupuncture, such as in dogs that are prone to arthritis or disc disease, but not yet showing symptoms, can receive treatments every 1 to 3 months. There are no hard and fast rules; much depends on the condition and what the owner is willing and able to do. But from my perspective (and from the perspective of a lot of solid evidence) doing some is better than doing none, especially considering how effective, safe, and non-invasive medical acupuncture truly is.

 

Just a final note. Many owners are concerned that their dog, cat, or horse will not tolerate placement of the needles. While it seems that these companions would mind dozens of needles being poked thru their skin, in reality they tolerate it very well. The release of endorphins is often so quick and fulminant that many times my patients doze off during their treatment! I always begin a new patient with gentle touch and massage, building a relationship of trust with them, before moving on to acupuncture and laser. The diameter of the needle is always gauged off of the tolerance level and size of the patient and I always ensure I am listening to what the patient is telling me thru nonverbal cues. My goal is for each session to be a healing and relaxing time for both pet and parent alike.

 

                Ozzie taking a snooze during his weekly acupuncture treatment

 

Sources

1. Tsuchiya, Masahiko; Sato, Eisuke F.; Inoue, Masayasu; Asada, Akira. Acupuncture Enhances Generation of Nitric Oxide and Increases Local Circulation. Anesthesia & Analgesia: Feb 2007;104(2):301-7.
2. Chae, Y.; Lee, H.; Kim, H. The neural substrates of verum acupuncture compared to non-penetrating placebo needle: An fMRI study. Neurosci. Lett. 2009, 450, 80–84.
3. Zeng, F.; Qin, W.; Ma, T.; Sun, J.; Tang, Y.; Yuan, K.; Li, Y.; Liu, J.; Liu, X.; Song, W.; et al. Influence of acupuncture treatment on cerebral activity in functional dyspepsia patients and its relationship with efficacy. Am. J. Gastroenterol. 2012, doi: 10.1038/ajg.2012.53.
4. Zhang, Z.-J.; Wang, X.-M.; McAlonan, G.M. Neural acupuncture unit: A new concept for interpreting effects and mechanisms of acupuncture. Pflugers Arch. 2011, 462, 645–653.
5. Robinson, N.G. One Medicine, One Acupuncture. Animals 2012, 2, 395-414.
6. Han JS, Terenius L. Neurochemical basis of acupuncture analgesia. Annu Rev Pharmacol Toxicol 1982;22:193–220.
7. McIntosh J. What is serotonin and what does it do? Medical News Today. https://www.medicalnewstoday.com/kc/serotonin-facts-232248. Accessed 27 March 2018.
8. Kietrys DM, Palombaro KM, Azzaretto E, Hubler R, Schaller B, Schlussel JM, Tucker M. Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2013 Sep;43(9):620-34.
9. Lin L-W, Fu Y-T, Dunning T, et al. Efficacy of Traditional Chinese Medicine for the management of constipation: a systematic review. J Alt Comp Med. 2009;15(12):1335-1346.
10. Widrin C, Scalp Acupuncture for the Treatment of Motor Function in Acute Spinal Cord Injury: A Case Report, Journal of Acupuncture and Meridian Studies (2018), https://doi.org/10.1016/j.jams.2018.01.002.
11. Sezgin Y, The Acupuncture Therapeutic Approach in Temporal Arteritis Vasculitis: A Case Report, Journal of Acupuncture and Meridian Studies (2018), https://doi.org/10.1016/j.jams.2017.12.002.
12. Yujie Jia, Xuezhu Zhang, Jianchun Yu, Jingxian Han, Tao Yu, Jiangwei Shi, Lan Zhao and Kun Nie. Acupuncture for patients with mild to moderate Alzheimer’s disease: a randomized controlled trial. Jia et al. BMC Complementary and Alternative Medicine (2017) 17:556.
13. Wanrong Zhang, MDa, Zhen Huang, MDa, Yuanyuan Jin, MDb. Acupuncture as a primary and independent treatment for a patient with chronic insomnia. Medicine (2017) 96:52(e9471).

 

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