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+++++++++++++++++++++++++++++++++ +++ +++ +++++++++++++++++++++++++++++++++ COMPLEMENTARY MEDICINE + + Is ACUPUNCTURE Suitable for My Patient? P RACTICING ACUPUNCTURE HAS added color and variety to my life as a primary care physician. Here are some clinical vignettes I want to share with you. A man in his 40s presented with a painful, disabled arm from a motor vehicle accident. He described his pain as "constant hot soup," which continued to burn despite all the strong narcotics, epidural injections and other treatments he had tried. After several sessions of acupuncture, we finally reached a point where his pain was tolerable enough for him to function daily as an office worker. However, this only lasted until he found out that his health insurance no longer covered acupuncture and his next option was to approach a neurosurgeon for a brain implant for adequate pain control. This implant alone cost in excess of $10,000, and the procedure carried much higher medical risks — but the entire procedure was fully covered. I had been working at a fertility clinic, performing acupuncture pre- and post- embryo transfer during in-vitro fertilization (IVF). A woman in her late 30s had failed her previous two trials of IVF procedures. She was nervous, frustrated and emotional. Using acupuncture, I worked patiently with her for several weeks prior to her next trial of IVF to alleviate her anxiety and tension. Then, when the big day came, I performed acupuncture before and after her embryo transfer and hoped for the best. Almost a year later, she proudly sent me a picture of her fraternal twins. Clinical Indications of Acupuncture Since the explosion of modern research in acupuncture, many meta-analyses and systematic reviews have been per- formed. One important source is The Cochrane Collaboration (www.Cochrane. org). Currently there are more than 70 acupuncture titles being reviewed, and almost 30 of these are published full reviews. According to these and other data, acu- puncture is documented to be effective in: + chronic back pain + acute pain, including dental pain + headache + fibromyalgia + hypertension + postoperative nausea and vomiting + chemotherapy-induced nausea + osteoarthritis of the knee + pain relief after oocyte retrieval + aiding gastrointestinal endoscopy + improving rates of pregnancy in women undergoing in vitro fertilization For the vast majority of conditions studied, the data appear inconclusive. The evidence regarding the effectiveness of acupuncture in treating addictions, asthma, Bell's palsy, facial pain, neck pain, cancer pain, depression, temporomandibular joint disorder, tinnitus, acute stroke, labor pain, insomnia, dysmenorrhea, sciatica, shoulder pain and surgical pain is currently insufficient. Unfortunately, the current data do not support recommendation of acupuncture for smoking cessation and weight reduction. In general, for patients with chronic pain, acupuncture appears to have much greater efficacy than no treatment at all. Therefore, the current recommendation (Grade 2B) is when safe alternatives are unavailable or limited, patients with chronic pain who are open to or interested in acupuncture should be referred for a trial of acupuncture. Shao Chyi Lee, M.D., has been a Bush Medical Fellow with the Bush Foundation (www.bushfoundation.org) since 2009. Visit www.acupunctureinmedicine.info for more information about acupuncture. n References: 1. Ahn, AC. et al. Acupuncture, in 2011 UpToDate. 2. Ernest, E. et al. The Desktop Guide to Complementary and Alternative Medicine. An evidence-based approach. Elsevier Ltd. 2006. 3. Manheimer, E. et al. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. BMJ. 2008 Mar 8; 336(7643):545-9. MDNEWS.COM n MD NEWS Twin Cities | 9