Battlefield Acupuncture

51 Pages·2017·1.51 MB·English

Battlefield Acupuncture: A non-Pharmacological/non-opioid
approach to fighting pain
Isaac Darko, MD.
VAMC TBI/Polytrauma Program Medical Director
UC PM&R Associate Professor
and
Angela Young, NP. Cincinnati VAMC TBI/Polytrauma Program

Northern Kentucky Brain Injury Conference
March 23th, 2018
Battlefield acupuncture (BFA) description
• No universally expressed definition

• Name coined in 2001 by Dr. Niemtzow. Probably influenced by
the events of 9/11 and the thought of it’s potential use on the
military battlefield

• Derived from auricular acupuncture, BFA can be described as “a diagnostic and
treatment system based on normalizing the body’s function through
stimulation of up to five specific mirrored points on the each external ear”

• In order to understand BFA, one must comprehend the history of Auricular
acupuncture as is derived from traditional Chinese acupuncture (TCA)
What is Traditional Chinese Acupuncture
• A way to stimulate healing

• It originated from China >5,000 years ago, used to treat acute
and chronic pain

• There is bidirectional electrical communication/energy , Qi, (pounced
“Chi”), between the skin and all organs, glands and tissue of the body
that travels along pathways (called Meridians) located within the body

• A break/disturbance in the flow of this pathway Illness or Pain

• Energy flow can be corrected by stimulating certain points on the body
along the energy pathway

• Then the progress of a disease can be arrested and even reversed,
bringing the patient back to health and normal function.
Meridians
• 12 main meridians
• Stomach
• Spleen
• Heart
• Small intestine
• Bladder
• Kidney
• Pericardium
• Triple burner
• Gallbladder
• Liver
• Lung
• Large intestine
http://www.chinesemeridian.com/img/u41.JPG
Traditional Chinese Acupuncture
• 470 BC- 24 AD
• Iron needles replaced bamboo, stones, and bone needles

• 1027 AD
• Meridians and acupuncture points became standardized

• Mid-16th Century
• Acupuncture was introduced into Europe Traditional Needles

• Placement of 1-20 needles; Needles range in size from just
breaking the surface of the skin up to 9 inches in length

• Needles remain in place for 15- 30 minutes

(www.spine-health.com, 2016)
General theories of how acupuncture works
• Neurotransmitter Theory: Acupuncture stimulates an electrical signal
to the brain resulting in a release of endogenous opioids (endorphins
and enkephalins)
• Acupuncture stimulates blood flow and tissue repair.
• Acupuncture analgesic effects are blocked by naloxone, an opioid antagonist
(Cheng R et al, Life Sci 1972)

• Autonomic Nervous System Theory: Acupuncture stimulates the
release of norepinephrine, acetylcholine and several types of opioids,
nerve signals to the brain that regulate the perception of pain
resulting in a return of the ANS to a relaxed and restful state reducing
pain
(www.mdacuclinic.com, 2016)
General theories of how acupuncture works
continued
• Vascular-interstitial Theory: Acupuncture affects the electrical activity
within the body enhancing transport in the tissues resulting in tissue
healing

• Blood Chemistry Theory: Acupuncture affects the concentration of blood
components such as triglycerides, and cholesterol allowing for homeostatic
regulation

• Gate Control Theory: Acupuncture receptors (mehanoreceptors) that
inhibit the transmission of nociceptive signals of painful stimuli in the
dorsal horn
(www.mdacuclinic.com, 2016)
How acupuncture works: still under investigation
• Researchers continue to develop an evidence-based picture of how
acupuncture works, armed with:
• a growing understanding of chronic pain and its relation to neurotransmitters
• functional MRI studies of the brain
• more details about the local effects of acupuncture needles

• Acupuncture treatment has both local and distant effects
• Evidence that acupuncture stimulation results in local biochemical effects that
promote tissue healing.

• The treatment also reduces pain by two mechanisms
• segmental analgesia (depressing the activity of the dorsal horn of the spinal cord) and
• extra-segmental analgesia (decreasing pain through activation of neurotransmitters centrally
in the brain)
Traditional Acupuncture: Early FMRI studies
• Cho et al. (1998; 2001) used fMRI to measure changes in areas of the brain
that are involved in pain perception, relay, and attenuation
• Somatosensory thalamus, anterior cingulate gyrus, and premotor cortex

• They stimulated the bladder and/or the gallbladder meridians in the Lower
extremity

• Both acupuncture and sham controls showed decreased activation
• Implies there is analgesic effects but not specificity of points

Meridian-Acupuncture
Pain Stimulation Sham-Acupuncture + Pain
+ Pain,
Cho et al. (1998; 2001)
Traditional Acupuncture works for Chronic Pain

• Value of Acupuncture in treating MSK pain and injuries is well documented

• A large number of randomized controlled trials provide growing evidence of the clinical
efficacy of acupuncture for treating a variety of medical conditions (National Institutes of Health,
1997; Ernst and White, 1999; Stux and Hammerschlag, 2001)

• Most Frequently cited literature for acupuncture is by Vickers et al. 2012
• Meta-Analysis: high-quality systematic review of Randomized controlled trials using data from 29 of 31
eligible trials, with a total of 17,922 patients analyzed
• 4 chronic pain conditions: back and neck pain, osteoarthritis, chronic headache, and shoulder pain.
• Chronic pain studies comparing Acupuncture+usual care (including OTC meds) vs Sham acupuncture
(needles inserted only superficially)
• Result: Acupuncture was superior to both sham and no acupuncture control groups for each pain
condition (all p<0.001)

• Medical acupuncture has gained respect due to its efficacy, portability, very low risk, cost-
effectiveness, and safety history as well as high patient acceptance. (World Health Organization
2002)