Acupuncture: Targeting Chronic Pain with Jonathan Ammen

WebMD Live Events Transcript

Join acupuncturist Jonathan Ammen to discuss the use of this complementary therapy for the treatment of chronic pain.

Event Date:  May 18, 2000.

Moderator: Welcome to WebMD Live! Our guest is Jonathan Ammen, MEd, Licensed Acupuncturist, and the topic is "Acupuncture: Targeting Chronic Pain".

Jonathan Ammen is the Director of Acupuncture at the Lahey Clinic in Massachusetts. He is board-certified in acupuncture and Chinese herbal medicine, and is the president of the Acupuncture Society of Massachusetts.

The opinions of Jonathan Ammen are his and his alone. If you have specific questions or are concerned about your health, you should consult your personal physician. This event is provided for information purposes only.

Welcome, Mr. Ammen! Thanks for joining us.

Ammen: Thank you for asking me.

Moderator: First off, please provide us with some background on acupuncture.

Ammen: Acupuncture has been around for a long time. It is a medical art that has flourished in China and throughout the Orient for at least 2,500 years.  Acupuncture is one of the five major areas of therapeutics within the field of traditional Chinese medicine.  It is not exclusively Chinese, though its origins are Chinese. Modern acupuncture is practiced in Japan and Korea, with very distinct and wonderful styles from each tradition.  The other areas of therapeutics within Oriental medicine include herbal medicine, manual therapy -- which is Tui Na -- and exercise therapy, as well as dietetics.  I have training and experience in all of these areas.

For people who might be interested in learning more about the origins of acupuncture, I know WebMD has an article on some of the history and developments in acupuncture. We also have information at the Lahey Clinic Homepage.  The URL there is www.Lahey.org. At this site, people should go to the "search" section and type in "acupuncture."

Moderator: How does acupuncture work?

Ammen: That's really a Nobel prize answer to that question. It can be answered wearing a Western scientific medicine hat, or an Oriental medicine hatI'll try to answer from both perspectives. From a Western scientific viewpoint, acupuncture needles, when they enter the skin, stimulate peripheral nerves which send messages into the central nervous system along the spinal cord and into the brain.   In the brain, various chemistry and electrical changes are evoked by acupuncture stimulus.  Those can include the release of endorphins, which are the body's natural pain relieving substance, as well as other neurotransmitters. Neurotransmitters, such as serotonin, can be associated with a host of brain changes and health benefits. From a scientific medical viewpoint, acupuncture stimulates blood circulation by dilating blood vessels all over the bodyIt has a regulating impact on the immune system, and may also have a regulating impact on certain endocrine functions. Which is why, for instance, acupuncture is so helpful in treating menstrual disorders. The answer to how acupuncture works, scientifically, can go on and on. I'll switch and speak about the Oriental perspective.  

Acupuncture is a technique which is used to balance and regulate the activity of the Qi, or Chi, in the bodyChi is usually described as the normal functional energy that is associated with all living processes. It flows through the body, through all living systems, in pathways called meridians.  Meridians are likened to rivers, or irrigation canals, in a poetic sense.  So acupuncture stimulation of points along the meridians regulates flow of Chi, or functional energy, in the body, and thereby enhances health. The meridian network is very complex.  It is understood to span all parts of the body with meridians continuously flowing into one another. Disease is understood to be something that can rise when its flow of Chi is somehow disrupted in one or more meridians, or one or more areas of the body.  Blockage of the Chi can result in pain, as well as dysfunction of organs or other tissues, and can have a broad impact on one's entire system. This is simply a way of describing every day, observable events.  When one sprains an ankle, they may have pain alongside of the leg, not just in the ankle, but all the way to the hip, even.  This is obstruction of the Chi from trauma.

Moderator:  Is acupuncture effective in treating low back pain?

Mr. Ammen:  Acupuncture can be very effective in the treatment of low back pain.  In fact, low back pain is one of the conditions that interested me, and led me to the study of acupuncture in the first place.  Low back pain can be caused by many things, so it wouldn't be right for me to speak too broadly about acupuncture's effect in low back pain without being a little bit specific. The simplest perspective might be to say that acupuncture can be helpful by reducing swelling and inflammation, and by doing so, relieving pain. This is one of the explanations I often use at work. Much of my practice is in a large, multi-disciplinary clinic and hospital, and I'm working with physicians who need to understand quickly how to make a referral. So this is one of the ways that I explain it. Even for people who have injuries, or degradation of spinal disks, or who have arthritic changes in the joints of the spine, acupuncture is often useful, probably because of this anti-inflammatory, swelling reducing effect, as well as its pain reducing effect.

Moderator:  Is acupuncture effective for treating migraines?  Is the procedure painful, and do you put needles into the forehead?

Ammen: That's a great question.  Yes.  Acupuncture is often effective for migraine headaches. Migraine headaches are often a complex condition with a number of different causative factors which may need to be addressed, together with receiving acupuncture treatment, in order to get the best result. But acupuncture is still often very helpful. And no, the procedure itself is not painful. I would suggest that anyone interested in this go to our Lahey web site and look up acupuncture. There is a transcript of a web chat series that I did in January with an explanation about what acupuncture is like and if it hurts. We also have pictures which show needles and what they look like. One of the pictures is of a six-year-old girl, who is my patient, with a needle in the back of her neck, sitting there smiling away at me.  So that's probably worth 1,000 words. About whether or not needles go in the forehead, they might. Different migraine types can require different acupuncture points.  So, that would depend on your particular problem, as well as the acupuncturist's experience.

Moderator: If pain is experienced during the procedure, does that mean it's being done wrong?

Ammen: There are different styles of acupuncture, as well as different needling techniques. These differences have a big impact on the sensation.  Many acupuncturists in the United States  now use a needling technique which was refined in Japan, where needles are inserted through a guide tube, which allows them to be tapped through the surface of the skin very quickly.  This reduces the sensation from the needling a great deal. There are specific acupuncture techniques in which we intentionally evoke sensations. These are usually not described as painful by our patients, though they can occasionally be intense. Some people will feel a brief pinching sensation, or a dull achy sensation. Sometimes an electric tingle is felt traveling along skin from the area of the acupuncture point.  Any uncomfortable sensation during acupuncture which lasts more than a few seconds is unnecessary, in my experience. 

Acupuncture is often used, and recommended, as part of a larger health care program. For example, my patients at Lahey Clinic routinely will receive a combination of acupuncture, Chinese herbal medicine, manual therapy, dietary recommendations, and exercise instruction. This is especially so for people with overall body aches, where a combination of acupuncture, at least with manual therapy, and perhaps also herbal medicines, is often given.

Moderator:  Are there risks associated with acupuncture?

Ammen: Yes, there are a few risks. They are relatively minor, for the most part.  Acupuncture needles do penetrate the skin, so they can cause bleeding. This bleeding is generally very little. We routinely hold a Q-tip in hand in the event of a tiny drop of blood.  It's also possible to have a small bruise, if a drop of blood leaks but does not come to the surface.

Moderator:  Is there long-term discomfort at acupuncture sites?

Mr. Ammen: Some patients can experience temporary discomfort or irritation at acupuncture sites following treatment.  Another risk is that because acupuncture causes blood vessels to dilate, or open wider all over the body,  some people, about 5% of people, will have a drop in blood pressure, enough to feel dizzy when they get up at the end of the treatment. This usually resolves within five minutes. The most significant risk factor associated with acupuncture would be the possibility of puncturing the chest wall, or abdominal cavity, and puncturing an internal organ. These kinds of events are possible, though extremely rare.   I understand that there have been approximately ten cases over the last 20 years where the chest wall has been punctured, causing a lung to collapse.  During that time, there have been somewhere between five and 12 million acupuncture treatments given per year. So the statistics are very small, and acupuncturists are well trained in how to avoid such an event.

Moderator:  What are the costs for these services?

Ammen: There is a range of costs that I'm aware of in my area, which is the Boston area, in Massachusetts.  At Lahey Clinic, the initial evaluation visit costs $85, and treatment visits are $65.  This fee is approximately the average, or normal fee, in our area.  Some charge more, some less.  I understand that probably the lower-end for treatment visits are probably in the $40 to $45 range in our area.  Sometimes, at the Student Clinic of New England School of Acupuncture, people can receive treatment at a very low rate when being treated by an acupuncture student under the supervision of the senior teacher.

Moderator:  Does health insurance cover the costs of acupuncture?

Ammen: For the most part, health insurance does not cover acupuncture.  But there are a few exceptions.  For instance, Workers' Compensation Insurance,  personal injury policies from automobile accidents, and some companies purchase insurance policies for employees that do have this coverage.  In the coming year or two, we'll certainly see a large increase in the number of insurers offering coverage. In some parts of the country the situation is different. I believe more coverage is available in California, for instance.

Moderator: Is acupuncture a one-time procedure?  Or do you need several visits to accomplish resolution to the person's problem?  

Ammen: Sometimes acupuncture does need to be repeated. Essentially, the goal of treatment is to correct the underlying imbalance, which is the causative factor in the person's pain.  And this is not always possible. Some people do require intermittent follow up in order to maintain a result.  For instance, I have a patient who has back pain which resulted from degeneration of the lumbar disks and arthritic changes in the joints of the spine, together with muscular contraction in the low back. Now this person's pain is largely under control, because the muscles and soft tissue are no longer inflamed and no longer compressing the nerves, causing back pain and leg pain. But the degenerative changes to the spine are not cured and leave this person susceptible to recurrences of pain, for which she has periodic follow up treatments.

Moderator:  Is acupuncture beneficial in the treatment of depression?

Mr. Ammen: From a Western scientific standpoint, the research is now being done, in fact, here in the Boston area, looking at acupuncture's effectiveness in the treatment of depression.  For a long time, acupuncturists in Chinese medicine have routinely treated depression, we believe with a great deal of success. Now, we'll have an opportunity to confirm this clinical observation via scientific research. We know that some of the brain chemistry changes evoked by acupuncture are similar to those which antidepressant medications try to accomplish.

Moderator: We've reached the end of our show. Thank you so much, Mr. Ammen, for taking the time to respond to our audience.

Ammen: If people have additional questions for me, they can contact me at www.Lahey.org. 

The opinions of Jonathan Ammen are his and his alone. If you have specific questions or are concerned about your health, you should consult your personal physician. This event is provided for information purposes only.

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