Acupuncture and the Oncology Patient

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Acupuncture and the Oncology Patient

• XXX Meeting
• Date

Nicola Kiely, Physiotherapist, Bon Secours
Hospital.
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• Western Acupuncture similar to Chinese acup to a
  casual observer.
• Needles are inserted into the body incl hands and
  feet, agitated by hand and sometimes electrical
  impulses, taken out after a period of time
  somewhere bt 5 and 30 mins

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• However considerable differences
• WA..medical dx made , needles influence
  physiology of the body a/c to scientific view and
  acup seen as conventional Rx along with drugs or
  surgery.
• Traditional Acup makes dx in terms of a
  disturbance to the bodys balance which needs to
  be corrected with needles.

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Acup. in the West

• 1970s Felix Mann
• Meridians dont exist, points dont exist
• Gate control theory of (Melzack and Wall 1965)
• Discovery of Endorphins (Hughes et al 1975)
• Studies show Acup released the endorphins (Han
  Terenius 1982)

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5 mechanisms to understand WA

• Local Effects..stim sensory nerve fibres in skin
  and muscle
• CGRP
• Local bl vessels to dilate..local bl flow
  increases
• Superficial and deep tissue healing
• Acup promotes local healing

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Segmental Analgesia

• Action potentials travel up nerve to part segment
  in spinal cord
• Depress activity of dorsal horn reducing response
  to pain
• e.g. pain in the knee joint reduced by needling
  muscles around the knee as nerves from the knee
  joint enter same segment as nerves from the
  muscles around it.
• Acup red. pain in the segment where the needles
  are inserted

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Extrasegmental analgesia

• Action potentials then travel on from the dorsal
  horn to the brainstem
• Descending nerve pathways.. ..neurotransmitters
  suppress pain
• Extrasegmental as not restricted to a single
  segment
• Acup reduces pain throughout the body

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Central Regulatory effects

• After reaching the mid-brain , the action
  potentials go onto influence other
  structures..cerebral cortex, hypothalmus and
  limbic system
• Calming effects and improves well being
• Autonomic nervous system and various female
  hormones such as those that control the menstrual
  cycle
• Acup has a calming effect and improves well-being

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Myofascial trigger points

• Small knots of tight muscle fibres
• Tender
• Taut bands
• Mvt of muscle restricted by pain
• Acup inactivates myofascial trigger points

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Patient Group

• Mainly Females
• Wide variety of vasomotor symptoms
• Mainly Hot Flushes, Night Sweats,Fatigue,Pain,CIPN
  .

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Some studies

• Frisk 2008RCT..45 pts with flushes due to
  Tamoxifen..Electroacup vs Hormone
  Replacementfreq of Hot flushes reduced by 50
• Lee 2009..Cochrane Review..Post-op nausea and
  vomiting..Acup using PC6..PC6 stim prevents PONV

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Acup and Gabapentin

• Electro-acup greatest reduction in hot flushes at
  end of Rx and 4 months off Rx
• Gabapentin similar reduction while on Rx but not
  off
• EA had less side effects to Gabapentin

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Some points for Hot Flushes

• LI4
• TE5
• LR3
• SP6
• ASAD points Sternum
• To note.. no needling to the affected side..risk
  of lymphoedema avoided

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Hot Flash Composite Score

• Frequency x Severity
• Severity measured mild, moderate, severe, very
  severe..score 1,2,3,4.
• E.g 13 hot flushes in a day x 3 (severe)39
• Measure before and after rxs at 1/12, 4, 8, 12.

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Acup. Service in the Bons

• Immediate access via GP or Consultant
• Referral letter necessary detailing pt hx and
  stage of disease etc..written conset from pt
• Cost same as physio cost
• Treatments weekly for 6 weeks
• Minimal ache felt from needles
• Big plus is it is non pharmacological
  intervention!
• Time with pt promotes physical and emotional
  well being

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• Thank you for your attention.