There is evidence that acupuncture can be considered as a viable treatment to reduce the pain and the physical dysfunction associated with osteoarthritis of the knee. This involves the management of pain and discomfort without medications.
At the level of the individual who has chronic pain we first have to work out which mechanisms are causing pain in that individual, and then proceed based on which mechanisms are causing pain in that individual. In a lot of chronic pain conditions, the pain may not be occurring because of damage or inflammation in the area of the body where someone is experiencing pain in the peripheral tissues, such as the knee.
The drug and non-drug therapies can be entirely different for each particular pain mechanism. So, patients need to empower themselves by rethinking where their pain is coming from and what types of doctors, therapists and treatments they should be seeing to get help with their pain. The patient can do a lot to direct their therapy in the right direction to help with their type of pain, including an awareness that a lot of drugs may only be marginally effective to treat chronic pain and have side effects. The patient has the best sense of what is going on in their body, and need to educate themselves and be more knowledgeable about managing their particular type of pain.
Osteoarthritis is by far the most common cause of arthritis, especially as people get to live longer and get tend to get heavier, especially in the western world. Nearly everyone will develop osteoarthritis if they live long enough and some of the most common areas to develop osteoarthritis are in the weight bearing areas such as the knees, the hips and the back.
Osteoarthritis was thought to be the classic peripheral pain condition where the degree of damage or inflammation seen on an x-ray or MRI or CAT scan would accurately predict who is experiencing pain and who is not experiencing pain. It was really thought to be a disease of the cartilage, and when the cartilage degraded, you eventually got bone rubbing on bone. And when bone is rubbing on bone, this would hurt. But 30% – 40% of people who have bone rubbing on bone have no pain, whereas 10% – 15% of these people do have severe knee pain. The point is that structural cartilage deterioration does not always cause pain – so what is causing this disparity? If there is no cartilage damage, then is the pain all in the head? Is it psychological? Then what is the appropriate drug and non-drug treatment?
The various underlying mechanisms of pain may need entirely different types of treatments because some people will not respond to opioids, surgical procedures or injections, and be more dependent on non-drug therapies. For example, the body’s two most potent internal analgesic systems are sleep and exercise, such as sleeping well and moving. Arthroplasty does not predictably relieve pain because not all people respond to a surgical procedure to remove their pain.
The sensory nerves throughout our body pick up things like heat, cold, chemicals, pressure and the like from the periphery. A lot of the information that is coming from the peripheral nerves is never supposed to be sent to the brain to be felt as pain. This is the information that most people don’t feel from the periphery, but people with a lot of chronic pain conditions do feel this information as pain. The pain is dependent on the pain pathways or neurotransmitters that inhibit and facilitate the transmission of pain to the brain, rather than what is happening out in the periphery. For example, it is not supposed to hurt to sit in a chair, but for people with chronic pain, sitting in a chair activates different nerves out in the periphery, and all of that information is allowed to go to the brain, to be felt as pain because the pain pathways to the brain are not working properly. A lot of things that aren’t supposed to hurt, do hurt, whereas normal people are more pain insensitive. For people with chronic pain, the normal filtering mechanisms whereby all the sensations that are going on in the peripheral tissues is not supposed to be felt as pain – but those filtering mechanisms are broken or absent or deficient, and this is why certain people experience pain for things that are not supposed to be painful. Sleep and exercise are some of the things that can assist these internal pain pathways. Only a third of the people in the general population have any type of chronic pain and usually have a low pain threshold and are more sensory sensitive.
These nerve pathways can be controlled. These nerve pathways can be changed.
Stress, anger, frustration and fear all amplify the overall experience of pain. Conversely, do something emotionally rewarding and it will have a pain relieving effect.
A rehabilitation approach can be particularly helpful for this type of pain – by getting people moving and getting people sleeping. Because of the pain, people reduce their activity levels. When you start becoming more active as a treatment for chronic pain, you have to start low, very slow and very gradually. The biggest mistake is to try to move straight into an exercise program. Slowly get better over time.
The NCBI website has an article on “Acupuncture and Osteoarthritis of the Knee”
There is strong evidence supporting the effectiveness of acupuncture for knee osteoarthritis. Please refer to AACMA – Australian Acupuncture and Chinese Medicine Association for The Acupuncture Evidence Project:
Further Related Reading:
Sinew acupuncture for Knee Osteoarthritis
Chronic Fatigue Syndrome – Is it a psychological disorder.that’s all in the head? Is it in the genes?
Western medicine is yet to find a cause, prevention or cure for Chronic Fatigue Syndrome(CFS). Western medicine even struggles to make a diagnosis of CFS and usually comes to this diagnosis only after excluding many other possible illnesses. In the meantime, your tests may all be normal, causing a doctor to be dismissive of you, and say that there is really nothing wrong with you, and so there isn’t anything that they can do for you, because they can only fix something that conforms to their current understanding. The frustrating thing for patients that have this condition is that they outwardly look normal – so they don’t get the empathy and the sympathy from friends, family, co-workers and doctors.
An individual can have different levels of CFS, ranging from “I’m always tired” right through to being bed-ridden and unable to care for themselves. Medical tests will not be able to predict who has this condition and how severe this condition will be in any given individual – there is a tremendous disparity. And what may help one person will make the symptoms of another person worse.
What drug and non-drug therapies work best? Unfortunately, because of the poor understanding of the mechanisms of this condition, a lot of the therapies simply won’t work, because they are not targeting the right areas. What is the correct treatment? What types of doctors and what types of treatments should a person be seeking to get help with their CFS? For example, physical activity or movement of some sort may, or may not help.
You have the power as a patient to direct your care in the direction that you feel is best for you, and go to the types of doctors, physical therapists, psychologists and people that are more likely to help you. For example, it may or may not be ideal to go to someone who has a needle because their solution will be to inject a drug that may only be marginally effective at best, with possible side effects. So, some of the non-drug therapies may need to be considered. You need to educate yourself and become more knowledgeable as a patient to become a better consumer of health care and direct your therapy in the direction that you think is appropriate.
The condition can be exacerbated by different types of stress, including both physical and psychological stress. Unfortunately, CFS causes you to be stressed because you can’t do what you want to do, you can’t do what your co-workers want you to do, or what your family wants you to do, which causes more stress, which cause more fatigue.
The rehabilitation approach aims to slowly reverse the downward spiral, and the functional decline, to gradually get better over time. This could involve doing some exercise, movement or activity – without over doing it and worsening the symptoms. Start slowly and increase slowly – carefully pace yourself which means keeping your activity levels even. Try to get a good night’s sleep by managing your sleep patterns.
The NCBI website has an article on randomized controlled clinical trials of acupuncture and moxibustion treatment of chronic fatigue syndrome patients.
Acupuncture for patients with chronic functional constipation:
A randomized controlled trial.
The three acupuncture treatments were as effective as the drug mosapride in improving stool frequency and stool consistency in chronic functional constipation.
Background of this study:
Acupuncture is used to treat chronic functional constipation (CFC) in China, despite limited evidence. The aim of this study is to assess the effectiveness and safety of acupuncture in managing CFC.
Methods of this study:
A multicentre randomized controlled trial was performed involving 684 patients with CFC; the patients were randomly allocated to receive He acupuncture (n = 172), Shu-mu acupuncture (n = 171), He-shu-mu acupuncture (n = 171), or oral administration of the drug mosapride (n = 170). Sixteen sessions of acupuncture were given in the treatment duration of 4 weeks. The primary outcome was the change in spontaneous bowel movements (SBMs) at week 4 (at the end of treatment) compared to baseline. The secondary outcomes included stool consistency (Bristol scale), the degree of straining during defecation, and adverse events.
Key results of this study:
The spontaneous bowel movements (SBMs) increased in all the four groups at week 4, and the magnitude of increase was equivalent in the four groups (He acupuncture, 2.7 [95% CI, 2.3-3.1]; Shu-mu acupuncture, 2.7 [95% CI, 2.3-3.0]; He-shu-mu acupuncture, 2.2 [95% CI, 1.9-2.5]; and mosapride, 2.4 [95% CI, 2.0-2.9]; P = .226). However, the change in SBMs at week 8 was significantly smaller in mosapride group (1.4 [95% CI, 1.0-1.8]) than the three acupuncture groups (2.4 [95% CI, 2.1-2.7], 2.3 [95% CI, 1.9-2.7], 2.1 [95% CI, 1.7-2.5] in He, Shu-mu, and He-shu-mu group, respectively, P = .005).
Conclusions and interferences of this study:
The three acupuncture treatments were as effective as the drug mosapride in improving stool frequency and stool consistency in chronic functional constipation, but the magnitude of the treatment effect is unknown due to the lack of sham acupuncture control.
© 2018 John Wiley & Sons Ltd.
© The Author(s).
Neurogastroenterol Motil. 2018 Jul;30(7):e13307. doi: 10.1111/nmo.13307. Epub 2018 Feb 2.
Note: the common side effects of the drug mosapride include dry mouth, abdominal pain, dizziness, headache, insomnia, malaise, nausea and diarrhea.
Poo, Poop, Stools and Bowel Movements
Invest in Yourself: Wellbeing,
Self-Care, and Your Environment
“You are the person who has to live with yourself, so it’s in your best interests to look after your own individual health and wellbeing and not to delegate responsibility to anyone else.”
From April 1st this year, many alternative health treatments will no longer be covered by your private health care insurance. Personally, I believe that this will place a greater burden on western medical resources because the focus of our healthcare system is on targeting disease rather than promoting health, balance and wellness. This emphasises the importance of taking care of our own individual health and wellbeing – which is where the responsibility ultimately belongs.
Sometimes it seems that taking care of ourselves is a luxury we can ill-afford, but we need to be very clear that disease takes its toll on our physical resources and affects our energy, mobility, and stamina, as well as affecting us mentally and emotionally. The real questions we need to ask ourselves is what quality of life are we aiming for, and how can we reach or maintain that level?
Let’s look at 3 key areas of health and well-being that you can influence:
- Rest, Change, and Recharging: In February I went to Sri Lanka and the Maldives for a 2-week holiday. This is the longest continuous break I have had in several years and it was amazingly refreshing. I’ve heard that it takes most people 5-7 days to unwind and 2-3 days to re-engage, which means that if your holiday is only 10 days you don’t have a real opportunity to simply rest and appreciate your holiday. I suspect this is true. I am also convinced that having at least a few days in the middle where you are neither unwinding, nor mentally re-engaging is very important for your overall health and stamina.
Maybe you can’t manage a 2-week trip away, but if you are committed to your own long term health and wellbeing you can set aside quarterly and annual breaks at home where you eliminate routine activities and focus on rest and recharging in whatever way is meaningful for you. I know people who schedule reading days, movie days, hikes, family outings, home renovations, or tourist trips in their own city during these breaks. The point is they are cutting loose from daily routine and connections and choosing to do something different and pleasurable. This has an incredible effect on your overall wellbeing.
- Environment: I’ve been struggling with fairly constant sinus issues for the past 18 months, but within a couple of days of arriving in Sri Lanka they were gone. The humidity worked its magic and it lasted for about a week after I arrived back in Melbourne. Obviously, I’m not going to move to the tropics (although that is sometimes tempting), but I asked myself what I could do to humidify my environment and came up with a couple of ideas: use a humidifier and nasal spray.
I think a good question to ask ourselves regularly: Is there something in my environment that is negatively affecting my physical, mental, or emotional wellbeing? If so, what could I do to change it? Often there are little tweaks we can make to our environment that can have a far greater impact than we expect.
- Self-Care and Restraint: It’s always tempting to go for the quick cure. We often rush to the doctor for an antibiotic and are upset when they don’t have a quick fix for our problem or tell us to wait a few more days and see, but often our body can deal with the problem itself – if we provide the opportunity.
While in Sri Lanka I had a gum infection. We were changing hotels every night and because the water was not safe to drink my teeth-cleaning routine was compromised. I noticed it one day, but it really wasn’t convenient to see a dentist so I decided to keep on going and hope it would go away. Sadly, that night my gum was terribly hot, swollen, and painful, but we were also out in the jungle, miles from any doctor or dentist.
One of my fellow travellers suggested I try rinsing my mouth with hot salty water. Miraculously (it really did feel miraculous) that relieved the pain and swelling. By the time I was back in a city where I could have seen a dentist, the infection had healed up by itself.
Don’t dismiss the ‘traditional home cures’ for many conditions. They often work just as well as antibiotics or other treatments, have fewer side-effects, and strengthen your immune defences.
It’s easy to ignore our own individual health and well-being until we’re really sick or desperate, but it’s very important to remember that your physical, mental, and emotional health are all intertwined and that how you treat yourself today will affect how much you are able to enjoy life in the future.
Gout: Causes, Symptoms, and Treatment
by Nadia Gazzi
“Everything starts with what you eat!”
Although heredity plays a part in your predisposition to gout, it’s your diet and lifestyle choices that are the primary factors in the age at which your symptoms present and their severity. Unfortunately, some of the foods we usually label as ‘healthy’ are major culprits when it comes to gout.
Gout is more common in men than women and tends to present in middle age or later. There is a certain hereditary predisposition, but factors like alcohol consumption, obesity, kidney disease, hypertension, high cholesterol, diabetes and lack of exercise, can exacerbate the symptoms and may provoke its onset.
Purines are found in most foods and aid with digestive and cardiovascular function. A diet that is high in purine (found in meat, offal, white flesh fish, shiitake mushrooms, legumes and alcohol) may encourage the onset of gout, especially if you do not drink enough water or get enough exercise. You can reduce your risk of gout and kidney stones if you drink eight glasses of water each day.
The classic symptoms of gout are swelling, heat and pain in the joints, especially the big toe, where built up uric acid settles. It is a form of arthritis and can also be found in the knees, ankles or rarely, the arms. When acute, it is incredibly painful and although the symptoms may decrease, gout is like a dormant volcano – it may sleep, but the fires do not go out and will emerge if provoked.
One of my recent clients had his first attack of gout in his early thirties and made drastic changes to his diet and exercise regime as a result. The symptoms seemed to vanish for several years until he took a new job which required a lot of travel and official entertaining. Due to the “go, go, go” nature of his work, he found it difficult to adhere to his new dietary requirements. The combination of foods high in purine and lack of movement caused his gout to flare up again in his knees (at the mature age of 35!). Unfortunately, it’s a vicious circle: the inflammation and pain of gout makes it hard to move, and the lack of movement makes it harder for the body to flush out the system.
This is where acupuncture can be extremely beneficial to jumpstart and promote continued healing! Acupuncture gets the energy moving through your body and frees the joints to move. As energy and blood flow improve, the uric crystals that have accumulated like rust are flushed out, the inflammation and pain are reduced and your system is able to filter and excrete the toxins more effectively. Changes in diet, increasing your fluid intake, exercise, and Chinese herbs are also helpful, but acupuncture is the main accelerant of healing.
When treating gout and other arthritic conditions it is important to strengthen the digestive system, liver, and kidneys so that the spleen is able to transform and process everything efficiently. Your goal is to focus on foods that cool your system down… dairy is great for gout because it is low in purine and cools your system down. You can also apply milk or yoghurt externally to reduce inflammation and alleviate sunburn.
Acupuncture for chronic nonpulsatile tinnitus:
A randomized clinical trial.
Acupuncture is effective in reducing the loudness and severity of tinnitus and can be a useful treatment for nonpulsatile chronic tinnitus.
Background of this study:
There is challenge to find an effective treatment for tinnitus. Few studies were done on the effects of acupuncture for tinnitus. This study evaluated the effect of acupuncture on chronic non-pulsatile tinnitus.
Methods of this study:
This randomized double-blind clinical trial was conducted from December 2014 to September 2015. Patients suffering from chronic non-pulsatile tinnitus were randomly allocated into two groups: acupuncture vs. placebo. They were treated in 15 sessions and at the end of the fifteenth sessions and 3 weeks after completion of the treatment, visual analog scale (VAS) for tinnitus loudness and tinnitus severity index (TSI) questionnaires were completed.
Results of this study:
The case group included 26 males and 18 females, and in the control group there were 27 males and 17 females: with mean age of 49.11±1.07 and 55.20±8.33 years, respectively (p=0.005). TSI and VAS before treatment were 43.84±2.81 and 9.56±0.43 in cases and 43.52±2.94 and 9.54±0.45 in controls, respectively. Both measures improved after 15 sessions in cases to 24.82±1.04 and 2.88±0.33, and to 33.16±1.24 and 7.86±0.23 in controls. The changes of TSI and VAS were significant in all groups (p<0.001). TSI and VAS in acupuncture group were lower than placebo group in each session (p<0.001), except TSI in the tenth session (p=0.392).
Conclusions of this study:
Acupuncture is effective in reducing the loudness and severity of tinnitus and can be a useful treatment for nonpulsatile chronic tinnitus.
© The Author(s).
- Naderinabi B,
- Soltanipour S,
- Nemati S,
- Saberi A,
- Parastesh S,
Caspian J Intern Med. 2018 Winter;9(1):38-45. doi: 10.22088/cjim.9.1.38.