Ladder of Invasiveness – Minimizing the risk from surgery

Do you know anyone that has undergone a surgical procedure and came out of the experience worse off than before the procedure?  I see this semi regularly.  Is there a better approach?  Is there a way to minimize the chance something like this might happen to you?

Of course the success or failure of a surgical procedure depends on the expertise of the surgeon, and of course the problem being treated.  When surgery is necessary, then we find the best surgeon we can and hope for the best.  Some do well, some experience no improvement and some come out of the experience worse than when they went in.

Consider the following information I obtained from   “Researchers reviewed records from 1,450 patients in the Ohio Bureau of Workers’ Compensation database who had diagnoses of disc degeneration, disc herniation or radiculopathy, a nerve condition that causes tingling and weakness of the limbs. Half of the patients had surgery to fuse two or more vertebrae in hopes of curing low back pain. The other half had no surgery, even though they had comparable diagnoses.

After two years, just 26 percent of those who had surgery returned to work. That’s compared to 67 percent of patients who didn’t have surgery. In what might be the most troubling study finding, researchers determined that there was a 41 percent increase in the use of painkillers, specifically opiates, in those who had surgery. “

This information was specific to fusion of two or more vertebra, but this type of outcome is not uncommon with other surgeries as well.  So how do we avoid, or at least minimize the chance we will experience a failed surgery?  I call it the ladder if invasiveness.

What is the ladder of invasiveness?  Simply put, prior to undergoing an invasive procedure that may very well make you worse, begin by using treatments that are benign and will not result in increased problems if there is no positive change.  Put another way, using acupuncture as an example, acupuncture for pain is generally extremely effective, but if a series of treatments does not result in lasting improvement, you are no worse off than before treatment.  If ultimately surgery is required, and it did not go well, you won’t regret having not tried another approach first.

It is important to point out that just because an MRI suggests a pain complaint is caused by bone spurs, stenosis, degenerative joints or whatever, does not mean this is actually the cause.  I see people all the time with an MRI indicating pain is caused by_______(fill in the blank) and acupuncture resolves the problem.  Acupuncture did not make bone spurs go away, but the pain complaint resolved.  What does this say about the MRI?  Not much.  The MRI did identify pathology, it just turned out the identified pathology was not the cause of the pain or at least not the entire cause.  This is fairly common.

Having said that, there are times surgery should be moved to the top of the treatment list, but outside of emergency situations, climbing the ladder of invasiveness is a better and safer way to go.

One other consideration.  In situations where someone undergoes surgery which did not resolve the pain, or made them worse, all is not lost.  Often times the underlying pathology will be corrected but pain continues due to continuation or initiation of neuropathic pain.  Neuropathic pain is treated poorly by conventional means but acupuncture is quite effective.  So utilizing acupuncture post-surgery may be very effective at resolving the pain and encouraging the healing process surgery began.

I wish you the very best of health!

What is Our Professions Greatest Honor?

Every year practitioners of any style of medicine spend time honing their skills, letting go of treatments that don’t work as well as we would like, and striving to perfect our skills so we can provide the very best of care to our fellow human beings.  We want this for our patients and when we ourselves are the patient, we hope to be treated the same.  The ability to help people in pain or suffering from illness is a privilege that touches all of us deeply.

When the people we serve feel like they have someone to talk with, someone who really cares about them, they will then be happy to refer family and friends.  The trust placed in us when someone makes a referral is our professions highest honor and it is the result of not only our technical skill and expertise, but it is also a reflection of how we care for others.  Thank you for the privilege I have been given to help you, and the honor you have bestowed on me by referring your family and friends.

Michael Wedge, L.Ac.

How Quickly Should Acupuncture Work?

There is a saying that goes Li Gan Jian Ying which translates as “Stand Pole, See Shadow. Said another way, when you stand a pole in the sun you should immediately see its shadow. When it comes to the treatment of pain, the response to acupuncture treatment should be immediate.

I have used various styles of acupuncture (there are multiple styles) since 1992 and they are not equal in their efficacy. All styles may produce the same end result (this is arguable) but one style is far more efficacious than others in the treatment of pain and injuries. This is the primary style I practice and one which is rapidly gaining in popularity in the profession, but still practiced by a small minority of practitioners.

It is very uncommon for someone to be treated that does not experience immediate improvement. The vast majority will obtain near complete or complete resolution of their pain within seconds. It will typically take more than one treatment to obtain long term or permanent resolution of the problem, but the pain relief during a treatment is nothing short of amazing.

If you are in pain, whether you have exhausted all your options or acupuncture is your first choice, I know you will be pleasantly surprised as to how quickly you feel better.

Stand pole, see shadow. Simple and powerful.

Can Acupuncture Treat Complex Regional Pain Syndrome?

Complex regional Pain Syndrome, (CRPS) which in the past has been called Reflex Sympathetic Dystrophy (RSD), is a chronic disease that results is significant suffering in those that are unfortunate enough to develop it. CRPS is rated as one of the most painful conditions a person can experience.  In fact the pain intensity is rated higher on the McGill Pain Scale than childbirth or amputation.  Keep in mind this is a constant, intense pain. How this condition develops and its component parts remains a bit of a mystery, but it begins following an injury and presents with intense pain, burning and or stabbing pain. Moving or touching the limb is often intolerable. Wikipedia states “the patient may also experience muscle spasms, local swelling, sensitivity to things such as water, touch, and vibrations, abnormally increased sweating, changes in skin temperature (usually hot but sometimes cold) and color (bright red or a reddish violet), softening and thinning of bones, joint tenderness or stiffness, and/or restricted or painful movement.”

In some cases of CRPS, there is actual nerve damage, but the majority of time the problem, at least in part, is related to simple neuropathic pain. This is pain that finds its origin in nerve dysfunction rather than direct nerve injury. The good news is acupuncture is extremely effective for most cases of neuropathic pain. CRPS is a progressive pathology, meaning it gets worse over time and this may impact the success experienced with acupuncture. But whether the CRPS is new or has been present for a long time, acupuncture is a very safe and comfortable approach that may very well reduce or eliminate the problem. In fact, most chronic pain, be it neck pain, back pain, or any other pain, is neuropathic in nature and will usually respond very well to acupuncture. CRPS is more involved than just simple neuropathic pain, so the results are not as predictable as in other pain conditions. In patients with neuropathic pain we assume the problem will be resolvable until proven otherwise. The success rate is typically very high, usually in the 90 percent range for those that follow the prescribed treatment plan.

It is worth noting, in cases of CRPS, the involved extremity is never needled. Not only would this approach likely be ineffective, the pain would likely be unbearable.

The bottom line is CRPS is a miserable problem to have and can be debilitating. Acupuncture is generally extremely effective at treating neuropathic pain and does so very effectively even when routine approaches to pain management have failed. There is no downside to acupuncture as it is a safe procedure. With so much to gain and nothing to lose, acupuncture should be part of the treatment plan.

Merry Christmas

I wanted to let all of you know how much I appreciate you and the opportunity you have given all of us at Premier Acupuncture to help you overcome pain and illness.  As you now know, the services we offer have helped you in ways you may never have thought possible; from experiencing the near instant reduction or elimination of pain to regaining health you thought you had lost forever.  Thank you for the honor to participate in your health care.  Please share your experience with family and friends.

From all of us at Premier Acupuncture, we wish you and yours a happy, peaceful and blessed Christmas and New Year.  Thank you for being part of our practice and life.  It is truly an honor!

Michael, Julie, Melissa

Chronic Pain, can it be treated?

Chronic pain is extremely disruptive to the individuals suffering from it and to those that care about them. If you look at pain clinics you will see an organized narcotic distribution center. I have talked with many, many chronic pain sufferers and how they have the choice of being drugged to the point they don’t have the quality of life they desire (and are still in pain), or they live with pain, which again prevents them from living the life they desire.

A quote from Wikipedia says “Complete and sustained remission of many neuropathies and most idiopathic chronic pain (pain that extends beyond the expected period of healing, or chronic pain that has no known underlying pathology) is rarely achieved, but much can be done to reduce suffering and improve quality of life.” But is this true? I conditionally say no it is not. Certainly not everyone that suffers from chronic pain can be cured, but conventional wisdom is wrong when it comes to believing pain control or resolution “is rarely achieved”.

Chronic neuropathic pain, pain which is not the result of major structural damage (the most common kind of chronic pain) can very frequently be treated and or resolved. In fact the ease at which this can be done will astound you. If people and physicians will step outside of their comfort zone and look beyond the standard of care, a standard that is arguably terrible (simply ask those with chronic pain), they will see just what else is available to help people suffering with chronic pain. In fact many are, including the American Academy of Pain Management, a mostly physician group, that has invited an acupuncturist to speak at their conventions. But the process of changing the minds of the masses is slow and many continue to suffer.

It has been my experience that someone with chronic pain, that is an appropriate candidate for acupuncture treatment, who follows the recommended treatment frequency, for the recommended duration, in other words, people who will stay the course, will more often than not find substantial or complete relief. I see this all the time.

Acupuncture is a safe, and highly effective treatment if provided by a skilled practitioner. If you or someone you know suffers from pain, maybe it’s time to consider an approach with 3800 or more years of history.

Why am I writing this blog? Out of a desire to educate. I see people spending months in physical therapy or chiropractic care, or on heavy medications, or simply suffering; even friends that simply refuse to see a possible answer that has been right next to them for many years. I am not suggesting these other treatment approaches are not valid, they are. Rather I am suggesting the public and the health care community look beyond the familiar and become comfortable with this highly effective form of treatment called acupuncture.

As I understand it, Asian medicine, which is inclusive of acupuncture, is the most common form of medicine practiced on the planet and it has grown by leaps and bounds in the United States since I began practicing in 1992. But we have a long way to go, and we will do so resolving the pain of one person at a time until everyone knows about the benefits of acupuncture.

Dry Needling

A trend has been developing where other health care professions have seen the incredible efficacy of acupuncture and wanted to add it to their scope of practice. In my opinion, and I have given this considerable thought, this is a practice that is not in the best interests of our patients. In fact it is potentially dangerous due to what I consider to be insufficient training and likely ineffective due to such a limited understanding of acupuncture. Acupuncturists spend 3-6 years above their undergraduate education, learning their trade, and physical therapist and in states that allow it, chiropractors, practice “dry needling” with as little as 24 hours of education and as I understand it, with little or no clinical training.

I will not expand on the negatives I see with this practice, but I think it is important for the public to understand the term dry needling is nothing more than a very limited form of acupuncture being rebranded so acupuncture could be added to the scope of practice of other providers, without adequate training. The comfort and safety of the public is paramount, and I believe the practice of dry needling is contrary to those interests. Setting safety and comfort aside, I believe it is important to understand the efficacy of dry needling is far inferior to any of the various forms of acupuncture. Basically dry needling involves placing needles into trigger points, or tender areas known as Ah Shi points in acupuncture parlance. But an acupuncture treatment rarely stops there and is capable of so much more than the effects of dry needling.

Trigger points and tender areas, two problems that are responsible for a considerable amount of human suffering, are typically quite easy to resolve, often times almost instantly if you are using the correct tools and have the proper skills. Dry needling is a poor and typically inadequate attempt, whether under the heading of adjunctive therapies added to physical therapy or chiropractic, or being used by an acupuncturist, to address musculoskeletal complaints. It may be a useful piece of the treatment protocol, but as a standalone approach, there are far more effective methods.

If you are looking for pain treatment, see a physical therapist for physical therapy if that’s the approach you feel is best, see a chiropractor if you want an adjustment and see an acupuncturist if you are looking for acupuncture. It’s your money, your health, your safety and comfort. Go to those that have the training and experience to help you achieve your health related goals. As for me, I would not go to a physical therapist for an adjustment, nor would I go to a chiropractor for acupuncture, or an acupuncturist for physical therapy. Do yourself a favor and obtain the care you need from the professional best trained to administer it.

Insanity Defined

It’s been said, to the point of being axiomatic, the definition of insanity is to keep doing the same thing over and over, but expecting a different outcome. Very few would disagree with this statement. That being the case, when it comes to health care, why do people keep doing the same thing over and over, expecting a different outcome. I am referring to those that utilize one treatment method, be it acupuncture, chiropractic or physical therapy, and continue to do so, even though they are not obtaining the results they desire. I am not singling out any type of treatment, because my comments apply across the board. For example, if you are using chiropractic care and have been doing so for months and your improvement is minimal, or you feel better for a short time, then need to return for an adjustment, maybe you should consider a different treatment approach. Chiropractic is fine and helps many people, same with physical therapy, massage and acupuncture, but if your goal is to get your pain under control, or resolve it completely, and the treatment you are using is not meeting your expectations, it’s time for change. Maybe this means changing approaches, or combining approaches. One thing’s for certain, if you are not getting better, do something different. I routinely treat patients effectively where chiropractic has been less than successful and I refer patients for chiropractic care when I am unable to achieve the results I expect. In fact we receive many referrals from the VA for treatment of chronic pain, and most respond very well. Typically by the time they are seen in my clinic they have received one or more of the following- chiropractic, physical therapy, surgery and almost all are on pain medications.

If you keep the following basic rule in mind, you will likely experience far better results. If what you are doing has been given a fair trial and you are not getting better, or your improvement is unsatisfactory, change your approach. My experience is most people in pain, be it chronic or from a new injury, can be effectively treated and live a far more comfortable life. Don’t you owe it to yourself and your family.

What does acupuncture & oriental medicine (AOM) treat

AOM has been around in one form or another for thousands of years and over that time it has developed into a complete system of medicine.  Our profession has done a poor job of educating the public as to its benefits and as a result, many are still unaware of its potential and the extensive research supporting its efficacy.  Compare this with chiropractors who have been very good at educating the public and you can see we in the AOM profession have a long way to go in our public relations efforts.

The truth is AOM has shown itself through outcome based studies to be a superior form of treatment for a variety of health concerns, especially pain and injury treatment.  I regularly see patients who have gone through conventional medical care, physical therapy, surgery and chiropractic with little or no benefit and within one or two treatments they are significantly improved and with a short course of treatment experience a near complete or complete resolution of their back pain, headaches, sciatica, etc.  I continue to be amazed at just how well AOM addresses pain related problems.  I am not suggesting everyone gets better, certainly that is not true, but AOM is a viable, safe and comfortable treatment that is capable of producing results when other treatments have failed.

To answer the question we started with, AOM can treat a wide variety of problems including pain, nausea, headaches, digestive problems, high blood pressure, hormonal imbalance, chronic fatigue, shoulder pain, arthritis of the knee and hip and much more.  The WHO (Word Health Organization) has published a list of health problems AOM has been proven to treat effectively.  They also include a list where AOM is suspected of providing effective treatment but where they feel additional research is needed and a list where AOM is considered questionable as to its efficacy.

The one point to take from all this is AOM is a viable treatment for many heath related problems where other treatments have failed.

March 13 2013 Rapid Pain Relief

I wanted to take a couple minutes and let you know about a wonderful new treatment for pain called PNT (pain neutralization technique).  I have been treating pain for over 21 years and have become skeptical about new treatments, but this one lives up to the hype, at least based on my clinical experience.  Take a look at our pain treatment page for additional information.  If you are suffering from pain, chronic or acute, you will likely find PNT nothing short of fantastic.  PNT is gentle, painless and quick. Additionally there are no needles or adjustments needed. Like any treatment, PNT will not work for everyone, but with so much to gain and nothing to lose, PNT might be just what you are looking for.

I have been asked if PNT can be combined with other treatments such as acupuncture, and the answer is yes.  For additional information, check out our Pain Treatment section for the web site.