Acupuncture strikes happy nerve with heart patients
Acupuncture strikes happy nerve with heart patients
Preliminary study shows positive results
Most surgical patients feel like human pincushions, so the notion of receiving acupuncture along with open-heart surgery may sound like torture to some.
Instead of groans of pain, open-heart surgical patients at Cedars-Sinai Medical Center in Los Angeles are sighing with relief when the acupuncture needles are inserted. And they say they’d do it again in a heartbeat, even if they had to pay out of their own pockets.
In an as yet unpublished preliminary study, Cedars-Sinai cardiothoracic surgeon Gregory Fontana, MD, subjected 20 post-surgical patients to acupuncture and says he was quite frankly "amazed at the results."
Fontana, who also is director of acupuncture and integrative therapies at Cedars-Sinai’s Integrative Medicine Medical Group, said the study was complicated by the hospital’s concern about risks to patients undergoing state-of-the art heart surgeries.
Patients in Fontana’s study received acupuncture treatments preoperatively, in the operating room, in the intensive care unit, and when they returned to their rooms. Nineteen of the 20 patients, a 95% approval rate, said the acupuncture treatments relieved a laundry list of postoperative issues. Patients said the treatments reduced pain and anxiety, relieved gastrointestinal distress, and helped them gain mobility.
What impressed Fontana even more was the extent of the acupuncture patients’ enthusiasm: 17 of the 20, or 85%, said they would pay for acupuncture out of their own pockets, even at a cost of $200 to $400.
"These results were beyond my wildest expectations," says Fontana, who now plans a broader study.
Conducting broader studies in acupuncture is very difficult, said Danish cardiologist Soren Ballegaard, MD, in an article for the journal Medical Acupuncture, because of the near impossibility of randomizing and blinding studies. Even sham acupuncture appears to have some beneficial effect, so it can’t be considered a placebo, and there is no true placebo alternative since a patient would know if he was receiving needling.1
Nevertheless, he studied 69 patients with angina and followed them for two years after treatment. Surgery was postponed in 61% of patients because of clinical improvement, and the annual number of in-hospital days was reduced by 90%, leading to a $12,000 savings per patient.
Ballegaard wrote that needles appear to have a biological effect of their own that may not be related specifically to Chinese acupuncture points. Random points within the same spinal segment may achieve similar results, he wrote.
"The antianginal effects of the needles may be due to positive hemodynamic alterations, rather than an increase in pain thresholds," he wrote.
The study suggests two major conclusions can be reached, according to Ballegaard:
• needling has an enhancing effect on the existing homeostatic mechanism concerning the myocardial oxygen consumption/demand ratio;
• needling affects the local tone of the sympathetic nervous system.
This means that patients with angina are able to increase the working capacity of their hearts, thereby having fewer angina attacks and a better quality of life.
In a later study of 211 patients with angina published in the Journal of Alternative and Complementary Medicine, Ballegaard got even more powerful results.2
Compared to only 8% of the subjects who had a life without limitations before they received acupuncture, 53% had a life without limitations just one year after the addition of acupuncture to standard pharmaceutical treatment, as did 69% after five years.
Over a five-year period, the estimated cost savings were $32,000 per patient, mainly because of a 90% reduction in hospitalizations and a 70% reduction in needed surgery. No increased risk for myocardial infarction or cardiac death was observed.
Patrick YP Mok, MD, a staff anesthesiologist at Medina (OH) General Hospital, employs acupuncture-assisted anesthesia in all types of surgery, even cardiac surgeries. "The primary goal of using acupuncture preoperatively is to complement and enhance the medical preparation rather than to replace it," he says.
However, he warns that acupuncture preparation of a patient for surgery does not replace a sound medical evaluation and diagnostic testing whenever it is indicated. In addition to standard presurgical evaluations, Mok assesses energetic and meridian conditions.
For preoperative treatment of cardiac patients, Mok says he chooses one or more of four acupuncture modalities: Korean hand acupuncture, auricular acupuncture, a short form of traditional Chinese medicine, or French energetic acupuncture.3
"Acupuncture is to be used particularly for cardiac and pulmonary patients who are receiving maximally tolerated medical treatments and still remain dyspneic and/or have chest pain," he notes.
He recommends application of acupuncture 20 to 30 minutes prior to surgery to produce the desired level of effectiveness and suggests a treatment 24 hours before surgery and another 20 minutes before surgery, which may even enhance the effect. Mok does not recommend preoperative acupuncture for cardiac patients with co-existing diabetes, since the patients’ blood sugar usually can be controlled within hours by using a computerized insulin pump, making acupuncture "redundant and unnecessary."
"In other medical conditions, including seizure disorder, coagulation disorder, or blood loss, acupuncture should not be used to replace medical treatment since there appears to be little value in its use in that manner," he says.
During surgery, Mok adds, acupuncture does not induce a true anesthesia, but it does have a "profound" analgesic and sedative effect, so he suggests the use of acupuncture combined with standard anesthetics. He says acupuncture enhances the results of regional and local anesthesia, allowing for a reduction in the need for pharmaceutical anesthesia.
Postoperatively, acupuncture can decrease the patient’s need for analgesics and enhance mobility, as well as fluid and food intake — all adding up to an early hospital discharge, says Mok.
Pain relief, easing of nausea and vomiting, post-extubation spasm of the larynx, urinary retention, paralytic ileus, and hiccups all have been treated successfully with acupuncture, says Mok.
References
1. Ballegaard S. Acupuncture and the cardiovascular system: A scientific challenge. Med Acupunct Summer 1998; 10(1). Available at: www.medicalacupuncture.org. Accessed Oct. 18, 2000.
2. Ballegaard S, Johannessen A, Karpatschof B, et al. Addition of acupuncture and self-care education in the treatment of patients with severe angina pectoris may be cost beneficial: An open, prospective study. J Altern Complement Med 1999; 5(5):405-413.
3. Mok YP. Acupuncture-assisted anesthesia. Med Acupunct Spring/Summer 2000; 12(1):28-31.
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