The Management of Post-operative Pain with Acupuncture

362 Pages·2010·12.77 MB·English

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First published 2007
ISBN-13: 978 0 443 10361 2
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Foreword
The ability of acupuncture to control pain is generally The problem with herbal medicine is that tonifying
recognised and, indeed, many acupuncture clinical the Spleen in such a case may aggravate the Dampness
trials concentrate exclusively on this application and make the patient worse. That is why when tonify-
of acupuncture. Acupuncture’s effectiveness in ing in such cases with herbal medicine, one must always
controlling pain has been documented ever since the pay attention to balancing cloying tonic herbs with herbs
times of the “Yellow Emperor’s Classic of Internal that resolve Dampness.
Medicine”. By contrast, no such problem arises with acupunc-
Although pain may be classified as Empty or Full, ture because, by the very insertion of a needle in a
in nearly every kind of pain there is some stagnation channel, we move Qi and Blood. To go back to the
of Qi and/or Blood obstructing the channels and above example, if we tonify ST-36 and SP-6 there is no
causing pain. Chinese medicine encapsulates this danger of these having a “cloying” effect in the way
concept in the saying “bu tong ze tong; tong ze bu tong” that herbal tonics would do.
which means “obstruction causes pain; if there is no It is this ability of acupuncture to move Qi and
obstruction, there is no pain”. Blood that renders it a therapy of choice in dealing
One of the great advantages of acupuncture is that with pain. Moreover, acupuncture is unique in that it
it is very effective in moving Qi and Blood. Indeed, not only moves Qi and Blood easily, it can also do this
whatever the needling technique, one cannot insert a quickly, sometimes even in a matter of seconds.
needle in a channel without moving Qi and Blood. If Dr Sun Peilin published his excellent book The
we were to ask “Which points move Qi and Blood?”, my Treatment of Pain with Chinese Herbs and Acupuncture in
answer would be “Every point!”. 2002. He has now followed that text with this on the
This is, in fact, an advantage of acupuncture over treatment of postoperative pain with acupuncture.
herbal medicine when dealing with complex Full- The book is a treasure-house of clinical gems with
Empty conditions (which are in the overwhelming many new slants on the treatment of pain with acu-
majority in outpatients with chronic diseases). When puncture. For example, there is a long chapter on the
we are faced with a patient suffering from a condi- importance of using the calming the Mind method in
tion characterised by simultaneous Fullness and order to stop pain.
Emptiness, we are always faced with the dilemma of Another very important feature of the book is a
whether we should concentrate on tonifying the Defi- detailed analysis of the channels for each area of pain
ciency or on eliminating pathogenic factors. so that the treatment is clearly honed on the right area
For example, a patient with chronic fatigue syn- and the right channel. A new feature of the book is a
drome presents with clear symptoms of Dampness reference to secondary channels (divergent, muscle
in the muscles and the Stomach-Spleen at the same and Luo) in the treatment of pain.
time as presenting with a severe deficiency of the The book discusses the functions of channels besides
Spleen. Should we concentrate on resolving Damp- that of points (as most modern Chinese books do). I
ness or on tonifying the Spleen? Or should we do have always considered it strange that, in the acupunc-
both simultaneously? ture literature in English, not much attention is given
viii foreword
to the secondary channels i.e. the muscle channels As an example of the application of the theory of
(Jing Jin), the divergent channels (Jing Bie) and the channels to clinical practice, in the chapter on breast
Connecting channels (Luo Mai). Dr Sun’s book is a pain, Dr Sun describes in detail all the channels
welcome addition to our library of Chinese medicine. influencing the breast, e.g. Stomach, Liver, Yin Qiao
Indeed, modern Chinese sources are also rather scanty Mai, Yin Wei Mai, Large Intestine divergent channel,
when it comes to the secondary channels. At best, the the Gall Bladder muscle channel, the Stomach muscle
pathways are described in detail but few indications channel, and the Heart muscle channel.
are given with regard to their clinical use. The book not only discusses the use of acupuncture
A knowledge of the secondary channels (Connect- to stop postoperative pain, but it also highlights the
ing, muscle and divergent channels) greatly enriches other important effects of acupuncture, such as stop-
our clinical practice. The Connecting channels are ping infection and promoting healing; both essential
involved in many common pathologies such as Qi after surgery.
stagnation and Blood stasis and play an important role
in the pathology of postoperative pain. Giovanni Maciocia
Preface
This book is intended to be the companion volume that can be applied besides point puncture, such as
toThe Treatment of Pain with Chinese Herbs and some specific needling techniques, moxibustion,
Acupuncture. auricular therapy, wrist and ankle needles,
Postoperative pain, minor or severe, is one of the embedding needle, Plum-Blossom needle, point
main complaints or complications associated with injection, electric stimulation, etc. It is logical and
an operation, occurring anything from a few hours practical that the more approaches that can be simul-
to a few years after the operation, even to the end of taneously applied with point puncture, the better the
life. Although postoperative pain is one of the topics therapeutic results that can be expected. Thus this
discussed in the category of pain syndromes, it still book emphasises knowledge on needle manipulations
calls for specific techniques and approaches that are and some important techniques, including some
different from routine treatments for postoperative supplementary and additional techniques.
pain. Acupuncture is one of the most powerful tech- Although operation can correct some tissues and
niques and approaches in dealing with postoperative can even save life, operation itself is a type of trau-
pain that occurs either immediately after the opera- matic injury that inevitably causes some damage to
tion or subsequently, or which exists long after the certain channels, collaterals, sinews, tendons and
operation. This is the principal reason why this book muscles, as well as some normal tissues. In order to
is devoted to the management of postoperative pain restore these extremely important components of
with acupuncture. the body and relieve postoperative pain, knowledge
In terms of acupuncture treatment for postopera- about regular meridians and extraordinary meridians,
tive pain, it is wrong to simply form an acupuncture as well as tendon–muscle meridians etc., is essential.
point prescription, to insert needles in some painful Taoism deals with the universal law of life, and
areas and then expect an excellent therapeutic result. TCM is actually the development of Taoism. There-
To ensure the achievement of such a therapeutic effect, fore, acupuncture treats postoperative pain based on
the most important issue for the practitioner is needle the theory that there should be balance between Yin
manipulation. Inadequate needle manipulation not and Yang, and smooth circulation of Qi and Blood.
only greatly influences the efficiency of the treatment, Postoperative pain occurs when this dynamic balance
affecting the confidence of the patient and continua- is disturbed, either partially or completely, after the
tion of the therapy, but also potentially damages the operation. All methods should be used to re-establish
reputation of acupuncture in managing postopera- balance in the body.
tive pain. Although some practitioners have learned Besides maintaining physical balance, acupuncture
the theory of acupuncture and Traditional Chinese treatment for postoperative pain also aims to regulate
Medicine (TCM) diagnosis, needle techniques are still the emotions, keeping them in balance. Acupuncture
their major difficulty, and thus it is not rare to hear treatment for postoperative pain while ignoring the
their doubts and complaints about acupuncture in the patient’s emotional state is an incomplete therapy.
treatment of postoperative pain. Moreover, even in the I personally want to sincerely express my thanks to
field of acupuncture itself, there are many approaches Taoism, because it is from Taoism that I was able to
x preface
find my balance both physically and emotionally in Since postoperative pain can be complicated
the last couple of years while compiling this book. in practice, in the last chapter of this book I
There is a saying in TCM: ‘the superior doctor introduce treatment with acupuncture for general
prevents illness, the mediocre doctor treats imminent postoperative complications. I am sure that in
illness, and the inferior doctor treats actual illness’. treating such complications, acupuncture can
This clearly indicates that prevention of occurrence be a useful supplementary therapy in assisting
or aggravation of postoperative pain with acupunc- routine classic treatment. Never hesitate and
ture is more important than pain treatment itself. renounce acupuncture treatment before giving it
Early application of acupuncture after the operation a try.
could be helpful in the prevention of postoperative
pain and accelerate the healing process. Belgium, Spring 2006 Sun Peilin
Acknowledgements
I acknowledge with sincere thanks the many people impossible for me to carry out this project alone.
who, in one way or another, helped and supported TCM is a carrier of Chinese culture, through which so
me to write this book. many people around the world have reason to study
I am deeply indebted to my Professor Shi Zhongan, Chinese culture, and through which I am able to meet
who educated and encouraged me in the field of so many colleagues, students and friends.
TCM and Chinese philosophy. It was a great shock I would like to thank the staff of Elsevier, particular
for me to hear that he passed away at the age of thanks to Karen Morley, Kerry McGechie, Jane
90 during the period I was compiling this book. Dingwall, Isobel Black, Andy Chapman, Ian
Professor Shi wrote two forewords and calligraphies Ramsden, Gillian Murray and Lisa Sanders for their
for the book titles for my two previous books. I really experience, efficiency and courtesy and for their
miss the time I continuously learned from him when constant help, suggestions and support.
I was a student and lecturer at Nanjing University I would also like to thank Dr Yao Fengli for his nice
of TCM. calligraphy for the title of this book.
I owe a debt of gratitude to Chinese culture, espe-
cially Taoism, Buddhism and Confucianism. Without Gent, Belgium Sun Peilin
inspiration from Chinese culture, it would have been 2006
1
Introduction
Postoperative pain
Everyone will, at some time or another, suffer from pain or disability. Pain is an unpleasant
experience associated with actual or potential tissue damage. Postoperative pain, from minor to
severe, is one of the main complaints or complications associated with an operation, occurring
anything from a few hours to a few years after the operation, even to the end of life. Acupunc-
ture treatment could be applied not only for the immediate occurrence of postoperative pain,
but also for pain occurring later.
It is true that surgical intervention is one of the most effective weapons in the arsenal against
many diseases. For example, surgical procedures to correct degenerated, bulging or ruptured
disks of the neck and lower back are often the last hope for patients suffering from spinal prob-
lems. Prior to the operation, these patients usually suffer from severe pain, numbness, stiffness
and various levels of disability, or even paralysis of the limbs, etc. When the pain and its asso-
ciated complaints become intolerable, most patients start to search from specialist to special-
ist, swallowing different medications – from anti-inflammatory muscle relaxants, narcotics and
anticonvulsants, to sedatives and antidepressants – possibly without resolving their problem.
Due to increased faith in medical assistance, such patients then come to their last hope: the
neurosurgeon.
If the operation itself is well done, surgical intervention could save lives and alleviate various
types of pain; however, it is possible to see in many cases that although the damaged tissues
have healed and no mistake in the operation is discovered, the pain continues.
There are also ‘failed surgeries’ in some cases, i.e.:
● In the long term, results are too often disappointing.
● In some situations patients experience either no relief of the problems at all, or a difference
in their pain level so small that it may not have been worth the surgery.
● In some cases, a new pain emerges that can be more disconcerting than the original
complaint.
● Initial relief may be followed by a recurrence of the pain within weeks, months or a few
years.
When surgery fails, the most unpleasant feeling is that the pain remains the same; some-
times there is even aggravation of the pain. On the other hand, postoperative pain can serve
as a warning signal, indicating that something is wrong with the operation. Postoperative
pain can therefore serve as one of nature’s ways of protecting patients from potential tissue
damage.
3
4 general introduction
Types of postoperative pain a stimulus that does not normally provoke pain. Vis-
ceral neuropathic pain as caused by peritoneal malig-
nancies (in the abdomen/pelvic region) may present
Clinically speaking, in Traditional Chinese Medicine
as a dull ache.
(TCM) postoperative pain can be subdivided into two
Neuropathic pain, unlike nociceptive pain, responds
groups: physical pain and mental pain. They can exist
poorly to opioids and may linger long after surgical
independently or in combination, but will undoubt-
wounds and trauma have healed. Traditional treatment
edly influence each other.
of neuropathic pain usually includes tricyclic anti-
depressants, anticonvulsants and antiarrhythmics.
PHYSICAL PAIN
Besides pain, there are other clinical symptoms that PSYCHOLOGICAL PAIN
may be experienced postoperatively – for example,
muscle tension, spasm, stiffness or weakness, nausea, This component of pain is caused by cognitive and
poor appetite, bad sleep and headache. There could be affective factors and includes depression, anxiety and/
also some immobilisation of an injured part in order or drug seeking.
to avoid pain from movement.
MENTAL PAIN Preoperative preparation
It has been observed that whatever the reason for the
Surgical candidates are often unprepared for what lies
pain after the operation, there could be a disturbance
ahead or expect complete relief of the pain or disability.
of Shen, causing feelings of instability in emotions,
When the pain remains either partially or completely
such as restlessness, insomnia, headache, poor mem-
after the operation, these patients frequently feel
ory, nervousness, stress, frustration, anger, hyperven-
unhappy, angry, fearful, stressed or frustrated, which
tilation, fear, etc. These emotions make the pain more
in turn will cause aggravation of pain.
intense and difficult to treat, and diminish the quality
In order to have the best preparation for surgery, it
of a person’s life in terms of psychology, sociology and
is imperative that patients have good dialogue and an
physiology.
understanding with the medical professionals.
In the view of modern medicine, generally speaking,
Nowadays, acupuncture is well known and gener-
there are three types of postoperative pain: nocicep-
ally accepted by more and more people. Both ancient
tive, neuropathic and psychological.
wisdom and modern scientific research reveal that
acupuncture is not just a matter of belief, but a safe
NOCICEPTIVE PAIN and effective alternative therapy for a variety of pain-
ful conditions, such as headaches, arthritis, back and
This is caused by tissue damage and inflammation in neck pain and soreness, premenstrual tension or pain-
response to trauma. The resulting pain is usually not ful cramps, as well as postoperative pain. Acupuncture
well localised. It is opioid responsive. is also effective in reducing stress, regulating the emo-
tions and improving the constructive lifestyle. Thus
it is more important for practitioners to convince the
NEUROPATHIC PAIN patient that they do not have to ‘live with it’. Trying
to ignore postoperative pain can lead to complications
This is caused by direct peripheral nerve or central and delay recovery.
nervous system (CNS) injury and may be a complica-
tion in up to 10% of surgical cases. Neuropathic pain
is usually localised and presents as a background of
numbness with burning and the electrical shocks of Postoperative pain
shooting pain. It may be caused by tumour or infection
management
invading the nerve, nerve injury from surgery, or from
toxins (chemotherapy). A special form of neuropathy,
called allodynia, occurs in about 30% of cases. Allody- Traditional Chinese Medicine views the body as a
nia is defined as an abnormal sensation to a normal balance between Yin and Yang, and Qi and Blood. Qi
stimulus (e.g. clothes touching the skin) or pain due to and Blood travel through the body along well-defined
introduction 5
pathways – channels and collaterals. When there is a ● To control the local tissue swelling
deficiency of Qi and Blood, or when they are stuck in ● To shorten the resolution of haematoma
one area, there is an imbalance between Yin and Yang, ● To assist the emotions
and Qi and Blood, as well as in the Zang-Fu organs; ● To regulate the appetite
thus the optimum functions of the Zang-Fu organs are ● To strengthen the energy
affected, channels and collaterals fail to maintain free ● To increase participation in usual functions
communication, body structures are disturbed, and ill- ● To enhance the quality of life
ness and pain develop. Points from different channels ● To minimise the side effects of the anaesthesia
are energetically connected to specific Zang-Fu organs ● To diminish the dosage of painkillers after the
and body structures. Postoperative pain management operation or reduce reliance on painkillers
with acupuncture is to use some selected points to ton- ● To minimise the use of other medications associated
ify the Qi and Blood, activate Qi and Blood circulation, with the pain and their attendant side effects
and balance Yin and Yang Zang-Fu organs, as well as ● To stimulate the rapid recovery of functional
the body structure. activities after the operation, etc.
During postoperative pain management, acupunc-
In short, acupuncture treatment for postoperative
ture treatment is carried out in combination with moxi-
pain control accelerates patients’ recovery and brings
bustion, point massage, cupping, electric stimulation,
all possible benefits without any harmful effects.
ear acupuncture, Chinese herbal medicine, etc., such
However, acupuncture treatment for postoperative
treatments often being applied simultaneously. These
pain control is only one of the ways to assist patients
additional techniques and methods are important treat-
to get rid of the pain: application of acupuncture does
ments that aim in the same direction, i.e. the relief of
not ignore necessary support from medical help. Dur-
postoperative pain.
ing acupuncture treatment for postoperative pain,
In terms of postoperative pain control, the aims of
contact and communication with other specialties (e.g.
acupuncture treatment include the following:
neurologists, neurosurgeons, orthopaedic surgeons,
● To completely relieve pain, or provide as much internists, radiologists, physical and occupational ther-
relief as possible apists) should be made in order to support patients at
● To reduce pain levels maximal points of need.
● To improve the ability to deal with pain