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EXTRA!
BY CINDY BORGMEYER
Like most practicing family physicians, Katherine Miller, M.D., sees a lot of patients with a lot of different health problems. And, like other FPs, she's devoted to solving those problems. For Miller, that's become quite a sticking point.
 Jana Nussen, M.D., of the Bryn Mawr (Pa.) Family Practice Residency, examines a model displaying acupuncture meridians and pressure points. |
Miller, assistant clinical professor of family medicine and community health at Tufts University in Boston, is one of some 20,000 certified acupuncturists in the United States. About one-third of them are medical doctors, she told students and residents during her Aug. 8 workshop at the National Conference of Family Practice Residents and Medical Students in Kansas City, Mo.
Acupuncture certification requirements vary from state to state, Miller explained, with four states providing no regulation of the practice. In most states, MDs and DOs can legally practice acupuncture with no formal training. "Only 12 different states -- although this may have changed recently -- require physicians to get specialized training," she said. In contrast, most states require other health professionals to be certified by the National Certification Commission for Acupuncture and Oriental Medicine.
A look at the numbers may help explain why.
Americans make more than 12 million visits to acupuncturists each year, said Miller, seeking treatment for a wide range of conditions. Many of those patients apparently find the relief they seek, a result borne out by a growing number of well-designed clinical trials.
Take postoperative pain and nausea, for example. A 2001 study in the journal Anesthesiology found that patients treated with acupuncture used half as much intravenous morphine for pain after surgery as the control group used. Patients in the treatment group also experienced less postoperative nausea compared with those in the control group. The study further demonstrated 30 percent to 50 percent reductions in levels of plasma cortisol -- a known indicator of stress -- in patients treated with acupuncture.
Those results reaffirm a 1997 NIH consensus statement that found acupuncture effective as a primary treatment for adult postoperative pain, nausea and vomiting caused by chemotherapy, and postoperative dental pain. The NIH statement also upheld the usefulness of acupuncture as an adjunctive treatment for several other conditions, including headache and fibromyalgia, and for rehabilitation after stroke.
 Course leader Katherine Miller, M.D., uses a pen and a volunteer to show the proper placement of a commonly used acupuncture point. |
Miller is the first to admit that it's difficult to ascertain exactly how acupuncture works, although some studies have suggested that the placement of the needles used in acupuncture causes endorphin release.
As for the why, she told participants at the session: "You have to take your brain out of your allopathic training. This has nothing to do with your allopathic training; there's no match-up with it. So forget about it for a minute."
She gave a brief overview of the philosophy behind traditional Chinese medicine, beginning with an explanation of Qi, pronounced "chee." "Qi is sort of a life force, a life energy. It's what lets you think, it's what makes you move," Miller said. When Qi is out of balance, when it fails to flow smoothly along the body's 12 main meridians, or pathways, that's when problems develop. Acupuncturists use needles to redirect the flow of Qi.
Go online to read upMiller recommends visiting these Web sites for reliable acupuncture information:
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In this context, treatment -- that is, proper needle placement -- varies
according to the nature of the problem. "For example, when you break
a bone, or you get a sprain, the thought is that all of the energy goes to
that place and gets stuck there, and that's why you have so much pain. So
the goal in that case is to pull the energy away from there," she said.
In other instances, such as with chronic low back pain, Qi may be depleted,
said Miller. In that case, the needles are placed to increase the flow of
Qi through the affected area.
Diagnosis is based largely on the symptom complex described by the patient, although some acupuncturists also use the traditional tongue exam and pulse diagnosis techniques. More advanced practitioners may even integrate patients' food, temperature and color preferences into the diagnostic process.
Reimbursement can be an issue, Miller admitted: "Sometimes you need to get a little creative." Once you've agreed on specific treatment goals with a patient, she recommends setting up an initial timeline for treatments -- once a week for one month, for example -- to gauge whether treatment is likely to succeed. Then treat until therapeutic goals have been met.
To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.
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Copyright © 2003 by
American Academy of Family Physicians.