SCI Forum Reports
Complementary and Alternative Medicine
January 8, 2002
Complementary and alternative medicine embraces a large variety of therapeutic practices, from biofeedback and yoga to herbal medicine and massage. In this evening's program, three speakers discussed four therapies: acupuncture, naturopathy, chiropractic, and massage therapy-and their applications to SCI.
Acupuncture
"Acupuncture is close to 5,000 years old," said Terry Courtney, a licensed acupuncture practitioner and chair of the Department of Acupuncture and Oriental Medicine at Bastyr University in Kenmore, WA. "It is part of a system of traditional oriental medicine that includes herbology; exercise and breathing techniques like Tai Chi and Qi Gung; oriental body work and massage techniques such as Tuina and Shiatsu; acupressure; nutritional advice; and meditation and relaxation." Acupuncture has grown in availability in the U.S. in recent years and is now licensed in 41 states (including Washington) and Puerto Rico.
Acupuncture is beneficial for both chronic and acute conditions and has been used successfully for immune enhancement and illness prevention, infectious diseases, rehabilitation, chemical dependency and pain, Courtney said. "One of the nice things about acupuncture is that it can be the primary source of health care for someone or a partner along with other medicines or techniques. It's very versatile that way."
Courtney said that research has demonstrated the effectiveness of acupuncture, and cited a recent study in which patients who received acupuncture reported they felt better (76%); missed fewer days of work (71%); got along better with others (69%); had less pain (64%); had more energy (58%); were more focused mentally (58%); and worked better (64%) (from: Health Visions 2000, Researching What Patients Say About Treatment. Meridians 3:2; Traditional Acupuncture Institute; 1-800-735-2968.
"When people ask me if there a side effect of getting acupuncture, I say-Yes, number one is relaxation, and number two is you generally feel better. Acupuncture cannot make somebody worse. It can either help you or you remain the same, but it cannot set you back."
When discussing acupuncture with new patients, "usually I have to spend a few minutes demystifying it," Courtney said. "It is commonly performed with a one-time-only disposable needle that is literally the diameter of a couple of shafts of hair-it's not anything remotely close to a hypodermic (in thickness). It is generally painless, or there's a very slight pricking sensation upon insertion. Most people find the experience very comfortable."
Acupuncture is based on the understanding that healthy functioning requires a smooth flow of energy in the body, from top to bottom, left to right, and front to back. A good flow of energy improves circulation, helps bladder function, and helps reduce skin breakdown-conditions that are of special concern to people with SCI.
"If there is a block in a channel or pathway and the energy is not moving well through that area, that can often be the source of discomfort, pain or circulatory problems," Courtney explained. Unblocking that pathway would be the focus of acupuncture treatments.
"For example, if someone is having a problem in the shoulder, we would treat not only the shoulder area itself but, because the shoulder is part of a larger pathway of energy in the body, we would also treat points farther down the pathway, on the lower arm and hand, and even on the leg," she said.
Like other health care practitioners, acupuncturists form diagnoses on the basis of several factors, including the patient's appearance and description of symptoms, physical examination, and medical history. "But when we diagnose a problem in Chinese medicine, we are using very different kinds of terminology," Courtney said. For example, in Western medicine, anemia, vertigo, insomnia, eczema, hypertension, and depression are all separate diagnostic categories. "In Chinese medicine, all of those problems relate to one diagnosis-blood deficiency-which means the blood is not nourishing the body (adequately)."
Alternatively, "where in Western medicine you might have one condition, in Chinese medicine you could have five or six different diagnoses and approaches to treatment," she explained. Thus, in a room of 25 people with the Western diagnosis of asthma, there could be 25 different Chinese diagnoses-wet asthma, dry asthma, cold asthma, hot asthma, and so on-each requiring different treatment.
How does acupuncture actually work? That's what Courtney called "the 50 million dollar Nobel prize-winning question. That's still under a lot of study. What we do know is there's a long clinical history that shows efficacy. But some of it defies Western understanding of the body."
Acupuncture's energy pathways or meridians do not seem to follow any nerve pathways recognized by Western medicine. Nonetheless, Western science recognizes that acupuncture stimulates the production of a number of chemicals and hormones in the body, including those that modulate pain. Acupuncture also stimulates bone regrowth, regulates blood pressure, increases red and white blood cells, and stimulates the clotting factor. "So it has a very pronounced effect on the body biochemically," but the mechanisms are not well understood, she said.
Courtney explained that the goals of acupuncture treatments for patients with paralysis are often to maximize function and prevent complications. "I have worked with people who were starting to identify a bladder infection, and by doing acupuncture points that reduce inflammation and infection, promote urination, and help digestion so there is more acidity in the urine and less sugar in the body to feed the infection, often we've been able to interrupt infections before they start to take off."
Likewise, she has used acupuncture to prevent pressure sores and reduce spasticity.. "One thing I've learned in 20 years as a practitioner is that acupuncture is a wonderful preventative medicine," she said.
Acupuncture can be very helpful in treating pain, including the neurogenic pain experienced by many people with SCI. "It's a very individual response," Courtney said. "I know patients who have had success, and others for whom acupuncture hasn't touched the pain. Some are helped by a combination (of acupuncture and medication)."
The number of treatments depends on the problem, and Courtney usually tells patients it's worth trying four to six treatments. "I've seen people get very good results from two treatments while others need nine or ten," she said.
Chiropractic
The next speaker of the evening was Robert Martinez, a licensed practitioner of both chiropractic and naturopathy. In his chiropractic practice, his SCI patients usually have paraplegia rather than quadriplegia, and are often wheelchair athletes. "There are lots of opportunities for intervention with paraplegia," he said. "With quadriplegia, the risks or difficulties sometimes outweigh the benefits."
Chiropractors use manipulation of the joints to stimulate lymph drainage, increase range of motion, improve symptoms that come from irritation of the nerves, and restore and enhance overall health.
Chiropractic technique varies, from energy-based adjustments involving almost no touching of the body, to high-velocity, low-amplitude thrusts that produce the famous pop or crunch, he said. "Depending on what the problem is, any of these treatments can be effective."
Postural strain and joint dysfunction are common to everyone with joints, as are headaches from neck pain and tension, he said. All are helped with spinal adjustments as well as home care approaches like those found in the book 7 Steps to a Pain-Free Life by Robin McKenzie (Dutton, New York, 2000). Carpal tunnel syndrome-often a complication of long-term wheelchair use-can be helped with chiropractic treatments. Martinez also recommended the book and tape Gentle Fitness by Catherine MacRae (available from the Web site http://www.gentlefitness.com), a home-based program for improving strength, balance, and sleep, and relieving pain, fatigue, cramps and stiffness. The author has multiple sclerosis and adapted the program for wheelchair users.
Martinez urged people to avoid chiropractors who claim to have specialized training in SCI or neurologic disorders (because there is no such training) or who have "too many letters after their name" (D. C., doctor of chiropractic, is sufficient). He does not recommend chiropractic treatment for acute injury or for any area of the body below the level of injury because, unlike acupuncture, "chiropractic can cause damage." He suggested that patients stop treatment if function isn't improving, or they are feeling worse or find themselves getting more dependent on treatment rather than more empowered to take care of themselves.
Martinez focuses on self-care in his Kirkland, WA, practice, and tells patients, "I can maintain your spine, or you can. Here are the exercises and stretches. How much do you want to do yourself and how much do you want to pay me to do?"
Naturopathy
Martinez also practices naturopathic medicine, which is a holistic method of health care that focuses on healing, not necessarily on cure, and on teaching the patient about wellness and self-care. "Frequently (health care practitioners) try to cure somebody when we should really be trying to heal," he said. "A lot of people are not cured of their cancer, but they are healed, and in that process they still die. All of us with chronic illness suffer problems that need to be healed. That's where natural medicine is very helpful. We treat the patient as a whole and focus on empowering them into healing." He recommends the book Total Wellness by Joseph Pizzorno (Prima Publishing, Rocklin, CA, 1996) for understanding this approach.
According to Martinez, immune suppression caused by stress is a common component of many chronic conditions. Resources for helping reduce stress are the books Learned Optimism by Martin Seligman (Knopf, New York, 1991) and Changes that Heal by Henry Cloud (Zondervan, Grand Rapids, MI, 1992), and the training video Beyond Tolerable Recovery by Ed Smith (available at www.theophostic.com ). Martinez believes that too much sugar in the diet is the culprit in many immune suppression illnesses and recommends The Wrinkle Cure by Nicholas Perriconne (Rodale, Emmaus, PA, 2000) for a good synopsis of simple things people can do with diet and supplements that bolster the immune system.
Better circulation and increased body warmth, which are often concerns for people with SCI, sometimes can be achieved through relaxation and meditation. The experts at this are the Tibetan monks who use meditation to keep themselves warm while sleeping naked in the snow. Martinez recommended the book Relaxation Response by Herbert Benson, MD, (Morrow, New York, 1975) for those who want to learn how to use this discipline to improve their own circulation and enhance body function. Warm pools, available at some community centers and health clubs, also improve circulation.
To prevent urinary tract infections (UTIs), which are so common in individuals with SCI, "the first thing I tell people is-you've got to pee five times a day," Martinez said. He advocates drinking 8-12 glasses of water a day to continuously flush fluid through the urethra to dislodge bacteria. Because research has shown that cranberry juice can prevent UTIs, Martinez suggests drinking 8-16 ounces of cranberry juice (unsweetened) a day, bearing in mind that it might weaken the effect of slightly alkaline drugs, such as many antidepressants and prescription painkillers, by causing them to be excreted more rapidly in the urine. Sugar should always be avoided with UTIs because it can stimulate bacterial growth in the urinary tract.
Uva Ursi or arbutin/hydroquinone can effectively treat acute bladder infections but should only be taken for two weeks or less and only under the guidance of a skilled practitioner because of its potential toxic effects to kidneys and liver and the possibility of serious drug interactions.
Natural medicine often involves the use of supplements, but Martinez believes they should never be a replacement for living a healthy lifestyle. "People ask me-what can you give me instead of this drug?" he said. "It's not about exchanging a drug for an herb, it's about figuring out why it needs to be taken and what's a reasonable choice. Sometimes a drug is cheaper and works better than a supplement, and sometimes a supplement can be taken in place of a drug if you change certain other dietary or lifestyle factors."
Martinez concluded with a final warning about chiropractors: "If (a chiropractor) isn't willing to make the effort to work with a doctor who's prescribing medications, that's your first warning that you don't want to be working with (him or her)." He recommended Bastyr University's Center for Natural Health in Seattle (206-834-4100) because the practitioners are comfortable working with a wide variety of patients and their doctors.
Massage Therapy
Like acupuncture, massage has ancient Chinese origins and can be traced back thousands of year, according to licensed massage therapist Jessica Grey. The benefits of massage include relaxation of muscles, contractions, and spasms; relief of general body tension; and improved circulation.
"Massage acts as a general cleanser," Grey said, "pushing lymphatic fluids and hastening the elimination of waste and toxic debris" that can accumulate as a result of the food we eat, the air we breathe, and the tensions of the day. After massage has broken down the toxins, Grey tells her clients to drink plenty of water for the rest of the day in order to flush the toxins out of the body.
Massage can help "overcome harmful fatigue byproducts resulting from strenuous exercise and injury." she said, "and improves muscle tone, nutrition of tissues, and metabolism."
When choosing a massage therapist, look for one who has a license, Grey said. "Ask them if they have had any experience with SCI, and if not, are they willing to learn. Tell them what you want to get out of massage." There are many different kinds of massage techniques-Swedish, Rolf, sports, etc.- as well as significant differences between practitioners, and sometimes it takes a while to find the therapist who feels right.
Grey often starts treatments with warm packs to warm up the muscles, followed by light massage, gradually building to deeper massage. She encourages clients to tell her if her touch is too light or too deep.
Costs for alternative health treatments can vary widely. All the speakers suggested calling different practitioners for prices and billing policies. Grey charges $60 for a one-hour massage. Naturopaths vary between $90 and $225 for initial visits, and return visits range from $35 to $70.
As with all health care, it's important for patients to ask their health insurance companies about their alternative medicine benefits before making an appointment.
Resources
National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health (NIH), has abundant information about therapies and providers on the NCCAM Web site ( www.nccam.nih.gov ) or by calling 1-888-644-6226, toll free.
Alternative Health News Online ( altmedicine.com ) maintains an updated listing of press releases and articles, an email newsletter, recommended reading, and other information.
Acupuncture Today ( www.acupuncturetoday.com ) has a newsletter, discussion forums, an acupuncture practitioner locator, and other information about acupuncture.