Mind-body

When it comes to health and well-being, we all know that what goes on in the mind can influence what goes on in the body. Who could doubt, for example, that psychological stress can have a negative impact on one’s physiological function? Positive mind-body interplay can occur, too, and the simple act of anticipating good health can at times promote healing. The question is, at what times?

The therapeutic encounter

Surprisingly, one of the best known catalysts for promoting healing is the interaction that takes place between a healthcare professional and a patient. I’ve written about this healing alliance before, and even humbly suggested that this natural baseline healing process receive more attention in the world of medical research. So imagine my surprise when — babba-bing, babba-boom — I come across a book published this year that provides all of the scientific evidence one could hope for regarding the importance of the therapeutic encounter: The Placebo Response and the Power of Unconscious Healing, by Dr. Richard Kradin. He is an MD, psychoanalyst, and medical researcher. If anyone is going to probe the role of mind-body interactions in maintaining health, who better than a practicing MD who conducts research and is also a psychoanalyst who has co-directed a course at Harvard on Mind/Body Science?

The placebo response

Medical researchers have known about the placebo response for a long time and have been concerned with designing experiments that take this phenomenon into account when attempting to test for the effectiveness of new treatments. This natural tendency toward healing is a distraction, in a way, for researchers, and it must be tested for as rigorously as the effects of the main treatment.

But what is a distraction for some is the core issue for others, and Dr. Kradin systematically goes about demonstrating how the mind can bring about objective, measurable healing responses. People don’t just imagine that they are getting better, they really are getting better.

And he describes how the interaction of healthcare providers and patients is a crucial component of this response. So there you have it: the very act of seeking help from another can enhance acquiring that help. The origins of this response undoubtedly lie in our deep history as social animals, but I’ll leave that part of the story for Dr. Kradin to relate.

Parade Magazine

If you missed it in last month’s March 9 issue of Parade Magazine, here’s what many were reading over their Sunday a.m. coffee cups: Thoughts Can Heal Your Body, by Robert Moss.

PNAS

Placebo responses are commonly associated with the modulation of pain, and in the on-line June 26, 2007 issue of the Proceedings of the National Academy of Sciences is this article: Placebo effects on human u-opioid activity during pain. A pharmacologically inert cream was applied to the arms of healthy volunteer patients. In some instances the doctors told the patients that this cream would have no effect on pain. In others, they were told that the cream was a highly effective pain reliever. Same cream in both cases. No possible physical effects. Then a painful heat stimulus was applied, and the researchers measured the analgesic effect on their subjects. They also measured opioid activity in the brain.

And the results? Partly expected, partly wow. Expected: the placebo group reported perceiving less pain. But here’s the amazing part: their brains were behaving differently. Several regions of their brains were responding by altering the pattern of their endogenous opioid activity. They were unconsciously creating a therapeutic effect. Wow.

Mind-body interactions. What will we learn next?

News, views & pets

Thinking about my profession and the public’s understanding of it, I became interested in how acupuncture is presented by the press. And what kinds of treatments catch the attention of health reporters. Treatments for fertility, particularly when used in conjunction with state-of-the-art Western procedures, seem to be the clear winners for shear numbers of reports. (Here’s another AP story on the subject to add to those I posted last month.)

Pets

Acupuncture for pets also catches the attention of news organizations. This recent article in the Oregonian tells the story of how an aging Labrador Retriever was successfully treated by Dr. Kelly Jenkins Nielsen. That’s right – Dr. Nielsen. After 20 years as an orthodox Western veterinarian, she decided to study acupuncture as an alternative treatment for the pets that came her way. Now it’s Dr. Nielsen, DVM LAc. (She is featured in an article in the Lake Oswego Review.)

Well, my sorta-half-Lab Otis is in good health and I have not yet entertained the idea of treating any non-human animal. But who knows? If he rolls in one more smelly thing, I may just start some sort of treatment program on him.

I had never heard of Buzzle.com before, but their news summaries include an article about how complementary modalities (acupuncture and chiropractics) have entered the world of veterinary medicine.

Humor

I don’t know why, but animal acupuncture seems to inspire a lot of humor. When browsing on-line organizations, for example, you find sites such as More Pets Get the Point, and the The “Paws-itive” Effects of Treatment. And some great cartoons are based on animals. My favorite has a woolly mammoth in it, and my vote for the animal most likely to show up in future cartoons is the species in this one.

The rest of the story

Although this article on the treatment of back pain is a notable exception, most acupuncture stories dealing with humans will not reach the threshold for being newsworthy. There’s nothing unexpected about that, I suppose. It’s probably the same for all healthcare providers — the big story is preventive medicine. The big unwritten story, that is.

Seeking fertility

I love working with patients who are seeking help with fertility. Whether they are trying on their own for the first time or taking extra steps prescribed by their doctors (often IUI or IVF), acupuncture has the potential to help achieve conception. And there are few things more rewarding than helping couples realize their dream of having a child.

Happily, these days, when couples first begin considering what options exist for them, there is a good chance they have already heard something about acupuncture.

News coverage

Over the past few years, the news media have brought attention to the effectiveness of acupuncture. CBS, FOX, and BBC have each run stories about the successes of acupuncture and the results of fertility research programs. These stories highlight how the modern techniques of reproductive medicine can be enhanced by the ancient tradition of Chinese medicine. Enhancement isn’t the whole story, however, and acupuncture can be of value to anyone seeking assistance. These latter people aren’t so newsworthy, I guess.

More sources

WebMD and the American Pregnancy Association also have interesting information about fertility and acupuncture, and as I was browsing around the web for what fellow licensed practitioners are saying, I found this article in Acupuncture Magazine by Jennifer Dubowsky. My hat’s off to Jennifer for this article and her other insightful contributions on the subject of fertility.

Personal testimonies

There’s nothing like hearing from someone who has gone down the same road, and like many professionals’ web sites, mine has testimonials from some of my fertility patients. But what can be more compelling than seeing and listening to real people? Like on YouTube: |1|2|.

Final thoughts

So there’s a lot of information out there readily available for interested couples. It shouldn’t come as a surprise to anyone, I suppose, that the general health and well-being of a patient – something that is at the heart of Chinese medicine — would have a direct impact on a patient’s fertility. Conception is a lot more than sperm meets egg. The physiological and emotional environments in which this takes place will have a dramatic impact on how events unfold. “Nourish the soil before planting the seed.” And then keep nourishing the soil through the ensuing pregnancy and birth. Then it’s . . . slow drum roll in the background . . . parenthood. But that’s a whole ‘nother story.

“Aculand”

It’s often the case that immediately after an acupuncture treatment a patient will experience a kind of dreamy, euphoric state. When I was in school students and teachers would refer to the after-effects of acupuncture as “aculand.” It’s not something any acupuncturist is attempting to achieve, it just seems to be one of the side effects of treatment.

My guess is it’s responsible for the items I often find left behind in my office or treatment room – checkbooks, sunglasses, watches. And it’s certainly on my mind when I schedule subsequent appointments. I always write them down on an appointment card and make sure they end up in a purse or pocket.

A research study of short term reactions to acupuncture

So imagine my surprise when I came across a research report on this very subject (“Short term reactions to acupuncture – a cross-sectional survey of patient reports” in Acupuncture in Medicine (2005, 23(3): 112-120 [abstract]). The authors don’t use the term “aculand.” Maybe it’s a term that’s not going to make it into the research vocabulary.

It’s a UK study with a sample size of 9408 patients! They were asked about their reactions during or immediately after treatment by practitioners of their choice (a total of 638 different acupuncturists).

The results

Well, I have to say, I was surprised at the frequency of responses. An amazing 95% of the patients reported experiencing at least one short-term reaction. The most common reaction? 79% reported feeling “relaxed.” Next, 33% felt “energized.” (This is more than 100% already because patients could report more than one response. The average number of responses was 1.8.) Next, 24% reported feeling “tired or drowsy.”

There were some responses on the “negative” side of the ledger, too. Which doesn’t surprise me. Temporary discomfort can be a part of healing. Some people get worse before they get better. It is totally normal for symptoms occasionally to flare up before they resolve. It’s my experience that if symptoms do get worse, they usually will last 24-48 hours and then improve.

And sometimes a small amount of pain is not really a negative thing. It can be the sensation of de qi, an integral component of acupuncture that is receiving its own research attention.

There was a very low response level for persistent “aggravation of symptoms” (1.8%). Interestingly, only 13 patients (an incredibly low 0.14%) responded that they were unwilling to have acupuncture again because of these “negative” reactions.

My new perspective

First of all, thanks to Hugh MacPherson and Kate Thomas for having conducted and published this study. It’s important to bring objective information to the table when talking about patient reactions to acupuncture. I was aware of the existence of short-term reactions, and my patients sometimes refer to them in their testimonials, but this study alerts me to its nearly universal – and variable — nature.

I’ll be watching my patients a little more closely. And maybe reducing the content of my lost and found drawer.