Clinical Kit 18-08-2014 Acupuncture & DN - Linked by Anatomy

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This all started when someone sent me a link to a YouTube animation in an email.

You will need to click on pic and have a look to understand the following discussion and I would welcome your thoughts and comments on the related blog post. See details at the end on where to put your comments.

mmmm. To get involved or not…. Do you respond when poked or rise above…. Will it improve the situation or muddy the waters…….

There are good physios that are also trained acupuncturists, and my thought is that they would caution against a reaction. So rather this is a clarification of some points as they rolled off my keyboard.

My thoughts are they (the cartoon characters) are talking about subjects with the wrong emphasis (reflecting the point of view presented).

The paramount subject should always be client safety. This can be looked at from the perspective of reported case studies and published papers. There was a decade review recently published (Ernst E, Lee MS, and Choi T-Y. Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews. Pain 152: 755-764, 2011.) which is the most recent, but others from the UK and Germany have also been published.

Most retrospective and prospective research that I am aware of specifically looks targets acupuncturists. Not sure if any research has specifically looked at DN or compared the two, and divides reactions into mild and severe categories.

Mild adverse reactions ranging from 8-10%. This amount is roughly broken into 2-3% for each of aggravation of pain, bleeding/bruise, and drowsiness/lightheaded sensations. It would seem logical that with needle insertion, whatever the paradigm behind where the needle is inserted, the chance of mild adverse response would be the same. Factors like degree of stimulation and quality of needle would seem more likely to relate to adverse reactions rather than treatment paradigm.

Serious adverse reactions are reported as 0.0005 per 100 interventions and relate to bacterial infection and pneumothorax with some resulting in death. Again, greater numbers are recorded in relation to acupuncture, not DN. This probably relates to predominant method most occur in China, Korea and southeast Asia, possible degree of training and possibly standardization of equipment. Western countries now have sterilized, single use needles as standard procedure and legal requirement.

The only recorded case in Australia in this decade report, was of a visiting Korean lady with a history of 1 year abdominal complaints for which she received regular acupuncture in Korea. They used gold tipped needles that were inserted, broken off and left tips insitu. Migration of some needles resulted in an abdominal bacterial infection of gut bacterial that manifested itself after she arrived in Australia. Following treated consisting of drainage of infected material and provision with antibiotics she made a full recovery. It should be pointed out that while this was the only recorded report, other accidents have occurred that this author is aware of. However they were settled out of court and are therefore never reported, which I believe to be to the detriment of general public education.

It is also necessary to consider training. Yes DN needle courses are shorter. The reason for this are basically two fold.

Firstly practitioners (physio, chiros, osteos, podiatrist, occupational therapists, doctors) enrolling in these courses in Australia have already completed at least a 4 year undergraduate university degree that as a core component, included large blocks of anatomy and physiology training. In Australia this involves theoretical learning (models - bone and plastic., texts, video, apps) and with cadavers. Often electives like dissection are also undertaken. These professions are both primary contact practitioners and treating professions, so they have also been trained to identify red and yellow flag presentations and are familiar with concepts of precautions and contraindications to a range of other treatment modalities
The second factor is that the application of acupuncture is based upon a completely different paradigm. To learn this body of knowledge is like learning another language and for this reason requires a much longer course duration. The Australian Physiotherapy Association has a self imposed guideline of a 2 day course for DN and 150 hours for acupuncture training, reflecting the difference of education required for each paradigm, even though physiotherapists are starting from the same place initially

However, regardless of the training background or clinical reasoning steps to arrive at selecting the needle insertion location, the process is still basically the same - tap and insert.

The other important aspect of training is staying within your scope of practice. The analogy I use is if you have been taught thoracic manipulations, you would not consider yourself then okay to go on and start performing cervical manipulations. In the same way, if you have learnt needle techniques for supraspinatus, it is not okay to drift medially and treat rhomboids or levator scapulae, just because they are sore, as a completely different set of anatomical conditions exist that need to be learnt and taken into consideration, before you tap and insert. This is why I am so keen on continuing to provide Living Anatomy Wet Lab Workshops. Client safety starts and finishes with anatomical knowledge, regardless of your treatment paradigm.

All the best,

Doug Cary FACP
Specialist Musculoskeletal Physiotherapist (awarded by Australian College of Physiotherapy, 2009)
PhD Candidate Curtin University
Clinical Director AAP Education

email: doug@aapeducation.com.au

ph/fx: 08 90715055

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