03/10/2015 Acupuncture and the Oncology Patient XXX Meeting Date Nicola Kiely, Physiotherapist, Bon Secours Hospital.

03/10/115 Western Acupuncture similar to Chinese acup to a casual observer. Needles are inserted into the body incl hands and feet, agitated by hand and sometimes electrical impulses, taken out after a period of time somewhere bt 5 and 30 mins

03/10/115 However considerable differences… WA..medical dx made, needles influence physiology of the body a/c to scientific view and acup seen as conventional Rx along with drugs or surgery. Traditional Acup makes dx in terms of a disturbance to the bodys ‘balance’ which needs to be corrected with needles.

03/10/115 Acup. in the West 1970s Felix Mann ‘Meridians don’t exist, points don’t exist’ Gate control theory of (Melzack and Wall 1965) Discovery of Endorphins (Hughes et al 1975) Studies show Acup released the endorphins (Han &Terenius 1982)

03/10/115 5 mechanisms to understand WA Local Effects..stim sensory nerve fibres in skin and muscle CGRP Local bl vessels to dilate..local bl flow increases Superficial and deep tissue healing Acup promotes local healing

03/10/115 Segmental Analgesia Action potentials travel up nerve to part segment in spinal cord Depress activity of dorsal horn reducing response to pain e.g. pain in the knee joint reduced by needling muscles around the knee as nerves from the knee joint enter same segment as nerves from the muscles around it. Acup red. pain in the segment where the needles are inserted

03/10/115 Extrasegmental analgesia Action potentials then travel on from the dorsal horn to the brainstem Descending nerve pathways....neurotransmitters suppress pain Extrasegmental as not restricted to a single segment Acup reduces pain throughout the body

03/10/115 Central Regulatory effects After reaching the mid-brain, the action potentials go onto influence other structures..cerebral cortex, hypothalmus and limbic system Calming effects and improves well –being Autonomic nervous system and various female hormones such as those that control the menstrual cycle Acup has a calming effect and improves well-being

03/10/115 Myofascial trigger points Small ‘knots’ of tight muscle fibres Tender Taut bands Mvt of muscle restricted by pain Acup inactivates myofascial trigger points

03/10/115 Patient Group Mainly Females Wide variety of vasomotor symptoms Mainly Hot Flushes, Night Sweats,Fatigue,Pain,CIPN.

03/10/115 Some studies Frisk 2008…RCT..45 pts with flushes due to Tamoxifen..Electroacup vs Hormone Replacement…freq of Hot flushes reduced by 50% Lee Cochrane Review..Post-op nausea and vomiting..Acup using PC6..PC6 stim prevents PONV

03/10/115

Acup and Gabapentin Electro-acup greatest reduction in hot flushes at end of Rx and 4 months off Rx Gabapentin similar reduction while on Rx but not off EA had less side effects to Gabapentin

03/10/115 Some points for Hot Flushes LI4 TE5 LR3 SP6 ASAD points Sternum To note.. no needling to the affected side..risk of lymphoedema avoided

03/10/115 Hot Flash Composite Score Frequency x Severity Severity measured mild, moderate, severe, very severe..score 1,2,3,4. E.g 13 hot flushes in a day x 3 (severe)=39 Measure before and after rxs at 1/12, 4, 8, 12.

03/10/115 Acup. Service in the Bons Immediate access via GP or Consultant Referral letter necessary detailing pt hx and stage of disease etc..written conset from pt Cost same as physio cost Treatments weekly for 6 weeks Minimal ache felt from needles Big plus is it is non pharmacological intervention! Time+ with pt promotes physical and emotional well being

03/10/115 Thank you for your attention.