1. Pain Relief Presented by: Dr Katalin Csoka L.Ac., Diplomate in Acupuncture, Ph.D., M.D. (Hungary) Website: www.biorient.com Integrative Approach:  Biomedicine/Western Medicine  Chinese Medicine  Science

2. Contents: I. Facts What is Pain? Clarification on pain-related terms Characteristics of pain Pain management/Facts Treatment of pain (East-West) Traditional Chinese Medicine-TCM TCM Treatment Modalities Auricular Pain Management Integration of TCM with Western Medicine Advantages of TCM II. Summary

3. What is Pain?  Pain is a feeling triggered in the nervous system. Pain may be sharp or dull. It may come and go, or it may be constant. You may feel pain in one area of your body.  Pain can be helpful. Without pain, you might seriously hurt yourself without knowing it, or you might not realize you have a medical problem that needs treatment. Once you take care of the problem, pain usually goes away. However, sometimes pain goes on for weeks, months or even years. This is called chronic pain. Sometimes chronic pain is due to an ongoing cause, such as cancer or arthritis. Sometimes the cause is unknown.

4. Clarification on pain-related terms  The word pain used without a modifier usually refers to physical pain, but it may also refer to pain in the broad sense, i.e. suffering  Nociception, the unconscious activity induced by a harmful stimulus in sense receptors, peripheral nerves, spinal column and brain  Qualifiers, such as mental, emotional, psychological, and spiritual, are often used for referring to more specific types of pain or suffering  The term unpleasant or unpleasantness commonly means painful or painfulness in a broad sense

5. Certain characteristics of the pain  Quality  Intensity  Localization  Radiation  Frequency and Duration  Onset and Offset  Exacerbating Factors  Ameliorating Factors

6. Cont….Certain characteristics of the pain  Localization of pain  Referred pain  Pain threshold  Pain tolerance  hyperalgesia  hypoalgesia  pain scale

7. Pain management  Multidisciplinary approach  Pharmacologic measures-analgesics/anesthesia  Physical exercise,  Psychological measures  Medical specialties  Anesthesiologist, Neurologist, Physiatrists or Psychiatrists  Physiotherapists, Chiropractors, and Occupational Therapists  Complementary and Alternative Medicine (CAM)  Traditional Chinese Medicine, herbal medicine, acupuncture  Nutritional Supplements  Hypnosis

8. Fact #1 *Sources: Pain – 76.2 million people, National Centers for Health Statistics Diabetes – 20.8 million people (diagnosed and estimated undiagnosed), American Diabetes Association Coronary Heart Disease (including heart attack and chest pain) and Stroke – 18.7 million people, American Heart Association Cancer – 1.4 million people, American Cancer Society Highlights from the National Center for Health Statistics Report: Health, United States, 2006, Special Feature on Pain 1

9. Fact #2  The annual cost of chronic pain in the United States, including healthcare expenses, lost income, and lost productivity, is estimated to be $100 billion.  When asked about four common types of pain, respondents of a National Institute of Health Statistics survey indicated that low back pain was the most common (27%), followed by severe headache or migraine pain (15%), neck pain (15%) and facial ache or pain (4%).

10. Treatment of Pain  Fortunately, there are many ways to treat pain. Treatment varies depending on the cause of pain.  Pain Relievers  TCM, Acupuncture  Surgery

11. 1. Pain Relievers  The major classes  Paracetamol and NSAIDs  COX-2 inhibitors  Opiates and morphinomimetics  Specific agents  Combinations  Topical or systemic  Psychotropic agents  Atypical and/or adjuvant analgesics  ADDICTION! ADVERSE EFFECTS! INTERACTIONS!

12. 2. TCM, Acupuncture  Zhou dynasty (1128-220 BC) for orthopedic pain conditions  Ming/Qing dynasties (1368-1644) Diagnostic techniques + physical rehab + physical modalities:  Heat Therapy  Moxibustion  Massage and Manipulation of tissues and joints  New Millennium:  Transdisciplinary Assessment

13. What is Traditional Chinese Medicine (TCM)?  TCM is defined as a medical science governing the theory and practice of traditional Chinese medicine. It includes:  Chinese medication,  pharmacology/herbalogy, acupuncture,  Massage,  Qigong.  There are fundamental differences in TCM and the western medical system. With some understanding of Chinese culture and philosophies, it may help one to see through and start to appreciate the value of TCM.  Colleges of traditional Chinese medicine and acupuncture have been founded in France, US, Italy and Australia.  Cooperation in TCM has been established between China and Japan, the United State and Germany.

14. Traditional Chinese Medicine  Traditional Chinese medicine is a range of traditional medical practices used in China that developed during several thousand years. It is a form of Oriental medicine, which includes other traditional East Asian medical systems such as Japanese and Korean medicine.  TCM says processes of the human body are interrelated and constantly interact with the environment. Therefore the theory looks for the signs of disharmony in the external and internal environment of a person in order to understand, treat and prevent illness and disease. TCM theory is based on a number of philosophical frameworks including the Theory of Yin-Yang, the Five Elements, the human body Meridian system, Zang Fu theory, and others.  Diagnosis and treatment are conducted with reference to these concepts. TCM does not usually operate within a scientific paradigm but some practitioners make efforts to bring practices into an evidence-based medicine framework. (From Wikipedia, the free encyclopedia)

15. What is PAIN by Traditional Chinese Medicine (TCM)?  Qi and Blood stagnation!  Qi stagnation - distension  Blood stagnation - PAIN

16. Cont…. TCM, Acupuncture  New Studies Confirm Acupuncture Relieves Pain MRI Scans Provide Objective Evidence that Treatment Works  "It is important for Western medicine to recognize that these acupoints really mean something in regard to pain relief,"  "So many people with pain, whether from cancer, headache or a chronic, unexplained condition, rely on medications such as morphine, which can become addicting. Acupuncture as no side effects, and other studies have shown the pain relief it provides can last for months."

17. Cont…. TCM, Acupuncture  Pain related conditions commonly treated by licensed acupuncturist:  Anxiety/Depression  Arthritis/Joint problems (TMJ, etc)  Back and Neck pain  Colds/Influenza  Cough/bronchitis  Effects of chemotherapy  Fibromyalgia  GI problems (IBS, Crohn’s disease, etc)  Headache/Migraine  Muscolosceletal injuries  PMS  Paralysis/Numbness  Sciatica  Skin problems  Tendonitis …..many MORE

18. TCM treatment modalities in Pain Management

19. Auricular Pain Management

20. Integration of TCM with Western Medicine  Western biomedicine emphasizes:  Analgesics (pain relievers)  TCM aims:  Overall condition of patient  Regulating Yin and Yang  Treating the disease by pattern identification  Side effects are minor  Less invasive  Generally more acceptable to patients

21. cont. Advantages of TCM  TCM has certain advantages:  Enhancing the immune system  Reinforcing the body’s Vital Qi  Cultivating the Root  Preventing, correcting, reducing iatrogen pain due to surgery, radio-and chemotherapy

22. cont. Advantages of TCM  The combined approach shows significant improvement in the efficacy of Western medicine:  Reduces symptoms associated with pain  Treats the side-effects of Western interventions  Enhances recovery time  Raising Quality of life  Reducing recurrence  Alleviating sufferings (pain)

23. Q & A  Is pain preventable?  Examples from my practice Q & A

24. Summary  Chinese medicine can be used as part of an overall treatment strategy to bring new hope to patients with PAIN.