1. JENNY MILLER, DC GETTING TO THE POINT: A DISCUSSION ON ACUPUNCTURE

2. DISCLAIMER The views and opinions expressed in my presentation today, including any examples or assumptions, are mine personally, and do not necessarily reflect the official policy or position of the Department of Veterans Affairs or any agency of the U.S. Government.”

3. INTRODUCTION Education/Background/Experience How did you get into acupuncture?

4. HOW DOES IT WORK? Eastern vs. Western Perspective Eastern Meridians Balance Western Muscular Tension Blood Flow Endorphins

5. TYPICAL VISIT Initial Visit 60 minutes Exam and History Initial treatment Follow-up Visit 30 minutes Continued treatment Self-care instructions

6. TYPICAL VISIT The “tools” Needles Vary in length and thickness Vary in material Electro-stimulation

13. TYPICAL VISIT Common Complaints Low back pain Neck pain Headaches Stress/Anxiety Sleep concerns Sinus pain/congestion

14. TYPICAL VISIT Cautions/Contraindications Often relative rather than absolute Unexplained or undiagnosed medical conditions Sepsis or overwhelming infection Unexplained/unstable syncope or seizure Pacemaker patient should avoid electro-stimulation Pregnancy Needle phobia Epilepsy or uncontrolled movements

15. TYPICAL VISIT Cautions/Contraindications (continued) Diabetes Allergy to stainless steel Non-cooperative/Confused patients Steroids Local contraindications Active infection Skin lesion Malignancy at the insertion site

16. TYPICAL VISIT Bleeding disorders & use of anti-coagulants These are not absolute contraindications as acupuncture needles are nearly always thinner or finer than phlebotomy needles and intravenous catheters which are routinely administered in hospitals; however, the acupuncture provider should always be notified of bleeding risks.

17. TYPICAL VISIT Considerations ADHD or inability to sit calmly Significantly low pain tolerance Needles should not be placed in the orbit or umbilicus

18. EFFECTIVENESS & LITERATURE Cherkin, D.C., Sherman, K.J., et al. (2009). A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Low Back Pain. Archives of Internal Medicine, 169(9), 858-866. Hollifield, M., Sinclair-Lian, N., Warner, T.D., & Hammerschlag, R. (2007). Acupuncture for Posttraumatic Stress Disorder: A Randomized Controlled Pilot Trial. Journal of Nervous & Mental Disease, 195 (6), 504-513.

19. EFFECTIVENESS & LITERATURE King, H., et al. (2015). Auricular Acupuncture for Sleep Disturbance in Veterans with Post-Traumatic Stress Disorder: A Feasibility Study. Military Medicine, 180 (5), 582-590. Li, J., et al. (2014). Acupuncture Treatment of Chronic Low Back Pain Reverses an Abnormal Default Mode Network in Correlation with Clinical Pain Relief. Acupuncture In Medicine: Journal of the British Medical Acupuncture Society, 32 (2), 102- 108.

20. INTEGRATIVE HEALTH Acupuncture is one piece of the puzzle Integrative Health Program offers Group Orientation Health Coach Massage Therapy “Bridge to Self-Care”

21. INTEGRATIVE HEALTH IH also works closely with these programs & groups: Nutrition and MOVE programs Yoga/Tai Chi Mind Body Medicine Group Smoking Cessation Group

22. ACUPRESSURE Digit Pressure Bracelets Ear Seeds Press Tacks

23. ACUPRESSURE

25. SELF-CARE Acupressure Breath work & breathing exercises Mantram/Affirmations/Visualization/Meditation Stretches/Exercises/Tennis ball/Foam roller Posture/Work station recommendations Essential Oils

26. CASE STUDIES 44 year old female CC: Bilateral knee pain 8-9/10 at worst; also cervical, thoracic, and headache pain Goal: increase walking which is limited to six blocks due to pain Participating in MOVE program & lost 20 pounds in 2-3 months

27. CASE STUDIES Treatment Twice per week for three weeks with follow up visit three weeks after Outcome Knee, headache, neck, upper back pain symptoms mild at most. No pain at time of visit Walking 3-5 miles 3-5 times per week Lost nearly 30 pounds total Self care: acupressure points, tennis ball massage Rated benefit of acupuncture 9 on scale of 10

28. CASE STUDIES 78 year old male CC: Headache, also knee pain, & right wrist pain Average HA pain 3-4/10 with severe HA once/week. Knee pain present 20 years. Intermittent, 8/10 with stairs Right wrist pain limits bowling activities Tai Chi and Yoga classes several times per week aid in sleep

29. CASE STUDIES Treatment Twice per week for three weeks Outcome Headaches “manageable” Knee pain improved, noted mainly with kneeling. Improved flexibility right wrist and decreased pain Planning to begin bowling that week Benefit rated 10 on scale of 10 Self-care: acupressure Continue tai chi and yoga classes

30. CASE STUDIES 46 year old male Mid and lower back pain 20 years Increased with prolonged activity Avoids going fishing due to low back pain Nightmares Consistently making sleep difficult Currently taking medications for nightmares

31. CASE STUDIES Treatment Twice per week for three weeks with follow up three to four weeks later Outcome Fishing on a weekly basis Started a new job spending more time on his feet No nightmares Benefit rated 9-10 on scale of 10