Author: Richard H. Adler

Acupuncture is widely practiced in the United States and through-out the world as a therapeutic intervention for numerous disease processes, including traumatic and non-traumatic musculoskeletal and neurological pathologies. Acupuncture has proved to be effective for relief and resolution of acute pain and chronic pain syndromes related to the full range of traumatically sustained musculoskeletal injuries.¹

Acupuncture is becoming more widely practiced in western allopathic and naturopathic medicine to treat chronic pain syndromes or other chronic diseases. Physicians devoting themselves to providing relief to chronic pain patients who suffer from traumatic musculoskeletal injuries have increasing turned to acupuncture as a safe, effective and relatively non-invasive therapy.

Acupuncture is the insertion of very fine needles, (sometimes in conjunction with electrical stimulus), on the body's surface, in order to influence physiological functioning of the body. Though acupuncture has not been scientifically established,² findings from basic research have begun to elucidate the mechanisms of action of acupuncture, including the release of opioids and other peptides in the central nervous system and the periphery and changes in neuroendocrine function. Many theories have been propounded to explain acupuncture including:

1. Augmentation of Immunity Theory. This theory suggests acupuncture's efficacy relates to its know effect of raising levels of triglycerides, specific hormones, prostaglandins, white blood counts, gamma globulins, opsonins, and overall anti-body levels.


2. The Endorphin Theory. This explanation states that acupuncture stimulates the secretions of endorphins in the body (specifically enkaphalins).


3. The Neurotransmitter Theory Proponents of this theory claim that certain neurotransmitter chemical levels (such as seratonin and noradrenaline) are affected by Acupuncture.


4. The Circulatory Theory This theory states that acupuncture has the effect of constricting or dilating blood vessels, likely due to the body's release of vasodilaters (such as histamine), in response to acupuncture.


5. The Gate Control Theory According to this widely held theory, the perception of pain is controlled by a part of the nervous system informally called "gates." If a gate is hit with too many pain impulses, it may become overwhelmed and close, thereby preventing some of the impulses of pain passing and being perceived by the mind. Nerve fibers which carry the impulses of pain are rather small nerve fibers called "C" fibers. These are the gates which it is theorized close during acupuncture.

Acupuncture is getting more attention among clinicians and research facilities. In 1997, the National Institute of Health stated:

[P]romising results have emerged . . . for [the] efficacy of acupuncture in adult post-operative and chemotherapy nausea and vomiting and in postoperative dental pain . . . addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma for which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful . . . . [t]here is sufficient evidence of acupuncture's value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value.

An increasingly wide-range of pain intervention specialists, including physiatrists, orthopedists, neurologists, anesthesiologists, chiropractors, osteopaths and naturopaths refer their injury patients for acupuncture therapy, particularly for chronic neurogenic and idiopathic pain. Acupuncture can be efficacious in a comprehensive program of physical rehabilitation to return traumatically injured people to optimal activities of daily living, particularly when other conventional approaches have been tried and not resulted in the hoped for gains in reducing pain and increasing function.

Very truly yours,
ADLER GIERSCH, P.S.

John R. Alexander
Attorney at Law

¹ A recent study found that acupuncture was effective at reducing chronic pain patients self reporting of pain levels. See Cherkin DC, Eisenberg D, Sherman KJetal. "Randomized Trial Comparing Traditional Chinese Medical Acupuncture. Therapeutic Massage and Self Care Education for Chronic Low Back Pain." Arch. Intern Med. 2001; 161: 1087-88

² In the West, acupuncture is considered an "alternative medicine". However, the first record of this ancient Chinese medical science is found in the 4,700 year old Huang Di Nei Jing (Yellow Emperor's Classic of Internal Medicine), which is said to have documented earlier theories of bodily functions propounded by Shen Nung, the father of Chinese Medicine

Shen Nung theorized the body had an energy force running within it known as "Qi" (roughly pronounced chee). The Qi consists of all essential life activities including the spiritual, the emotional, the mental and the physical aspects of life. A person's health is influenced by the flow of Qi in the body, in combination with the universal forces of Yin and Yang. If the flow of Qi is insufficient, unbalanced or interrupted, Yin and Yang become unbalanced, and illness may occur. Qi travels throughout the body along "meridians" or special pathways. Acupuncture points are specific locations where the meridians come to the surface of the skin, and are easily accessible by "needling," The connections between them ensure that there is an even circulation of Qi, a balance between Yin and Yang.

Energy always flows up and down these pathways. If pathways are obstructed, deficient, excessive, or unbalanced, Yin and Yang are said to be out of balance. This causes illness. Acupuncture is said to restore the balance.

Acupuncturists use as many as nine types of Acupuncture needles, though only six are commonly used today. These needles vary in length, width of shaft, and shape of head. Points on the meridians are needled in the range of 15 degrees to 90 degrees relative to the skin surface. In most cases, a sensation felt by the patient is desired. This sensation which is not pain is called "deqi" (pronounced dah-chee). The following techniques are some which may be used immediately following needle insertion: raising and thrusting, twirling or rotation, a combination of raising and thrusting and rotation, plucking, scraping (vibrations sent through the needle), and trembling (another vibration technique).