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Acupuncture for Post-Operative Recovery




Acupuncture is Important for Postsurgical Recovery

If you have had surgery or plan to have surgery, you are not alone, 51.4 million operations are performed each year in the United States (Shantha, 2014). Surgery is trauma to the body, that leaves the body with several side effects. After surgery, patients can experience pain, nausea, wounds, scar tissue, and immune suppression. Patients commonly are prescribed medication to help with pain and other side effects. There was a study done that tracked opioid use among 36,177 surgical patients who have never taken opioids previously. According to Dr. Chad Brummett, director of pain research at the University of Michigan Medical school, about 2,170 of the patients not using opioids before surgery continued to fill prescriptions for their opioid for three months after their surgery (Brummett, et al., 2017). In orthopedic surgery alone, there were 5.3 million surgeries in 2010. That number was estimated to grow to 6.6 million in 2020 (Dyrda, 2011). With Orthopedic surgery so prevalent, orthopedic surgeons are the third-highest prescribers of opioids in the United States (Morris & Mir, 2015). This is where supplementing with acupuncture can be advantageous. Acupuncture has several important healing mechanisms and should be included in your post-surgical recovery plan. 

Pain

Pain is one of the top reasons for acupuncture visits, especially for chronic pain. The World Health Organization recognizes acupuncture for its safe and effective results in treating pain. Insertion of an acupuncture needle stimulates the body's release of its natural pain killers, endorphins and enkephalins. A study was done on acupuncture in the emergency department for acute pain, this study concluded that acupuncture was as effective as intravenous morphine for acute pain. Seeking acupuncture after surgery for pain should be considered (Grissa, et al., 2016). Pain is a pervasive side effect after surgery; about 75% of patients experience moderate to severe pain after surgery (Wu, et al., 2016). The standard of care for pain after surgery is prescribing pain medication like opioids to patients. Pain medication, although can take care of the pain, comes with many side effects, including addiction, dizziness, nausea, decrease mobility, sedation, all of which can inhibit the patient's recovery. In the 2016 meta-analysis, a systematic review was published on the efficacy of acupuncture in postoperative pain management. This systematic review used thirteen studies in a total of 682 patients. The meta-analysis concluded that acupuncture was effective in reducing postoperative pain and decreases the use of analgesics one-day post-surgery (Wu, et al., 2016).

Healing

Acupuncture affects the local tissue from the moment the needle is inserted to help with healing and pain reduction. The needles trigger one of the body's most powerful vasodilators, which can also lead to the release of other neuropeptides. These chemicals have powerful therapeutic effects on local tissues. It was discovered that local neurochemical accumulation consists of prostaglandins, red blood cells, white blood cells, glutamate, Substance P, and serotonin (Corradino, 2017). These chemicals assist with the mitigation of pain, decrease in inflammation, increase in local circulation, help to fight infection, and promote healing of local areas (Corradino, 2017).

Another side effect that always comes with surgery is the formation of scar tissue. As mentioned earlier, surgery is a type of trauma to the body, and according to Dr. Janet Yueh, all trauma ends up causing inflammation and swelling of the tissues, and overtime that inflammation ends up being converted into scar tissue (Esposito, 2016). Although the target of surgery is to repair the area, sometimes excessive scar tissue builds up after surgery which can be detrimental to the area. There are several surgeries that require surgical revisions because too much scar tissue formed after surgery. Personally, this is something I have seen several times with patients. Scar tissue can leave a feeling of pain, soreness, and inhibit range of motion. In traditional Chinese Medicine, an acupuncturist will see a scar as a stagnation of qi and blood. Qi is the movement of energy, oxygen, and blood throughout the body. If there is a stagnation of qi and blood, pain will occur, and healing will not take place. Treating the stagnation of qi and blood with acupuncture can reduce pain and promote healing.

A study was done on a 48-year old woman who suffered from severe scar pain for three months. After receiving acupuncture treatments, eight sessions in a total of five weeks, she experienced significant pain reduction. Her pain went from a 7/10 to a 1 or 2/10 on the Likert scale (Fang,2014). Acupuncture can also help in the healing process after surgery. The body was made to have the ability to heal itself; acupuncture gives the body a boost in that healing process. Electroacupuncture with specific frequencies applied to the body can enable neuropeptides in the central nervous system, which, in return, can promote physiological effects and activate the self-healing mechanisms (Han, 2003).  

Immune Support

Surgery puts tremendous stress on the body and influences the body's immune system. Surgical trauma affects both innate and acquired immunity (Dąbrowska & Słotwiński, 2014).

 After surgery, the immune system is compromised, and it may take several weeks to months for the immune system to return to normal. This is why the body is susceptible to infection post-surgery. Those with cancer and other serious illness are more defenseless to immunosuppression post-surgery. Specific acupuncture points can boost the body's immune system. Stomach 36 is a point located on the lateral side of the leg. This point is generally used for immune-related issues. Bilateral electroacupuncture protects the intestinal mucosal immune barrier in sepsis (Liang, et al., 2015). There was a study done that concluded that acupuncture was effective in treating mice with sepsis, which shows acupuncture’s fantastic ability to boost the body's immunity (Torgan, 2014). For those with already compromised immune systems heading into surgery, acupuncture should be considered to build up the immune system and prepare the body for surgery. Prevention is always key. 

Conclusion

The number of surgeries performed each year is increasing. Pain is anticipated after surgery; surgeons typically turn to opioids to manage the pain, but this method has added to the ongoing opioid crisis. Acupuncture is proven to help reduce pain, even post-operative pain. This can help reduce the number of opioids taken and therefore reduce the risk of addiction. Surgery suppresses the immune system, and those who undergo surgery are susceptible to infection, especially those who are already immunocompromised. Acupuncture is shown to boost the immune system and help prevent infection. Healing after surgery is critical. Acupuncture’s healing mechanisms can provide an enhancement in healing. For your next operation, find a local acupuncturist to help your recovery.

By: Dr. Melissa Levy, DACM, AP


References

Brummett, C. M., Waljee, J. F., Goesling, J., Moser, S., Lin, P., Englesbe, M. J., … Nallamothu, B. K. (2017). New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults. JAMA Surgery152(6). doi: 10.1001/jamasurg.2017.0504

Corradino, M. D. (2017). Neuropuncture: a clinical handbook of neuroscience acupuncture. London: Singing Dragon.

Dyrda, L. (2011, May 26). Number of Orthopedic Surgeries to Reach 6.6M by 2020. Retrieved from https://www.beckersasc.com/orthopedic-spine-driven-ascs/number-of-orthopedic-surgeries-to-reach-66m-by-2020.html

Dąbrowska, A. M., & Słotwiński, R. (2014). The immune response to surgery and infection. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439968/

Esposito, L. (2016, December 14). Surgical Scar Tissue: a Less-Talked-About Side Effect. Retrieved from https://health.usnews.com/wellness/articles/2016-12-14/surgical-scar-tissue-a-less-talked-about-side-effect

Fang, S. (2014). The Successful Treatment of Pain Associated with Scar Tissue Using Acupuncture. Journal of Acupuncture and Meridian Studies7(5), 262–264. doi: 10.1016/j.jams.2014.05.001

Grissa, M. H., Baccouche, H., Boubaker, H., Beltaief, K., Bzeouich, N., Fredj, N., … Nouira, S. (2016). Acupuncture vs intravenous morphine in the management of acute pain in the ED. The American Journal of Emergency Medicine34(11), 2112–2116. doi: 10.1016/j.ajem.2016.07.028

Han, J.-S. (2003). Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends in Neurosciences26(1), 17–22. doi: 10.1016/s0166-2236(02)00006-1

Liang, F., Cooper, E. L., Wang, H., Jing, X., Quispe-Cabanillas, J. G., & Kondo, T. (2015). Acupuncture and Immunity. Evidence-Based Complementary and Alternative Medicine2015, 1–2. doi: 10.1155/2015/260620

Morris, B. J., & Mir, H. R. (2015). The Opioid Epidemic. Journal of the American Academy of Orthopaedic Surgeons23(5), 267–271. doi: 10.5435/jaaos-d-14-00163

Shantha , D. T. R. (2014, January 17). Number of surgeries per year in US. Retrieved from http://infomory.com/numbers/number-of-surgeries-per-year-in-us/

Torgan, C. (2014, May 10). Electroacupuncture Reduces Sepsis in Mice. Retrieved from https://www.nih.gov/news-events/nih-research-matters/electroacupuncture-reduces-sepsis-mice

Wu, M.-S., Chen, K.-H., Chen, I.-F., Huang, S. K., Tzeng, P.-C., Yeh, M.-L., … Chen, C. (2016). The Efficacy of Acupuncture in Post-Operative Pain Management: A Systematic Review and Meta-Analysis. Plos One11(3). doi: 10.1371/journal.pone.0150367


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