How Does Acupuncture Work? Part II

acupuncture meridiansIn Part I of How Does Acupuncture Work? we discovered how qi, blood, yin, and yang interact. Let’s take a deeper look at the way these forces merge to create the major organs of the body.

The Organs in Chinese Medicine

The primary organs in Chinese medicine include the Liver, Heart, Spleen, Lungs, and Kidneys. Each of these organs has a “sphere of influence,” meaning it impacts the function of other aspects of the body and can offer diagnostic clues leading to treatment possibilities based on deep-seated relationships.

Here are a few examples of internal imbalances leading to external signs and symptoms:

The Liver impacts the eyes in Chinese medicine. Virtually all eye symptoms can be traced back to Liver disharmonies. This may sound absurd in Western medicine, but we know that by treating the Liver in Chinese medicine, we can impact eye health.

The same is true for the Lungs. In Chinese medicine, the Lungs are responsible for the skin. Unlike the example of the Liver, the relationship between lung health and skin health is well-documented in allopathic medicine. For example, we know patients with asthma and allergies are more likely to develop eczema.

Through questioning patients about subjective symptoms, the acupuncturist is able to work backward to diagnose imbalances deeper in the body.

Investigating in this way yields many clinical benefits. For one, acupuncturists pay attention to signs and symptoms that may be overlooked by other practitioners. In fact, many acupuncture patients are surprised by the specificity of our diagnostic approach. We often ask questions other healthcare practitioners do not ask.

The next time your acupuncturist rattles off a list of strange questions, know they are gathering important information that will result in a customized treatment strategy designed specifically for your condition.

The relationship between all these disparate signs and symptoms can be confusing to Western patients. But rest assured, it’s the acupuncturist’s job to discover these relationships, not yours.

 

Seeing the Bigger Picture

Acupuncturists also gather objective information on a patient’s health by examining the body.

One of the primary ways we get information about what is happening internally is by feeling the radial pulse in your wrists.

Each wrist offers a window into your internal environment. I feel the pulse bilaterally at a superficial level and deeper, closer to the bone. This technique tells me about the state of each of the organ systems mentioned above, as well as the vitality of qi, blood, yin, and yang.

Acupuncturists also investigate the tongue. Believe it or not, your tongue tells a story about your inner climate. Do you run hot or cold? Do you have phlegm in your intestines or lungs? The tongue will often reveal these conditions. (If you are curious about tongue diagnosis, check out Why Does My Acupuncturist Look at My Tongue?)

We also physically examine the body. We may feel for changes in skin texture, how pain responds to pressure, or if the area is hot or cold. All of these signs and symptoms give us clues to what is happening internally. Once we decide on a diagnosis, we treat these imbalances by influencing the meridian system.

 

Qi and the Meridians

In Chinese medicine the human body is a connected system of relationships. Electrical and metabolic information is sent through the body via a network of invisible channels called meridians.

Meridians connect all parts of the body in a continuous network of impulses. This is why we can insert an acupuncture needle in the foot to affect the hip or one in the hand to halt sneezing. In fact, qi moving through the meridian system is the real “secret” to how acupuncture works. It is how information is conveyed.

When this system of communication is disrupted or blocked, we experience pain and dysfunction. Also, when the body is weak, the signals being sent through the meridians become weak. Acupuncture revives this signal by stimulating the qi and blood. It also directs the qi to correct the flow of these impulses so that the body functions in a healthy way.

Without the meridian system, and the theories of qi, blood, yin, yang, and the organs, there would be no Chinese medicine as we know it. If we ignore the idea of qi, throw out the theory of the organs, and simply stick a needle in a muscle, we will not be able to address truly complex health issues. Patients may experience temporary pain relief, and even a sense of relaxation, but to unravel deeper problems, such as asthma and heart arrhythmias, the ancient Chinese theories are indispensable.

As an acupuncturist and an acupuncture patient, the theoretical scaffolding beneath acupuncture has always made sense to me. It is what differentiates it from practices like dry needling or trigger point therapy, techniques that employ acupuncture needles but abandon Chinese medical theory.

As acupuncture treatment evolves in the United States, it is important that we not forget the importance of balancing qi, blood, yin, and yang, which are the basis of health. Acupuncture helps thousands of people every day all across the world because of its foundational theories, not in spite of them. Ancient Chinese doctors understood this.

We are lucky to have inherited such a profound vision of human health, one that is both applicable to modern illness and flexible enough to accommodate new knowledge. Even as we seek to explain how acupuncture works in contemporary language, we can appreciate its roots in the dynamic balance between yin and yang.

How Does Acupuncture Work? Part I

During graduate school I was part of an acupuncture education outreach effort. When I told our program director the topic of our presentation—how does acupuncture work—she laughed.

“Good luck figuring that out!”

She was right. Acupuncture is not easy to explain—and I watch it in action every day.

Despite this challenge, I’ve learned that educating people about how acupuncture works is important. We are curious beings, after all. Also, patients and practitioners, not to mention insurance providers and medical doctors, all want to understand how acupuncture provides relief.

In this post I hope to shed some light on this difficult question by giving you a short-and-sweet primer on the theory behind this powerful medicine.

 

The Roots of Acupuncture

The answer to “how does acupuncture work?” is embedded in a cultural perspective that is different from Western medical science. While Chinese medicine is based on observation of nature—with humans being an inextricable part of their environment—the ancient Chinese were not conducting double-blind placebo-controlled studies. Nor did they have the concept of germ theory or the endocrine system.

Even still, Chinese medicine is highly empirical, meaning it developed based on visible changes in wellbeing after implementing certain therapeutic techniques. Acupuncture and herbal medicine are not just theoretical—or superstitious—forms of medicine. In fact, Chinese medicine is the oldest and most contiguous body of textual medicine in the world, meaning what we use today has been refined through clinical practice and passed down in books over millennia.

Chinese medicine is also highly adaptable to modern illness, which is why it remains so clinically relevant and important to modern healthcare. Many theories and treatment methods used in the contemporary clinic were discovered over 2,000 years ago and are still applicable to patients with iPhones and Facebook accounts.

So just what was in these ancient texts?

The history of Chinese medicine began with the first herbal medicine text, the Shennong BencaoThe Divine Husbandman’s Classic of Materia Medica. This book was compiled 2,500 years ago and includes many well-known herbs that are still in use today, including ginseng and ginger.

The first acupuncture text was the Huang Di Nei JingThe Yellow Emperor’s Classic of Medicine, compiled 2,200 years ago during the Warring States Period in China. This manuscript introduced the ideas of yin and yang into medicine, concepts that could already by found in the religious philosophy of Taoism.

These ideas were flexible in that they could be applied to broad scenarios, such as weather and climate, or minute workings in the body, like growth and development, death and decay. The flexibility of Chinese medical theory is really what keeps it clinically effective even today.

 

Qi, Blood, Yin and Yang: Navigating the Inner Ecosystem

Much like an ecosystem, Chinese medicine is based on patterns and relationships that are visible in the natural environment.

We think of the outside world as a complex system of elemental interactions: water, soil, wind, sunlight. Similarly, the body is its own ecosystem. However, the primary relationships in your body occur between qi, blood, yin and yang.

Yin and yang are opposites, yin being dark, moist, heavy, cool, and receptive, and yang being light, warm, expansive, and generative. An important thing to remember about yin and yang is that these terms only have meaning in relationship to one another; they are inextricably connected. If we say a person who is cold lacks yang, we can only determine this by weighing it against the yin qualities present in their body.

Qi and blood have a similar relationship. Qi is life-force energy in Chinese medicine. It permeates and animates everything. I like to think of it as the electrical impulse that is always present in living organisms. Blood, like yin, is dense and nutritive. It moves all over the body, feeding the cells of the muscles, brain, and all the internal organs. The qi carries the blood around the body, pulling it forward with a magnetic force.

When qi, blood, yin and yang are in a state of balance, people feel good. When these forces are out of whack, disease comes about. The job of an acupuncturist is to determine what is imbalanced and adjust it through sending a corrective message through the needles.

 

Diagnosing Imbalances of Qi, Blood, Yin and Yang

But just how does an acupuncturist diagnose disease? First, we need to know how the yin, yang, blood and qi are interacting.

As an acupuncturist, I use many methods of investigation to determine what is out of balance in my patients. Some imbalances are temporary, acute, surface-level disease states, such as a cold, flu, or injury.

Other problems run deeper and become a part of a patient’s constitutional makeup. They grow from the little things we do, or that happen to us, over months or years. Sometimes they are even with us from childhood. I often think of these imbalances as “body habits.” They are harder to interrupt and often require maintenance support, including acupuncture treatment or herbal medicine, over a longer period of time.

Your body’s symptoms are subjective messages sent to alert you that something is off. My role is to question you about these symptoms so that a pattern emerges.

Through interpreting the relationship between symptoms (subjective) and signs (objective), I then reach a diagnosis designed to address the imbalances of qi, blood, yin and yang.

Next time, in How Does Acupuncture Work Part II, we’ll look at the role the internal organs play in diagnosing and treating disease. We’ll also learn the theory behind why acupuncture needles impact the health of qi, blood, yin, and yang.

The mystery continues…

The Healing Benefits of a Long Winter’s Nap

I just love winter in Colorado. Even though our snowy season has been quite mild this year, I adore the cozy comforts of winter. In my house, cold weather means lap blankets, doubled-up socks, never-ending mugs of tea, homemade soup, and, my favorite cold weather pastime, sleeping.

Over the last few years, sleep has become my primary medicine for everything from headaches to emotional distress to digestive issues. Although I rarely sleep late into the morning, I am happy to head to bed at 7:30 p.m. if I feel ready for a long winter’s nap.

I’ve learned that indulging my sleep habit makes my waking hours more productive and fulfilling. I need less caffeine to get my brain working, and my stress remains manageable when I get enough rest. My life feels noticeably easier when I’ve slept well. Like drinking plenty of water, sleep really is a miracle drug.

During the holiday season, I took two weeks off to rest and go within. As part of my time off, I incorporated a few of what I call Healing Naps. On the surface, these just look like plain old naps. (Maybe you’ve taken one of those already today.) To make my naps even more wonderful, I include a simple addition: before falling asleep, I imagine myself bathed in warm light as I lay in bed.

This loving, gentle blanket of light feels very similar to the way I feel when I receive an acupuncture treatment. I’ve even begun using this light-awareness technique before going to bed in the evening. I encourage you to try it, especially if you have insomnia or fitful sleep. The healing benefit of consciously directing warm, loving thoughts toward yourself before bed translates into a deeper sense of safety, which we need in order to let go into sleep. This safety resembles being “tucked in” as a child.

Sleep is a time of letting go, slowing down, and opening up. Why rush it? Give yourself an extra hour. Take a nap if you have the time on a Saturdayafternoon. Allow yourself to experience the regenerative peace of a temporary hibernation.

Like the sweet red fox pictured above, may you have the healing benefits of restful winter sleep. And if your sleep is not so restful, let’s talk about how acupuncture can help.

Sage Advice: Wisdom from My Grandmother

girl on the edge

As a child, I was very close to my maternal grandmother. A former Navy WAVE and an airplane mechanic during WWII, my grandmother was unlike most of the other older women I knew. For one, she didn’t cook. My grandmother’s idea of a home-cooked meal was sliced potatoes and onions fried in butter, a reminder of her Polish-Russian childhood in Chicago. She was also fine with eating M&Ms for dinner or cracking pistachios while watching TV and smoking cigarettes at the kitchen table.

Hailing from the Windy City, she was a Cubs fan, but she’d root for the White Sox, too. As long as Chicago baseball was on TV, she had a favorite. Always embarrassed of her thinning hair, she wore a wig my whole life and only changed out of her slacks for a skirt when someone graduated or passed away.

When I was about ten years old, my grandma was diagnosed with bladder cancer. After her surgery she spent the rest of her life emptying a catheter bag every few hours. It was a good thing my grandma had such a robust sense of humor because her catheter schedule was unforgiving. Whenever she stood up from a game of cards to excuse herself so that she could empty her bag, she told us it was “Howdy Doody time,” a reference to the old black and white children’s television show. Her non-existent bladder was calling.

My grandmother always spoke to me as if I were an adult. She accepted that I was capable of understanding life experiences beyond my age. In keeping with her faith in my ability to comprehend the bigger things in life, she told me one truly amazing story.

During her cancer surgery, she’d gone through a near-death experience on the operating table. When I asked her what it was like, she folded her hands—she had the most lovely, slender fingers—and said, “All I can say is that you have nothing to be afraid of.”

“You mean of dying?” I said.

“Right. Of dying.”

What a gift to give a little girl.

 

Since starting my work with elders, I’ve discovered that the vulnerability of childhood can mirror the vulnerability of old age. Whereas childhood is imbued with the hope that accompanies a bolt of growth, development, and physical transformation, in our culture, the breakdown of the physical body is often seen as a tragedy.

There is not a clear social role for elders in the United States, especially if they are not a part of traditional family units, such as LGBTQ seniors or elders who live in isolation. As a culture, we have a lot of work to do when it comes to embracing our seniors as sources of wisdom and guidance, in matters both big and small.

I often ask myself how different our society would be if we respected our elders as living treasures. How much healthier would we be if we examined what it means to have a long life—even with its many triumphs and failures? What if we regarded old age as an honorable stepping-stone toward our transition from this world into death?

The sheer mass of knowledge our elders carry in their life experiences is deeply moving for me. And yet sometimes, even without our knowing it, we prevent older adults from having a voice. Or we diminish the power of their experiences by reducing them to being “cute” or “sweet.” Sometimes, I think, we are actually afraid of what they want to say to us.

It is becoming more and more important that we fight our tendency to ignore or shy away from the challenges of old age. After all, America is aging; we hear that announcement everywhere. As caregivers, we are in a position to learn so much from the people we serve. Also, in more plain language, our elders are going where we are going before us. They are pioneers of the human body and the human spirit. To mistakenly believe they are moving backward because they cannot participate in our fast-paced, hyper-driven culture is an insult to the journey they are walking. They are clued into some other rhythm of life that runs beneath the surface of all our lives if we are brave enough to examine it.

Many of the clients I work with live in what I would characterize as physically small orbits: they may rarely leave their homes, and their contact with the outside world is often very limited. No doubt, some elders prefer it this way. Plenty of my patients are happy being solitary. Others, however, long for community connection, conversations, and a chance to feel involved. Like many people, they want to contribute.

It is my experience that many elders long to care for us, to guide us younger folks toward living positive, healthy lives. Even though I am hired to take care of my patients, my patients also nourish me. They tell me to slow down. They advise me not to work too hard. And they are genuinely happy for me when I take time off or visit my family. They care about me.

One of my favorite pieces of advice came from an elder in her 90s. “You think you have a lot of pep, but you don’t! Don’t overdo it.” This kind of insight is commonly called “sage advice,” meaning it is earned through the wisdom of time and experience. Elders are living repositories of this hard-earned knowledge—intelligence that cannot be bought. If we listen, our grandmothers and grandfathers, our fathers and mothers, have so much love to give us. Sometimes that love comes from having learned something the hard way, maybe in a way they are not so proud of but are willing to share with us so that our paths become easier. What a blessing.

My grandmother died fifteen years ago but, thankfully, not before she told me about her experience on that operating table. What a gift to ease the heart and mind of a little girl who, like all of us, is worried about what death will bring. How could I ever repay her for sharing that insight with me, that amazing wisdom she garnered through her own body and mind? I will carry her words with me all my life.

Now, as I work with elders who are approaching death, I am reminded of my grandmother’s sage advice: don’t be afraid. What better gift can we give one another than the mercy of solace? And what better source of comfort and confidence than a kind soul who has walked the path before us?

More Than Comfort: Therapeutic Presence in Alzheimer’s and Dementia Care

woman in grey jacket
This month I invited a dear friend, Heather Campbell Grimes, to guest blog for Boulder Acupuncture and Herbs. Heather writes about her experience working as a massage therapist in a memory care facility for patients with Alzheimer’s and dementia. Her insights on the importance of touch and the power of grounded presence in caring for this unique population are welcome inspiration for anyone working with elders. Thank you, Heather

Her real name is not Mary, but we’ll call her that for now. I knock on Mary’s door and then announce who I am before unlocking it with a key. The door leads directly into her bedroom. She’s where she always is: curled up and contorted in her bed, watching DVD re-runs of the TV show MASH.

She says, “Thank god it’s you. They’ve been coming in all morning, trying to get me to go to exercise.” Mary is in her early seventies, but a nasty fall about six months earlier—which resulted in a broken leg, a broken hip, and three major surgeries—left her looking frail and much older. I assume this, however, because I didn’t know her before she came to the Alzheimer’s and dementia residence where she lives now, where I work. From what her family tells me, her physical traumas—and a move cross-country to live in a place where she can receive constant care and that is closer to her daughter—exacerbated her dementia.

Propping herself up is a slow and painful process. Her shoulder-length gray hair is tied up in a little-girl ponytail, with at least a dozen bobby pins attempting to restrain the wispy side pieces. Mary has all-over body pain, as she describes it, and is prescribed legitimate pain-killers to take twice a day. They may or may not help the pain, but they do not free Mary enough —physically or emotionally—to want to leave her bed.

“Good morning, Mary,” I say and lug the massage table into her space. I set it up, loud and clunky, while she scoots herself to the edge of her bed, wincing from the pain. I roll her walker over to her and help her to stand before she shuffles herself to her bathroom. (Her home consists of a bedroom and a bathroom.) She voluntarily gets up for meals and that’s about it. And her weekly massage.

It’s a struggle for her to undress and climb onto the massage table, but she would have it no other way. I have tried to massage her fully clothed and in her recliner, half-clothed in her bed, but nothing is as satisfying to her as having her on the table for the full hour-long experience.

I’ve learned that she loves Frank Sinatra, so I bring my phone with me and we listen to the “Ultimate Sinatra Collection.” Mary is very inquisitive about Frank, so we’ve looked up quite a bit of his history on my phone—he was married four times and recorded over a thousand songs. She lights up when she talks about him, as if we had not had the very same conversation the week before, and the week before that.

Within minutes on the massage table, her body shifts from a tense assortment of stiff and rigid bones to feeling as though there is some space in there between the joints—some slight sense of buoyancy that I am pretty sure she doesn’t experience on a regular day. Her mood shifts from laser-focusing on her ailments to wanting to chat about music, my family, the words that go ‘on’ things. (Mary often talks about what words she would put ‘on’ things to describe them. She often says she’d put the word ‘ache’ on her leg, ‘sore’ on her foot, or ‘underwear’ on her Depends.)

The specific massage strokes are of no particular importance, though I know to work extra gently on most of her body, to focus on her shoulders and back, and to lay off her feet. What is most important, at least I believe, is the invitation for Mary to inhabit her body without resentment. Our one hour a week may be one of the few occasions where she can feel the sensations of her body without bracing herself against them. This increases her overall body awareness as well as palpably easing her anxiety.

And without all that struggle, she is able to relax and connect with me in a very human way. She doesn’t always remember my name (though I wear a nametag), and she repeats the same sentences over and over. But she always remembers that I have two daughters and am in the process of adopting the youngest. She asks about them every time.

Mary is one example of the numerous people with Alzheimer’s and dementia who I have had the good fortune to work with over the years. I’ve been a massage therapist for eleven years but have focused primarily on working with folks who have Alzheimer’s and dementia for the past six years. I work at a memory care facility that houses only this specific population.

Every one of my clients is supremely unique, with specific needs and thresholds. More often than not, I work with the residents for frequent, shorter chunks of time—fifteen minutes, twice a week is the most common—where they stay fully clothed and sit in a comfortable chair in a public area. It takes them such a long time to undress and re-dress, and the effort of climbing on and off of a standard massage table is just too much for most of them. But there are a few—Mary being one of them— who are agile enough to get on the massage table and who want only that.

Regardless of where the massage session is located, or how long it lasts, the connection is still there and is the pinnacle of our work. Every human has a basic need for caring touch, and although the staff where I work is exceptional, the fact is they have many people to look after. Often the residents’ experience touch primarily when they are getting dressed or toileted—the daily necessities.

The touch provided by a massage therapist is of a very different variety. It provides nurturance and attendance, sometimes helping a drowsy resident to grow more alert, sometimes aiding an agitated resident to calm down.

I also work as another set of eyes and ears to help provide the best care for these residents, letting the nurses and family know if a resident is more restless or confused than usual, or if they are complaining of pain in a certain area. This provides many of the families (as they are the ones who hire me) with a bit more peace of mind. It certainly does take a village.

One of the things I love most about working with this specific population is the genuineness of our interactions. There is nothing to ‘fix’, as it were, simply comfort and connection to offer. Most of my clients are not able to hold a typical conversation, so finding a way to relate with them requires a bit more curiosity and imagination. When I am attentive and grounded, my time with my residents feels incredibly valuable and satisfying. So when something is off, I can usually trace it back to where my mind and heart are at, how present I am being with them. This is a great service to me.

So when I am about to leave Mary in her room after her massage session, she may or may not want to come out to the common area with me. Likely not. But she does have a certain sparkle in her eye and a smile on her face as we hug and she says, thank you.

Heather Campbell Grimes is a blogger, freelance writer, and stage performer. Heather is also a massage therapist who specializes in working with elders who have Alzheimers and dementia. She is a devoted mother and foster-mother, and she lives with her husband and family outside Boulder, Colorado. You can find Heather at hcgrimes.org.

Acupuncture for Alzheimer’s and Dementia

senior in hat

Alzheimer’s disease and dementia impact over 5 million people in the United States. According to the Alzheimer’s Association, nearly 70,000 people in Colorado live with memory loss. With Alzheimer’s and dementia on the rise, complementary care options are critical for helping manage this widespread health crisis. Acupuncture can be an effective part of treating the many symptoms that occur with Alzheimer’s and other forms of dementia.

Alzheimer’s is a difficult condition to treat. Like many complex diseases, the causes are not well understood. Western medical intervention can help patients manage certain symptoms, but conventional treatment options have been ineffective in halting the progression of the disease. Given the increasing number of patients diagnosed with this illness, and the growth of our aging population, pharmaceutical companies and research institutions are scrambling to find a cure for this devastating disease.

Alzheimer’s and dementia primarily affect people over 65, though early-onset dementia does occur. There are currently 5.5 million people living with Alzheimer’s or dementia in the United States, and that number is expected to rise as our population ages. The widespread prevalence of these conditions has shot up dramatically over the last 17 years; since 2000, deaths from Alzheimer’s disease have gone up 89%. Alzheimer’s is now the sixth leading cause of death in Colorado and the United States as a whole.

The course of cognitive diseases like these can be long. Some patients live a decade with progressively complicating symptoms. There are currently no known cures or preventative methods to stop Alzheimer’s disease. This means the full burden of the disease usually comes in old age when one’s health may already be compromised. It is not uncommon for older adults living with Alzheimer’s or dementia to have diabetes, heart disease, or other chronic illnesses.

Even in elders who do not exhibit memory loss, old age brings a host of physical and mental difficulties. Acupuncture excels in treating many conditions that show up in our later years, including arthritis, digestive issues, insomnia, hypertension, depression, and anxiety. It is important to remember that although Alzheimer’s and dementia are memory disorders, patients may suffer from physical illnesses that are manageable through complementary medicine, such as massage and acupuncture.

We know that the personality changes that accompany dementia can be challenging, both for patients and caregivers. Recent research in the U.S. on the efficacy of acupuncture in treating depression and anxiety in Alzheimer’s patients has been promising. These diseases can instigate profound feelings of despair and cause an increase in social isolation. Acupuncture, different from talk therapy, offers a body-mind treatment that can calm feelings of anxiety and lift the mood. Treatment offers patients the chance to interact with someone outside their normal sphere of care, which can stimulate social connection.

Acupuncture also excels in treating pain of all kinds. Many seniors report living with pain, which can lead to a decrease in physical activity and changes in sleep patterns. Movement is critical for maintaining health and inspiring participation in activities that bring us joy. Many dementia patients are still capable of physical exercise and should be encouraged to stay active as a way of promoting their overall health. Acupuncture keeps seniors moving by alleviating back, knee, neck, and foot pain.

Expanded research on using acupuncture and Chinese herbs in treating Alzheimer’s is being explored in China and Japan where prevalence of the disease is also on the rise. While we cannot claim that East Asian medicine currently offers a strong method for halting or reversing this disease, we can provide supportive care in the realm of helping to manage co-existing symptoms. Hopefully, as research on Alzheimer’s and dementia increases, comprehensive approaches to treatment will become available to patients at all stages of the disease. Ideally, we will discover ways of preventing these conditions as well.

At Boulder Acupuncture and Herbs, we treat patients in the early and middle stages of Alzheimer’s and dementia. We use both acupuncture and Shiatsu to help manage pain, depression, fatigue, and anxiety in patients with cognitive disorders. Our approach to each patient is dependent on the client’s comfort level, receptivity, and physical condition. Some patients may be seen privately, while others need a care partner present. We can also visit patients in their homes or in memory care facilities in Boulder.

The challenges of living with dementia can be overwhelming for many patients, especially during the early stages of the disease when rapidly changing capabilities can cause intense distress. Similarly, caring for a loved one diagnosed with dementia is also incredibly challenging. Managing this disease is a group effort, and we want to be of service. Call us to discuss how acupuncture might help ease the discomfort of living with dementia.

Prescription Opioid Abuse in Elders

brain

The prescription opioid epidemic in the Unites States has reached unprecedented numbers. The Department of Health and Human Services states that nearly 80 people die from opioid-related overdose in the Unites States every day. These deaths come from both recreational drugs, like heroin, and prescription painkillers. Seniors are particularly at a risk because they are often prescribed these medications for pain. Luckily, acupuncture can offer immediate help with prescription opioid abuse in elders.

But first, how does opioid abuse develop? Prescription painkillers are best used to manage acute pain, meaning post-surgical discomfort or after sustaining an injury or fall. Chronic pain, such as that associated with arthritis or old injuries, is less responsive to opioid intervention and can actually create a cycle of tolerance and dependence.

How did we reach this point of widespread addiction to pain medication?

A contributing factor was the medical community’s shift to treating pain as the “fifth vital sign” starting in the 1990s. This meant that after heart and respiratory rates, blood pressure, and body temperature, doctors screened patients about pain. For patients living with pain, this was a blessing. As many chronic pain sufferers will attest, intractable pain can lead to depression, loss of income, and strained personal relationships. There is no doubt that chronic pain changes the landscape of life.

Despite their efforts to alleviate pain, the medical community’s move to prescribe high-powered medications to help millions of patients has resulted in a complex public health problem.

Although the face of the opioid epidemic is not typically portrayed as a senior aging at home, we know elders are impacted by this trend. Kaiser Health News reported that in 2011, 15% of Medicare patients were prescribed opioids after a hospital visit. Ninety days after being discharged, 42% of those patients were still taking those medications. Clearly opioid abuse is becoming a concern for elderly patients.

The Dangers of Opioid Abuse in Elders

Painkillers change pain perception by activating opioid receptors in the brain. The relationship between a pain site and the way the brain recognizes pain are altered by the addition of prescription medication. As the brain becomes accustomed to the flood of introduced opioids, its receptor sites multiply. This is why opioid drugs are so highly addictive. The body becomes chemically dependent on receiving this additional influx of opioid to function comfortably.

The side effects of opioid use in seniors are especially worrisome, including changes in cognition and poor motor control leading to falls. When taken in high amounts, these medications are particularly dangerous. For elders with memory impairment, accidentally doubling up on doses can be deadly.

Unlike younger adults seniors do not metabolize opiates at the same rate, meaning more of the drug is likely to stay in the body for a longer period of time. Family members or friends who sympathetically offer painkillers should be aware that elders carry a greater risk of overdose due to decreased liver and kidney capacity. Never share opioids with a senior.

Even when elders are appropriately prescribed opiates, these medications can bring unwanted negative symptoms, including:

  • nausea
  • constipation
  • urinary retention
  • sedation
  • skin rashes
  • compromised respiration
  • cardiac symptoms
  • lowered libido
  • heightened pain perception
  • decrease in bone density

For some patients multiple doses of opioids per day can lead to physical dependence in less than one week. It is important that elders have a recovery plan in place to transition off of these drugs as soon as possible.

This is where acupuncture can help.

Acupuncture Helps Prescription Opioid Abuse in Elders

 Pain creates neural pathways in the brain that stimulate the body to release its own naturally occurring opioids, including endorphins. When pain thresholds are exceeded, such as after surgery, the body cannot control the sense of discomfort. Prescription opioids are particularly useful in helping the body manage this type of severe pain.

Over time, as the trauma from surgery or a fall heals, communication between the pain site and the brain relaxes. In an ideal scenario, painkillers—natural and introduced—are no longer needed. When the body does not heal effectively, pain can linger, continuing to send alarm messages to the brain. Chronic pain creates a particularly insidious cycle of depletion in the body, requiring higher and higher doses of medication to provide relief.

The insertion of acupuncture needles naturally stimulates the release of endorphins, assisting the body in repairing itself. Acupuncture also combats inflammation, which reduces feelings of pain and stiffness. It increases blood flow, helping tissues flush out stagnant blood and encouraging the lymphatic system to repair compromised areas. And, most importantly, it interferes with the distressed messages ricocheting between the brain and distal pain sites, leading to a real change in pain perception.

All of this occurs over repeated acupuncture treatments. Patients suffering from chronic pain, and especially those on opioids, should expect to receive multiple acupuncture treatments to change underlying dysfunction. In some cases, acupuncture is incapable of resolving the pain entirely, especially if the trauma happened years—or decades—ago. Our goal is to help patients feel as comfortable as possible given their personal health history and constitution.

It is important to remember that acupuncture does not work like a pill. Once a patient has become accustomed to taking medication, especially an opiate, the expectation that acupuncture will bring substantial relief right away is misplaced. A course of treatment can last anywhere from two to six months, and sometimes longer, depending on the severity of the condition.

Chronic pain is a complicated problem. It requires clients, and practitioners, to be patient with the body as it repairs itself. Additionally, if a patient is addicted to opioid medications, the process of reducing prescription dependence is particularly challenging. It requires a team approach, which can include medical care, physical therapy, massage, and acupuncture. Get help when it’s needed, and don’t give up too quickly.

Alta Mira recovery center in California says that drug dependence in elders can be overlooked or dismissed because of a perceived lack of urgency. This attitude is often motivated by our cultural beliefs about the limits of old age. At Boulder Acupuncture and Herbs, we are committed to offering seniors access to drug-free alternatives that do not erode quality of life, no matter your age.

If you or a loved one is caught in the cycle of chronic pain, call us today. If you’ve sustained a recent injury, get in to see our acupuncturist right away. Acupuncture will speed up the recovery process and lower your risk of developing drug reliance. And if opioid abuse is already a concern, talk with us about how we can work with you and your doctor to break the cycle of dependence.

For more information on chronic pain in elders, see our article Pain Management in Older Adults.

 

Works Referenced

Chau, Diane, et al. Opiates and Elderly: Use and Side Effects. Clinical Interventions in Aging. 2008. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2546472/.

Esposito, Jenny. Silent Epidemic: Seniors and Addiction. U.S. News and World Report online. December 2, 2015. http://health.usnews.com/health-news/patient-advice/articles/2015/12/02/silent-epidemic-seniors-and-addiction.

Gold, Jenny. Opioids Can Derail the Lives of Older People, Too. http://www.npr.org/sections/health-shots/2016/12/20/502470255/opioids-can-derail-the-lives-of-older-people-too.

Prescription Opioid Abuse In The Elderly An Urgent Concern. Narcanon website. http://www.narconon.org/blog/narconon/prescription-opioid-abuse-in-the-elderly-an-urgent-concern/.

Sphar, Brittany. Opioid Considerations in the Elderly. Presentation at University of Colorado Internal Medicine Department of Geriatrics Grand Rounds. March 17, 2016. http://www.ucdenver.edu/academics/colleges/medicalschool/departments/medicine/geriatrics/grandrounds/Documents/15-16/GeriatricGrandRounds-Sphar-031716.pdf.

The Opioid Epidemic: By the Numbers. U.S. Department of Health and Human Services. Updated June 2016. https://www.hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf.

Why Opioid Addiction in Seniors Remains a Hidden Epidemic. Alta Mira website. Posted September 2016. https://www.altamirarecovery.com/blog/opioid-addiction-seniors-remains-hidden-epidemic/.

 

Acupuncture: Breaking the Cycle of Pain and Depression in Seniors

Chronic pain andsenior playing piano depression are frequently diagnosed in senior patients. Conventional medical treatments for these conditions include surgery, prescription medications, and physical therapy. For some seniors, these measures are not enough. Once initiated, the antagonistic relationship between depression and chronic pain can become debilitating, requiring higher doses of medication and increasingly complicated surgeries. Acupuncture can successfully break the cycle of pain and depression in seniors, offering exponential relief from both physical and mental symptoms.

In our previous article, Acupuncture: An Ideal Treatment for Senior Depression, we learned that depression impacts 14% of seniors in Colorado. Recognizing the physical and psychological symptoms of depression in older adults is important, as they can be different from those of younger patients. We now know that chronic pain is a key indicator for depression in elders.

Pain has a wide-reaching impact on senior health. Just under half of elders report living with pain—and those numbers can climb to as high as 80%. Pain distorts daily life and can lead to mental health complications, such as social withdrawal, depression, and anxiety. Managing the link between pain and psychological discomfort is critical for effectively treating elders. The Western medical community has long recognized this connection, though the side effects of conventional treatment options can create a new set of difficulties for seniors. Let’s look at how pain and depression are treated by medical doctors.

Pain and Depression in Western Medicine

The relationship between depression and pain is well documented in Western medicine. Chronic pain patients are three times more likely to suffer from depression and anxiety. Similarly, depressed patients are more susceptible to chronic pain. With this link identified, many psychiatric pharmaceuticals, such as SSRI and tricyclic antidepressants, treat pain in addition to mood.

Pain patients often have difficulty sleeping, present with lower energy, feel concerned about their future, and report that daily activities require an extra push. The brain pathways created through serotonin, a neurotransmitter that contributes to feeling well, are modified in patients with chronic pain, as well as those with depression. These changes can cause heightened pain perception, instigating negative shifts in mood. This is one reason why many patients living with chronic pain are on more than one medication, including sleep aids and mood stabilizers, in addition to pain prescriptions.

Because pain is so prevalent in elders, many patients are also prescribed opioids, such as Fentanyl and OxyContin. These drugs can heighten social withdrawal and lethargy, especially when prescribed in high doses. For patients whose physical activities, mental stimulation, and social interaction have diminished, fewer opportunities exist to break the cycle of pain and isolation. Many elders become completely reliant on medication to manage their pain, contributing to feelings of depression.

The constellation of symptoms accompanying chronic pain can be difficult, and costly, to manage. Older adults living with pain and depression especially present a complicated health picture and are at a greater risk of being medicated for overlapping conditions. Since most senior depression develops later in life, often accompanied by chronic pain, we cannot ignore the relationship between physical discomfort, mental health, and drug interactions.

Luckily, acupuncture offers a low-cost, drug-free option for treating this complex problem.

Treating Pain and Depression in Seniors with Acupuncture

Elders often experience dramatic changes in health, social roles, financial stability, living conditions, and support systems in their later years. The vulnerability accompanying old age is profound. Losses in ability can create both mental and physical handicaps in patients who were once vibrant and self-directed. Even more than increasing pain levels, loss of ability to take part in previously well-loved activities poses a greater risk for depression in elders. We must keep seniors mentally and physically engaged.

Acupuncture is a full-spectrum, drug-free pain treatment option with impacts far beyond the relief of physical symptoms. Through strategically placed stainless steel needles, we can positively interact with muscle fibers, blood pathways, and biochemical responses in the organs, including the brain. Acupuncture breaks the cycle of pain by disrupting dysfunctional communication trails between the brain and the body. This allows the body to reset its pain receptors while simultaneously healing the location of the trauma.

One way we do this is by treating the brain, and distal parts of the body, through points on the ear. The ear has a direct line of communication to the brain and can be used to stimulate the release of endorphins, shift the flow of blood from one part of the brain to another, and send messages to the rest of the body. Treatments combining the use of ear acupuncture with points elsewhere on the limbs and trunk are effective in treating many different ailments.

The number-one reason older patients try acupuncture is to manage chronic, recalcitrant pain. Though because the benefits of acupuncture are not well publicized in senior populations, many patients I see only consider acupuncture after years of surgery, physical therapy, and medication. Their pain levels are often quite high, even after conventional medical intervention. Lurking beneath the surface of the physical symptoms, depression and anxiety often hide in the background, aggravating pain perception.

Acupuncture offers a win-win option in breaking the cycle of pain and depression because we address physical and psychological symptoms at the same time—all without the intervention of drug therapy. Best of all, if you or a loved one is currently on medication for pain, insomnia, or depression, acupuncture will not negatively interfere with those prescriptions. It is a safe addition to your healthcare plan that can fill in the gaps left by more conventional treatments.

Our elders need alternative options for managing pain and depression. Boulder Acupuncture and Herbs is committed to offering affordable treatment options to seniors living with these debilitating conditions. If you have questions about how acupuncture can become a part of your treatment plan, call us today.

In our next article, we will look at a growing healthcare concern in senior populations, opioid addiction, and how acupuncture can help.

 

Works Referenced

Chou, Kee-Lee. (2007). “Reciprocal relationship between pain and depression in older adults: evidence from the English Longitudinal Study of Ageing. Journal of Affective Disorders. Volume 102.

Colorado Department of Public Health and Environment. 2016. The health of Colorado’s older adult population data infographic. http://www.chd.dphe.state.co.us/Age/Healthy-Aging-in-Colorado-Infographic.html

“Depression and Pain.” (2009) Harvard Health Publications online. http://www.health.harvard.edu/mind-and-mood/depression_and_pain.

Korff, Michael, et al. (1996) “The Relationship Between Pain and Depression.” The British Journal of Psychiatry. Volume 168.

Acupuncture: An Ideal Treatment for Senior Depression

senior alone on bench

Depression impacts 14% of seniors in Colorado. The symptoms of depression in older adults can range from fatigue and poor appetite to hopelessness and thoughts of suicide. Most elders living with depression do not develop symptoms until later in life and are often unfamiliar with treatment options. In addition, many may be reluctant to share details about their experience due to a perceived social bias against mental illness. Acupuncture, because of its unique ability to simultaneously address both the physical and emotional aspects of health, is an ideal treatment for senior depression.

The factors leading to depression in seniors are different from those of younger adults. Many of these factors are linked to physiological changes that may appear with age. Patients with advancing stages of certain diseases, such as Alzheimer’s and dementia, often develop depression due to organic changes in the brain. Other seniors are impacted more by the social implications of aging, including a loss of freedom, autonomy, purpose, and meaningful identity.

In this article we will first become familiar with physical and mental considerations in identifying senior depression. We will then look at when acupuncture is an ideal choice for an elder living with this condition. Because of the far-reaching, and potentially devastating, effects of depression, we must understand how to offer the right assistance at the right time.

 

Physical Symptoms in Senior Depression

Particular diseases are linked to depression in older adults. Patients with Alzheimer’s disease, Parkinson’s, dementia and those recovering from stroke carry a greater risk of developing depression due to physical changes in the brain. Elders with cardiovascular disease, hypo- and hyper-thyroidism, and Type II diabetes also show a propensity for depression. Often patients are treated for mood changes in the context of managing these chronic illnesses.

When identifying depression in a senior, it is imperative to determine if mood changes are due to the progression of a disease, either previously diagnosed or currently unidentified. Mental health shifts can point to hidden physiological changes that must not be overlooked. Always consider whether a change in mood is coming from physical illness before starting treatment for depression.

Even with this screening in place though, many seniors my not articulate their feelings of sadness, hopelessness, or anxiety openly to family or caregivers. The signs of depression in seniors can be difficult to identify and are sometimes dismissed as being part of “old age”—even by the patient herself. While aging does bring unique life challenges, certain physical changes should not be ignored.

 

Possible Physical Indications of Depression in Seniors

Insomnia: Insomnia and depression are closely linked in elders. Patients with lifelong sleep problems have a higher risk of developing depression. A recent onset of insomnia may also indicate a senior is having a mood shift. Correcting the insomnia is important, as poor sleep lowers immunity, clouds cognition, and can lead to accidents and falls.

Fatigue: Daytime exhaustion may be a sign of poor sleep, but this is not always the case. Fatigue can point to a variety of issues, including physical complications from hypotension or hypothyroidism. Fatigue can also be a sign of mental disengagement and avoidance. Both fatigue and depression can create a sensation of being physically “dragged down,” leaving the patient feeling helpless to complete the basic Activities of Daily Living (ADLs) or engage socially with friends and family.

Lack of Appetite: Disinterest in food can also be a sign of depression in seniors, a condition we see more in women than men. The implications of poor nutrition are numerous, including blood sugar instability, increased frailty and risk of falls, and dehydration. Diseases of the digestive tract should be ruled out, including constipation.

Physical symptoms are sometimes the only clues we have to helping seniors with mental health concerns. If you notice changes in sleep, appetite, or energy levels, see a medical doctor to rule out infection or disease. Often shifts in mental outlook are directly related to changes in physical health, especially in patients managing complex diseases. A clear diagnosis is always the first course of action.

 

Mental Symptoms in Senior Depression

Depression can be tied to a number of triggers in older adults. For some, the losses of aging—including diminished physical vigor, reduced mental clarity, changing social roles, and grief over losing a spouse—can be overwhelming. Lack of control over the processes of illness and death may cause some seniors to feel regret, sorrow, and fear. Caregivers should be able to offer solace and companionship to elders who are navigating this difficult terrain.

Life changes that may trigger depression in a senior include:

  • Death of a spouse
  • Moving to assisted living, a memory care unit, or a skilled nursing facility
  • Deterioration of physical health
  • Memory loss, especially in the early stages of Alzheimer’s
  • Change in financial status
  • Sudden isolation
  • Loss of a social role, either in the family or community

Seniors may also experience a state of “depression without sadness,” meaning they can be depressed even in the absence of an emotional trigger. They may say they have nothing to feel sad about, and yet, as caregivers, we may observe physical or emotional changes that suggest there is something deeper going on. The following indicators may help us identify hidden symptoms of depression.

 

Possible Mental Indications of Depression in Seniors

Anxiety: Seniors who are anxious are more likely to develop symptoms of depression if triggered by a life-changing event. Also, elders who live with both anxiety and depression may not respond as quickly to conventional treatment (medication and psychotherapy). Helping seniors feel less anxious may lead to emotional resiliency and feelings of self-empowerment and stability in the face of difficult life transitions.

Lack of Interest in Life: Engagement, purpose, and connection are important during every phase of life. Some elders see the last phase of life as an opportunity to let go of relationships, roles, or obligations they no longer need or enjoy. For some, self-reflection becomes their main focus. Others use this time to create relationships, travel, or learn new hobbies. A lack of interest in life, including hopelessness about the future, could be a sign of depression in an older adult and should be taken seriously.

Grief: Grief, or bereavement, is differentiated from depression. At the same time, untended grief can turn into depression, especially if the loss of a loved one coincides with another trigger, such as a move to an assisted living facility. Some elders may feel they need to “get over it” but are unable to transform their grief in a timeframe that feels reasonable to them. It is important to tap into a network of care for elders working through loss of a loved one. Luckily, hospices across the country offer grief counseling and support groups for the bereaved. These services are often free and can make an enormous difference in an elder’s recovery.

Mental and physical symptoms often mix to present a complicated health picture in older adults. The combination of emotional loss and changes in physical wellbeing can initiate feelings of despair in elders who have lived long lives of independence and vitality. Attending to both physical and emotional needs is crucial for maintaining a positive mental outlook in seniors and offering the best care possible.

 

Acupuncture for Depression in Seniors

Acupuncture is a unique drug-free alternative that treats a spectrum of body-mind concerns in older adults. Treatments are automatically designed to address physical issues, as well as mental discomfort. In fact, acupuncture theory is built on an inherent relationship between physical wellbeing and mental health.

Acupuncture is particularly powerful in treating seniors because we begin by addressing physical discomfort. Older adults usually feel safe talking about pain or the progression of diseases, such as hypertension and COPD, with an acupuncturist. Patients understand that acupuncture helps with physical ailments, and they can measure changes in physical health after seeing a practitioner.

The benefit of having an acupuncturist on your caregiving team is that patients receive emotional support in the context of physical care. This mimics the Western medical model of going to the doctor for physical pain and being asked about mood. I find patients respond well to this approach and are grateful that I ask about their mental wellbeing.

When I treat older adults, I always ask about mood. Some patients talk openly with me about their feelings; others are more private with their answers. I work to create a relationship of trust so that patients understand I am committed to helping them both physically and emotionally. Each of my treatments addresses the body-mind spectrum.

If patients wish to share how they’re feeling, acupuncture treatments almost always allow time for connecting. While clients are resting with needles inserted, I offer to talk if they feel inclined. This combination of authentic listening, attention to physical care, and gentle touch make a noticeable difference in an elder’s life.

At Boulder Acupuncture and Herbs, senior mental health is important to us. We are connected to social workers, psychotherapists, geriatric medical doctors, and other alternative medical practitioners who can help. If acupuncture is not the ideal treatment for you or a loved one, we will refer you to the right provider.

Emotional wellbeing is an important part of healthy aging. Our mission is to provide full-spectrum care for every senior we see in our clinic. When you work with us, you can be confident we will always consider your mental health concerns in the context of treating your physical condition.

 

Works Referenced

Carnarius, Megan (2015). A Deeper Perspective on Alzheimer’s and Other Dementias: Practical Tools with Spiritual Insights. Findhorn Press (Scotland, UK).

Colorado Department of Public Health and Environment. 2016. The health of Colorado’s older adult population data infographic. http://www.chd.dphe.state.co.us/Age/Healthy-Aging-in-Colorado-Infographic.html.

Fiske, Amy, et al. (2009). “Depression in Older Adults.” Annual Review of Clinical Psychology. Accessed via National Institutes of Health https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852580/.