Acupuncture & Oriental Medicine Approaches to Women s Pelvic Pain. Rande Lucas, L.Ac., MSTOM, RN, BSN

Transcription

1 Acupuncture & Oriental Medicine Approaches to Women s Pelvic Pain Rande Lucas, L.Ac., MSTOM, RN, BSN

2 Pelvic Pain 1 in 10 women between ages of suffer from chronic pelvic pain. Endometriosis Pelvic inflammatory disease Ovarian cysts PCOS Musculoskeletal Constipation Irritable Bowel Syndrome Uterine fibroids Poor posture

3 Requires: Accurate assessment and work up to differential diagnosis and prescribed treatment plan. Diagnostic studies are used or exploratory surgery. Exact timing of when and how long the pain occurs in relation to a monthly menstrual cycle can often be a clue. Any abdominal or pelvic pain occurring monthly should be examined to see what changes of anatomy and physiology may be responsible for causing the pain. 35% have no clear cause. Diagnosis is difficult.

4 Traditionally Prescribed: NSAID s and pain medications. Tricyclic antidepressants or Gabapentin (for seizure disorders) stops nerves in pelvis from transmitting pain messages. Counseling Biofeedback, cognitive behavioral therapy, interpersonal counseling. 50% of chronic pelvic pain sufferers have histories of physical or sexual abuse. Hysterectomy 80% become pain free even when no specific diagnosis could be made. Embolotherapy minimally invasive surgery that blocks off bulging varicose veins.

5 Oriental Medicine s Perspective on Pelvic Pain Traditional Chinese Medicine (TCM) Theory Based on the concept of Qi which is energy that flows along meridians in the body. Disruptions in the flow of Qi causes disharmonies in the body which manifest as illness or pain. Needling acupuncture points regulates the flow of Qi.

6 What is QI? Qi vital force, root of the human body. Changes and movement of Qi explain all vital activities of the human body. It is what makes us us!

7 Pain TONG BU ZI TONG, BU TONG ZI TONG Where there is pain there is Qi stagnation, where there is Qi stagnation there is pain.

8 Causes of Disease in Oriental Medicine Disruptions in the movement of Qi create imbalances in the normal function of organs and meridians. Manifestations of Qi imbalance left untreated develop into disease. Qi is the commander of blood and blood is the mother of Qi. Explains the relationship for the material foundation of function activities of the body. Qi is Yang and Blood is Yin.

9 Yin and Yang Two mutually complementary and opposing principles Yang: Active, bright, male, summer, heat, daytime Yin: Receptive, dark, female, winter, cold, nighttime Used to explain some of the pathological changes of the organs and tissues.

10 Causative Factors of Menstrual Disease & Pelvic Pain External Internal Neither

11 External Wai Yin Wind Cold Heat Dampness Dryness Summer-heat

12 Yin Internal Nei Yin TCM Definition: seven effects or emotions Anger Liver Fear Kidney Thought Spleen Grief Lung Joy Heart

13 Neither Bu Nei Bu Wai Yin Trauma Iatrogenesis Ex. BCP Diet and Lifestyle imbalances Sexual Abuse Bedroom taxation

14 Traditional Chinese Medicine Patterns of Disharmony for Pelvic Pain Pattern Diagnosis usually involves: Liver Qi Stagnation Blood Deficiency Blood Stagnation Damp-Cold

15 Liver Qi Stagnation: Stabbing pain Irritability Hypochondriac pain Constipation Sore breasts Muscle tension Purple tongue Wiry pulse

16 Blood Deficiency: Dull pain Scanty menses Poor memory Anxiety Poor sleep & fatigue Dizziness Dull/pale complexion Pale tongue Choppy, thin pulse

17 Blood Stagnation: Stabbing intense pain Tumors & cysts Menses with heavy clotting Purple tongue Wiry pulse

18 Damp-Cold: Pain relieved by heat Loose stools Pale tongue with greasy coating Deep pulse

19 Mechanism of Disease Development Relates to different organs: Pubescent Kidneys Middle Age Liver Elderly Spleen

20 Evaluation Develops: Appropriate treatment strategy Appropriate treatment methods

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22 Steps to successful treatment of Pelvic Pain Intake: review of medical history, body systems and physical examination (includes pulse, tongue and abdominal & meridian assessment). TCM diagnosis is made based on categorization of the patient s signs and symptoms into TCM patterns of disharmony.

23 How does this relate to Pelvic Pain? Pelvis is a large area. Houses many organs and multiple meridians. Large amounts of blood pass through it. Movement of Qi and Blood through the pelvis is like a funnel as it passes into the lower body.

24 Treatment: May include different modalities such as acupuncture, moxibustion, herbs, and dietary modifications. Frequency: at least weekly for 8-12 weeks. Takes 3-6 months to regulate the menstrual cycle. Acupuncture works to balance the flow of energy and influence the proper function of organs. Herbs work at the biochemical level in the body.

25 Herbal Medicine in Treatment of Pelvic Pain Goals: Reduce Pain and Inflammation Regulate Menstrual Cycle Regulate Qi and Blood in Meridians

26 Chinese Herbal Medicine Herbal Medicine uses plants, animals and mineral Typically multiple herbs combined together Combinations of herbs that work together to increase the efficacy of the formula. Balances and avoids side effects Herbs should be treated just as a drug Prescribed by licensed and trained practitioners: Acupuncturists with training in Chinese Herbal Medicine.

27 Many Factors must be taken into Account Potential Side Effects with Medications and Herbs Absorption Distribution Metabolism Elimination

28 Absorption Binding in the Gastrintestinal Tract Change in the ph of the Stomach acidity = less absorption Change in Intestinal Motility

29 Distribution Narrow window of safety index Protein bound medications (ex. Coumadin, Dilantin) Difficult to predict interactions Start slow, increase gradually & monitor closely

30 Metabolism Liver Enzymer Inducer metabolism of herbs/drugs Liver Enzyme Inhibitor metabolism of herbs/drugs May need to dosage of drugs/herbs

31 Elimination Herbs are not usually a problem unless there is kidney disease or dialysis patient. Toxicity rare, but usually only when combined with other nephrotoxic herbs. Dosage is usually decreased when this is a concern. May need to check blood chemistry more frequently.

32 Formulation of Chinese Herbal Formulas Constitution Synergistic and Antagonistic Effects

33 Constitution Appropriate for the patient. Will the patient be able to tolerate the formula prescribed. Herbs are often bitter in nature and can be difficult to digest. Treat at the root level.

34 Synergistic and Antagonistic Effects: Synergistic enhances the overall function of the formula Antagonistic effects balance the formula and prevent side effects. Ex. Gan Cao Licorice

35 Herb-Drug Interactions Anticoagulants Blood invigorating herbs Diuretics may further deplete electrolytes (1 of banana = 1meq K+ Potassium) Sympathomimics caution used with hypertension, seizures, diabetes, thyroid conditions

36 Other Issues to Consider Pregnancy generally prohibited, but some can be used with caution Nursing presence of herbs in the breast milk, but can be a way to treat babies Geriatrics slower absorption, metabolism, and elimination Pediatrics works well, but taste is challenging

37 Common Adverse Reactions Nausea and vomiting Constipation and diarrhea Headache Allergic reaction

38 Prevention of Interactions: Take Herbs and Medications separately by 2-4 hours. Herbs should be treated just as a drug. Prescribed by licensed and trained practitioners, Licensed Acupuncturists with training in Chinese Herbal Medicine. Lifestyle

39 Prevention of Menstrual Disease and Pelvic Pain Avoid excess emotions in general fear, anger Avoid excess fatigue

40 Women shouldn t dwell on negative thoughts or frustrations Leads to Liver Qi depression/stagnation and Blood stasis Avoid chilled, uncooked foods prior or during menses and avoid catching any external cold diseases Prevents Blood from being congealed

41 Avoid intercourse during menses Damages meridians Leads to flooding and/or leaking Can also develop abnormal vaginal discharge, blocked menstruation, congealed lumps in lower abdomen

42 Eat and drink moderately, and avoid stimulating foods Maintain regular sleep cycles

43 In Closing: Oriental Medicine can be successful in eliminating pelvic pain because treatment occurs at the root level, not just at symptoms. Acupuncture works very well in pain management and reducing inflammation. Combined with allopathic medicine it can reduce or eliminate need for narcotic pain relievers.

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45 Chinese Herbs are best utilized when a pattern of diagnosis is defined using Traditional Chinese Medicine framework. Application of Chinese Herbs based solely on symptomology can result in unsuccessful resolution of problem and doesn t address the root problem.

46 Most Importantly: BE HAPPY! This is good for alleviating and avoiding most all health problems.

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48 Bibiography Maciocia, Giovanni. Obstetrics & Gynecology in Chinese Medicine. NewYork: Churchill Livingstone, 1998 Flaws, Bob. A Handbook of Menstrual Diseases in Chinese Medicine. Boulder: Blue Poppy Press, Inc, 1997 Masakazu, Ikeda. The Practice of Japanese Acupuncture and Moxibustion. Seattle: Eastland Press, 2005 Deadman, Peter, Al-Khafaji, Mazin. Manual of Acupuncture. East Sussex: Journal of Chinese Medicine Publications, 2001 Kaptchuk, Ted. The Web that as no Weaver. Chicago: Contemporary Books, 2000

49 Thank you! Rande Lucas, L.Ac., MSTOM, RN, BSN