d

Find the silence
   which contains thought.
       --Hakuin       

    

Pain

Neck pain? Back pain? Knee pain?
Sciatica? Headaches? Carpal Tunnel?


The list is endless. Pain is the #1 reason most patients come to see me. Acupuncture is widely recognized as being effective in treating pain and many insurance companies are moving quickly to cover acupuncture for the treatment of pain.


Acute Pain

To suffer an injury, you have asked your body to do something that it is not designed or prepared to do. The possibilities are endless-- sports injuries, repetitive use injuries, trauma, and injuries that “come out of nowhere.” Your body initially responds by sending a great deal of blood into the area to clean it, repair it and ultimately restore the area to its normal functioning. In this initial acute stage, the area swells with heat and fluid, splinting the area, which hopefully conveys the message to you not to move it.

Patients often ask me to clarify for them when to use ice vs. heat. Use ice with acute inflammation for generally up to 36-72 hours after an injury. Ideally, you can freeze a Dixie cup of water and perform ice massage for 5 minutes 3x/day. This can be accompanied by rest, compression (wrapping the area in an Ace bandage), and elevation for a limb injury in particular. Once the inflammation decreases to the touch and feels less “irritated” within, you can begin alternating ice with heat. Where ever ice goes, blood moves away, hence ice’s ability to decrease inflammation. Where ever heat goes, blood follows. It is through the infusion of fresh blood that healing can begin. But as you still may have minor levels of inflammation you start and end with ice. This may be used for 3-7 days depending on your response. From there you begin to move away from ice by beginning and ending with heat for another 7 days, again depending on your response. From here, you may fall into the chronic stage where heat can provide the greatest relief and ice is only used on the occasion where you may have aggravated the injury through overuse. One of the ways to identify whether the “stiffness” you feel is inflammation or simply tight muscles, is if the area feels worse with heat. You will usually know within moments. If so, you are inflamed and should stop using heat immediately and begin using ice.

The sooner you get treatment, the quicker your results are likely to be. Acupuncture and Chinese herbs are excellent for all acute injuries, especially in conjunction with Western medicine and its ability to properly diagnose the severity of the injury—sprains, strains, breaks, etc. Even if you have broken your ankle and are in a cast, the beauty of the way I treat is that I never place needles at the sight of the acute injury. More often than not, I needle the opposite foot and opposite hand with great affect. And herbs can be a tremendous help in repairing tissue and bone. Through 4000 years of use, the Chinese have figured out which herbs go to which part of the body. When you take an aspirin, it works systemically as it searches for areas of pain. With Chinese herbs, I can, in effect, give you an aspirin that is specific to your foot. How amazing is that?


Chronic Pain

The transition from the acute stage to the sub-acute stage can take sometimes just a few days if treated properly. It is often signaled by a marked decrease in inflammation—though there could remain a low-grade chronic inflammation that is more of a systemic imbalance and should be diagnosed by your physician-- and a reduction in swelling with a commensurate increase in range of motion and a more comfortable resumption of daily activities. From the sub-acute to the chronic stage can take anywhere from a week to a few months. It is in this time that pain can still linger. Why?

There are 3 aspects of chronic pain to consider:

1. There may still be physiological reasons for the pain.

a. There may be trigger points—adhesions in the local tissue, called fascia, that are painful and can refer pain to other areas in your body. Let’s say you have suffered from “tennis elbow.” Even after the acute inflammatory tendonitis is gone, we would still need to work out the soft tissue in the forearm to clear out any irritating knots. As long as they continue to be present, the proper functioning of your local muscles will be compromised creating a greater chance of the tennis elbow to return.

b. There could be vertebral disc issues, like a bulge or herniation, that need to be managed and supported through proper treatment like acupuncture, physical therapy or chiropractic care. This is most commonly seen in neck and low back injuries.

c. There could be postural imbalances that contributed to your injury in the first place and continue to support the presence of pain even long after the injury has occurred. The knee is the most obvious example here. Uneven gait patterns can translate up to the knee contributing to pain, which can further translate into the hip and low back contributing to pain there, too. The body desires balance and will find it one way or another. It does so through compensation patterns that, in and of themselves, need to be unwound and eventually corrected if new areas of pain are to be prevented from occurring.

d. There may be ergonomic issues at play. What movements in your daily life are contributing to the imbalance and the resulting pain? Is it the way you sit at your computer, the clutch you use in your car, or picking up your 35lb baby everyday that is constantly aggravating your condition? How might we modify these activities?

e. There could be neuro-chemical imbalances in our brains, like being low in endorphins, which is our main endogenous analgesic.

f. Lastly, there could be organ imbalances that can be affecting channel flow. In Chinese Medicine, there are energy channels called meridians that flow through the body and connect to their respective organs. Imbalance in the organ can lead to imbalance in the meridian and vice versa. Consider chronic shoulder pain. You suffer from shoulder pain due to a car accident 5 years ago and have tried everything to treat it with little lasting result. How are your bowel movements? Are you constipated? Both the Large and Small Intestine Channel flow through the shoulder. Long-term constipation and indigestion can most definitely affect circulation in the shoulder.

2. There is your perception and experience of the pain.

Pain, in and of itself, is something we need to treat. This is why Pain Management is such a huge field of medicine. Acupuncture can be very helpful in this area. I expect to find the precise acupuncture point that can change your experience of your pain within seconds. That is how immediate this medicine can work. This may not immediately affect structure or the other reasons mentioned above for pain, but if your perception of the pain is lessened, then, for as long as it lasts, you have found relief. From there, your activities of daily living can resume, you can sleep more restfully, and we can even work on the local soft tissue with less irritation.

3. There is your attachment to the pain.

There is a fine balance between embracing your pain as part of you rather than something you must fight against, while at the same time not being consumed by it or identifying with it too much. Much of the dynamic in Western medicine is about fighting disease. Drugs are often prefixed with “anti”: anti-hypertensive, anti-cholesterol, etc. When we have chronic pain or any chronic condition, can we address the issue while at the same time not being at war with our own body? Can we welcome the messages the pain may be giving us? We may need pain medication, but do we rely on it too much in an effort to numb ourselves because we can’t deal with the real changes we must make?

The other side of this reveals itself in the language patients use. My red flags go up when I hear them say, “I have a bad back.” To me, it reveals how much they have identified with their pain, how attached to it they are and how much subsequent fear they may have of letting it go. Who would they be if they were not “Joe with the bad back?” What would they talk about instead? How else might they limit their involvement in their own life? What if they don’t have any more pain? What then?

The other type of statement I may hear is “I can’t stand the pain,” or if severe enough “I can’t live with this pain.” How disrupted is their spirit? Do they feel defeated by their pain? Do I need to refer them to a Psychotherapist or their Family Doctor for a different type of care? Should I be concerned for their safety?

When I feel a patient’s spirit is affected by their chronic pain, not only do I treat the pain, but I must also address the spirit. Each time I place a needle into a point and ask the patient to move their neck, for example, and the pain changes, I am introducing Possibility. I am introducing space for change, an opportunity for the patient to see that there is another way of experiencing their body that is not about their pain, but rather relief and pleasure. And when that patient drops into a deep restful state during the treatment, we are beginning to disentangle and re-wire their attachment to their pain. And if we can couple this profound kinesthetic shift with an understanding of their attachment to their former state, then we can begin to see longer-lasting change. And for the latter type of work, I encourage them to see a Psychotherapist to work out those issues. My role is to connect those troubled aspects of their spiritual body with their physical experience. Working from both angles yields the best results when it comes to this kind of chronic pain.

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Pain is a gift; it is a messenger. It says, “Pay attention to this area. Something is wrong and we need to fix it.” Not feeling pain is a problem. Yet it is simply easier for most of us to numb ourselves out of feeling it, repress it, or live in denial of it. For to do otherwise, necessitates action. When you are ready to act and to address your pain, I can help.

We are fortunate to be living in a time where the choices for treatment are abundant. Where we can utilize all the diagnostic gifts that Western Medicine offers to tell us what exactly is causing us pain. Yet, with or without that knowledge, there are choices like Chinese Medicine that can help you deal with all kinds of pain, no matter acute or chronic, structural or internal, physical or emotional. Your choices are many, and I am honored to be one of them.


 

© Jordan Hoffman, L.Ac., Dipl. OM, 2009. All Rights Reserved.

The information presented here is not medical advice, is not intended as medical advice, and is intended to provide only general, non-specific information related to Chinese Medicine and Acupuncture and is not intended to cover all the issues related to the topic discussed. You should consult a licensed health practitioner before using any of this information.

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2001 S. Barrington Ave. Ste 116 Los Angeles, CA 90025  l  21201 Victory Blvd. Ste. 135 Canoga Park, CA 91303  l  310-729-9061  l  © Jordan Hoffman Acupuncture 2010
 
 
This site and any articles on this site are not medical advice and are not intended as medical advice and are intended to provide only general, non-specific information related to Chinese Medicine and acupuncture and are not intended to cover all the issues related to the topic discussed. You should consult a licensed health practitioner before using any of the information on this site and any articles.