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

Pelvic Pain • 1 in 10 women between ages of 18-50 suffer from chronic pelvic pain. – Endometriosis – Pelvic inflammatory disease

– Ovarian cysts – PCOS – Musculoskeletal – Constipation – Irritable Bowel Syndrome

– Uterine fibroids – Poor posture

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.

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.

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.

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”!

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.”

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.

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.

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

“Wai Yin”

External • • • • • •

Wind Cold Heat Dampness Dryness Summer-heat

“Nei Yin”

Yin Internal

TCM Definition: seven effects or emotions

• • • • •

Anger Fear Thought Grief Joy

→ → → → →

Liver Kidney Spleen Lung Heart

Neither “Bu Nei Bu Wai Yin” • • • • •

Trauma Iatrogenesis Ex. BCP Diet and Lifestyle imbalances Sexual Abuse Bedroom taxation

Traditional Chinese Medicine Patterns of Disharmony for Pelvic Pain Pattern Diagnosis usually involves: • • • •

Liver Qi Stagnation Blood Deficiency Blood Stagnation Damp-Cold

Liver Qi Stagnation: • • • • • • • •

Stabbing pain Irritability Hypochondriac pain Constipation Sore breasts Muscle tension Purple tongue Wiry pulse

Blood Deficiency: • • • • • • • • •

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

Blood Stagnation: • • • • •

Stabbing intense pain Tumors & cysts Menses with heavy clotting Purple tongue Wiry pulse

Damp-Cold: • • • •

Pain relieved by heat Loose stools Pale tongue with greasy coating Deep pulse

Mechanism of Disease Development Relates to different organs: • Pubescent • Middle Age • Elderly

→ → →

Kidneys Liver Spleen

Evaluation Develops: • Appropriate treatment strategy • Appropriate treatment methods

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.

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.

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.

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

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.

Many Factors must be taken into Account Potential Side Effects with Medications and Herbs

• • • •

Absorption Distribution Metabolism Elimination

Absorption • Binding in the Gastrintestinal Tract • Change in the pH of the Stomach ↓ acidity = less absorption • Change in Intestinal Motility

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

Metabolism • Liver Enzymer Inducer ↑ metabolism of herbs/drugs • Liver Enzyme Inhibitor ↓ metabolism of herbs/drugs • May need to ↓ dosage of drugs/herbs

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.

Formulation of Chinese Herbal Formulas

• Constitution • Synergistic and Antagonistic Effects

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.

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

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

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

Common Adverse Reactions • Nausea and vomiting • Constipation and diarrhea

• Headache • Allergic reaction

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

Prevention of Menstrual Disease and Pelvic Pain  Avoid excess emotions in general – fear, anger

 Avoid excess fatigue

 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

 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

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

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.

• 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.

Most Importantly:

BE HAPPY! • This is good for alleviating and avoiding most all health problems.

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

Thank you! Rande Lucas, L.Ac., MSTOM, RN, BSN 907-336-6692 [email protected]