Acupuncture Therapy for Lymphedema
My Personal Opinion - Acupuncture and Lymphedema
It is rare that in this website I offer my own personal opinion on a treatment option. Usually I give the information for my readers to draw their own conclusions based on the evidence provided.
However, there is one treatment that is beginning to be used for lymphedema that I feel so strongly about, I must comment.
Dangers with Acupuncture and Lymphedema
1. The many holes put into your leg offers a wide open gate to potentially life threatening infection. Bacteria will have many access points to inside your lymphedema limb. Each one of these holes can become a prime septic foci for a potentially life-threatening bacterial infection.
We must remember that a limb with lymphedema is an immunodeficient limb, in others words the entire immune response mechanism in that a limb is effected. This makes us especially susceptible to infections such as cellulitis, lymphangitis, lymphadenitis, impetigo and erysipelas. Each infection also causes further damaage to the remaining lymphatics.
2. The lymphorrhea (fluid) that is drained by this action has disastrous effects on your skin. The fluid is very caustic and can cause severe deterioration of the dermal layers. Skin breakdown from this fluid is a very real danger.
3. This is only a crude stop-gap treatment method. Without proper wrapping and garment use, the fluid will simply re-collect.
4. There is no uniform standard rules or laws throughout the United States that govern acupuncture. Nor are there laws regulating training, sanitation requirement or licensing. You are pretty much on your own when selecting an acupuncture therapist.
You must also have treatment and a self-management program of exercises, compression garments, and/or compression bandages that will prevent the accumulation of fluid.
It is interesting that having been challenged on the efficacy of using acupuncture for lymphedema, practioners are now claiming it is safe because the needles do not pierce the skin deeply or don’t even have to be used in the area effected by lymphedema. However, a dermal opening is still an opening whether or not it is in the lymphedematous limb.. Bacteria can still enter.
Four years after this page first came out, I stand firm in my opinion the acupuncture has no place in the treatment of lymphedema.
Finally, in the past year there have been interesting articles written, by Chinese doctors, themselves, urging a tightening up of the methodology and control. This is the weak area of research in attempting to verify the over-all efficacy of acupuncture in the treatment of many medical conditions it claims to help.
Please before you even begin to try this treatment, consider well the consequences.
Below information is a review of the medical literature.
Pat O’Connor
Update November 20, 2008
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What is Acupuncture?
It is an ancient Chinese form of medicine that the technique of inserting thin needles through the skin at specific points on the body to control pain and other symptoms. It is a type of complementary and alternative medicine.
Acupuncture as defined by the National Center for Complementary and Alternative Medicine is the practice of inserting thin needles into specific body points to improve health and well-being. It originated in China more than 2,000 years ago. American practices of acupuncture use medical traditions from China, Japan, Korea and other countries. In the United States, the best-known type involves putting hair-thin, metallic needles in your skin.
With lymphedema patients, it also is used as a method of draining the accumulated fluids in a lymphovenous limb.
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NATIONAL LYMPHEDEMA NETWORK
Question Corner
From July-September 1998 NLN Newsletter
Addressed by Judith Casley-Smith, PhD, MD
Q: In February 1998, I had a lumpectomy with lymph node removal. When necessary, I have used acupuncture successfully for the past 15 years. I have been told not to do this anymore, but I’m not sure I understand why, since the acupuncturist washes down the area with alcohol, uses sterile needles which are then discarded and washes the area a second time after treatment. I get the feeling my doctor just doesn’t believe in acupuncture and this might be the reason for his feel-feelings on the subject. Is acupuncture really contraindicated for lymphedema patients and, if so, why?
A: This question brings another question to mind. Have you been having the acupuncture in the affected limb? If the acupuncture has been in the affected limb, then we would advise a patient to stay away from any potential needle sticks in spite of the best-intended sterile technique. If the needle stick of the acupuncture is in a remote part of the body, then the likelihood of infection to the affected limb certainly lessens, but does not completely go away. I would say acupuncture is contraindicated for lymphedema patients - certainly in the affected limb - and alternate modes of therapy should be tried before subjecting oneself to acupuncture generally when lymphedema is present. Those few patients who have tried it have reported no benefit or reduction in the lymphedema.
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Contraindications for Acupuncture from Memorial Sloan-Kettering Cancer Center
- Neutropenia, thrombocytopenia, or history of endocarditis
Acupuncture may increase risk of infection and bleeding. Use with caution. - Pregnancy
Pregnant women should inform practitioners before seeking acupuncture treatment - Lymphedema
Needles should not be placed in the limbs of patients with lymphedema. - Pacemakers
Electrical stimulation is contraindicated for patients wearing electronic medical devices.
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Safety Aspects of Acupuncture in Palliative Care
Summary
Acupuncture can mask symptoms of cancer and tumour progression. It is not safe to use such a therapy without full knowledge of the clinical stage of the disease,and the current status of orthodox therapy.
Contraindications to acupuncture needling include an unstable spine, severe clotting disorder, neutropenia and lymphoedema. Whilst semi-permanent needles are used increasingly in symptom control and pain management they should not be used in patients with valvular heart disease or in vulnerable neutropenic patients.
Acupuncture has an increasing role in support for pain and symptom management, but patients should not be advised to abandon conventional treatments in favour of complementary or alternative therapies alone, and should not have their hopes raised inappropriately, or have any guilt projected on to them for the cause of their cancer.
Key Words
Acupuncture, palliative medicine, adverse events, safety.
Jacqueline Filshie, Consultant in anaesthetics and pain management
Royal Marsden Hospitals, London & Surrey
Honorary senior lecturer, Institute of Cancer Research
Correspondence:
jacqueline.filshie@btinternet.com
Current situations about studies on the evaluation of clinical efficacy of acupuncture
Zhen Ci Yan Jiu. 2008 Feb
Chengdu University of Chinese Medicine, Chengdu 610075, China.
To evaluate the efficacy of acupuncture scientifically and objectively is a major issue for the development of acupuncture medicine. Although some progresses have already been gained in the research of the evaluation of clinical therapeutic effects of acupuncture at present, some problems as empirical evaluation method, following evaluation indexes of Western medicine, poorer quality of evaluation studies, etc. still exist. Thus, it is urgent to establish a reasonable evaluating system for acupuncture clinical efficacy which accords with the theory of acupuncture, embodies the characteristics and advantages of acupuncture clinic, perfecting the clinical evaluation method, and improving the quality of clinical efficacy evaluation and accelerating the sustainable development of acupuncture clinic. Through reasonable analysis on the current situations about the clinical evaluation research of acupuncture and combining some new concepts and methods, the authors of the present paper hold that the new evaluation system should embody the characteristic of the theory and clinical practice of acupuncture and fully make use of the methods of evidence-based medicine and some measuring scales. They also advocate trying to establish an “evidence-based-goal-attainment scale” method by combining standardized population evaluation with individualized diagnosis-treatment evaluation so as to enhance the international development of acupuncture.
PMID: 18386648 [PubMed - in process]
Acupuncture clinical studies and evidence-based medicine–an update
Zhen Ci Yan Jiu. 2008 Feb
Center for Integrative Medicine, Department of Family Medicine, University of Maryland, Baltimore, MD 21207, USA. llao@compmed.umm.edu
Acupuncture has been widely used in the West in recent years and demand has been growing for scientific evaluation of its clinical efficacy. The practice of evidence-based medicine has brought new challenges in the design of acupuncture research, and publication of randomized clinical trials on acupuncture has significantly increased. While systematic reviews of these trials have advanced our current knowledge, they have exposed deficiencies in research design and revealed that one design can not answer all research questions. Few clinical studies conducted in China have been published in the West, and most published in Chinese suffer from methodological design flaws that render the results unreliable and unconvincing. Such flaws include inadequate or no randomization, inadequate control, unsatisfactory outcome measurements, lack of proper concealment, insufficient follow-up, and improper statistical analysis. To foster high quality acupuncture clinical research in China, we must cultivate innovation and creativity in research design. It is unwise to simply follow or copy the research methodology of Western pharmaceutical studies. Acupuncture and traditional Chinese medicine (TCM) must be evaluated using rigorous scientific methods that preserve the essence of TCM concepts, so that acupuncture and TCM, these ancient healing arts, can continue to play an important role in the health care systems of modern societies.
PMID: 18386647 [PubMed - in process]
Discussion on randomized controlled trials about clinical researches of acupuncture and moxibustion medicine
Zhongguo Zhen Jiu. 2007 Jul
Section of Acupuncture & Moxibustion, West China Hospital of Sichuan University, Chengdu 610041, China.
The characteristics of clinical tests of acupuncture and moxibustion were analyzed by studies of the literature about clinical evidence-based trials of acupuncture and moxibustion medicine at present and on the basis of full analysis on the cause of insufficient evidence of clinical researches of acupuncture and moxibustion, in combination with the authors’ experiences of clinical studies, and it is put forward that future clinical researches of acupuncture and moxibustion medicine should actively search for new research methods, insist evidence-based acupuncture and moxibustion medical researches, pay attention to retaining own researching characteristics of the acupuncture and moxibustion medicine, accumulate experiences, gradually establish and perfect the assessment system conforming with clinical research methods of acupuncture and moxibustion medicine, elevate the position of acupuncture and moxibustion medicine and develop the acupuncture and moxibustion medicine.
PMID: 17722836 [PubMed - indexed for MEDLINE]
First report of methicillin-resistant Staphylococcus aureus septic arthritis complicating acupuncture: simple procedure resulting in most devastating outcome.
Diagn Microbiol Infect Dis. 2008 Nov 4
Woo PC, Lau SK, Yuen KY.
State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong; Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong; Department of Microbiology, The University of Hong Kong, Hong Kong.
We report the 1st case of methicillin-resistant Staphylococcus aureus (MRSA) septic arthritis after acupuncture, with articular cartilage destruction and chronic osteomyelitis. The patient responded to arthrotomy, synovectomy, and 6 months of antibiotics. The emergence of community-associated MRSA infections would further aggravate the problem. Strict adherence to proper infection control guidelines is mandatory.
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External Links:
Adverse Reactions after Acupuncture: A Review
Palle Rosted MD
Consultant Medical Acupuncturist
Clinical Lecturer Sheffield University
Weston Park Hospital
Sheffield S10 2SJ (UK)
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Lymphedema risk from acupuncture?
Be Wary of Acupuncture, Qigong, and “Chinese Medicine”
Stephen Barrett, M.D.
Acupuncture: Can it help? - Mayo Clinic
An Introduction to Acupuncture - National Center for Complementary and Alternative Medicine
Acupuncture - Clinical Trials.gov
Acupuncture for Lowering Blood Pressure: Systematic Review and Meta-analysis
