Acupuncture Alleviates Pain After Tonsillectomy in Children

The study showed that acupuncture significantly decreased pain after tonsillectomy in children (2-17 years of age) with reported pain levels before acupuncture of 5.52 (SD=2.28) out of 10 which fell to 1.92 (SD=2.43) after acupuncture.

This retrospective research was conducted in 31 patients who underwent a tonsillectomy within a 3 month period of time by Dr. James Ochi, one of only a handful of dual board-certified ENT and medical acupuncture in the United States. No study patients received any narcotics for pain control beyond tylenol, ibuprofen, and a single dose of intra-operative dexamethasone. The tonsillectomy itself was performed using electrocautery set at 24W.

The acupuncture points used for pain control are shown below and was performed bilaterally:

Image taken from the Research Paper

All patients received acupuncture at LI4 (between thumb and index finger). Additional points were found effective in relieving tonsillectomy pain and provided on an as needed basis at (in decreasing frequency) CV23, GV24.5 and GV20. Acupuncture points LI20, LI11, and LI10 were utilized in only a few patients.

LI4 point is hypothesized to work so well because:

"Stimulation at LI4 increases activity in the somatosensory cortex and a region of the brainstem known as the periaqueductal gray area, as revealed by functional magnetic resonance imaging, that are involved in processing pain signals." [link]

Although promising, in order to be fully convinced of the effectiveness of acupuncture for post-tonsillectomy pain, further research that is prospective, randomized, and controlled is required.

BUT... because the risks and side effects are so nominal, it can't hurt to give it a try for those patients and families interested in doing so.

For full disclosure, I personally have no experience in providing acupuncture and I would suggest taking these research findings to a reputable and licensed acupuncturist to get this done in those who are interested.


Reference:
Acupuncture instead of codeine for tonsillectomy pain in children. International Journal of Pediatric Otorhinolaryngology Volume 77, Issue 12 , Pages 2058-2062, December 2013

Read More

Compact EMG System for Targeted Muscle Injections

An EMG system (ElectroMyoGraphy) is a critical piece of equipment when it comes to targeted muscle injections in and around the neck, especially when you cannot see or feel the muscle.

This scenario is especially true when dealing with spasmodic dysphonia for which targeted botox injections are quite helpful. Given the muscles that need to be injected are contained inside the voicebox and not able to be seen and felt from outside the neck, accurate injection is quite difficult without EMG guidance.

Watch a video of this procedure using a traditional EMG system.

However, such traditional EMG systems are "overkill" in terms of technology and cost when all it is being used for is muscle placement.

It was with great excitement that a compact EMG device has been developed for just such a need when all that is required is needle localization for directed drug delivery.

Check out the MyoGuide made by Intronix Technologies based in Canada. The US supplier is Ambu.

I've been using MyoGuide for a few months now and am quite pleased with its performance. It pretty much does exactly what I want it to do... no more or less. There is both audio and display feedback, though I mainly depend on audio. It runs only on batteries.

For head and neck muscle injections, I find that a volume setting of 8 and vertical sensitivity of 6 works best.

My personal preference is using Ambu Inoject 35mm 27G needle for ADductor spasmodic dysphonia and the Allergan EMG needle for ABductor spasmodic dysphonia.

For those interested in trying out this device, there is a 2 week free trial.

Read More

Ear Pain Causes Based on Acupuncture Principles

When a patient complains of ear pain or pressure, I wonder if an acupuncturist sees a problem with the whole body rather than a problem just around the ear itself...

Read More

Allergy Shots in the Leg? Abdomen?

It is not uncommon that we have patients that ask if allergy shots can be administered in the leg (or other part of the body) rather than the usual behind the upper arm.

Before we answer that question, let's ask why we given it in the upper arm in the first place!

1) Easy to access
2) Easy to monitor for any adverse reaction
3) All the good studies done are based on injections administered to the upper arm
4) No good studies performed determining whether injections done at other body sites has equal efficacy to the arm.
5) If anaphylaxis occurs, a tourniquet can be easily applied to the arm proximal to the injection site which theoretically would decrease allergen traveling systemically

Given these answers, is it possible to give allergy shots in other body locations other than the arm?

Yes... BUT...

1) No good studies performed determining whether injections done at other body sites has equal efficacy to the arm.

2) If anaphylaxis occurs, may not be possible to apply a tourniquet easily (if given in the abdomen for example)

3) May not be as easy to monitor for a reaction (if given in the buttocks for example)

SO...

It is recommended that allergy shots be given in the upper arm and not other locations.

Reference:

Ask the expert. AAAAI 2/6/12

Read More