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Below is the transcript from this podcast.

The medical information on this podcast is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information should not be used as a substitute for professional diagnosis or treatment.

Please consult with your health care provider, or contact Changing Elements Acupuncture and Herbs, before making any healthcare decisions or purchases.

Hello, and welcome to Changing Health Acupuncture Radio where we talk about living healthy in today’s world. I am honored that you are giving your time today to learn more about your health, and I hope that I can provide some answers for you. My name is Erik Jackson, I am a licensed acupuncturist in Texas, and I look forward to presenting you with some information over the next thirty minutes or so.

Last time, I spoke on the training of acupuncturists and broadly touched on what Oriental Medicine can do for fatigue. Today, I am going to respond to an article about the CDC’s new regulations regarding the use of opioids and talk a bit more about the methods of action for acupuncture.

Before I begin, I want to briefly touch on a question that I should have answered last time. Many people ask, “Are the needles in acupuncture clean?” And my answer is, “Yes.” Acupuncture needles are pre-packaged, single-use only, and are sterilized with ethylene oxide, which is a common method for medical equipment. Going into this answer a bit further, acupuncturists are required in the U.S. to take a clean needle technique training as well as OSHA training before they even start their internship. Acupuncturists are required to swab all of the points they will be using with alcohol before placing the needles. One concern that I have come across is that there are some in my profession who feel like it is OK to needle through pantyhose and/or compression socks. Most acupuncturists do not, but, as I have encountered this with two individuals, I would strongly urge any of you who are using an acupuncturist to not go to anyone who would needle through any clothing. This is an unsanitary practice and, is a serious breach of training and professional standards. This is also why I suggest to my clients that they wear loose fitting clothing as they can avoid needing to use a gown if it is easy for me to access the area on their body they would like me to work on.

So, now that I have answered that question, I would like to speak about the new guidelines released from the CDC. As I have said before, my clinic focuses on pain management, fatigue, and mental stress. So, today we will be looking at PAIN!

I have recently acquired a first-hand knowledge of PAIN, as my exercise routine with Freeletics just had me do 60 pull-ups, 100 push-ups, and 180 squats. So my body is telling me all about pain. For those of you looking for a workout program, Freeletics is very affordable, it is adaptive to your skill level, and since it is body weight only you just need space for the times you run, and a pull-up bar. It is pretty intense though so be sure that you can handle it.
So, getting into the meat of today’s talk, the CDC released new guidelines on March 15th in the Journal of American Medical Association (JAMA) for physicians on how to use opioid pharmaceuticals to manage pain. So, check out the report for yourself, but broadly the CDC was asking 5 questions on the use of opioids which were:

  1. How effective are opioids and at what duration and dosage?
  2. What are the adverse effects?
  3. What dosing strategies should be used?
  4. How do we address the risks?
  5. What to do with Acute vs. long term pain

What the CDC found was that opioids are effective at mitigating pain, but they really meet their max effective duration within 12 weeks of use and, frankly, people should really only ever be on opioids for seven days or less, with 3 days or less being the standard recommendation. Now this is for normal, nonpalliative cases, but, my point is, and what the CDC is saying, is that there are too many people on a pharmaceutical that is dangerous for much longer than that pharmaceutical was ever intended to be used for.

When it comes right down to it, opioids are a band-aid method. They reduce the perception of pain, they do not, in fact, heal the body. All pain, ultimately, comes back to some form of inflammation, and the opioids are not reducing that. Acupuncture can. You see, with acupuncture, when a person is needled the body improves blood flow to the area, stimulates the local immune system, and at the end of the treatment the now healing tissues release substances which turn off the inflammatory reaction, which is what is causing the pain in the first place. Like I mentioned last time, Oriental Medicine is holistic and looks at treating the cause instead of just the symptom.

So, going back to the new guidelines from the CDC, I already mentioned the 5 questions they sought to ask, but I have yet to touch on the actual guidelines. There were 12 guidelines which were proposed so I will go over those now. These guidelines were designed for healthcare practitioners, so I will be speaking on them in less technical terms.

  1. Therapies that do not use pharmaceuticals, and specifically do not use opioids, are preferred when dealing with chronic pain.
  2. If you are going to use opioids, have very clear and realistic treatment goals.
  3. Before starting opioid therapy, know the risks and realistic benefits of the therapy, and reassess during the therapy if there will be periodic usage of opioids.
  4. If using opioids for chronic pain, make use of immediate-release opioids instead of extended release or long-acting ones.
  5. Use the lowest effective dosage.
  6. Be mindful of the duration of opioid treatment for acute pain and keep it to a minimum. Three days or less should be standard, over a week should be needed rarely.
  7. Have regular assessments on the continued effectiveness of the opioid treatment if it is to be used long term. Assess its benefits and risks and be willing to discontinue it when need be.
  8. Evaluate the risks before starting and have reassessments during the opioid therapy to continue monitoring the risks. Make and implement plans to mitigate these risks.
  9. Pay attention to other medications you are on.
  10. Test to see if there are any other pharmaceuticals in the patient or illicit drugs.
  11. Avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible.
  12. Offer treatment for people who develop an opioid disorder.

So, in short, the CDC is trying to get healthcare providers to limit the use of opioids in favor of more effective pain treatments which will have fewer side effects and less of an addiction risk. Furthermore, they are calling for better planning and monitoring of longer term opioid treatments, especially with individuals who are using other medications or supplements.

So, to touch on these guidelines a little more in depth:

As the CDC recognized in their study and even stated as their first guideline, there are better ways of addressing chronic pain such, dietary therapy, exercise, and cognitive behavioral therapy or CBT. These are all things I can help with, along with supplement recommendations and treatments which will reduce inflammation, which is the cause of pain in the body. A proper diet and exercise will improve circulation and tissue repair which will reduce inflammation and pain.

Now, I am not a counselor and I don’t have a psychological background but, I do understand some of how the brain works, and I can help with a meditation program that will act on a similar principle to the opioids in that it will reduce the perception of pain. Meditation, and mindfulness practices, have got an unusual history and a lot of people think that they are a bunch of “woowoo,” but there have been some good research out there and one work in particular that I found interesting was from Paul Ekman, a PhD. in clinical psychology. This is the same guy who really made face reading a popular skill and it is his work that inspired the TV series Lie to Me a couple years back. Ekman had a conversation with the Dalai Lama and, in a book titled Emotional Awareness, Overcoming the obstacles to psychological balance and compassion, in this book, Eckman proposes the idea: that the reason people who meditate regularly seem to do better emotionally, is that by taking control of their breathing on a regular basis—which is an automatic bodily process—they then gain the skill of being able to impose some control over other automatic bodily processes as well, such as our emotional reactions. It is an idea that I particularly like and hope that you will be able to take something away from it as well. While I am on the subject, another book I would recommend is The Ancient Art of Stoic Joy by William B. Irvine. It offers a similar mindfulness approach, but has more mental discipline techniques and has a unique view on life. Basically, the goal of life, in Irvine’s mind, is not happiness or material wealth, but doing and becoming the best you can as well as having a peaceful emotional state. One of the primary exercises of a Stoic is to visualize the worst possible outcomes and really try to feel that, so that one is prepared for bad situations so that when they arise they affect you less. Not necessarily the sunniest practices, but it does allow one to be more realistic and resilient to the stresses of life. If you are more resistant to stress, in whatever form, it has measurable health benefits as your body will produce less cortisol—which, as I mentioned last time, means your adrenals are healthier and means you will have less fatigue.

So, I got off topic for a bit there; I hope you will forgive the deviation. The next thing I wanted to touch on from the CDC was the risks of opioids. Now, we all know that they are highly addictive substances, but the other issue that they pose, which the CDC mentioned, was that they can damage the endocrine system and cause cardiovascular events. So the fatigue that I mentioned last time from your adrenals or thyroid not working, is something that taking opioids could lead to. This is another thing which make CBT or mindfulness/meditation practices a nice alternative to opioids; both of them work on the principle of reducing the perception of pain, but the opioids can potentially harm the system which produces stress reactions. Mental discipline therapies don’t. Also, there could be heart issues and there is a chance of more serious issues: all of these are going to be linked to the dosage; what other medications you may be taking; what you are being treated for; and the way your own body reacts to things. This is not something to play around with. If you have to use it, if you really need it, then be very careful and talk with your healthcare providers and keep them updated.

The last part that I wanted to talk about was benzodiazepines. The CDC specifically stated in their guidelines that opioids should not be used with benzodiazepines, if possible. Benzodiazepines treat for anxiety, insomnia, agitation, seizures, muscle spasms, and alcohol withdrawal; so, if you are being treated with a pharmaceutical for any of those, be sure to mention that to your healthcare provider if you are considering an opioid therapy. These pharmaceuticals also work on a neurotransmitter in the body called GABA—which you can get supplements for and will help to treat anxiety. So, if you are taking a GABA supplement, inform your healthcare provider if you are planning on going on an opioid therapy.

So, as we are at the end of our talk today, I’d like to cover a few important details. Firstly, this is a national broadcast but I do have a clinic in Denton, Texas, which is located at 524 N. Locust St—right next to the post office and a restaurant, called The Greenhouse. I am available for phone consultations, and patient visits, both which you can schedule through my website, and “chelements” is all one word. If you go on there I have a few supplements for sale which treat for pain and fatigue, among other things; ‘though I do recommend that you call me for a consultation before you purchase. My number is 940-441-5404 [repeated]. My website has a number of previous articles that I have written, including a fairly technical review that I wrote on one of the works of Dr. Ritiche Shoemaker who has worked with Chronic Inflammatory Response Syndrome—which I mentioned last time but I will mention it again as it covers aspects of inflammation which I touched on today. I would love to hear from you with suggestions or questions through my website or my Facebook page, Changing Elements Acupuncture and Herbs, or Twitter, @changingelement.

I am planning another broadcast around April 10th or so and I look forward to speaking with all of you then. For those of you in the Dallas area who would like to meet me in person, I will be at the Denton Community Market regularly starting in April, and also, starting next month, I will be doing a one hour Qigong workshop at 2 PM the first Saturday of every month at Fred Moore Park in Denton. So that will be April 2nd, at 2 PM when that happens, which will be after the Denton Community Market—which will also start that day at 10 AM and go until 1 PM. I will also be giving a talk at Natural Grocers in Denton, on University St., on the 29th of this month—so, in a little over a week—at 7 pm ’til 7:45. I will mostly be giving an introduction to how the training of acupuncturists, as well as how acupuncture and Oriental Medicine work, and there will be time to answer specific questions at the end. Hope you have a great day and ’til next time, I am Erik Jackson, this is Changing Health Acupuncture Radio from Changing Elements Acupuncture and Herbs in Denton, Texas.

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