A Needling question

[Donn]

Hi all.
My Mother is prone to "alternative" medicine viewpoints; not at all from the 'reasons why' point of view (she doesn't care about chi and energy and so on), but from the 'it worked for me' pov.

Take accupuncture for e.g. She had a very sore hand, she tells me it took time to build in pain, but she was very sore for 3 months.The muscle between the index finger and the thumb, behind that flange of skin (I don't know the muscle-name) was the trouble.

She tells me that no amount of manipulation by her physiotherapist (various massages and stretching and "re-alignments crunch, crack" - mainly to her spine to relieve pressure on the cord) had any effect. Eventually her physiotherapist poked a needle into the muscle and she tells me it hurt like blazes, but that within a few minutes the pain went away and it has not come back (almost 10 years later).

Now, I find this exasperating when I try to explain to her about why 'alternative medicine' is not real. I can make no defence, because she simply holds her hand up and shrugs with a superior "Accupuncture fixed me" look...

What could have happened? Could the needle have had some effect on her nerves in her hand?
I suppose it might all be in her mind, but that's still a cure! Strange, but effective.

Whaddaya'll think?

 

[Dragonrock]

It's impossible for me to know exactly what happened, but what I usually point out is the weakness of human memory. Our memories are affected by our prejudices and ideas. Perhaps the pain didn't last as long as she remembers or it wasn't cured as miraculously as she thinks. Now, saying this to her will probably not go over well, but I doubt you'll find any physyological reason for the pain relef.

 

[Nucular]

Eventually her physiotherapist poked a needle into the muscle and she tells me it hurt like blazes, but that within a few minutes the pain went away and it has not come back (almost 10 years later).

Hm, I'm no expert but that doesn't sound much like acupuncture to me... don't know what it is, though. Did the physio shove the needle into her back or her hand?

 

[Donn]

Re: Re: A Needling question

Did the physio shove the needle into her back or her hand?

Yes, her hand. I have been to the same physio (pre JREF days, you understand ) and the needles are long with a funny little sheath around them. Sometimes she (the physio) would attach them to an electric machine and they would pulse electricity into the muscles.

 

[Soapy Sam]

Donn- Physios are a pragmatic bunch in my experience. They are far more apt to use treatments like accupuncture, TENS machines , Alexander Technique (if you want to call that a treatment), ultrasound, as well as sympathy, outright lies, flattery and verbal abuse if they think it will get you back on your feet and out of their hair.

(I know several physios. They all remind me of Terry Pratchett's witches- caring, scary people).

This does not mean they believe in such treatments. I know of some who have used ultrasound and TENS machines switched off to see if the patient noticed any difference. There's a fundamental mindset distinction you should note here-

A woowoo practitioner, finding an effect continues with the machine switched off, is apt to postulate a magical healing force, like Reiki.

A physio is more likely to postulate placebo effect and if the patient feels better afterwards, will keep the machine switched off to save on the power bills.

Don't think she will tell the patient that though.

This may be wholly inexcusable in medical / ethical terms, but believe me, they do it.

A wise person pays attention to his mother.
Her hand got better.
Good.
I'm afraid you must learn to live with it.

 

[Nucular]

Yes, I agree with Soapy Sam, physios are a practical bunch - I've worked with a few, some fairly closely, and they're not averse to using every trick in the book to help someone...

They're also, though, not immune to buying into the woo-wooism they might happen to use (I know one very good physio who rarely passes up the opportunity to extoll the virtues of crystal healing).

It sounds unlike 'conventional' acupuncture to me because
a) it "hurt like blazes", which implies a somewhat different approach to the usual very shallow application, even with a mild electric shock, and
b) it was applied directly to the offending chunk of body, rather than the traditional approach of 'manipulating chi' through application to various prescribed irrelevant parts of the body.

Especially in conjunction with an electric shock, it's not impossible that any direct invasion of a malfunctioning muscle could sort out a problem (for example, a cramp or spasm); the danger, as ever, is that an untested intervention, especially an invasive one, could cause more harm than good; though thankfully, in this case, it appears not to have.

The bottom line is that she got better, which can only be a good thing; but it's impossible to know from this case what caused this - the technique itself, or suggestion and expectation, coupled with a treatment which hurts (and therefore cannot be in vain).

 

[Jyera]

These practical Physiotherapist, are perhaps the darling of doctors who advocate, the return of the "human touch" in the healing professions.

Some doctors criticize the situation of overwhelming medical tools, equipments, drugs and informations like x-ray, DNA analysis, blood test result, brain scan etc, etc.

The over-focus of the drugs equipment and information had "get in the way of the doctor patient relationship".

The video by Bill Moyer explore aspects of doctor-patient relationship. Like talking to patient to know their fears, worries, anxiety. Giving patient care, hope, and a sense of confidence that they are in good hands. Title is "Healing and the mind"

Also consider fever. Dispensing drugs(paracetamol) to bring down the temperature of a person with fever, is only done because it'll make the patient feels better, not because it'll cure him. In fact suppressing the fever delays the recovery. This is a daliy demostration of the important Doc-Patient relationship, which is beyond just cold and impersonal diagnose-prescribe routine.

 

[Donn]

Wow - very interesting replies so far.
I also enjoy the practical nature of physiotherapy. I have a bad back and tend to visit often. It strikes me as odd that we would let them get away with the tricks that we would poo-poo in others - but I do understand. They are legitimate and educated. I put all the brakes on when my mother wants to go to the local 'Natural Healer' for hand-waving sessions!

Still, am confused. How can I say "Accupuncture by a physio works, accupuncture by any other is woo?"

(One more quick tale, I am online during expensive hours, so I must be brief.)
My mother had a horrible infection under her fingernail. The skin-doc told her it was a fungus (I think) she picked-up from gardening.

She spent much cash and over a year trying his pills and creams to no avail. (This story begins to sound familiar )
Her friend (a mighty Woo of formiddable nature) told her to buy cheap Sunlight Soap (a brand here in South Africa - green with a strong smell) and to break bits off, soften them and then jam that under the nail.
Bingo! Within a week, I saw it, the infection was gone. Of course, the new pills the doc had just started her on may have been the reason, masked by the soap... I don't know.

Hoo boy! Try defending medicine now!

Ok - gotta go - cheers!

 

[Jyera]

Perhaps my experience with Physiotheraphy in my country are different.

I had a sprained ankle which healed significantly, naturally, without treatement after 1-2 years. It retained a slight roundish appearance and developed occassional short sharp acute pain.
I went to the physiotherapist to do ankle enhancing exercise regularly. It did not work.

After that I when for acupuncturist who gave me acupuncture as well as some black chinese pills said to reduce swelling. It worked. My ankle is sharp looking and I have no more pain.

While it is arguable to others whether the Pill, or Acupuncture or placebo, or even the exercise helped. My experience tells "Acupuncture good, Physiotheraphy lousy, for my particular case." . However please do not take my word for it that this proves accupuncture works. But I do not mind going for accupuncture again.

But then again, I have since, not get desperate enough to need to visit an acupuncturist again.

I think the expertise of the person doing the accupuncture is very important.

 

[Jyera]

Second account here demostrate that a good cure by a comptent professional can look simple.

Not about accupuncture, but about traditional chinese "sprain and dislocation specialist.

At 12 years old, I broke and dislocated my left wrist. I was in shock and was rushed went to a hospital. A doctor took an x-ray of my wrist, told 2 nurse to attend to me, and disappeared. The 2 nurses attempted a "1-2-3 PULL!!!" feat to put my dislocated wrist back. They failed and them promptly plasted up my wrist. Still dislocated and very ugly.

I was skeptical and went to reputable (family run) traditional chinese "sprain and dislocation specialist" in china town.

The physician took a look , pull a few fingers to find out what is happening under my "unbroken" skin. Then he hold my wrist between his thumb and fingers. With a single, fast but firm action, slided my wrist back into it's perfect location and shape.

His action Look simple, but you know he knows exactly what to do.

The conventional Doctor had all the technology(x-ray), but he did nothing. He didn't personally attempted to put my dislocated wrist back. And didn't ensure the nurses do a good job.

If I did not go for non-conventional treatment, my wrist will still be ugly.

 

[Prester John]

think the expertise of the person doing the accupuncture is very important.

You are assuming that acupuncture works, the scientific evidence does not support this, so its probably coincidental effects!


As for dislocation, well i wouldn't get a Nurse to do it, bad Dr for letting them try, a proper physio would be neccessary. Technique and experience required, which you got through your alt specialist.


Re Fungal Nail Infections:

Anti Fungals take longer than anti bacterials to show effects. Not knowing whats in the soap there may well be ingredients with anti fungal properties. MAybe it was a combination, maybe it was the prescibed drugs.

Of course running multiple treatments at the same time makes it impossible to decide which if any are causing the observed effects. Thats why we have rdbpc trials. The trial stage is also where most alt meds stop showing effects, so obviously science is wrong

 

[Donn]

Prester John, I muddied the waters by relating the soapy nail anecdote. I wanted to stay focussed on the needle.

I was hoping to have something to tell my Mother that would remove the 'magical' overtones. She is so smug about the whole thing!

What the physio told her was - roughly - that the needle goes in very close to the nerve (by design) and that causes blood and oxygen to rush to the spot and it is this extra blood and oxygen that relieves the pressure on the nerve (and thus the pain) and causes healing.

Is this in any way real?

 

[Cinorjer]

What the physio told her was - roughly - that the needle goes in very close to the nerve (by design) and that causes blood and oxygen to rush to the spot and it is this extra blood and oxygen that relieves the pressure on the nerve (and thus the pain) and causes healing.

Is this in any way real?

Sticking a needle in someone causes an injury, and the body has a complex reaction that isolates and eventually heals the injured area. But this explanation the physio gave is a wild stab in the dark. For one thing, blood rushing to an injury would increase pressure, not reduce it. Also, without cutting someone open, a small nerve is impossible to locate exactly through the skin like that. For all you know, the physio nailed the nerve right on the button or missed it by a long shot.

You're running into the coincidence effect. Pain of this type will almost always go away on its own, eventually. Your mother was having various treatments done over time. Whatever treatment coincided with the pain going away will be credited with causing a cure. If the pain had lingered a while longer and the physio had been trying leaches, then your mother would be convinced the leaches had cured it. In reality, it might have only been time and the body's ability to heal itself. But the desire to find cause and effect will override any critical thinking you might present her with.

Jerry

 

[Donn]

Cinorjer - fantastic reply, thanks a lot.
I will print that out and let her read it for herself.

Will post her reply soonest.

 

[phildonnia]

On any given day, it is more likely that you will be pain-free.

So, weakening the premises, if you have pain, the following day is more likely to be pain-free.

And finally, if you have pain, and you seek alternative therapy, then it is more likely that the following day will be pain-free.

Assigning any significance to this fact is sometimes called "fallacy of regression to the mean".

 

[Donn]

On any given day, it is more likely that you will be pain-free.

So, weakening the premises, if you have pain, the following day is more likely to be pain-free.

And finally, if you have pain, and you seek alternative therapy, then it is more likely that the following day will be pain-free.

Assigning any significance to this fact is sometimes called "fallacy of regression to the mean".

What about the situation when on any given day you are in pain?
My mom was very sore for about 3 months, with a build-up of pain before that. The needle stopped the pain immediately.

Your fallacy does not apply in this case.

 

[Donn]

Well, I gave my Mother some of your responses and she is still muttering about it. I don't think she has been convinced one bit.

I am still on the fence. I don't really think there is anything in acupuncture, but I think there may be something in the idea of muscle-release-by-puncture, something I don't know (not being medical) and you lot have not thought about.

The conviction she displays when she relates how after continuous pain, one needle solved the problem - well, it's very hard to call her a liar or say her memory is out of whack.

So, I dunno.

Thanks for all the replies.

 

[TeaBag420]

What about the situation when on any given day you are in pain?
My mom was very sore for about 3 months, with a build-up of pain before that. The needle stopped the pain immediately.

Your fallacy does not apply in this case.

The other poster doesn't understand what regression to the mean means.

It's entirely possible that what happened with your mother (assuming it happened as described) was an incidence of "gating" where stimulation of one nerve cancels out the signal from another. This is well known in standard Western medicine. People whose first response to a tap on the knee is to cry "woo woo" tend to forget it.

 

[KFCA]

One other more "medical" possibility.

Conventional pain management physicians sometimes give "trigger point injections" into muscles, which is sometimes useful in relieving pain.

The injection apparently consists only of procaine, a local anesthetic, which wears off quickly. The desired therapeutic effect is to disrupt the trigger point's muscle fibers by the needle itself. Since an accupuncturist usually inerts MANY needles, it's possible that your mother's practitioner was just lucky enough to hit a trigger point, as a pain management physician might, thus breaking down the pain-causing trigger point & ending her pain.

 

[Donn]

Originally posted by Cinorjer Also, without cutting someone open, a small nerve is impossible to locate exactly through the skin like that. For all you know, the physio nailed the nerve right on the button or missed it by a long shot.

Vs.

TeaBag420It's entirely possible that what happened with your mother (assuming it happened as described) was an incidence of "gating" where stimulation of one nerve cancels out the signal from another.

Interesting to hear a potential opening in this closed issue!
How does 'gating' work if one cannot know for sure where any particular nerve is?

KFCASince an accupuncturist usually inerts MANY needles, it's possible that your mother's practitioner was just lucky enough to hit a trigger point, as a pain management physician might, thus breaking down the pain-causing trigger point & ending her pain.

The physio only used one needle on her hand. Needle, poke, bingo!
When you say "Breaking down the pain-causing trigger point", do you mean the needle physically tears the 'trigger' (nerve?) to shreds, thus leaving it, well ... dead?