S01_E16 - Pins and Needles - Let's talk Acupuncture!

Speaker 1: 0:03

Welcome to the healthy matters podcast with Dr. David Hilton, primary care physician and acute care hospitalist at Hennepin healthcare in downtown Minneapolis, where we cover the latest in health healthcare, and what matters to you. And now here's your host, Dr. David Hilton.

Speaker 2: 0:20

Hey everybody. And welcome to the healthy matters podcast. I am your host, Dr. David Hilton. Today, we're gonna talk about acupuncture with one of my friends and colleagues at Hennepin healthcare, Jessica Brown. That is a topic that I think is gonna interest a whole bunch of people, including myself. And so we're gonna get right to it. First of all, Jessica, thank you for being here on the podcast.

Speaker 3: 0:38

Thank you so much for having me. It's nice to be here.

Speaker 2: 0:41

It's great to have you. So Jessica, as a colleague of mine here, uh, in downtown Minneapolis at a major medical center, 7,000 person organization, uh, an academic medical center, and you're an acupuncturist and you're not the only one. What are you doing here? Working in this, um, this big hospital system. Tell us about your program real quickly.

Speaker 3: 0:59

Well, I am one of eight acupuncturists that are on staff here at Hennepin healthcare. And, um, interestingly, if you didn't know, this Hennepin was the first major health organization to hire an acupuncturist in the country. So the legacy here of acupuncture and integrative health is quite rich. I have colleagues that I work with that have been here for 30 plus years. So we've actually been here for a long time. Our providers are at six of the community clinics and at the CSC building here. Wow.

Speaker 2: 1:32

Tell us right off the top, what are the most common things you see? And then I'm gonna ask you later to talk us through what someone might expect when they come to see you or one of your colleagues, but what do you see commonly?

Speaker 3: 1:43

So obviously what we see most is usually pain complaints predominantly because that is what insurance covers, uh, most easily. So we do see a lot of acute and chronic neck back joint, headache, pain, but we also see issues of digestion. We see sleep, we see anxiety. We have providers who specialize in treatments for oncology support, orthopedics, perinatal work, working with pre and post pregnancy. We do work with women's health issues, including all stages of women's lives, um, menstruation, menopause, like I said, pregnancy. So what we treat is varied it's wide, but what we see most that gets people in the door and that people are referred for is definitely pain.

Speaker 2: 2:35

So Jessica, in my practice, I hear a lot from, uh, women around the time of menopause. Mm-hmm<affirmative> about the, the myriad symptoms that people can get ranging from the vasomotor symptoms, which are, uh, most women will know as hot flashes, energy, uh, issues, maybe some mood things, um, pelvic pain, all these things happen to women around the time of menopause. What do you have to offer for those, those folks? I

Speaker 3: 2:59

Think it's acupuncture is so helpful in this regard, because honestly there aren't a lot of tools for physicians to use in terms of like hormones and, you know, there, there are things that exist, but there can be side effects for people that are less than pleasant. One of the things that I've seen with acupuncture just in my own practice is how it can help with specifically hot flashes

Speaker 2: 3:26

With that. Yeah. That's the biggest one that women talk to me about.

Speaker 3: 3:28

It's a big one. Um, because I think we have a greater understanding of, of the mechanisms of how acupuncture works on pain, but when it comes to things like hot flashes and hormonal issues, it's still kind of being studied. We don't fully understand. We know that it impacts that endocrine system. We know that it impacts the hormones, but, um, we don't have a solid grasp on exactly what it's doing or if we, there probably are some people out there that do, but maybe I haven't read it yet, but the truth is anecdotally. I see it

Speaker 2: 3:59

Help another really cool and um, important thing. Uh, I wanna talk about headache then. Yes. Headache is one of, again, one of the more common things that I see in a primary care practice. Yeah. What's the role of acupuncture in treating headaches.

Speaker 3: 4:13

So headaches are, as you know, they're multifaceted, they can be from many different causes. So sometimes they're hormone related. Oftentimes I'll see people, women who have, uh, increased headaches around their cycle, but sometimes they're also due to things like trauma and the CSC, the clinic and specialty center here at Hennepin. We are physically right next door to the traumatic brain injury clinic. And so we get a lot of referrals from them just to help with managing the headaches after someone has had any kind of head trauma. Um, as you know, those headaches can be long lasting and difficult to resolve. And again, when you talk about medication, there are side effects to many of the medications that are used. And so acupuncture's a nice tool to use in order to manage those headaches. A lot of headaches are also related to tension and acupuncture's extremely good at diffusing, uh, neck, upper back tension, which if that is the cause of the headaches, sometimes that takes care of it for people.

Speaker 2: 5:17

So acupuncture's been around a great long time. I understand mm-hmm<affirmative> do we know how it works? I mean, you probably know a whole lot.<laugh> about how it works, but I I'm gonna guess that many, many, uh, doctors like me don't and I wanna guess much of the public doesn't know. Right.

Speaker 3: 5:32

Without getting too granular in terms of like discussing specific neurotransmitters and things like that.

Speaker 2: 5:39

Oh God, do you wanna geek out on neurotransmitters?

Speaker 3: 5:41

We're not gonna do that today. That's not very fun for

Speaker 2: 5:44

We're recording this podcast a little early in the morning and I, I can't even say neurotransmitters. No,

Speaker 3: 5:49

But essentially with the needle that we use, we're creating a stimulation in the body that engages multiple systems of the body, including the nervous system, the cardiovascular system, the endocrine system and the immune system. So we're having a local effect. So if there is a local pain area, we're definitely treating that area, but we're also stimulating increased circulation. We're stimulating the release of endorphins and Lins, which your body's natural pain killers. And we also impact other areas like sleep general sense of wellbeing. People find that after treatment, even if they're coming in for one specific issue like pain, they're finding that there is, uh, an impact on these other systems, including digestion and sleep and other areas. So it's got a local and systemic response. There's more research being done all the time. There's this connective tissue that we all have in our body that covers most things called fascia. There's a lot of work being done as to how acupuncture is influencing that fascia to communicate with the systems in the body. It goes straight to the central nervous system, basically giving instructions to the body on what we want it to do and what we wanna adjust.

Speaker 2: 7:09

So you talked about pain as what brings a lot or most people in at least initially when you're treating the pain. I understand that you're the needles. Don't always just go in the place where the pain is. You said there's a local response. Mm-hmm,<affirmative>, it's not always right where the pain is. Is that not accurate?

Speaker 3: 7:25

No, it's true. Sometimes we are needling locally. In addition to often needling, distally, meaning other areas of the body, sometimes on the hands or the feet, the head, even the ears are very powerful in using points on the ears to impact other areas of the body. So the wonderful piece of acupuncture is that if we can't go local, for instance, if there is a wound that isn't fully healed, or if the local site is just too painful for someone and they don't feel comfortable having you go locally, we can impact the body's healing mechanism by using other points in the body that are on different areas. And that sometimes surprises people when you're starting a treatment. And you're swabbing an area, um, with an alcohol swab that you might needle in, it's completely

Speaker 2: 8:16

Different place. And far away

Speaker 3: 8:17

From what heard, it's a very different place. I, I had a pro a professor who would describe it, like if you're gonna turn on a light and for instance, in this room on the ceiling, oftentimes you're using a switch on the wall that's pretty far away, but it still works. That connection is there. And those connections in the body exist. And so you can use those switches that are in other areas of the body

Speaker 2: 8:38

That is that most concise and easy explanation I've ever heard about the light switch. That totally makes sense to me.

Speaker 3: 8:45

Probably why he's a professor

Speaker 2: 8:46

That, oh, well, whoever, I don't know if he came up with that, but that really works for me. That is turning on a switch somewhere else. Yes. So, okay. A lot of people don't love needles, right? Your job is to actually put them in a person's body. Yes. And not only that, sometimes you put'em in a place that is actually hurting. Right. Does it, does it okay. Just when you do localized pain control mm-hmm<affirmative>, doesn't it hurt to put a needle in a place where something already hurts.

Speaker 3: 9:09

I think that's, what's really surprising for people. Um, first of all, it, you know, you can see me, the audience can't see me, but I, I look pretty benign. I don't look very scary. I don't

Speaker 2: 9:20

Think, no, you don't look scary and all just, and

Speaker 3: 9:21

So I, I think I, you know, I think when people see us and they see that we're, um, meeting and greeting them with kindness, and we're not scary people, obviously we're doing this because we know that it can help. And if we can tell people, um, get them past that fear barrier of the needles, most of the time, I will say most people find that it's so comfortable. The needles themselves are a little bit thicker than a human hair. We're not talking about getting a shot or getting your blood drawn. And so when we insert them, you might feel a pinch or a poke almost like somebody's pulling a single hair on your arm very quickly. But oftentimes there are points where you don't feel them at all because the needle is so thin. And so once the needle is in, also there may be dull ache sensation, but usually people don't feel them at all. And so once we put the needles in, we have people rest for about 20 to 30 minutes and the re

Speaker 2: 10:18

With the needles

Speaker 3: 10:18

In, with the needles in, and the reason that we do that is there's this kind of, uh, excitatory response that your body has with the initial stimulation of putting the needles in. But if you retain the needles, there's this relaxation, the secondary response that we get, they've even seen with functional MRI, that it activates the area of your brain involved with rest and relaxation. So there is a literal sedating effect that can happen with acupuncture. So if we retain those needles and people are able to relax with them and it allows for the needles to work, it allows for people to relax. It allows for increased circulation to the area that's affected. And oftentimes we can immediately see at the end of the treatment, first of all, people are often relaxed and they feel really good, but they also have a reduction in the swelling and the pain and even the heat in the affected area. And so getting that kind of immediate response for people after a very relaxing session, that is really where we get the buy in. They're actually excited to come back and have multiple treatments. And that's what we want them to do is come for a series of treatments. Cuz oftentimes there's a building, a cumulative effect where we'll wanna see them for four to six visits and evaluate how it's going. See if they're getting that response that we want, make adjustments where we need to, and then plan a treatment course going forward.

Speaker 2: 11:47

So paint a picture for me. I'm coming in for back pain. Yes. Let's just say mm-hmm<affirmative> do I have I lie on my belly on a table? Do I have one needle sticking out of me somewhere? Do I have 30? Do I look like a pin cushion? What do I look like? Or how, how talk us through it?

Speaker 3: 12:01

That is, um, that's the other beauty of acupuncture is it's very tailored to the specific person's needs. So if you're coming in for back pain, we have multiple things that we can try. Even with positioning. Oftentimes we're gonna try and get you to be able to comfortably lay prone, meaning, you know, face down. But if that's not comfortable for you, we can have you lay on your side. As long as we can get to the areas we want to get to. So a person coming in would experience, I would explain the treatment to them, obviously ask if they have any questions and often people do and we want them to feel comfortable before we even start the procedure and feel like they know what to expect. Once they're lying down, we're gonna swab the areas with an alcohol swab and then start the insertion of the needles. We want people to communicate with us. If there is anything that is uncomfortable, we want them to tell us right away and we will back that needle off or take it out by and large though, people are like, oh my, this is much easier than I thought it would be

Speaker 2: 13:04

Right. If they were nervous about it, it's not that probably doesn't pan out. It's

Speaker 3: 13:07

Not sick. Exactly. So then we'll insert needles and that can be anywhere from six to 30. Honestly, it depends on what we're treating. It depends on the tolerance of the patient. It depends on how their body is responding. If you have back pain and it goes basically from your neck all the way to your lower back, we're probably gonna use a fair number of needles because we're gonna look for those areas of tension in the muscles, along the spine and insert needles to try and get those to loosen up. So it varies a lot in terms of how many needles we use. But what I will say is consistent is that what to expect at the beginning of the experience, in terms of the explanation and then the insertions of the needle and the retention time of 20 to 30 minutes. And then at the end, coming in and taking out the needles and then the person's free to go. There's really nothing that's contraindicated. After the treatment, people can go about their day. They might feel more relaxed. Some people actually feel more energized and ready to take on the world, but it varies. And so we just ask that people follow up because oftentimes we'll find better results that then stay with a series of treatments. We don't wanna keep people as permanent patients necessarily because we want to get them to a point where they are at a better place. They're able to do their activities of daily living more comfortably, and then they don't need us. And they always know where we are. If they need to come back,

Speaker 2: 14:38

We are gonna take a short break. But when we come back, I'm gonna ask you to kind of comment on the role of acupuncture in the larger healthcare system. How does that all fit together? The various treatment modalities that people can do, we are gonna get back to the conversation right after this short break. So stay with us.

Speaker 1: 14:56

You're listening to the healthy matters podcast with Dr. David Hilton, have a question or a comment for the doctor become a part of our show by reaching out to us@healthymattersathcmed.org. Or give us a call at six one two eight seven three talk. And now let's get back to more healthy conversation.

Speaker 2: 15:16

And we're back talking to Jessica Brown acupuncturist at Hennepin healthcare. I've been meaning to ask you, what does it take to become an acupuncturist?

Speaker 3: 15:24

So our acupuncturists are all masters level. A lot of acupuncturists now are coming out at a doctorate level, but when most of us trained it was master's level, which was, um, you have your undergraduate degree, then you go to graduate school. Um, graduate school was three years, um, full time. And at the end of graduate school, after you have about 750 hours of clinical practice, um, you then take national board exams. Uh, the national board exams you're taking anywhere from three to four, depending on if you're doing the herbal certification, along with it, once you pass the national board exams, then you apply for licensure through the Minnesota board of medical practice.

Speaker 2: 16:05

So you are licensed through the same board of medical practice. And I

Speaker 3: 16:07

Am absolutely are. I was gonna say that it's the same board that licenses you and other MDs. Um, and so it, the, the criteria here in Minnesota is actually fairly strict to be a licensed to acupuncturist.

Speaker 2: 16:19

I, I don't think many people knew that that it's licensed through the same rigorous process as, uh, other healthcare professionals. So Jessica let's, let's shift a little bit to when somebody should see you, I might be wrong on this, but my perception in my own internal medicine practice is that people, um, understandably they want something to make me feel better. Right. And often, I don't know if that's just how we've come along as a society. They think that answer is in a pill bottle. Mm-hmm<affirmative> and maybe sometimes it's in a pill bottle, but maybe not. What, what are your comments about someone who's experiencing chronic pain? When should they see you? Should it be only after they've tried every pill in the world and then they come to see you. Right. I think I have an, a, a preview of what that might your answer to that might be, or should they come to see you first or comment on that? If you could?

Speaker 3: 17:08

Sure. I mean, I think, uh, the earlier we get somebody in the progression or chain of illness, it, it is easier to get better effects, but that doesn't mean that we can't help people who have had for instance, chronic pain for the last 20 years. Really, if you have pain, people ask me, will this help with this, that or the other thing? And I often will just say, it's worth a try. Like oftentimes we can notice change. We can notice progress. Even if something is really entrenched and has been there for a long time. Um, the other great thing is we work alongside other modalities, including chiropractic, including physical therapy and acupuncture can often help with pain management to help them do those other kinds of therapies that might be stressing them a little bit where they're having to do home exercises or push things a little bit for recovery acupuncture can often help alongside those to regulate the pain for them so that they can do those other things more comfortably. You

Speaker 2: 18:15

Said it it's worth a try. That would imply that it's safe. Is that the case?

Speaker 3: 18:19

Absolutely.

Speaker 2: 18:20

Cause I'm here to tell listeners that that most of the medications you can take are not all safe or at least they have a significant risk to taking them, right. Opioids being the top one among them. They have a significant, significant risk to taking them. Yeah, what's the safety profile of acupuncture.

Speaker 3: 18:38

So acupuncture is extremely safe because it's minimally invasive and we're not actually injecting anything into the patient. There isn't a lot for the body to have to sort through and figure out we're not creating a situation where the body really has to understand what's going on chemically and is rife with potential side effects. It can be a subtle response that acupuncture has, but that being said subtle is not always bad. If, if we can subtly move the needle with people without using any kind of chemical intervention or anything, that's gonna create any dependency that can often be life changing for people, it can bring them out of kind of this necessity to take their medication on time. Sometimes people will forget that they didn't need their medication that they, that the subtlety is in realizing that you've gone through your day and not noticed your pain. Well,

Speaker 2: 19:41

I love that. Yeah, that is, that is truly the goal actually. Mm-hmm<affirmative> so that you could, cause we can't always make pain go away. No, a hundred percent. The goal isn't to get you on a pain scale of zero to 10, always to zero. Sometimes that's not possible

Speaker 3: 19:54

Sometimes it's just noticing that you're not noticing as much.

Speaker 2: 19:57

Exactly. I really like that, that perspective. Mm-hmm,<affirmative> just a teeny bit of shift to a little bit of historical stuff. Where did acupuncture come from? So

Speaker 3: 20:05

Acupuncture's been around for 2,500 plus years, um, developed initially in China, it's a very practical and pragmatic approach. Um, which people get a little bit uncertain when they hear words like Chi they think, oh, what is this mystical magical energy. Right. But truthfully, she is a description of function. She is just describing the body's function and it's describing vitality. So

Speaker 2: 20:34

Is C I or Q I

Speaker 3: 20:36

Q I Q I Q I is the Chinese way to spell that. And like I said, it's, it's a very practical approach to, to treating the body.

Speaker 2: 20:46

Okay. So what is Chi then you, you said, um, it's sort of like, it's sort of an energy. Are we talking, you know, I'm a star wars fan, is this like the forces with you? Is it some energy around us? Is it within us? And what, how do you manipulate it? Yeah. What are you talking about?<laugh>

Speaker 3: 21:01

So I, I think people get, they, they start to look at acupuncture as, um, being a little woo, woo. If I can say that. Yeah, because they hear this word Chi and they think it's some mystical energy that we can't quite quantify, but in truth, Chi is just a way to describe vitality. It's a way to describe your body's function. And if we have illness or trauma or even emotional trauma, it can disrupt that vitality. It can disrupt the function in your body. So when we use acupuncture, we're just trying to help the body come back into balance, come back into a state of having good Chi flow, which is just basically where things are functioning as they should. And you're feeling your full vitality.

Speaker 2: 21:49

Yeah. I, it's hard to, um, not resonate with that, bringing your body back into balance. I think being out of balance is half the problem of, of most people's, uh, it's, it's a problem for me, you know, and that I'm not always in a, a very good balance. I really like that. And the fact that it's been going on for thousands of years, mm-hmm<affirmative>, um, people don't do things for thousands of years

Speaker 3: 22:10

If they don't work.

Speaker 2: 22:11

If, if it is completely,

Speaker 3: 22:13

They tend, tend not to. Yeah. Right. And I think what's interesting is there's more and more evidence around how acupuncture works and certainly that it does work. And I, I, I think that that's a misconception that people have is that there isn't solid evidence. And the truth is there is a lot, our own us department of veterans affairs worked with the Australian department of veterans affairs. And they actually did like this combination of 13,000 studies in meta-analysis and found that there's evidence that acupuncture is effective in 117 conditions and moderate evidence for 46. So like it works in multiple ways on multiple body systems for many, many things. And as we talked about it, we do a lot with pain, but we also do work with post-stroke where there's dysfunction in the body that's left over after stroke. We can try and get better utilization of, of limbs. And we can work with cancer related symptoms that come up in terms of nausea and vomiting. And that's one of the passions of mine is working with people as they go through that process, just trying to help ease the process, help them through the symptoms that are gonna come as they go through oncology treatment. I

Speaker 2: 23:33

Was gonna ask you about that, Jessica mm-hmm cause I'm aware that you do, uh, work with cancer patients sometimes mm-hmm<affirmative> and mm-hmm<affirmative> the, the, the side effects of the treatments of cancer are enormous. Yeah. They're big nausea being the prominent one that a lot of people think of and we give exceptionally powerful drugs, right. Again, to treat the side effects of the drugs yeah. Is acupuncture effective for, for those, it,

Speaker 3: 23:56

It is it's, it's highly effective for nausea, but people think of nausea a lot when they talk about oncology and cancer treatment. Um, honestly the biggest complaint though, that we see is fatigue. Mm it's extremely exhausting to go through, uh, cancer treatment. And so what we're also trying to do is we're just trying to keep people's energy level up. We're trying to help them with appetite, which is a very important thing as well, that can take a hit during cancer treatment. So, um, we definitely can help with that and just overall stress, it's a stressful experience. And so if we can help kind of modulate that stress response and help with sleep as well. It's really important.

Speaker 2: 24:37

Let's say more about that. That's stress that mind, body, um, connection between stress, anxiety, maybe mood mm-hmm<affirmative> maybe, um, uh, depressed mood. What's the role of acupuncture there.

Speaker 3: 24:49

So sometimes we're limited by what insurance will cover, but as I said, usually when a patient comes in, even if they're coming in for a pain complaint, we're gonna often ask about these other things. We're gonna ask about stress. We're gonna ask about sleep. We're gonna ask about digestion because we can work on all of those things. At the same time, we don't have to just focus on only the area of pain, um, which is a nice spot to be in, in terms of a provider. You know, oftentimes providers are limited to just kind of working on what the patient's reporting in terms of pain, but for us, we can work on the whole system and people, even if we don't clue them in that maybe they will notice an, an improvement in these areas. Oftentimes they will come in and they will self report that, oh my gosh, I've just been sleeping so much better. I've just generally felt better. I'm less reactive at home. I'm less irritable. Um, and so those are really just kind of the, as, as you, as we'd say, side effects, right? If you're gonna have side effects, those are not one bad ones to

Speaker 2: 25:55

Have not bad side effects at all. And it also resonates with me that you talked about some of the scientific evidence because we are at an academic medical center. We are, and we need to do things that, that have, uh, a foundation absolutely. Uh, in scientific accuracy. And this does

Speaker 3: 26:09

This absolutely does. It does. And I think another, uh, misconception is that it's all placebo effect. Mm that's another thing that people have talked about, well, you know, you have to believe in it to work. And what I would say is, first of all, why is the placebo effect? Why does that get such a bad rap? I would argue that even in your own practice, Dr. Hilton, that placebo effect is at play. If you form a good, positive relationship with your patients, they're gonna have better outcomes. Yep. And so maybe on some level, absolutely acupuncture is working on a placebo effect. And if people believe that it works, then it may work a little better. But I would argue that that goes across every branch of medicine. If people believe that their surgeon cares about them, they're gonna have better outcomes. And so I don't like to dismiss the placebo effect because I do think it's important, but that is certainly not the only thing that acupuncture is working on. That's not the only level it's working on.

Speaker 2: 27:11

That's awesome. Jessica. That's awesome. Because there is, I, I have heard that I've read medical literature, that if your surgeon yes, tells you, it explains the surgery they're about to do, and they do it in a positive way. And they say, you know, I think this is gonna help you versus saying, eh, I don't know. It might help. It might not. It's more likely to help, you know, that is, that's the positive attitude thing. So I like that, that you address that. So we've been talking to Jessica Brown acupuncturist, Hennepin healthcare, one of eight count eight acupuncturists at our academic safety net hospital here in downtown Minneapolis. It's been a great show. I've learned a ton. Thank you so much for being here.

Speaker 3: 27:44

Thank you so much for having

Speaker 2: 27:45

Me. It's been great having this conversation. I hope to get you back on a future show listeners. Thank you for tuning into this episode as always keep your questions and comments coming and we'll address'em on a future episode and in the meantime, be healthy and be well.

Speaker 1: 28:01

Thanks for listening to the healthy matters podcast with Dr. David Hilton, for more information on healthy matters or to browse the archive, visit our website@healthymatters.org. And if you have a question or comment for the doctor, email us@healthymattersathcmed.org, or give us a call at six one two eight seven three. Talk if you enjoyed this podcast and would like to support us, please leave us a review and share the healthy matters podcast with your friends and family. The healthy matters podcast is made possible by Hennepin healthcare in Minneapolis, Minnesota, and engineered by John Lucas at highball executive producers are Jonathan Camuto and Christine Hill. Please remember we can only give general medical advice during this program. And every case is unique. We urge you to consult with your personal physician. If you have more serious or pressing health concerns until next time, be healthy and be well.