DAVID MARKS, MD: Welcome to our webcast. I'm Dr. David Marks. Alternative or complementary medicine has become increasingly popular over the last few years, especially in the treatment of arthritis. What are these alternative therapies, and do they work?
Joining us to answer these questions is Dr. Allan Gibofsky. He is Professor of Medicine and Public Health at Cornell, and a Rheumatologist at the Hospital for Special Surgery. Welcome.
Next to him is Dr. Ifeoma Okoronkwo, or Dr. O., who is Clinical Instructor at NYU School of Medicine and is an attending physician at the Rusk Institute. Thanks for being here.
What are the different types of alternative therapy that we have to deal with?
IFEOMA OKORONKWO, MD: Well, there is really a broad spectrum of therapies and interventions. One could look at it as that there are mechanical interventions and there are non-mechanical interventions. Some of the more common mechanical interventions would be acupuncture, massage therapy, chiropractic. More esoteric ones would be healing touch, Reiki, etc.
Some of the non-mechanical interventions include some of the oral modalities and medicines, such as herbs. Glucosamine is a very common vitamin or supplement. And also magnets.
DAVID MARKS, MD: Let's talk about acupuncture to start. Does it work?
IFEOMA OKORONKWO, MD: Yes it does. Every day I'm increasingly surprised as to how well it works, particularly to address pain issues and arthritis pain.
As you may or may not know, acupuncture is a very old tradition, over 2,500 years old. It's roots lay in a philosophy based on Taoism. Taoism says, briefly, that we are one with nature. As one, as a unit, when there is a pathology or pathologic factor inside us or even outside of us, grief, trauma, this can translate into imbalance in that unity. Acupuncture seeks to diagnose the imbalance, and through stimulation of various points in the body, heals that imbalance.
DAVID MARKS, MD: A lot of people, I think, may have the impression that acupuncture hurts because they are being stuck with needles.
IFEOMA OKORONKWO, MD: I do have some tools here. I will say that no it doesn't hurt, but you do feel it. There is a sensation that we call "chi" that upon insertion of a needle into an acu-point, you feel the initial little prick. It's negligible for most. But then you feel a sensation, and that sensation can range anywhere from a warmth, an electricity, even an achy-ness. But ultimately, people feel this almost elation, and somewhat of a surprise based on the stimulation of that point, particularly important points to the Chinese diagnosis.
ALLAN GIBOFSKY, MD: Quite frankly, the insertion of a acupuncture needle at the appropriate point or appropriate meridian, as I'm sure Dr. O. will teach us, really has no pain at all. I've had acupuncture performed on me. I would tell you that as an appropriate analgesic it worked. As an anesthetic it worked. There is also the use of acupuncture to change various behavioral habits, such as smoking and nail biting. In a number of instances, it works as well.
The fact that we may not know exactly how it works is less important than the fact that in many people it does work. There have been control trial again and again that demonstrate clear advantages to appropriately performed acupuncture when compared to sham techniques.
So I think we need to be exceptionally open minded to the use of this skill in our patients with painful conditions and debilitating conditions.
DAVID MARKS, MD: When should it be used in arthritis?
ALLAN GIBOFSKY, MD: I think that acupuncture is part of a physician's armamentarium and should be use, not instead of, but together with the various other modalities available such as physical therapy and medication. In some instances in my experience, patients who are receiving appropriate acupuncture therapy have been able to lessen their use of pain medications and other medications which have side effects. Dr. O., would you agree?
IFEOMA OKORONKWO, MD: Indeed. In fact, that's exactly how we use it at NYU, where it is an integrative medicine rather than an alternative medicine to the traditional approaches.
Particularly with analgesia or pain, the literature is very strong in the uses of acupuncture to address these pain syndromes.
DAVID MARKS, MD: Why don't you very quickly show us what you brought and tell us how it's used.
IFEOMA OKORONKWO, MD: Indeed, Allan mentioned the use of acupuncture for some additions; not just drug addiction or nicotine addictions, i.e., smoke cessation, but also for weight loss.
Some of the tools that we use for that might be these tiny little needles, which are millimeters in length, placed in the ear. That's called auricular or ear acupuncture. Oftentimes combined with this, we might use electrical stimulation to the acu-points, known as electrical acupuncture. This device, you can have various intensities of electricity to stimulate the points. So you have to be very careful. Acupuncture is not a benign intervention. Believe it or not, people can get worse. So you have to really integrate the Chinese tradition with the traditional medicine to get effective results.
DAVID MARKS, MD: But some of these things may work for some people. The story is that we really need to study them further to see really which ones are more effective and which ones aren't.
ALLAN GIBOFSKY, MD: And when they do work, or when our patients think they work, as long as they are not harming the patient, we need to keep an open mind. I have patients who ask me, "Should I wear a copper bracelet." My response to them is "Absolutely wear a copper bracelet, and remember to put it on when you're reaching for the medication that I prescribed to you." If a medication is working, fine. But if an integrative therapy - and I really love that word. I'm going to begin using it more and more. If an integrative therapy does no harm - and that's the first rubric of our profession, above all do no harm - we really need to be more open-minded and to encourage our patients to make use of what works for them.
DAVID MARKS, MD: Well that's going to be the last word. Thank you both for joining us. And thank you for joining our webcast. I'm Dr. David Marks. Goodbye.