Acupuncture in haemophiliacs or potential bleeders

[Guest guest]

Hi All, & Andrea,

 

Have any of you treated serious haemophiliac cases with acupuncture?

Any problems after needling these?

 

See:

 

WALLNY, T. A.1; BRACKMANN, H. H.2; GUNIA, G.3; WILBERTZ, P.1;

OLDENBURG, J.2; KRAFT, C. N.4 Successful pain treatment in

arthropathic lower extremities by acupuncture in haemophilia

patients. Haemophilia, Volume 12, Number 5, September 2006 , pp. 500-

502(3). Publisher: Blackwell Publishing. 1: Haemophilia Center,

University of Bonn, Bonn/St Bernhard-Hospital, Orthopaedic

Department, Kamp-Lintfort, 2: Haemophilia Center, University of Bonn,

Bonn 3: University of Potsdam, Institute of Sport Science, Potsdam 4:

Orthopaedic Department, University Clinic, University of Duesseldorf.

Acupuncture is successfully used in the treatment of degenerative

osteoarthritis. The treatment of haemophilic arthropathies can

require strong painkillers with severe side-effects. Therefore, a

special yet simple acupuncture technique was evaluated in the

treatment of these joint problems. Twelve patients with a factor VIII

activity <1% and at least one painful arthropathy in both lower

extremities were included in this single-blinded study. The non-

treated side served as a control. Treatment was assessed by a visual

analogue scale (VAS) and an orthopaedic clinical examination. Only

one needle was inserted at the rear fontanelle once per week and in

15 cycles. Ten of 12 patients showed an improvement of their pain

perception. The average VAS could be reduced from 6.8 to 5.0. The

side not receiving treatment showed a reduction from 4.1 to 4.0. No

side-effects were observed. Even though interpretation of our data

are limited due to the small patient numbers, significant improvement

of the VAS after treatment suggests that acupuncture has a measurable

positive effect in pain management for haemophilic arthropathy of the

lower extremities. Keywords: acupuncture; arthropathies; haemophilia;

pain. Document Type: Research article DOI: 10.1111/j.1365-

2516.2006.01308.x

 

Exposição: XXV International Congress of the Word Federation of

Hemofilia, Sevilla - Espanha. Data: 19 a 24 - maio - 2003:

Acupuncture treatment in the haemophilic arthropathy. The objective

of this work is to evaluate the acupuncture treatment of the pain in

the haemophilic arthropathy in substitution to the anti-

inflammatories. The methodology used was a case report of a

haemophilic patient, who was submitted to a surgical sinovectomy of

the left knee. He developed extension deformity of the left knee and

started bleeding in the right ankle, that answered poorly to factor

VIII and had a effective answer to anti-inflammatory. The treatment

with acupuncture begun in July 2001. The protocol consisted of two

sessions weekly of needling and moxabustan, for 3 weeks and, later a

weekly session. The analogical scale of pain (ASP) was applied before

and after each session. In the first sessions after the treatment, he

complained of no pain in the right knee and left ankle. Actually

complains of pain of the right ankle that disappears at the end of

each session and appears again, around 2/3 days after, however, of

smaller intensity. We concluded that the acupuncture showed effective

in the pain treatment due secondary arthrosis of the haemophilic

arthropathy.

 

However, another article says: According to a report of two cases in

Australia, acupuncture may be effective for relieving joint

arthropathies secondary to hemophilia. Acupuncture in this population

should be used only as a last resort, when other treatments have

failed or when symptoms persist. Guidelines and precautions for using

acupuncture in hemophilia should be closely observed (Koh 1981).

 

According to the recommendations of some practitioners: *

Cryoprecipitate should be easily available and precede acupuncture

needling; * Factor VIII activity should be raised at least 15% prior

to the process to account for the minor trauma involved in

acupuncture; * Needles should be used sparingly in as few points as

possible; * Pressure should be applied for longer periods after

removal of needles; * Treatments should be limited in number; *

Acupuncture around cranial, lingual, laryngeal, pericardial, and

pleural cavities should be strictly avoided due to potential

lethality in hemophiliac patients; * Insert needles cautiously near

blood vessels such as BL40 (popliteal), LU09 (radial), or KI03

(posterior tibial). In spite of its dangers, acupuncture may relieve

pain when other treatments have failed. It may also be an effective

substitute for medications whose side effects include

gastrointestinal bleeding (Koh 1981).

 

See also: Acupuncture used in the Management of Pain due to

Arthropathy in a Patient with Haemophilia

http://www.acupunctureinmedicine.org.uk/showarticle.php?artid=444

 

 

wrote:

> It is quite possible that patients taking warfarin/coumadin will bleed

> more with acupuncture than the average patient. I have experienced

> this. Pay extra attention when removing needles to make sure any

> bleeding stops, especially bleeding under the skin. I use thinner

> needles with these patients, and insert them more superficially than I

> otherwise might - both because of the warfarin use and also because

> these patients are often frail. I'd also steer away from sliding

> cupping techniques.

 

Douglas Knapp wrote:

> I have and do treat many patients on warfarin, and i find that, other

> than closing the hole maybe a little more, there is no real concern

> with treating these people. They generally bruise more easily, and

> thus, are more accepting of ending up with a bruise, if it does

> happen.

 

I agree with Douglas. I have needled a few people with multiple

visible drug-induced bruising without serious bleeding after

acupuncture. However, I do minimal manipulation of needles in those

people - just simple insertion & twirling of 30-guage Hwato needles

until typical Deqi is reached. I also watch for bleeding while the

needles are in (but have not seen this yet) and put pressure on each

point for a longer time after needle-removal.

 

In people at risk from bleeding, one can use non-invasive methods to

activate acupoints. These include laser, TENS, acupressure with skin

friction, point massage with rubefacient ointments (like MOOV or

Tiger Balm), etc.

 

Best regards,

 

[Guest guest]

Hi Phil,

 

I assume by " Andrea " , you were addressing me, Andrea Beth. No, I have not

treated anyone who has hemophelia. This is an interesting article. In addition

to the precautions listed, I would also suggest using the thinnest gauge

needles.

 

Andrea Beth

 

 

Traditional Oriental Medicine

753 N. Main Street, Suite C-1

Cottonwood, AZ 86326

(928) 274-1373

 

< wrote: Hi All, & Andrea,

 

Have any of you treated serious haemophiliac cases with acupuncture?

Any problems after needling these?

 

See:

 

WALLNY, T. A.1; BRACKMANN, H. H.2; GUNIA, G.3; WILBERTZ, P.1;

OLDENBURG, J.2; KRAFT, C. N.4 Successful pain treatment in

arthropathic lower extremities by acupuncture in haemophilia

patients. Haemophilia, Volume 12, Number 5, September 2006 , pp. 500-

502(3). Publisher: Blackwell Publishing. 1: Haemophilia Center,

University of Bonn, Bonn/St Bernhard-Hospital, Orthopaedic

Department, Kamp-Lintfort, 2: Haemophilia Center, University of Bonn,

Bonn 3: University of Potsdam, Institute of Sport Science, Potsdam 4:

Orthopaedic Department, University Clinic, University of Duesseldorf.

Acupuncture is successfully used in the treatment of degenerative

osteoarthritis. The treatment of haemophilic arthropathies can

require strong painkillers with severe side-effects. Therefore, a

special yet simple acupuncture technique was evaluated in the

treatment of these joint problems. Twelve patients with a factor VIII

activity <1% and at least one painful arthropathy in both lower

extremities were included in this single-blinded study. The non-

treated side served as a control. Treatment was assessed by a visual

analogue scale (VAS) and an orthopaedic clinical examination. Only

one needle was inserted at the rear fontanelle once per week and in

15 cycles. Ten of 12 patients showed an improvement of their pain

perception. The average VAS could be reduced from 6.8 to 5.0. The

side not receiving treatment showed a reduction from 4.1 to 4.0. No

side-effects were observed. Even though interpretation of our data

are limited due to the small patient numbers, significant improvement

of the VAS after treatment suggests that acupuncture has a measurable

positive effect in pain management for haemophilic arthropathy of the

lower extremities. Keywords: acupuncture; arthropathies; haemophilia;

pain. Document Type: Research article DOI: 10.1111/j.1365-

2516.2006.01308.x

 

Exposição: XXV International Congress of the Word Federation of

Hemofilia, Sevilla - Espanha. Data: 19 a 24 - maio - 2003:

Acupuncture treatment in the haemophilic arthropathy. The objective

of this work is to evaluate the acupuncture treatment of the pain in

the haemophilic arthropathy in substitution to the anti-

inflammatories. The methodology used was a case report of a

haemophilic patient, who was submitted to a surgical sinovectomy of

the left knee. He developed extension deformity of the left knee and

started bleeding in the right ankle, that answered poorly to factor

VIII and had a effective answer to anti-inflammatory. The treatment

with acupuncture begun in July 2001. The protocol consisted of two

sessions weekly of needling and moxabustan, for 3 weeks and, later a

weekly session. The analogical scale of pain (ASP) was applied before

and after each session. In the first sessions after the treatment, he

complained of no pain in the right knee and left ankle. Actually

complains of pain of the right ankle that disappears at the end of

each session and appears again, around 2/3 days after, however, of

smaller intensity. We concluded that the acupuncture showed effective

in the pain treatment due secondary arthrosis of the haemophilic

arthropathy.

 

However, another article says: According to a report of two cases in

Australia, acupuncture may be effective for relieving joint

arthropathies secondary to hemophilia. Acupuncture in this population

should be used only as a last resort, when other treatments have

failed or when symptoms persist. Guidelines and precautions for using

acupuncture in hemophilia should be closely observed (Koh 1981).

 

According to the recommendations of some practitioners: *

Cryoprecipitate should be easily available and precede acupuncture

needling; * Factor VIII activity should be raised at least 15% prior

to the process to account for the minor trauma involved in

acupuncture; * Needles should be used sparingly in as few points as

possible; * Pressure should be applied for longer periods after

removal of needles; * Treatments should be limited in number; *

Acupuncture around cranial, lingual, laryngeal, pericardial, and

pleural cavities should be strictly avoided due to potential

lethality in hemophiliac patients; * Insert needles cautiously near

blood vessels such as BL40 (popliteal), LU09 (radial), or KI03

(posterior tibial). In spite of its dangers, acupuncture may relieve

pain when other treatments have failed. It may also be an effective

substitute for medications whose side effects include

gastrointestinal bleeding (Koh 1981).

 

See also: Acupuncture used in the Management of Pain due to

Arthropathy in a Patient with Haemophilia

http://www.acupunctureinmedicine.org.uk/showarticle.php?artid=444

 

 

 

 

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