Prickled Pink


Acupuncture gains acceptance in U.S. children’s hospitals

By Sara Solovitch
Illustration by Jessie Hartland

A nurse’s assistant sits outside the open doorway. Her job is to keep watch over the girl on the bed. The girl is 16 but she looks 40. Pockets of loose skin hang over her eyes. She weighs 76 pounds and, if left on her own, will starve herself to death.

Brenda Golianu, MD, a Lucile Packard Children’s Hospital anesthesiologist trained in acupuncture, darkens the room and waits for the girl to roll up her pink pajama bottoms and make herself comfortable on the air mattress.

Anorexia has left her with abdominal pain and severe headaches. Acupuncture relieves both symptoms.
“Take a deep breath in,” Golianu instructs, then eases a small, transparent acupuncture needle just below a bony knee. “If it causes a little bit of aching, that’s OK. If it causes a sharp pain, I want you to tell me and I’ll take it out.”

She slips another needle behind the other knee, then one in each foot, thumb and wrist. Within seconds, the girl is sleeping. Her narrow chest rises and falls rhythmically while Golianu waits beside her in the darkness and watches the monitor. When the respiratory rate falls to eight breaths a minute, she nods, satisfied. It’s an indicator of profound relaxation.

Golianu, a Stanford assistant professor of anesthesia, was an undergraduate at MIT doing her junior year abroad in China when she first observed acupuncture at work. She later traveled to Taiwan, spent several months observing acupuncture at the Chinese Medical College there and then studied it in a clinic in Japan. But it was during her residency at Stanford that she became convinced of its benefits.

“There were patients in the pain clinic for whom nothing seemed to work,” she says. “Medications were of no significant benefit. It was very frustrating.”

In the past 10 years, acupuncture has made its way into a growing number of major children’s hospitals – including Packard Children’s Hospital and Children’s Hospital Boston, where doctors use it to wean babies off opiate medicines, ease the pain of rheumatoid arthritis and reduce nausea from chemotherapy.

More than a third of all pain treatment centers in the United States offer it as therapy and an estimated 3,500 physicians have acupuncture credentials — using it to treat everything from heroin addiction to low back pain and postoperative surgery pain.

Good points

Acupuncture offers pain relief

Not long ago most U.S. caregivers placed acupuncture on the far side of alternative medicine. Times have changed. Now many hospital-based pain and palliative care centers recommend acupuncture for a wide range of common problems, including:
• Abdominal pain
• Carpal tunnel syndrome
• Dental pain
• Fibromyalgia
• Hip pain
• Lower back pain
• Menstrual cramps
• Migraine headaches
• Myofascial pain
• Nausea from chemo- therapy
• Postoperative surgical pain
• Tennis elbow

“There has been an explosion of interest in the hospital setting over the last five or six years,” says James Dowden,executive administrator of the American Academy of Medical Acupuncture.

The centuries-old Chinese practice was developed from observations that led to the theory that energy flows through channels between the surface of the body and internal organs. Traditional Chinese medicine teaches that pain and disease result when these channels become blocked.

Physiological Logic

Western medicine has a different explanation. Scientists have identified the body’s nearly 400 acupuncture points as conductors of electromagnetic signals, prompting the release of endorphins and opioids – the body’s natural painkillers – to the muscles, spinal cord and brain.

Physiologic changes have been well documented, including alterations in brain chemistry through the release of neurotransmitters and hormones. A 1998 study in the Proceedings of the National Academy of Sciences showed changes in blood flow in the visual cortex of the brain when an acupuncture needle was inserted in the fifth toe to treat ocular problems.

“Acupuncture has the singular advantage of being a relatively benign treatment,” says Dowden. “You can treat the patients and the worst that can happen is they don’t get better. So it is very good as an alternative treatment – if the alternative is surgery or medication.”

For Golianu, it isn’t an either/or issue. “I think it’s a matter of integrating the two,” she says.

But it can take a healthy dose of persuasion to get a child to try acupuncture, despite the fact that its fine, solid needles typically do not cause any of the pain associated with vaccinations.

Indeed, an April 2000 study in Pediatrics found that 70 percent of children treated with acupuncture felt it helped their symptoms, while two-thirds described the treatment as pleasant.

Babies and teenagers make the best subjects. Carly Brown, a 14-year-old Packard Hospital patient suffering from unexplained abdominal pain, is eager to try it when Julie Good, MD, a pediatrician who specializes in palliative care, stops by her hospital room.

Good, who studied acupuncture during her fellowship in pain management at Packard, has just inserted three needles in Carly’s abdomen when Tzielan Lee, MD, a pediatric rheumatology fellow, enters the room.

Lee had ordered some tests on Carly and wants to discuss their findings: the possibility that minocycline, a strong antibiotic that she’d been taking months earlier for acne, might have set off an autoimmune reaction that would account for her abdominal pain.

But first Lee apologizes: She has a stuffy nose, she says, and is sounding very nasal.

“Would you like to try a little acupuncture for that?” Good offers. Without wasting a minute, she tears out a couple of needles and pushes them into opposite sides of Lee’s nose. It makes her look a bit like a walrus.

“Oh wow!” she exclaims, laughing. “That feels really good. The electricity is amazing. Oh yes, that just opened it all up.”

Lee turns to Carly. “Do you mind if I talk to you like this?”

Carly, prone on the bed with needles still sticking out from various parts of her body, giggles.

“It’s going to get better,” Lee reassures her. “It could take up to a year but it will get better.”

“But she’s not going to have to suffer for a year?” her mother asks anxiously.

“She’s not going to have to suffer for a year because we have some tools to work with here,” says Lee. The needles in her nose wiggle as she speaks.

Lee turns to Good and marvels: “I’m definitely less stuffed!”

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