Research on Acupuncture for Joint Pain in Breast Cancer

Some of you may know that for the past several years Adam has been performing the acupuncture for two acupuncture clinical trials for breast cancer patients at the University of Pennsylvania. Both of the studies are now complete and one of them was recently published. You can read a write-up about the published study on the Huffington Post website.

This study investigated the use of acupuncture to help control the joint pain that is a common side effect of a class of medications called aromatase-inhibitors (or AIs). Postmenopausal breast cancer patients with hormone-sensitive cancers are often put on AIs in order to help keep estrogen levels low and prevent an exacerbation or recurrence of the cancer. Patients are typically on AIs for 5 years. Unfortunately, joint pain is a serious and common side effect of AIs, so much so that many patients stop taking the medications before the recommended 5 year period is complete. The results of the study were positive and significant, showing that acupuncture was able to lower pain scores.

The patients in our study were randomized to one of three treatment groups: real acupuncture, sham acupuncture or waitlist control. Most of you are probably wondering what sham acupuncture is and why we would use it, so I’ll fill you in. The sham acupuncture is theoretically used as a placebo control. To perform sham acupuncture, we use a blunt-tipped needle for which the body of the needle retracts into the handle of the needle (like a stage dagger) when it is pressed into the skin. We also apply the sham needles at “sham” acupuncture points that do not lie on the regular meridians.

The use of sham acupuncture in research is a very controversial topic, with many people feeling that, for several reasons, it is not an inert intervention and therefore not a reliable placebo. Two of the main reasons that some people feel sham acupuncture is unreliable have to do with the type of needle used and the points selected. There are, in fact, styles of acupuncture treatment that are “non-insertive”. To perform a non-insertive acupuncture treatment, practitioners hold the needles on top of the patient’s skin at the acupuncture point and the needle never penetrates through the skin (much like the sham needles). Toyohari is one of these non-insertive styles of acupuncture. We were exposed to Toyohari during our education at NESA, where several professors use the style in their practices.

The other issue is the use of sham acupuncture points. There are many in the field that state that there is no such thing as a sham point and that all points on the body can and do have some effect on the patient. The “real” points we used in our study, and the points that are used in most acupuncture research, are based on TCM (Traditional Chinese Medicine) theory. Once again, there are other styles of acupuncture besides TCM that utilize completely different points, most notably Master Tung’s acupuncture.¬†There are also many different Korean, Japanese, Tibetan and Vietnamese (to name a few) styles of acupuncture, which utilize different points than TCM acupuncture. So what one person calls a “sham” acupuncture point, others may utilize for “real” treatments.

These two reasons may partly explain why in our study, and in most studies that use this type of sham acupuncture, the sham treatments do show a positive effect. In our study, the effects of sham acupuncture were not as strong or as long-lasting as the beneficial effects of real acupuncture, but there is still an effect. Skeptics of acupuncture use these kinds of findings to say things like: “it doesn’t matter where you stick the needles”, “there’s only an effect because of the attention you are paying to the patient” and “the theories of Chinese medicine are bogus”.

Obviously we don’t agree with the skeptics and while we feel that acupuncture research is important and it has its place, for us the proof is in the pudding of daily practice.

Chinese Herbal Liniments

Walk into an herb store in any city’s Chinatown and you will see shelves full of herbal products that are for external use only. Pain-relieving ointments, oils and patches, creams and lotions for your skin and on and on. Within the rich history of Chinese herbal medicine, there is a well-developed “specialty” of using herbal medicines externally. Being the tinkerer that I am, I have played around with making some herbal preparations over the years, mainly salves, balms and liniments. In today’s post I wanted to talk about how I make liniments for external application.

I generally make two liniments, one for traumatic injuries with visible swelling, inflammation and bruising (this type of liniment is traditionally called Die Da Jiu, literally “hit fall wine”), and one for chronic tendon injuries or other lingering soft-tissue injuries. Both of these types of liniments have their roots in martial arts tradition and they are used to treat injuries that may happen in the course of training. The intersection of martial arts and Chinese medicine is a strong one, with many martial arts masters being proficient in the use of Chinese herbs and acupuncture (or acupressure) techniques. Many martial arts schools have specific recipes for liniments that are passed down through generations and kept secret from outsiders.

While there may be secret recipes and closely guarded techniques for preparing these medicines, the basic method of making them is quite simple: soak herbs in alcohol for months to years, strain off liquid and use it. Of course there is a little more finesse required in determining the herbs to use, the dosages and the type of alcohol to soak in. Most say that the longer the herbs steep in the alcohol, the stronger the liniment gets. The scientist in me (he’s in there somewhere) feels that there must be a time when all of the active constituents have been extracted from the herbs and the liniment won’t really get any stronger by steeping longer. The acupuncturist in me agrees that longer is better!


Trauma Liniment Steeping in Glass Carboy

I have read a lot about making liniments and I’ve experimented with different recipes to come up with a couple that I like. I generally try to use 100 proof vodka, which is 50% alcohol and 50% water. Traditionally, rice wine was used to make the liniments and other herbal preparations (the ancients in China probably didn’t have very easy access to Nikolai 100 proof vodka!) Some of the chemical constituents in herbs are soluble in water and some in alcohol, so I like the balance that the 100 proof vodka gives you. I recommend steeping the herbs in glass containers, not plastic. I use 3 gallon carboys. I like to steep my herbs for at least 6 months and usually for a full year. I give the bottles a good shake every now and then to mix them up. If you’ve been in the office, you might have noticed a few of these bottles sitting around.


Tendon Lotion


Close up of herbs soaking


After soaking, shaking and waiting… and waiting… and waiting some more, it’s time to strain off the liquid and bottle it up.


Straining solid herbs out of the liquid


Bottling the liniment


Voila, the finished product

So just to review quickly, the Trauma Liniment would be used in the case of a recent, acute injury. A badly sprained and swollen ankle or “throwing your back out” are both good examples of when to use this. You would gently massage the liniment into the swollen area 3-5x/day.¬† The Tendon Lotion would be used for any nagging, lingering tendon or other soft-tissue injuries such as tennis or golfer’s elbow. The Tendon Lotion could also be used for that ankle sprain that happened months ago, isn’t really swollen or bruised anymore and just isn’t healing. The Tendon Lotion is applied the same way the Trauma Liniment is, although if you can warm the area up before applying the Tendon Lotion, that’s even better. Both of these liniments are great to have on hand at home, they are a valuable part of your home medicine kit.

If you’d like to purchase either of these liniments, just email us at the office. If you are an acupuncturist or other healthcare provider who would like to sell these products out of your office, you can also let us know via the email link.