Many dog lovers turn to integrative or alternative medicine to help their animal companions with painful conditions. This is particularly common in chronic pain conditions that are not adequately controlled by conventional means, or when side effects associated with long-term use of other pain medications is problematic. For others, personal preference leads them to other treatment options. Combining traditional pharmaceutical pain medications with physical therapy, chiropractic, massage, acupuncture, laser, nutraceuticals, and herbal supplements is becoming more commonplace in veterinary medicine as we seek to manage pain with fewer opiate medications.
Tramadol, a medication which acts in people as an opiate analgesic, was once commonly prescribed as an oral painkiller for both chronic and acute pain management in dogs; however Tramadol has fallen out of favor as an effective pain killer, as recent research has demonstrated that most dogs lack the ability to break down Tramadol into a functional opiate molecule to modulate pain, though this does occur in both humans and in cats. And studies have also shown that long-term use of opiate medications for chronic pain can lead to more intense pain perception over time, a situation called “opiate induced hyperalgesia,” which is a paradoxical response whereby a patient receiving opioids for the treatment of pain could actually become more sensitive to certain painful stimuli.
Additionally due to the current opiate epidemic crisis, the pain-relieving effects of acupuncture have become more heavily funded for research as scientists seek proven alternatives to opiate pain control for people.
Meanwhile, acupuncture has been practiced for over 4,000 years in China and other Asian countries. Western cultures had rejected acupuncture for many centuries because of lack of ability to provide research and scientifically accepted evidence that it was effective. It is only with our more current understanding of neurophysiology that acupuncture has gained acceptance in the Western world. Acupuncture was introduced to the United States in the 1950s but gained popular interest in the 1970s when diplomatic relations with the People’s Republic of China improved. The International Veterinary Acupuncture Society was formed in 1974 and has been training veterinarians in acupuncture ever since, along with other organizations.
There are more than 360 documented acupuncture points in the body, with more than 150 points identified in companion animal medicine. Each point has a specific anatomic location and characteristic effects. Acupuncture was studied classically in humans and horses, and there is a large amount of ongoing research to validate transposition of acupoints from humans to other species, as well as to elucidate the mechanisms and efficacy of treatment. There is an ever-growing body of evidence for acupuncture analgesia and disease treatment, which can be found for both human and veterinary applications. In 1997, the National Institutes of Health released a consensus paper that stated that acupuncture was useful for musculoskeletal pain, osteoarthritis, immunomodulation, gastrointestinal, pulmonary, and reproductive pathologies, as well as addiction and stroke rehabilitation (National Institutes of Health, 1997). In 1998, the American Veterinary Medical Association released a position statement, classifying acupuncture as a medical or surgical procedure, recommending specific training for veterinarians.
Acupuncture works by stimulation of “acupoints” on the body surface by means of a solid needle, with or without electrical stimulation. Such stimulation alters biochemical and physical properties of the body leading to effects on the central nervous system. Though there are no unique microscopic structures at acupuncture points, there are some characteristics of acupoints that distinguish them from the surrounding skin. Acupuncture points contain a higher density of free nerve endings than the surrounding tissue. These points represent neurovascular bundles containing free nerve endings, an artery, vein, and lymphatic channel, and numerous mast cells, which release histamine when stimulated. Additionally acupuncture points are often located along the pathways of major peripheral nerves or their superficial branches, where cutaneous nerves emerge from deep fascia, where nerves emerge from bony foramina, at the bifurcation of peripheral nerves, or along tendons or ligaments, making them more accessible.
Locally, insertion of the needle at an acupoint stimulates fast transmitting pain fibers called “A delta fibers” and activates interneurons in the spinal cord, producing neurotransmitters that inhibit slower pain “C fibers.” That is how acupuncture acts locally for pain control, which is called “segmental analgesia.” Through these signals, the brain is alerted to the stimulus of the acupuncture needle and produces more natural pain killers or “endogenous opioids” and serotonin, among other chemicals, to help with ongoing inhibition of pain. Acupoints can be stimulated by a variety of methods, including finger pressure (known as acupressure), needles, and injection of saline or other solutions. Choice of needle is determined by therapeutic indication, and veterinary texts reference multiple options for insertion depth, angle, and techniques for manipulation upon placement in tissue. The intensity of the effect may be enhanced by the application of current electroacupuncture, which effectively has been proven to reduce chronic pain.
The frequency and duration of acupuncture treatment is governed at least in part by response to treatment, but 20 minutes weekly for four to six treatments have been recommended and improvement is usually seen in one to three days and can have longer lasting cumulative effects with repeat treatment.
Ilana Stubel, MA, DVM, CVSMT, CCRT, is founder of Pacifica’s A Well Adjusted Pet, Veterinary Rehabilitation and Integrative Wellness Center, and has been in general veterinary practice for almost 25 years with a special interest in integrative medicine. She is also a certified veterinary acupuncture therapist.
Acupuncture can help with pain in dogs.
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