Acupuncture program brings solace for patients in hospice

The Boston Globe: Joan Woods is finally getting some relief.

In her Winthrop living room, she is silent in her pink, comfy chair. Just moments before, Daria Casinelli, a licensed acupuncturist, inserted 14 needles in Woods’ wrists, feet, and ears to help reduce the pain she feels in her feet and stomach, and to allow the 80-year-old former nurse to breathe easier.

After a few minutes, Woods opens her eyes, smiles, and sighs. “It’s hard to explain what peace this gives me," she says.

For the last four years, Woods has battled cancer with chemotherapy, radiation, and surgery. A few months ago, doctors told her that the cancer had spread to her lungs. That’s when she decided to stop traditional treatment and enter hospice. In March, the doctors gave her six months to live, so she contacted All Care Hospice, based in Lynn. After explaining her symptoms and diagnosis, the hospice asked if she would be interested in a new program offering treatment from licensed acupuncturists.

Woods, who does not like to take pain medication, had previously seen an acupuncturist to treat her migraines and herniated discs, and remembered the experience as pleasant and calming. “When it was offered to me, I jumped at the chance," she says.

The program — which marks the first time a Massachusetts hospice has offered acupuncture to patients — began in April, after Dr. Lewis Hays, All Care’s medical director, met with officials from a local acupuncture school. As part of its postgraduate program, the school agreed to recruit working acupuncturists to treat hospice patients. Both organizations agreed that the free program had mutual benefits: The acupuncturists earn postgraduate credits and the patients are exposed to a treatment that doesn’t require drugs and can often bring immediate, temporary relief.

“It’s an idea whose time has come, absolutely," says Hays, who believes that acupuncture is effective in treating symptoms that many in hospice face, such as pain, shortness of breath, anxiety, nausea, and vomiting.

While acupuncture has been used for thousands of years in China and neighboring countries to treat pain and other symptoms, it is considered a complementary treatment in the United States, is rarely used in hospitals, and is not covered by most health insurance plans. For acupuncturists like Casinelli, the program already has been a learning experience. In addition to treating hospice patients weekly, she also is part of an interdisciplinary team — including a doctor, nurse, social worker, chaplain, and home health aide — that discusses how to best care for the patient

PsychCentral: Acupuncture Effective for Undetermined Illness

Despite the advances of modern medicine, one in five patients has symptoms that are unexplained and untreated, contributing to stress for both the provider and individual. Further, studies have shown that the cost of managing the treatment of a patient with medically unexplained symptoms can be twice that of a patient with a diagnosis.

In an effort to provide a solution, a UK research team performed a clinical randomized controlled study on the efficacy of acupuncture for the undiagnosed disorders. Included in the research design was a linked interview of each patient’s subjective opinion of the intervention.

Some 80 patients from GP practices across London were selected to have five-element acupuncture added to their usual care. The results of the research are published in the British Journal of General Practice. The study group was made up of 80 adults, 80 percent female with an average age of 50 years and from a variety of ethnic backgrounds who had consulted their GP at least eight times in the past year. Nearly 60 percent reported musculoskeletal health problems, of which almost two-thirds had been present for a year. The patients were randomly divided into an acupuncture group and a control group. Eight acupuncturists administered individual five-element acupuncture to the acupuncture group immediately, up to 12 sessions over 26 weeks. The same numbers of treatments were made available to the control group after 26 weeks.

At 26 weeks the patients were asked to complete a number of questionnaires including the individualized health status questionnaire “Measure Yourself Medical Outcome Profile.” The acupuncture group registered a significantly improved overall score when compared with the control group. They also showed improved well-being but did not show any change in GP and other clinical visits or the number of medications they were taking. Between 26 and 52 weeks, the acupuncture group maintained their improvement and the control group, now receiving their acupuncture treatments, showed “catch up” improvement. Results from the associated qualitative study, which focused on the patients’ experiences, supported the quantitative work.

This tool identified that participating patients had a variety of longstanding symptoms and disability including chronic pain, fatigue and emotional problems which affected their ability to work, socialize and carry out everyday tasks.

Participating patients reported that their acupuncture consultations became increasingly valuable. They appreciated the amount of time they had with each acupuncturist and the interactive and holistic nature of the sessions – there was a sense that the practitioners were listening to their concerns and, via therapy, doing something positive about them.

This patient-centered orientation encouraged individuals to take an active role in their treatment, resulting in cognitive and behavioral lifestyle changes, such as a new self-awareness about what caused stress in their lives, and a subsequent ability to deal with stress more effectively; and taking their own initiatives based on advice from the acupuncturists about diet, exercise, relaxation and social activities.

Comments from participating patients included: “the energy is the main thing I have noticed. You know, yeah, it’s marvelous! Where I was going out and cutting my grass, now I’m going out and cutting my neighbor’s after because he’s elderly”; “I had to reduce my medication. That’s the big help actually, because medication was giving me more trouble…side effects”; and “It kind of boosts you, somehow or another.”

Dr. Charlotte Paterson, who managed the randomized control trial and the longitudinal study of patients’ experiences, commented: “Our research indicates that the addition of up to 12 five-element acupuncture consultations to the usual care experienced by the patients in the trial was feasible and acceptable and resulted in improved overall well-being that was sustained for up to a year.

“This is the first trial to investigate the effectiveness of acupuncture treatment to those with unexplained symptoms, and the next development will be to carry out a cost-effectiveness study with a longer follow-up period. While further studies are required, this particular study suggests that GPs may recommend a series of five-element acupuncture consultations to patients with unexplained symptoms as a safe and potentially effective intervention.”

She added: “Such intervention could not only result in potential resource savings for the (National Health Service), but would also improve the quality of life for a group of patients for whom traditional biomedicine has little in the way of effective diagnosis and treatment.”