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Although the practice is thousands of years old, today in the US, the use of acupuncture remains controversial.  However, given the relative ineffectiveness of many treatments for chronic pain, and given the growing evidence of acupuncture's effectiveness, it is no wonder that more and more people are turning to this ancient Chinese technique for relief (you can read about my own acupuncture experience in this month's Special Report).

Dr. Frederick Paola has a Certificate in Medical Acupuncture from UCLA, a medical degree from Yale, and a law degree from NYU.  He has designed a physician's course on medical acupuncture and recently published a review on the use of acupuncture in treating spinal cord injury.  We put Dr. Paola In The Spotlight to learn more about this promising and controversial subject.

What is Traditional Chinese Medicine (TCM)?
P:  It’s an ancient school of healing that employs a therapeutic combination of acupuncture and Chinese herbalism.

What role does acupuncture play in TCM?
P:  In TCM, acupuncture—the insertion of needles at specific acupoints—is employed to influence the flow of energy or Qi in the acupuncture channels.

How did you become interested in acupuncture and spinal cord injury (SCI)?
My interest in acupuncture came first. In the mid 1990’s, I was looking for something I could do for my patients besides writing another prescription for the newest pharmaceutical. Acupuncture seemed like a perfect choice. When I took a job on a VA SCI unit, applying acupuncture to SCI-specific problems just seemed natural.

You recently published a review on the use of acupuncture in SCI. What did you conclude?
P:  We concluded that while the methodological limitations of many of the studies we cited made it difficult to draw firm conclusions about efficacy, acupuncture appears to be of promise in the treatment of a number of SCI-related conditions.

Why is there so much controversy surrounding acupuncture?
P:  To Westerners it’s different. It’s foreign. It’s based on theories and rooted in traditions unfamiliar to Western physicians. And so it’s treated with skepticism by western practitioners, who demand to see scientific proof of efficacy. Yet many of those same practitioners would think nothing of employing a pharmaceutical off-label, or referring a patient for a surgical procedure whose efficacy has not been demonstrated. In short, there’s a double standard.

Can acupuncture be used to treat almost anything?
P:  Yes, but it’s important to understand the difference between saying it can be used to “treat” almost everything and it can be used to “cure” almost everything. Acupuncture is not a panacea. Just as Western medicine is limited, so, too, is Chinese medicine.

What’s the specific theory behind how acupuncture could help someone with syringomyelia?
P:  If one were going to interpret syringomelia from a Chinese medicine perspective, the accumulation of fluid within the spinal cord developing in association with spinal trauma represents “Phlegm.” The main cause of Phlegm formation is a deficiency of Spleen energy—specifically an impairment of the Spleen’s ability to transform and transport Body Fluids. If Kidney energy is deficient—as it is likely to be in SCI patients—it will be unable to provide the Heat necessary for the Spleen to transform and transport Body Fluids, giving rise to Phlegm. And so the acupuncturist would attempt to remedy the problem by strengthening Spleen and Kidney.

Do you believe acupuncture works because of the reasons stated in TCM, or do you think there may be another mechanism at play?
P:  I don’t think we know why it works. So I think saying it works because it helps to move Qi is as good an explanation as any other.

Can and should acupuncture and TCM be evaluated using the scientific method?
P:  Should it? I think that’s largely a political question. As a practical matter, the American health care delivery system will demand such an evaluation. I believe that any such evaluation of acupuncture for the treatment of SCI-related conditions should be carried out carefully and systematically by qualified practitioners of acupuncture, in concert with spinal cord medicine specialists, using designs that can withstand rigorous scrutiny.

Does TCM make predictions that have been experimentally proven, or are its explanations after the fact?
P:  The NIH Consensus Development Panel on Acupuncture concluded, “There is sufficient evidence of [acupuncture’s] potential value to conventional medicine . . . to expand its use into conventional medicine and to encourage further studies . . . Further research is likely to uncover additional areas where acupuncture interventions will be useful.”

Do you think acupuncture will ever become mainstream?
P:  About 6000 MD’s have been trained in acupuncture in the last 15 years or so. It is becoming—or has become—mainstream.

What are your duties as an attending physician for the SCI Service at the VA?
P:  I’ve since returned to the practice of general internal medicine; but as an attending physician for the SCI Service at the VA, I rendered both primary care and SCI-related specialty care to spinal cord injured veterans.

What role do you think acupuncture should play in treating SCI?
P:  The NIH Consensus Development Panel on Acupuncture concluded that the use of acupuncture should be expanded into conventional medicine and further studies encouraged. I believe the same may be said regarding acupuncture and spinal cord medicine. Directions for such further studies might include, for example, the role of acupuncture 1) in the acute phase of SCI; 2) in the prevention and treatment of autonomic dysreflexia; 3) in the management of areflexic bladder and detrusor-sphincter dyssynergia; and 4) in the management of neurogenic bowel. Additionally, more work is needed on the role of acupuncture in the management of SCI-related chronic pain and spasticity and in the management of pressure ulcers. Because of the heterogeneity of acupuncture, these research trials should be designed to assess the absolute and relative efficacy of competing acupuncture approaches (e.g., traditional Chinese, Japanese meridian, French energetics, Korean hand, Five Elements, auriculomedicine, scalp acupuncture, and neuroanatomic) in the treatment of SCI patients.
 

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In the Spotlight:

Frederick Paola, M.D., J.D.
Affiliate Associate
Professor of Medicine
Division of Medical Ethics and Humanities
University of South Florida College of Medicine
 

Qualifications:

• Hospitalist, South Florida Inpatient Medical Specialists, Naples, FL

• Former Staff Physician, Spinal Cord Injury Center, James A. Haley VA Hosp, Tampa, FL

• Created and (beginning in March 2001) taught, twice yearly, 2 day course for physicians entitled “Introduction to Medical Acupuncture” for the National Procedures Institute.

• Member, American Association of Medical Acupuncture

Education: 

• Certificate in Medical Acupuncture, UCLA School of Medicine, '98

• JD, NYU School of Law, '91

• MD, Yale University School of Medicine, '84

• BS, SUNY at Stony Brook, '80
   

Selected Publications:

• Paola F and Arnold M.  Acupuncture and Spinal Cord Medicine.  J Spinal Cord Med 2003;26(1):12-20.

Spinal Cord Injury Facts

• Over 200,000 individuals in US are spinal cord injured

• There are approximately 11,000 new spinal cord injuries each year

• 82% of injured are men

• Average age at time of injury is 32

• Vehicular accidents account for 38.5% of spinal cord injuries

• Average first year expense for a SCI is $329,841

• 56.3% of SCI individuals are unemployed ten years after injury

Sources:  National Spinal Cord Injury Statistical Center; Christopher Reeve Paralysis Foundation