pcare acupuncture report 2006-2009

8/14/2019 PCARE Acupuncture Report 2006-2009

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Palliative Care

Acupuncture Program

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Supportive Care Program, Palliative Care ServiceDepartment of Family & Social Medicine

Montefiore Medical Center


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Montefiore Palliative Care Acupuncture Program 1

Contents

Introduction 2

About Us 3

About the Program 4

Te Need or Integrative reatmentStrategies in Chronic Pain 5

Why Acupuncture? 6

Program Results 8

Patient Utilization 8

Patient estimonials 12

Feedback rom Acupuncture Interns 18

Contact Us 21

Te Palliative Care

Acupuncture Program

was made possible through

the generosity o the

Balm Foundation and

many individual donors.


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Montefiore Palliative Care Acupuncture Program2

Introduction

The Palliative Care Acupuncture Program at Monteore Medical Center was launched as a pilotin March 2006 to provide free acupuncture treatments to low-income people living with chronic

pain. The program was part of the Palliative Care Services Supportive Care Program, offering a

range of supportive, complementary care and educational services to improve the quality of life

of people living with chronic pain and those at the end of life.

The Acupuncture Program was introduced forpatients of our outpatient pain clinic through aunique collaboration with the Swedish InstituteCollege of Health Sciences, a licensed acupuncturetraining institute. This resource efcient strategyenabled us to offer acupuncture at no cost topatients, while providing a unique supervisedinternship for advanced acupuncture interns.

In May 2007, through the generous support ofthe Balm Foundation, we introduced a secondacupuncture clinic focusing on care for peopleliving with HIV/AIDS and pain. In total, 151patients received ongoing weekly acupuncture as acomplement to their regular medical care.

Many patients experience pain, depression andanxiety unresolved by standard medicine, yet are

unable to access the range of therapeutic servicesavailable to higher income populations. Ourprogram was able to address this gap by offeringacupuncture free of charge at one of Monteorescommunity clinics, a setting that is accessible,familiar and trusted by patients.

As the personal testimonials in this collectionreveal, participant feedback has been exceptionally

positive. Patients report signicant physical andpsychological benets, as well as high levels ofsatisfaction with the program itself. They alsoconvey that the program allowed them rare andmuch appreciated moments of comfort and relief,and provided new hope for alleviating their pain.


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About Us

Montefore Medical Center, the universityhospital for Albert Einstein College of Medicine, isa leading healthcare resource for low-income andminority residents of the Bronx, one of the mosteconomically, medically and socially disenfranchisedcommunities in the nation.

Almost half of patients served by Monteoreidentify as Latino and one third as AfricanAmerican. According to the 2000 census, 30 to45 percent of Bronx families and over 40 percentof children under 18 live below the poverty level.Prevalence rates for poverty-related diseases suchas substance abuse, HIV/AIDS and mortality fromHIV are over 50 percent higher than the citywideaverage. Over half the population is uninsured or onMedicaid. Social problems such as violence, crime

and incarceration are pandemic.

Montefore Palliative Care Service (PCARE)

Launched in 2000, PCARE provides state-of-the-art,multidisciplinary care to minimize symptom distressfor people who have serious illnesses that are notresponding to curative treatment. PCARE providesexpertise in pain and symptom management, advance

care planning and psychosocial support to over1,800 hospitalized patients each year through a teamof fellowship-trained doctors, nurse practitioners,medical social workers, and a psychiatrist. PCARE isa division of the Monteore and Einstein Departmentof Family and Social Medicine.

PCARE provides consultative pain managementservices to approximately 400 people on an

outpatient basis each year. Patients come toPCAREs Outpatient Pain Clinic for pain stemmingfrom a variety of complex and chronic conditions

including degenerative musculoskeletal disorders,chronic progressive neurological illnesses, multiplesclerosis, cancer, rheumatoid arthritis, diabetes, andHIV. Along with physical illness, over half of patientsreport psychological symptoms such as depressionand anxiety.

Montefore Center or Positive Living/

Inectious Disease Clinic (ID Clinic)The ID Clinic is a nationally-recognized, model HIV/AIDS primary care clinic, providing multispecialtyoutpatient HIV primary care to one of the largestand most diverse HIV-positive patient populationsin the nation. The clinic serves approximately 2,700adults each year through an integrated team of over45 healthcare professionals including physicians,

nurse practitioners, psychiatrists, psychologists,gynecologists, obstetricians, dermatologists, painspecialists, hepatitis C and diabetes specialists, socialworkers, nurses, and dietitians. Ninety-one percent ofpatients have incomes below the federal poverty level.

The ID Clinic is part of the Monteore AIDS Center,which also includes an inpatient service, a researchunit, an on-site outpatient specialty pharmacy, HIVtesting and counseling, and a renowned HIV/AIDSquality of care program.


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About the Program

Each semester, six to seven advanced studentinterns provided free acupuncture to patientsin exchange for the use of our site as a clinicalpractice setting. Interns were directly supervised bylicensed clinical faculty from the Swedish Institute,

with Monteore oversight. In total, 28 studentscompleted their internship at Monteore.

One of the keys to our programs success was thatit combined the resources of two institutions in acost-effective manner that benetted all involved.

We were able to offer acupuncture at no cost to ourpatients. In turn, interns gained experience workingwith patients with complex medical proles whoare unlikely to be able to gain access to theseservices otherwise. Interns repeatedly stated thatour patient population is highly distinct from thepatients they are exposed to in their Manhattanschool clinic, making our program an importantlearning experience.

Three interns worked at the PCARE Pain Clinic one

morning a week under the direct supervision of alicensed clinical acupuncturist. Each intern treatedone patient per hour in a private treatment room,for a total of twelve patients per week. The secondgroup of interns worked at the Monteore ID Clinicone afternoon each week, providing care for peoplewith HIV/AIDS and pain.

Patients were referred to the program by their

PCARE or ID Clinic physician or nurse practitioneraccording to a series of inclusion and exclusion

criteria. The program communicated with eachreferred patient to provide information andanswer questions about receiving acupuncture.Participants were offered a 6-week block oftreatmentsa standard number used in medicalsettings for lasting clinical effectswith the optionof continuing for additional treatment blocks.

Our program offered patients a high qualitytreatment experience, centered on personal,focused attention and care. Patients were scheduledwith the same acupuncturist each week to developan ongoing relationship and for continuity ofcare. Each session, patients spent a full hourwith their acupuncturist in a private treatmentrooma marked divergence from the often rushedpace of standard healthcare. The acupuncturistinvestigated in detail how the patient was feelingand any changes in health or symptoms since thelast appointment. Patients then received treatmentstailored to their individual health needs and had theopportunity to rest for as long as 1520 minutes

with the acupuncture needles.

Patients were referred for acupuncture for a varietyof pain conditions (see Program Results, page 8 formore details). The acupuncture intake process alsoincludes specic questions on emotions, mood andhealth behaviors. Acupuncture thus often servedas a gateway to address other important concernsin patients lives such as depression, anxiety and

sleeping difculties.

PCARE launched the Acupuncture Program in March 2006 in collaboration with theSwedish Institute College of Health Sciences Acupuncture Clinical Internship Program.


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Te Need or Integrative reatmentStrategies in Chronic PainChronic pain, the number one cause of disabilityin the United States, is a complex sensory andemotional experience that can affect all aspectsof a persons lifephysical, psychological,emotional, and social (1). People living with painroutinely experience limitation of personal, socialand work activities, a sense of demoralizationand powerlessness, preoccupation with pain,depression and anxiety, and increased dependenceon healthcare services (2).

Socioeconomic disadvantage is a predictor ofdisabling pain and pain is more prevalent amongminorities, who are more likely to live in poorcommunities (3). It is also known that peoplewith considerable past or present life stress oftenperceive chronic pain as unmanageable becauseit amplies the baseline stress already in existence(4). Indeed, we nd that our patients experience ofpain is often further exacerbated by the effects ofliving in an impoverished community. Patients maylack social support, with family networks strainedby longstanding poverty, mental health issues orsubstance abuse. Many patients themselves havestruggled with mental illness or substance abuse,

and lack coping skills. Some have also experiencedsignicant trauma in their lives.

Despite advances in medical knowledge, diagnosticprocedures and treatments, no one currenttreatment provides consistent and permanentrelief for everyone with pain. Medications are oftenessential to alleviate pain, but 1) they address onlythe physical aspects of pain, 2) they often produce

troubling side effects, 3) they are sometimesineffective, leading patients to request increasinglylarger doses of potentially addictive medications or

to feel stranded without options to manage theirpain, and 4) they may have signicant interactionswith other medications, markedly reducing qualityof life.

It is widely recognized that optimal treatmentof chronic pain involves a multidisciplinary,integrative approachcombining multiplehealthcare strategies to address the individualstotal experience of living with pain, at differentstages of healing. This might include standardtreatments such as medications and physicaltherapy, along with approaches such as counseling,support groups, acupuncture, massage therapy,chiropractic, relaxation techniques, gentle yoga or

other movement therapies, and good nutrition.

See page 20 of this document for citations on this page.


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Why Acupuncture?

Research studies indicate that acupuncture iseffective in relieving chronic pain including neckpain (1, 2), low back pain (3, 4), knee or hip

pain (5, 6), peripheral joint pain (7), and painfuldiabetic neuropathy (8). Acupuncture has hadpositive results in treating symptoms of HIV/AIDSsuch as peripheral neuropathy (9) and diarrhea(10), and can be helpful in smoking cessation (11)and the treatment of drug addiction (12, 13, 14).Studies also suggest benets for such mental healthissues as depression and anxiety (15, 16, 17), aswell as to improve the quality of sleep (18, 19).Acupuncture is considered a safe treatment method,with a lower risk of adverse side effects than withmany standard drug treatments (20).

When treating chronic pain, interventions thatrespond with sensitivity to peoples needs, promotethe mastery of skills to cope with pain, and

reinforce the potential for healing are essential.Acupuncture treats the whole person, evaluatingphysical symptoms along with diet, lifestyle,emotions, and mood to improve health and wellbeing on all levels. Acupuncturists also encourage abalanced diet and lifestyle, teach special techniquesfor self-care, and champion the individuals capacityfor self-knowledge and healing.

Despite these benets, most people in low-incomeneighborhoods cannot afford acupuncture orother integrative treatments because of a lack ofinsurance coverage, high out of pocket fees and

Acupuncture has been used for thousands of years to treat pain and other health conditionsand to increase overall health. PCARE introduced acupuncture because of its recognized effects

on decreasing pain, reducing stress and providing a deep sense of relaxation.


Acupuncture treats the whole person,evaluating physical symptoms along with

diet, liestyle, emotions, and mood to

improve health and well being on all levels.


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a simple lack of local services. Living in resource-poor neighborhoods in the Bronx, many patientsdepend on programs such as ours for this type ofhealing therapy.

It is sometimes assumed that people living in low-income communities would not be interested inreceiving integrative medicine. While planning

our acupuncture clinic, the question in fact arosewhether our patient population would evenconsider acupuncture at all. Participant feedbackon their experiences with our acupuncture clinichas shown that patients are decidedly interestedand benet signicantly. Many participants choseto return for additional treatment blocks, and weconsistently received new referrals for people whowere eager to try acupuncture for the rst time.

People with chronic pain often already facelimitations, a sense of powerlessness and areduction of choices by virtue of their state ofhealth. We believe that healthcare should be anarena that truly supports patients and encouragesthem to explore options in care as a means toimprove health, enhance self-efcacy and createchange in their lives. Our acupuncture program

was successful as a meaningful way to providepatients with expanded choices in healing throughan effective modality that promotes individualizedand empowered care.


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Pain Clinic

ID Clinic

GENDER

Female

81%

63%

Latino

39%

60%

African American

33%

27%

White

27%

12%

South East Asian

1%

1%

ETHNICITY

Range

1986

2586

Median

56

50

60% Grouping

4565

4560

AGE

Patient Demographics

A total of 151 patients received acupuncturethrough the Acupuncture Program: 67 in the Pain

Clinic and 84 in the ID Clinic. In both clinics, themajority of participants were women and identiedas Latino or African American. Participantsages were also similar, with a median age of 56in the Pain Clinic and 50 in the ID Clinic. These


Te program had high compliance, with70% o Pain Clinic participants completing

the minimum 4 treatments.

Program Results

demographic ndings are consistent with generaltrends in chronic pain. Studies show the majority of

people living with chronic pain are women betweenthe ages of 4564 (1). Women have been found tobe at greater risk for many pain conditions and tendto have higher pain sensitivity than men (2).

Patient Utilization


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Frequency o AttendanceA total of 749 acupuncture treatments wereadministered in the Pain Clinic from March2006December 2008. We had high levels ofcompliance, with 70 percent of participantscompleting at least 4 treatments, which was theminimum requirement of the program. Fifty-onepercent completed at least 6 treatments, theminimum expectation for clinical results, with 30percent completing between 10 and 60 treatments.

Treatments were offered in sessions, each of whichconsisted of 6 treatments. Fifty-seven percent ofparticipants chose to return for more than onesession, attending between two and 12 sessions.

In the ID Clinic, a total of 485 treatments wereadministered from May 2007April 2009. Forty-two percent of participants completed at least fourtreatments. Thirty-two percent completed at leastsix treatments, with 14 percent completing between10 and 53 treatments. Forty-four percent ofpatients chose to return for more than one session,attending between two and 10 sessions. Thatpatients in the ID clinic participated less regularlythan patients in the Pain Clinic is consistent withthe lower rate of attendance for medical care in theID Clinic in general.

The gure below shows the number of treatments

completed at both clinics.

NUMBEROF

PATIENTS

Pain Clinic

ID Clinic

30

25

20

15

10

5

01 2 3 4 5 6 7 8 9 1030 3160

NUMBER OF TREATMENTS

Number of Treatments per Patient


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42%

27%

15%

7%5% 4%

19%

29%

29%

23%

Other

Hypertension/Heart Disease

Depression/Anxiety

Respiratory Conditions

Back Pain/Degenerative Disc Disease

Arthritis

Musculoskeletal Pain

Neuropathic Pain

Other

Cancer-Related Pain

Pain ClinicComorbidities Indicated(n=21)

Pain ClinicReasons for Referral(n=59)

In the Pain Clinic, the majority of patients were referred for back pain/degenerative disc diseaseor arthritis. The most common comorbidities indicated on the referral were depression/anxietyand hypertension/heart disease, followed by respiratory conditions.

Reasons or Reerral


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The majority of patients in the ID Clinic were referred for back pain/degenerative disc disease ormusculoskeletal pain, followed by neuropathic pain. The most frequent comorbidities indicated werehypertension/heart disease, hepatitis and respiratory conditions, followed by depression/anxiety. Ninetypercent of patients treated for acupuncture in the ID Clinic were HIV positive.

30%

21%11%

9%

8% 3%

9%

9% Back Pain/Degenerative Disc Disease

Musculoskeletal Pain

Neuropathic Pain

Arthritis

Smoking Cessation

Other

Headache

Cancer-Related Pain

ID ClinicReasons for Referral(n=72)

ID ClinicComorbidities Indicated(n=50)

28%

24%22%

13%

13%

Other

Hypertension/Heart Disease

Depression/Anxiety

Respiratory Conditions

Hepatitis


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Program Results

Feedback rom Patients

Patients have reported high levels of satisfaction with the Acupuncture Program, especially the

quality of services and staff. They describe improvements in pain, mood and sleep following their

acupuncture experience. On an emotional level, patients explain that acupuncture helped them

feel less depressed and anxious, better able to cope, and more condent in their ability to handle

what are often profound life challenges. They convey that the program allowed them rare and

much appreciated moments of comfort and relief, and provided new hope for alleviating their

pain and health complaints.

Your program has made me eel hope that I

wont have to live with this pain orever.

Patient estimonials

Robin*Ive been receiving acupuncture for about a yearand half now, and I have to say it has helped mysevere back pain and also improved my mood. Ihave back pain which is chronic and a deteriorating

condition. I nd that when the clinic is not inoperation, my back deteriorates and my moodalso deteriorates. My experience has been thatevery time I start acupuncture again, I have markedimprovement in my pain and my mood.

When my pain rst started I had to take massivedoses of Ibuprofen, Celebrex and anothermedication, which Ive stopped taking sincestarting acupuncture. Acupuncture denitely had

a relationship to my being able to stop taking themedications. I just received a treatment and thedifference in how I feel now, both physically andemotionally, versus when I came in is a marked

improvement.

My rst encounter was so amazing. The intern saidyoure hot and I said what does that mean? Shesaid youre holding emotion and we need to releasethe emotions from your body. And she told me thatI may experience crying and explained how the bodyreleases things through the bodily uid. Three hoursafter the intervention, I was sitting on a bench and

just burst into tears. It wasnt tears that emanatedfrom a feeling state of sadness. It just poured outand that went on for about a week. And I knew*All names have been changed to respect privacy.


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what was going on because it had been explainedto me. But the fact that I had such a quick reactionand my body responded so to the intervention, Isaid this is a miracle, this stuff is amazing. So thatkind of just hooked me, and then the fact that I seesuch immediate resultsand Im fortunate that mybody does respond so well to this, without pillsits the body healing itself, which is I think the best

way to approach anything if one can.Based on this experience, I plan to avail myself ofacupuncture for the rest of my life. This has beena wonderful experience, truly. Im very glad myphysician referred me, I truly am.

CaroleMy experience [with acupuncture] is a very goodone and I will never forget it. When I came hereI was all messed upI mean mentally, physicallyand everything. I have a young grandson who hascancer and when I came in everything was justcrazy with him, so it made me crazy. Ive beencoming for twelve weeks and Ive been feeling somuch better in the last four or ve visits. Each timeI come it gets better and better.

The staff here is wonderful. Everybody has treatedme very good from the rst day. I felt so at home,so relaxed, I could just speak my mind. Andwhen I leave here I feel like a million dollars. If Ishould ever need to come back I will denitelycome because its one of the best experiences Ivehad dealing with hospitals and sickness. I wouldrecommend it to anybody. Since Ive been comingIm more relaxed and see things differently and feeldifferently, so I feel like I could take on the worldnow. The sky is the limit. So thank you. So much.

DeborahAcupuncture is helping me when it comes tosleeping. I used to be up every hour, even withsleeping pills. Id take a sleeping pill, sleep for anhour and get up. Now I get to sleep most of thenight. Say I get up at 4am, Ill take one sleeping pill

and sleep until 9. That is a big improvement.

This is my eighth time coming. The people areabsolutely wonderful. They explain things as theydo them and answer any questions I have. Overallits denitely been a positive experience. I wouldeven want to have it more often.


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EduardoMy experience with the acupuncture is verygood. Its the rst time that I take acupunctureand its helpingme a lot. I wasinterested in havingacupuncturemostly for my

pain. Before Istarted takingacupuncture, it wasvery hard for meto walk because ofthe pain in my legs.I think Im havinga good treatmentbecause my painis getting muchbetter. I talked to[the acupuncturist]and Ive seen manychanges since Istarted takingacupuncture.

Before acupuncture I just took medication, pills,but it doesnt work. I decided to tr y acupuncturebecause I think its something natural. Try to dothings naturalI think its better than a lot ofmedications for your body. I think Im going to useacupuncture for everything I want to treat.

ClaraThis was my rst experience with acupuncture.I was looking for relief and I think I found it. It

helped, especially with myhands and my neckI wasable to turn my head more.

Then they started workingon my back and it was

feeling better. I had a lot ofproblems and my body wasreally responding.

Before acupuncture, mypain wasnt going awayand I was really gettingfrustrated and it wasmaking my condition

worse. I really need helpbecause my hands aredying, theyre atrophying.But the acupuncture I feltwas doing something forme. I actually went downon the opioids I felt the

pain was a little better. Not only that, but in my

own heart I was able to ght. I had lost the will toght until I got acupuncture. I think the talking tome while they were working with me gave me hope.Medicine without hopeI dont care how muchmedicine you do, if you lost hope, its not going tohelp. But when I was getting the acupuncture, theacupuncturist talked to me the whole time and Icould feel that as he was talking it didnt hurt andmy body starting responding to the touch. Then I

understood what the acupuncture meant.


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If you lose hope, your body is going to fall, yourmind just stops responding without hopeyouknow, what are you doing all this for? But when Iwas getting acupuncture I was feeling hope. Im aghter, but I was giving up. With all the drugs inyou, and I hate drugs. That still bothers me when Ihear opioids. It is a serious medication. And then

they wanted to put me on methadone. I foughtagainst it. I saw too many people growing upnodding out. I saw a lot of strong men dying offthose drugs. And so did I want it in my body? No.People say this is different. It s no different whenyoure thinking about what you saw, even if nowits legitimate.

Oh my goodness. I really did have a good

experience with the acupuncture clinic. I metwonderful people that I was able to put my trustin, because as I said I lost trust I had a lot offaith in the rst [acupuncturist]. He was verygentle. Im very fortunate that I got a chance tomeet everyone in the acupuncture [clinic] and tolearn what its about.

I dont think old but I am a senior citizen. Where

do I go now? Where do I go? Acupuncture gaveme hope.

NildaThis is my third time coming and I nevertook acupuncture before. The rst time I hadacupuncture, before that I couldnt sleep, but sincethe rst day I took [acupuncture] its working forme, so Im proud Im taking it. Before I couldntsleep the whole night but ever since Ive been takingacupuncture Ive been able to sleep at night.

I always have severe pains but with thisacupuncture the pain is not as strong as before.I notice because I used to take so many pills.OxyContin in the morning, OxyContin in themiddle, OxyContin at night. But with this, Im nottaking the one in the middle, just in the morningand at night. [My pain is] not totally gone becausewhat I have is not going to go away completely,

but with acupuncturelike I had a headache thismorning and right now [after the acupuncturetreatment] it disappeared. It s working!

Ive always wanted to try [acupuncture]. The otherday I asked my doctor, he said I was thinking aboutthat. I dont know what else to give you for thepain. The only thing is acupuncture, try it. So hewas the one that brought me to acupuncture. Imhappy he did. He told me about acupuncture. Andit worked.

I had lost the will

to fght until I got

acupuncture.

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JanetThis is my second round of acupuncture. WhenI started I had a lot of pain. I have some pain inmy leg, but my groin and my lower back are whereit hurts a lot. Its not so bad now. Its comingalong and Im hoping that [the acupuncture] willeliminate the rest of the pain. Its not as much painas I had when I rst started so Im hoping that this

other cycle will help me.

I think [the acupuncture has] helped a lot. I feelreally good after I come, and so I started goingshopping [right afterwards], but the therapistsaid not to do that, to go home and rest. Soak inthe tub with Epsom salts. And I found that to bevery helpful. Before I started coming I didnt goanywhere too much because of the pain when I

walk. And then when I started I was taking a cabhere. It has subsided so that Im able to come bybus. I have to take two buses. So that shows methat its helping. Im not spending a lot of car fareanymore.

Id never had acupuncture before but my doctorsuggested it and I told her that I was willing totry it. I trusted her. At rst when I came I wasafraid because Im scared of needles. But theacupuncturists are very nice. They really made mefeel at ease and thats why I was willing to keepcoming back.

They should have acupuncture available all thetime. Im glad they got it, not only for me but forother patients who really need it. They should keep

it because a lot of people really need acupuncture.They really do and theyre not getting it. Im justglad I can get it.

JamesWell, basically acupuncture has been a lifesaverto me so far because Ive been going through a lotof pain. I heard so much about the acupuncture.Its been a good experience for me and it s helpedmy back a great deal. Especially the lady whostaking caring of me, shes shown me many thingsabout why [I have] pain and how I can relieve it.

Wonderful stafftheyre nice, they take time toexplain to you how to take care of your body andavoid the pressure Im going through.

The way theyre training these [acupuncturists]is unbelievable. Theyre very courteous. They askyou before they do anything. They try to give youcondence and put you at relief. They explain to

you, really explain to you what its all about, dontlook for miracles right away because youve beengoing through this pain for a while. These thingsdont happen overnight.

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I have chronic back pain and the acupuncture gaveme a lot of hope. I was on a dialysis machine forabout seven and a half years, and being in thosechairs, I was giving up on it. Three years ago I gota kidney, but during that course I believe my backwent through hell and taking the pills and all thatsort of stuff really didnt help me, and I never didwant to take too much pills anyway. So when I got

the opportunity for the acupuncture I jumped atit. Its been working out quite well. I believe thatacupuncture would be a little more pushed up ifpeople realize it does help you. Like today I was alittle upset over something and the acupuncturerelaxed me and my back feels much better now.

The acupuncture has denitely helped me physically.When I leave here I have to do many things, but I

have condence because I just got the acupuncture.

I know I can manage to do this and do that withoutthinking about the pain. I can face some of theseobstacles in a new way these days. And believe meits very hard to have pains in your body and back.

You dont have to look bad to feel bad

I say you should keep it up. If you can encourageother people like yourself thats trying to keep itgoing, and that attitude, taking time and asking

people. Because believe it or not there are so manypeople that are stressed out and in pain. Andthe point is that the ones that can afford it getit but the ones that barely can cant. I know thatacupuncture denitely will help anybody that goeswith it and sticks with it. I hope people realize theyshould have acupuncture brought to the peoplemore, realize how can it help you. What youre

doing is very grand. Dont give up on it.

I can ace someo these obstacles

in a new way...

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Program Results

Acupuncture Intern estimonials

Sarah*What I value most about my experience in the Bronxare the daily one-on-one sessions with patients.Ive seen patients respond dramatically well totheir acupuncture treatments. One patient haddebilitating pain that was gone when she stoodup after her rst treatment, and [the pain] hasntreturned. Another patient suffered from an asthmaattack which stopped within a few minutes ofneedle placement, with her pulse and respirationalso returning to normal rates. I believe that thegentle mind/body/spirit approach that acupunctureoffers is the chief reason these patients respond so

quickly and so well.

I also feel that this internship helped me developmy knowledge and skills in treating patients. Ifelt challenged as an acupuncturist in a positiveway to come up with treatments that address thepatients whole self, especially as many patientshave complex physical and psychological healthconditions. I believe I grew in my sensitivity and

my ability to connect with many different types ofpeople. It has been a great learning experience andvery rewarding.

AnneI applied for this internship because I wantedto experience what working in a hospital settingwould be like and to work with patients whomight otherwise not have access to acupuncture.I specically wanted to work with patients withchronic pain who have not had success with painrelief despite medical interventions.

I greatly enjoyed my internship. I was able towork with patients who are on many medicationsand to deal with the complexity of diagnosis andtreatment from a Chinese medical point of view.

The one commonality I observed among all thepatients was the presence of signicant mental oremotional distress. I learned about the complexityof issuesphysical ailments, mental/psychologicaldifculties and even spiritual issues patientswere struggling with. It was both humbling andgratifying to work with people who are coming toacupuncture not because of some new age desirebut because they are near their wits end.

*All names have been changed to respect privacy.

Feedback rom Acupuncture Interns

As their testimonials reveal, program interns reported signicant personal and professional growth

from their work at Monteore, including increased awareness of the challenges facing our patient

population, enhanced sensitivity to the multifaceted nature of chronic pain and of HIV, and a greater

level of professionalism. Interns also draw attention to the signicant, sometimes astonishing,

effects the acupuncture treatments had on patients physical health and psychological well being.

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I like the idea of working in collaborationwith other healthcare practitioners whoare also treating the same patients. For thisreason, I especially appreciated learningthe dynamics of working with patients aspart of an integrated team of healthcareproviders. I truly feel I grew as a person aswell as an acupuncturist/healer.

DanaI applied for this internship to work withclients with HIV/AIDS, some of whomalso deal with the challenges of nancialpoverty, mental illness and disability. Ifeel I really gained from this experience.I gained condence in my skills as a new

acupuncturist. I had the privilege ofworking with patients coping with multiplestruggles, and was able to help them onthe mind/body/spirit levels. I was also able touse my Spanish each clinical day, which was verymeaningful for me.

There are so many special experiences andmoments I would like to share involving my work

with the patients. I worked with a woman who isdisabled as a result of a medical accident severalyears ago. She experienced extreme pain in bothlegs. After the rst session her pain was signicantlybetter, and after the third she began gettingmovement back in both legs. She and her familyexpressed happiness and a sense of hope for apossible full recovery one day.

Another patient, an elderly woman with a diagnosisof bromyalgia, had a complaint of severe anddebilitating hip and groin pain. She only hadslight and temporary improvement after the rst

two sessions, and it was hard for her to believethat she would ever have signicant relief, thoughI explained it sometimes takes time. She feltdepressed and wept in the ofce. The day of herthird appointment she came into the examinationroom wearing a bright red blouse, without the useof her cane, and with a big smile on her face. Sheembraced me and told me she felt much better.

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The Need for Integrative Treatment Strategies in Chronic

Pain References1) Weiner K. Pain Issues: Pain is an Epidemic.American Academy of Pain Management, 2003.www.aapainmanage.org/literature/Articles/PainAnEpidemic.pdf

2) Turk DC, Monarch ES. Biopsychosocial Perspective on ChronicPain. In Turk & Gatchel, eds. Psychological Approaches to PainManagement. Guilford Press: New York, 2002.

3) Green CR, Anderson KO, Baker TA, et al. The unequal burdenof pain: confronting racial and ethnic disparities in pain. PainMedicine. 2003;4(3):277-94.

4) Green CR, Anderson KO, Baker TA, et al. The unequal burdenof pain: confronting racial and ethnic disparities in pain. PainMedicine. 2003;4(3):277-94.

Why Acupuncture References

1) Trinh KV, Graham N, Gross AR, et al. Acupuncture for neckdisorders. Cochrane Database Syst Rev. 2006;3:CD004870.

2) Willich SN, Reinhold T, Selim D, et al. Cost-effectiveness ofacupuncture treatment in patients with chronic neck pain. Pain.2006;125(1-2):107-13.

3) Manheimer E, White A, Berman B, et al. Meta-analysis:acupuncture for low back pain.Ann Intern Med. 2005;142(8):651-63.

4) Brinkhaus B, Witt CM, Jena S, et al. Acupuncture in patientswith chronic low back pain: a randomized controlled trial.ArchIntern Med. 2006;166(4):450-7.

5) Witt CM, Jena S, Brinkhaus B, et al. Acupuncture in patientswith osteoarthritis of the knee or hip: a randomized, controlledtrial with an additional nonrandomized arm.Arthritis Rheum.2006;54(11):3485-93.

6) Berman BM, Lao L, Langenberg P, et al. Acupuncture fortreating knee osteoarthritis. Summaries for Patients.Ann InternMed. 2004;141(12):1-20.

7) Kwon YD, Pittler MH, Ernst E. Acupuncture for peripheraljoint osteoarthritis: a systematic review and meta-analysis.Rheumatology (Oxford). 2006; 45(11):1331-7.

8) Abuaisha BB, Costanzi JB, Boulton AJ. Acupuncture for thetreatment of chronic painful peripheral diabetic neuropathy: along-term study. Diabetes Res Clin Pract. 1998; 39(2):115-21.

9) Phillips KD, Skelton WD, Hand GA. Effect of acupunctureadministered in a group setting on pain and subjective peripheralneuropathy in persons with human immunodeciency virusdisease. J Altern Complement Med. 2004 Jun;10(3):449-55.

10) Anastasi JK, McMahon DJ. Testing strategies to reduce

diarrhea in persons with HIV using traditional Chinese medicine:acupuncture and moxibustion.J Assoc Nurses AIDS Care. 2003 May-Jun;14(3):28-40.

11) Bier ID, Wilson J, Studt P, Shakleton M. Auricularacupuncture, education, and smoking cessation: a randomized,sham-controlled trial.Am J Public Health. 2002 Oct;92(10):1642-7.

12) Avants SK, Margolin A, Holford TR, Kosten TR. A randomizedcontrolled trial of auricular acupuncture for cocaine dependence.Arch Int Med. 2000;160(15):2305-12.

13) Courbasson CM, de Sorkin AA, Dullerud B, Van Wyk L.

Acupuncture treatment for women with concurrent substanceuse and anxiety/depression: an effective alternative therapy? FamCommunity Health. 2007 Apr-Jun;30(2):112-20.

14) Liu TT, Shi J, Epstein DH, et al. A meta-analysis ofacupuncture combined with opioid receptor agonists fortreatment of opiate-withdrawal symptoms. Cell Mol Neurobiol.2009 Jun;29(4):449-54.

15) Wang H, Qi H, Wang BS, et al. Is acupuncture benecial indepression: a meta-analysis of 8 randomized controlled trials. JAffect Disord. 2008 Dec;111(2-3):125-34.

16) Pilkington K, Kirkwood G, Rampes H, et al. Acupuncturefor anxiety and anxiety disorders--a systematic literature review.Acupunct Med. 2007 Jun;25(1-2):1-10.

17) Samuels N, Gropp C, Singer SR, Oberbaum M. Acupuncturefor psychiatric illness: a literature review. Behav Med. 2008Summer;34(2):55-64.

18) Huang W, Kutner N, Bliwise DL. A systematic review of theeffects of acupuncture in treating insomnia. Sleep Med Rev. 2009;13(1):73-104.

19) Kalavapalli R. Singareddy R. Role of acupuncture in the

treatment of insomnia: a comprehensive review. Complement TherClin Pract. 2007 Aug;13(3):184-93.

20) National Center for Complementary and Alternative Medicine,NIH. Acupuncture for Pain. http://nccam.nih.gov/health/acupuncture/acupuncture-for-pain.htm

Program Results References

1) American Pain Foundation. Pain Facts & Figures. 2009. www.painfoundation.org/newsroom/reporter-resources/pain-facts-gures.html

2) Fillingim RB, King CD, Ribeiro-Dasilva MC, et al. Sex, gender,and pain: a review of recent clinical and experimental ndings. JPain. 2009 May;10(5):447-85.

Reerences

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For More InormationMany resources are available to learn more about

acupuncture and other integrative modalities thatcan help with chronic pain. The following websitesare recommended for high quality information.

Contact UsTo learn more about the Monteore Palliative CareService please call (718) 920-6378 or contactRonit Fallek, Director, Supportive Care Program, at(718) 920-6576 or [email protected].

Special thanks to Benjamin G. Anderson for his help

producing this report.

Designed by: mprintdesign.com

Get the Facts: Acupuncture

National Center for Complementary and AlternativeMedicine, National Institutes of Health

http://nccam.nih.gov/health/acupunctureBasic information on acupuncture, including its use forpain, what to expect from a treatment, and side effects

and risks.

New Approaches to Chronic DiseaseChronic Pain

Continuum Center for Health & Healing, Beth IsraelMedical Center

www.healingchronicdisease.org

This NIH-funded, multimedia patient education websiteoffers in-depth, evidence-based information, resourcesand research summaries, and unique online exercises tohelp people manage Chronic Pain, Heart Disease andDiabetes in an integrative way. (English and Spanish)

aking Charge o Your Health

University of Minnesota

http://takingcharge.csh.umn.edu

Explore Complementary Therapies offers extensiveinformation on many healing practices. Navigate theHealth Care System provides information and tools tohelp you take charge of your healthcare. Create a Healthy

Lifestyle features an online program to help you improveyour physical, mental, social, and spiritual health.


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