This year’s theme is “Acupuncture for Occupational Health & Wellbeing” and this is an excellent opportunity for AFPA members to highlight the benefits of traditional acupuncture.
ACUPUNCTURE FOR OCCUPATIONAL HEALTH & WELLBEING
Prevalence of Absenteeism in Ireland
According to an IBEC survey in 2010, the average number of days work lost per employee averaged at 5.98 days. When we extrapolate this figure to the economy generally, the total cost to the economy of days lost through absence was around 11 million days (IBEC, 2011). More recent figures from a 2014 Small Firms Association (SFA) survey report 4,052,222 work days lost in 2014. For large businesses the average absenteeism rate is 2.34% or 5.4 days per employee whereas in businesses with less than 50 employees the rate is 2.06% or 4.7 days per employee. The Public Service Sick Leave Statistics for 2016 show the rate of sick leave is 4.1% and on average 8.9 working days were taken per Full-Time Equivalent (FTE) in the Public Service during that year (Department of Public Expenditure and Reform, 2016).
Back pain and anxiety/depression are the biggest contributors to absenteeism (SFA). This is seen also in claims from health assurance companies. Friends First reported that back issues accounted for 28% of the €34m in income protection claims last year (Charlie Weston, 2016). This was the highest category for claims, followed by psychological issues. Aviva Life & Pensions reported that Musculoskeletal and mental health conditions contributed to over 60% of total claims in 2017 (Aviva, 2018).
Musculoskeletal conditions comprise over 150 diseases and syndromes, which are usually associated with pain of varying severity. They can broadly be categorized as joint diseases, physical disability, spinal disorders, and conditions resulting from trauma. Common areas affected include the hands, wrists, elbows, neck, shoulders, lower back, hips, ankles and feet (European Commission). It is the leading cause of temporary work disability amongst Ireland’s working age population and costs Ireland €750m each year and 7 million days in absenteeism (FFW, 2013).
How can acupuncture help?
Traditional acupuncture treatments are based on an individual diagnosis and work by treating the underlying root cause of any condition as well as the symptoms. Acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules and the resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being. A 2010 study, using fMRI to monitor the effects of several classical acupoints on the human brain, indicated that acupuncture modulates the limbic network, an important intrinsic regulatory system of the human brain (Hui, Napadow, et al., 2010). A more recent paper suggests that increasing evidence supports the role of connective tissue in the mechanism of acupuncture (Langevin & Schnyer, 2017).
ACUPUNCTURE FOR CONDITIONS RELATED TO ABSENTEEISM
In Jan 2013, the results of a study which examined “Why Patients Visit Their Doctor” were published. This study included 142,377 patients and found that four of the top ten conditions that result in a GP visit have a strong pain involvement. These include chronic neurological disorders and headaches & migraines. However just over one third of all visits are related to joint disorders including osteoarthritis (33.6%) and slightly less than one quarter of all visits are related to back problems (23.9%). These two categories combine to give a total of 57.5%.
What can acupuncture do for pain?
Chinese Medicine has a saying: “通则不痛，不通则痛” “When there is free flow, there is no pain. When there is no free flow, there is pain”.
This statement underpins the treatment of pain with Acupuncture, which recognises pain as an obstruction of the free flow of the body’s Qi, Blood and other body substances. This can be seen as swelling, inflammation, bruising and abnormal coloration of the skin and underlying tissues, as well as being felt by the patient as pain.
The aim of Acupuncture is to restore the free flow and thereby relieve the pain. Using the body’s channel system, an acupuncturist will insert an average of 6 to 8 sterile acupuncture needles into acupuncture points on the patient’s body to relieve the pain. Treatment can be exclusively in the local area of pain or can be exclusively distal to the area of pain or a combination of both local and distal needling can be used. Acupuncture works by treating the underlying root cause of the condition causing the pain as well as the symptoms.
STRESS, ANXIETY & DEPRESSION
Stress is the feeling of being under too much mental or emotional pressure and can have a significant impact on a person’s mental and physical well-being. Many of life’s demands can cause stress, such as work, relationships, illness, major life events and money problems and it can manifest as symptoms such as insomnia, anxiety, depression and physical pain. Mental health issues, including stress, anxiety and depression, are the reason for one-in-five visits to a GP (“Causes of stress”), and, according to the 2014 Small Firms Association Report, stress, anxiety and depression account for over 20% of absenteeism from work in Ireland thereby costing small business €98 million per annum (“Small Firms Association”).
What can acupuncture do for stress, anxiety & depression?
The Chinese characters 紧张 (stress or tension) and 精神紧张 (nervous tension) convey a sense of tightness or tautness, of something stretched really tight, which is exactly what happens in a body under stress.
A 2011 randomised controlled trial (RCT) (Huang et al., 2011) suggested that acupuncture might be successful in treating the symptoms of chronic stress (Huang 2011) while a crossover study with healthy individuals subjected to stress testing found that acupuncture was more effective than a ‘control’ point (Fassoulaki et al., 2003). More recently, in 2014 Sparrow et al, found that some patients’ HRV increased over weeks to months during the course of acupuncture treatment for hypertension as evidenced by a decrease in their LF/HF ratio, indicating a relative decrease in their physiologic stress (Sparrow & Golianu, 2014).
According to research, acupuncture may specifically benefit anxiety disorders and symptoms of anxiety by acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry(Hui, Marina, et al., 2010; Hui et al., 2009); improving stress induced memory impairment (Kim et al., 2011); reducing serum levels of corticosterone and the number of tyrosine hydroxylase-immunoreactive cells (Park et al., 2010); and reversing stress-induced changes in behaviour and biochemistry (Kim et al., 2009).
Studies indicate that acupuncture can have a specific positive effect on depression by altering the brain’s mood chemistry, increasing production of serotonin (Sprott et al., 1998) and endorphins (Wang & Wang, 2010).
In the first randomised trial of acupuncture and counselling for patients continuing to experience depression in primary care, researchers found statistically significant benefits at 3 months associated with both interventions when provided alongside usual care. (Macpherson et al., 2013)
A 2014 study by Spackman et al., Cost-Effectiveness Analysis of Acupuncture, Counselling and Usual Care in Treating Patients with Depression, found that, at 3 months, patients treated with acupuncture or counselling were less likely than patients treated with usual care to report that they were moderately or extremely anxious or depressed rather than not anxious or depressed. The 3-month improvement in anxiety and depression was sustained over the trial period to 12 months (Spackman et al., 2014). The NIHR study, Acupuncture for Chronic Pain and Depression in Primary Care: A Programme of Research, found acupuncture to be clinically effective and cost-effective for treating depression. (MacPherson et al., 2017)
PROFESSIONAL ACUPUNCTURISTS IN IRELAND
Acupuncture as practiced by Professional Traditional Acupuncturists is widely used in mainstream hospitals throughout the World, including the Whittington Hospital in London which has a dedicated Pain Clinic run entirely by TCM practitioners. The therapeutic benefits of acupuncture have been embraced internationally due to its proven effectiveness not only in respect of the management of chronic and acute conditions but also in the treatment of their underlying causes. It is now the largest drug-free healthcare therapy in the World whilst being compatible with and therefore capable of being used alongside Western (Orthodox) Medicine. In Ireland acupuncture is becoming increasingly acknowledged within mainstream healthcare as a treatment option for many conditions and is included in many private health insurance plans. This potential of acupuncture to deliver timely, cost effective, safe and clinically effective management of a range of conditions has yet to be fully exploited and referrals to acupuncture clinics are likely to become more commonplace as happens in other countries.
Established in 1987, the Acupuncture Foundation Professional Association (AFPA) is the longest established independent professional register of acupuncturists and practitioners of Traditional Chinese Medicine in Ireland. Members work within the guidelines set out in 2006 by the Department of Health and Children. They are graduates from many Colleges in Ireland and abroad and all are bound by a Code of Ethics and Practice which is strictly
enforced by the AFPA.
We are active members of the European TCM Association (ETCMA) and collaborate with our international colleagues in achieving the best outcomes for our patients.
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