KMCRIC

Dr. Thomas Lundeberg

Karolinska Institute University Hospital, Sweden

Title: Novel Understanding of Physiological Effects of Acupuncture on Pai, Anxiety and Depression

Related session: Acupuncture and Emotional Networks

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Q1.

So, I got just short questions.

Yes.

Q2.

First, we all know that there are specific effect and nonspecific effects of acupuncture, right?

Yeah.

Q3.

So, what do you think about the nonspecific effects, what do they do to acupuncture and how can we, you know, utilize them to... in practice, how can we use them?

I think part of the, so called the nonspecific effects are specific... in the sense that, I think, what we are doing is that, first, I think in the clinical practice, not research but, in clinical practice, patients coming to seek a physician or acupuncturist is worried about his condition. So, he’s basically driven by worries and by unpleasantness. So, the two driving forces are emotional and cognitive. So, that’s the main reason to seek the doctor.

And I think that, if you are a therapist then examine the patient properly. I don’t think it’s really important if you do it in western perspective or eastern perspective, I just think that the time is bound with the patient. Examining them gives them that... you’re basically; you’re seeing the patient for whom they are. You follow?

So, what I mean is that, the patient is allowed to express their worries. If you then, can communicate any kind of therapeutic relationship, in other words, by seeing their problems, you see them. It’s kind of empathy mirrored neuro-related. But this will not determine how good you are as a therapist. So, basically one part is that you recognize their problem and you can communicate that to them. And you can give an explanation to possible causes, western or eastern. But then... So, I think that this is a part of it, that’s the first one.

The second part is what you are doing when you’re treating them, in other words, it could be simple touch. But I think that by putting a needle, evoking that Qi is a stronger response, as long as it’s not painful. So, basically what you’re telling someone, if you’re friend with someone, you say hello, this is like this, this is empathy mediated communication, just with eyes basically, or hand little bit. But when you touch the patient like this, then you have a...a...another effect. These are other centers being activated. So possibly this will change the functional connectivity in the brain. So, empathy, that could be two parts of the brain being activated... like the pre-frontal cortex and the, say for example, with part of hippocampus and the medulla of course.

But the other one, when you touch them, touch deactivates, or as shown by Professor Larson (?) possibly reduces the activity in the stress related. Then, by doing that, you allow for another effect to your needle. You follow this?

So, I think by, by with your acupuncture, you’re basically telling your patient, very firmly, that you are going to get well. You are going to get well is when you stimulate the needle. It is a strong sensation but it’s a positive one, so it’s stronger than giving massage. So I think that’s that... that’s specifically related to acupuncture. I think you can get the same effect with other treatments but not as good.

So, it’s a continuum with lights, so therefore you can get the effect also with like that. Deeper you go in b..t.. can get the responses.

Q4.

Okay, so what is it about acupuncture that it’s more intense than massage? I mean, you can do massage very intensely, too.

Yeah, I think, but the problem is first you get deeper, so I think, deep stimulation is more effective, and it’s purer stimulation. When you do massage, you know, you have a belt, a beta, afferent, and you also have a little bit of a delta, possibly a C, but especially those. But when you have a delta activation, like we’re doing stimulate the needle, say delta or c, but mainly delta I think, it’s a purer stimulation. I think the other one is like a noise signal, so it’s too much sensory input. So I think, if you can have pure sensory input, that gives you better effect. “Purer.”

Q5.

Purer, more pure.

Yeah.

Q6.

What do you think of the lower of self awareness can produce the acupuncture effect? Can you mention about that?

How do you mean? Lower?

Q7.

Lower awareness of the self.

Yeah, lower awareness of the self. Yes, yeah. I think that’s a, in many patients you’ll find that they have a reduced awareness of themselves. I think you have done that in your studies. Looking... trying to look for different aspects of awareness. I think that if you take yourself, you yourself are basically a castract of how you interact with others. So if your personality starts to disintegrate like in chronic pain or chronic stress, you don’t feel that you are yourself. By adding your needling, to... you reconstruct the self. You are basically there, sending signals in that the brain can recognize, and they are strong. So, I think ntwseek(another good thing?) with acupuncture is the strongness and I think you can use moxibustion as well. The problem is that we have difficulty in controlling it. So I think, that would be very interesting to do. Cause I think it’s another pathway. So that would be something to look for, I mean, regulated controlled in stimulation without provoking allition.

Q8.

Can you comment on the magnitude, I mean, in terms of therapeutic effect. Can you comment on magnitude of pure stimulation? Acupuncture stimulation?

Yeah.

Q9.

And the, the others, I mean, patient doctor interaction.

Oh, Okay.

Q10.

It sounds to me all you mentioned about, you know, touch or any consultation or something. It belongs to patient doctor interaction relationship.

Yeah, I agree, I think...

Q11.

So, can you comment on the magnitude?

Yeah, okay, that’s different. I think that they are two different things. The first, doctor therapist relationship is one thing, and the...

Q12.

Doctor Therapist?

Doctor Therapist, or a thera... I mean, sorry, doctor patient, I mean. Doctor patient relationship. That’s more about the self. I mean, what you’re doing in the patient is that you reconstruct the self. And that is more mechanism related to empathy related mechanism.

Whereas; healing, is mediated more by a compassion related mechanism. I think they’re quite different actually. So, there are structures being activated. And I think, what you find within healing, is that there’s much more reward. So, if you’re a good person, you should look for reward mechanism, actually. So, if a good patient giving good reward in your therapist, that is rewarding you as well as the society in other words, it’s a benefit to be a good treat-er. Cause you get more patient but also the patients come back, so... I think there’s cost benefit into being that. 

So I think you’re doing two different things.

If you’re talking about magnitude and the stimulation, I still think that the compassion you need much more tune into the patient’s level of anxiety and hyper-responsiveness. Like Harris showed the first day, I think this is very true. If you have a hyper anxiety person, very worried, the whole nervous system is super sensitive, so then you need to go down. So I think, I think this is good suggestion, either you should do heart rate variability. The good, the ones that responded was showing a decrease in heart rate variability. That was the decrease in sympathetic tone. Whereas; the ones that are not responding, are the ones that don’t change. Or you could use this thumb test that Harris was talking about, to see if they’re hypersensitive before, then do lower stimulation. Or you can do electrical trans measurements, you know like the Irene L was talking about, fairly similar to the other one. That could give you an indication of how much you need to stimulate.

So, I think the magnitude is found on the patient. In general, it should be strong as possible but just below the level where you evoke the opposite directions. So, I think because, when it comes too strong, you’ll have totally the opposite effect. And that I think is along the way what Kathleen W showed. In her study, she basically showed that, the strong the better until you reach the level where you have the opposite effect. So I think those studies are quite the...out there... 

Q13.

Can I ask you one last question?

Yeah.

Q14.

So, in the presentation, you talked about pain intensity and unpleasantness related to the pain. So how do you evaluate on the pleasantness, the methodology, I’m curious about it.

I think there is, when we did it the first time, it was rated by VAS scale, asking for, you know, numeric rated scales, basically asking for what pleasantness, maximum unpleasantness.

Q15.

Is it from like zero to hundred?

Yes. Zero to hundred. Or, either graphic rated scale. We also have the questionnaires rating on pleasantness. It’s the Swedish local scale.

Q16.

Oh, Swedish local.

But I think you can use the VAS scale is good enough.

Q17.

All scales?

Regular VAS scale is good enough. I think the unpleasantness, the typical thing about pleasantness is when you ask the patient, is that they would say, the unpleasantness is a sensation or emotion I have in all of me. It is in my stomach, it’s in my heart. It’s not predefined by location. Whereas; pain intensity, is defined by a specific location. So I think there is, you can definitely do that.

And I think, unpleasantness, also shown by Sicilia Norbrick in our presentation on spinal coding your patients. It was very clear that when you compare massage and acupuncture, in these patients, the unpleasantness posed a big difference. So, I think unpleasantness is important.

Also, from cost, if you look on society, because that is what takes the patient to the doctor. It is the degree of pleasantness. Of course, when you like control... so, I think that is. Okay?

Q18.

Okay, great. Thank you.

No problem.

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