Opioids are often prescribed to manage pain postoperatively for total knee arthroplasty (TKA). Acupuncture, specifically electroauricular acupuncture, is a better alternative, reducing and even eliminating the need for opioids, according to a prospective cohort study by S. Cheng, and colleagues, involving 41 patients.
All patients were "undergoing primary unilateral TKA under neuraxial anesthesia received a standardized, opioid-free intraoperative protocol including electroauricular acupuncture," and did not report chronic pain or opioid use within six weeks before surgery.
Electroauricular acupuncture was administered at eight specific ear points: Hypothalamus, Amygdala, Hippocampus, Prefrontal Cortex, Point Zero, Shen Men, Insula, and Vagus. Patients were discharged with a one-time prescription for 42 oxycodone pills (5 mg dose per pill) or an equivalent opioid (hydromorphone or tramadol).
The primary outcome measure: ability to maintain a "low-dose" opioid regimen, defined as 15 or fewer oxycodone pills (or 112.5 oral morphine equivalents) from surgery until 30 days postoperatively. Approximately two-thirds (65 percent) were able to do so, with 7 percent not using opioids at all for 30 days. None of the 41 patients used opioids after 30 days.
While this study did not have a comparison group, the authors note in their paper, published in Medical Acupuncture: "When comparing this cohort to a previous hospital-wide survey of patients who underwent TKA, the percentage of patients maintaining a low-dose opioid regimen was statistically significantly improved (65% versus 9%) ... While the survey data were over a 6-week period (rather than 30 days as in the current cohort), the current authors believe this had little effect as all of the current study patients had stopped opioid use by POD 30."
Pelvic pain has a prevalence of >25% in women and >15% in men, and up to 50% of cases are undiagnosed, demonstrating that there is a definite need for pelvic care awareness among health care practitioners. As holistic practitioners, acupuncturists offer a safe space for clients and are often the practitioners clients seek out when nothing else has worked. Thus, acupuncturists are presented with an opportunity to serve an underserved population.
Though the creation of a financially sustainable, health-promoting model feels far away today, we are casting a vision for a full return on health, believing that this compels us to keep one foot firmly rooted in caring for the sick and the other foot firmly founded in maintaining health. Shifting from a fee-for-service model to value-based care using a phased approach is paramount.
Traditional Chinese medicine and the Vedic traditions both offer rich frameworks for understanding human health, emphasizing the balance of physical, mental, and spiritual aspects. The concept of "souls" or spiritual components in TCM, namely Hun, Po, Shen, Yi, and Zhi, bears significant similarities to the yogic concept of koshas. Their similarities and differences provide insights into how these systems contribute to holistic health practices.
