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."
In the tradition of the Five Elements, the spirit leads us to the source of function or dysfunction. As a pelvic health specialist, I have found that the spirit of the points on the pelvis are particularly important in supporting our clients, as they connect deeply with the spirit. Working with the points on the pelvis is often pivotal for the client and thus requires a well-designed foundation.
To plateau and profit or release and replace is an ethical dilemma we clinicians will face sometime during our career. In work situations in which oversight ranges from limited to excessive, we navigate our practices, businesses and/or positions between the poles of profit and loss, moral and legal. The question is: What do we do when the patient's clinical progress becomes stagnant, yet they will freely continue to receive treatment?
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Long COVID has challenged conventional medical paradigms. There is certainly a growing need for therapies that bridge traditional pharmacology with integrative strategies. Among the more unconventional options, nicotine – delivered via low-dose transdermal patches – has surfaced as a potential tool. While the idea may sound wacky, emerging evidence and clinical anecdotes suggest it warrants exploration.
