Search for tag: "acupuncture"

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Troy: You've got to say something like, "Troy puts the stud in studies," or something like that. Something good. I'm just kidding.

Scot: I will never say that.

Troy: I was just trying to think of something better than "Troy's articles" or whatever you called it.

Scot: That's us. It's a "Sideshow" episode. That's what we like to call a soft start. You caught us in the middle of a little prepping trying to decide what we're calling this segment, where Troy scans the medical journals so you don't have to and then shares an article that hopefully is of some interest.

Troy: Hopefully.

Scot: Yeah, this is "Who Cares About Men's Health," a "Sideshow" episode. My name is Scot. With me, as always, the MD to my BS, Dr. Troy Madsen.

Troy: Hey, Scot.

Scot: And Producer Mitch.

Mitch: Hey there.

Scot: All right, Troy. Let's take a look at your articles, hear what you've got. Go ahead and put those articles on display.

Troy: Look at the articles.

Scot: Yeah. Go ahead and put those articles out on display for us. We're going to pick one.

Troy: Oh, we're picking?

Scot: Oh, yeah. I mean, unless you just decided you had one that you . . .

Troy: I decided.

Scot: Oh, okay.

Troy: This title is so good that I knew even if I gave you my list of five, including the one on green urine that I keep trying to get you to pick, I know you'd pick this one.

Scot: All right.

Troy: And I'm just going to read it to you and if you don't like it, if you're just like, "No, we would not have picked that one," let me know and I'll pull up some other ones.

Scot: Okay.

Troy: The title of this article from the "Journal of Emergency Medicine," the title is "Battlefield Acupuncture Versus Standard Pharmacologic Treatment of Low Back Pain in the Emergency Department: A Randomized Controlled Trial."

Mitch: Oh, Troy, I did a bunch of interviews about this. Keep going.

Troy: Yeah. Tell me I have not piqued your interest.

Scot: So when you say battlefield, you mean like a war battlefield?

Troy: That's a good question.

Scot: Oh, okay. Well, I guess, Troy . . .

Troy: I'm hoping I piqued your interest enough that I can . . . I'll explain what battlefield acupuncture is. I didn't know before this article.

Scot: Move forward with this one. Go for it.

Troy: Okay, we got it. So battlefield acupuncture, to your question, is a technique using acupuncture. So you're familiar with acupuncture? You use these little needles in different spots. Ideally, the way this is designed, it's supposed to then relieve pain or lead to different effects.

Acupuncture, of course, is considered an alternative therapy, and it's one of those things where it has gained more mainstream acceptance as these types of studies have come out. But it's been considered a traditional therapy, an alternative therapy. It is not something I have ever done or have ever practiced. I did spend a day shadowing, spending time with an acupuncturist during med school, which was really cool, to kind of see what she did and hear her philosophy and see her approach and see the patient's response.

But battlefield acupuncture is a technique where there are certain little needles that look more like little tiny darts that are placed in specific places in either one or both ears.

The idea behind this is that these spots are said to influence the central nervous system pain response. And by putting these little needles in these different spots in the ear, they then decrease pain that is coming from other sites in the body. I mean, that's the theory. Again, I'm not a traditional practitioner, but I'm just kind of reading what I found on it.

Scot: Time out. In the ear, or in the part around the ear, or the earlobe?

Troy: In various parts. So yeah, let me clarify that. Not in the tympanic membrane. You're not going in the ear hole. These are different spots . . .

Scot: Okay.

Troy: Yeah, these are different spots on the auricle of the ear. You do not want to puncture the eardrum. These are spots . . .

If you just do a Google search for this, you can see photos of where these spots are. They're basically at the very top of the auricle of the ear, so the very top of the ear, and then kind of maybe half an inch down from there. And there's another spot half an inch down from there. There's a spot on the earlobe. There's a spot just on the very front part of the earlobe.

So they're like little tiny darts, and they actually have a tool that you use to place these. They just stay in place until they fall out. So it's usually three or four days. You put these in there, you leave them in, and you just send people home with these in place.

Scot: Wow.

Troy: Yeah, it's fascinating. Again, I have never done this. I've never been trained on this. This is the first article I've seen looking at treatment of low back pain.

And then you might ask, "Why would I even care about this? Because surely I have some great treatment for low back pain." I can tell you that when you see a patient come to the ER, the first thing you'll see is their name and a chief complaint and that's what shows up. And when the chief complaint is low back pain, that to me is one of the most frustrating things to go and see because there is so little that I can offer.

It used to be these patients would come in and everyone would just get opioids, like, "Okay, here's your script for Norco or Lortab." That's a horrible way to approach it and that's what's led to the current opioid epidemic.

So now when people come in, I say, "Well, you can try ibuprofen or Tylenol." "Well, I've already been trying that."

"Well, you could try some lidocaine, some numbing cream on there." "Well, I've tried that."

"Well, you could try physical therapy." And we actually had a physical therapy in our emergency department and did a study on it, and that was great. But that person was only there 30 hours a week and the emergency department is open 24/7, so that's not something I can offer that often.

So if there was something I could actually do and say, "There's evidence behind this and this is going to help you," and people actually did it and said, "Wow, it helped me," that would be really cool.

So this study, essentially what they did is they took patients who came into the emergency department . . . It's a fairly small study, more of a pilot study we would call it, where it's kind of like, "Hey, let's try to see if it works. If it works, let's do a bigger study."

So they only had 52 patients. Twenty-six of these were randomized either to getting this battlefield acupuncture done or to just standard treatment, which would be the stuff I talked about where it's just like, "Hey, do whatever you normally do."

The patients with the battlefield acupuncture had a significant decrease in their pain score when compared to the patients who just had standard treatment.

And they then contacted these patients two to three days after they were there and found that the patients who had the battlefield acupuncture continued to have a significant improvement in their pain scores compared to those who were sent home either with a prescription or with just standard stuff we would do for low back pain.

Of course, there were no difference in any adverse effects. It's not like these patients were getting a lot of infections, they were complaining of a lot of pain or bleeding, or anything like that.

So their conclusion was that this potentially shows some promise. I can tell you please don't come to the ER right now and ask for battlefield acupuncture, because we don't have the tools there. It is not something we're doing. But maybe a study like this and some subsequent studies, if they continue to show this works, maybe it's something we're going to learn to do. I would love to be able to offer something better than what I can realistically offer in the ER.

So kind of a cool study. A pretty simple thing, it looks like, to do. It's just something we're not doing now, but maybe we'll see more of this in the future.

Mitch: I have to chime in because I've done it.

Troy: So when you say you've done it, have you performed this on people?

Mitch: Yes, I have.

Troy: Wow. This is cool.

Mitch: Okay, so 2011, it was my old life as a documentary filmmaker. We were working on a project called "The Painful Truth," and we were traveling all over the country investigating chronic pain patients and how they are treating their different conditions and how it impacts their family. And I got to actually go to this big medical conference. And one of the rooms where they were doing a breakout session was all about battlefield acupuncture.

You go in there and up on front, there's like this cute small woman who's been studying it and she published the paper. And then there are these military guys in full uniform with all their awards and medals and everything, talking about how they were using acupuncture in the ears and the tragus and all these different parts to stop people from going into shock on the battlefield.

Troy: Wow. So that's where it got the name then. I had no idea before this.

Mitch: So I was actually able to get one of them to be interviewed with us. And when we were talking about the interview, he pulls out first an orange and he's like, "Here's the tool. I want to show you how easy it is here. Here, why don't you go ahead and put some of these little brads in." And it's like a little gun and it's just, "Pew, pew, pew." So I bedazzled an orange.

And then he's like, "Do you want to see what it feels like?" And I'm like, "Absolutely, yes, a thousand times." And so he clips my ear. I'm trying to find some photos of it right now. But he clips my ears, and I didn't feel anything because I wasn't going into shock. But I'm like, "Wow."

And then he asked if I would feel comfortable doing it with my cameraman, and I said, "For real?" And the guy was not sure, but I'm like, "Oh, come on. It'll be fun." So yeah, I got to basically bedazzle my cameraman's ear with this tool. And it was just . . .

Troy: Did they draw the spots on there for you to shoot this little gun into, or did you just see it and you're just like, "Okay, there, there, there"?

Mitch: So they had a little printout and they were like, "Here's where you're going to do it." And then when I was doing it, he took his little Sharpie and did little dots on the guy's ear to be like, "Here's where you're going to shoot it."

Troy: Make sure you hit the right spots, yeah.

Mitch: And so the big part of it is that this for them at that time was . . . This was not necessarily something that a battlefield medic would need to have special training for. They can train anyone to do it, right?

Troy: Yeah. It's sounds so simple.

Mitch: So it was really kind of cool to . . . And especially for him, the guy who was giving me the interview and everything, he was like, "These for so long have been treated as 'alternative medicine.'" Big quotation fingers there. But they're starting to find real applications. And so it's kind of exciting to hear that you also found a study about it.

Troy: Yeah, that is fascinating. Again, it's not something I've ever been trained on. And there probably are other emergency-department-based studies that have done this kind of thing, but there are not a lot. And maybe there are some others with low back pain, but this is the first time I've seen this.

I would love to be able to do this. Again, I would love to also maybe see some larger studies just saying, "Yeah, this panned out and we are seeing an improvement and this works."

Again, Mitch, like you said, it sounds super simple to do. As I've looked at pictures of it, it's like, "Okay, just hit these five spots." It's not rocket science, and you just need that tool, the same tool you had, which we don't have. But that's so cool you were doing that.

So if we can do this, I'm going to bring you in to teach us all how to do it, Mitch. Apparently, you're the expert now. You have more experience with this probably than any physician in our emergency department. So you're coming in.

Mitch: Okay. All right.

Troy: I love it.

Scot: Can we get you one of these guns on eBay?

Mitch: I don't know.

Troy: They have them on eBay?

Scot: What do they cost? What does one of these things cost?

Troy: I don't know. I've never looked into it.

Mitch: It was like a handheld staple gun. It was between a hole-punch, like one of those single handheld hold-punches. It was kind of like that plus a staple gun. It didn't feel too technical.

Troy: Yeah. We should probably clarify. Don't do this at home with a staple gun. It would be unwise and unsterile. But yeah, it seems like if you have the proper tools and a sterile device that's designed for this, it doesn't sound difficult.

Scot: Troy is a physician, right? Mitch mentioned something that resonated with me. Alternative medicines, right? There's a lot of stuff out there that people swear by. But as a physician, or at least many physicians I've talked to, until they can see some hard evidence that it actually makes a difference, they don't really accept it as a treatment. But it sounds like you would be in all the way on this because of this study?

Troy: I would like to see at least a couple more studies that replicate the results. At the same time, I don't want to just do something just to do it. It would be nice to see something that helps. I would be open to doing this if a patient . . . if I talk to them about options and I said, "Hey, there's been a small study. It seems to make a difference."

The big thing for me is, "Is there a big downside to this? Am I going to be causing harm?" And if I'm not going to be causing harm, and they did not report significant adverse effects with this, if I'm not going to be causing infections in their ear, or a lot of bleeding or things like that, and there's reasonable evidence to support it, I would offer it to a patient specifically that way. I would say, "This is something . . . there's been a small study." I'd say, "We can try it if you're interested."

Scot: And if this really did work, that sounds like it would change your life. It would make you go from seeing name and back pain to name and I can help this person. Name and back pain, going, "Oh, geez," to name and back pain and, "I have something I could probably do."

Troy: I would love to have that. If anyone asks me, "What is the most frustrating thing you deal with in the emergency department?" it is back pain, because people come there wanting answers and wanting a quick fix and it's a 15-minute discussion often of saying, "Hey, this is what you need to do. It's going to be a long process. You're going to have to do physical therapy. I'm not going to prescribe opioids for this. I do not want to do that. I do not want to create potential for addiction." And then I'll offer them the Lidocaine, things like that, and say, "Well, maybe this will help."

But yeah, to be able to just be like, "Yeah, I can try this. We can do this and there's evidence to support it," would be wonderful.

So we'll see what happens. Again, it's one of those articles where you see it like, "Oh, that's really cool." I can't say it changes my practice right now where I'm going to start doing this. Obviously, I don't have the tools to do it right now or the training. But it's one of those that maybe we're going to see more on this. It takes a while for these things to come into practice, but maybe in five years, this will be a standard approach in the emergency department. Who knows?

Scot: All right. You made it to the end. Good for you. Be sure to check out some of our other "Who Cares About Men's Health" episodes.

What you just heard is what we call a "Sideshow." It's where sometimes we talk about health topics that aren't necessarily directly related to what we normally would talk about, which is the core four plus one more. That is to be healthy now and in the future, you should concentrate on your nutrition, your activity, your sleep, your emotional health, and you've got to know your genetics.

Plus, we also have episodes that are dedicated just to men's health issues. So check out some of those episodes as well.

And if you know somebody that would find any of them useful, please go ahead and let them know about the podcast. It's the best way that you can help us grow the podcast.

If you want to reach out, lots of ways to do that. You can call us at 601-55SCOPE and leave a voicemail, you can email us at hello@thescoperadio.com, or you can check out our Facebook page. That's facebook.com/whocaresmenshealth.

Thanks for listening, and thanks for caring about men's health.

Interviewer: Can you believe that there's a school actually called Headache School? And if you have headaches, you might want to go to this school. So we're going to talk to Dr. Jared Bartell. He's assistant professor in neurology. He's a doctor, but he's also an expert in headache. He did his fellowship in headache medicine, they call it and today we're going to find out more about the University of Utah Health Headache School, why you have one, what it is, and who can benefit. So Dr. Bartell, thank you for being on the show today. I do appreciate it very much.

Dr. Bartell: Thanks, Scot. Happy to be here.

Interviewer: Yeah. So tell me a little bit briefly, I just I'm curious. So headache medicine is what it's called, that you do. Explain the additional training you've had and what that means?

Dr. Bartell: Yeah. So I finished my neurology residency at the University of Wisconsin. And in neurology, you learn about all aspects of epilepsy, multiple sclerosis, stroke, various things that affect the central nervous system and the peripheral nerves too. But headache is certainly within that and we learn a lot about headache in residency. For those people that want to do more outpatient neurology, headache is really a big part of that.

So I spent this last year doing headache fellowship at University of Utah training with the guys there at the university. I learned about various procedures to use for headache, things like Botox, nerve blocks, the different types of medicines that you can use, both for prevention and for rescue of headaches. The nice thing about headache medicine these days is that there really are a lot of new treatments available within the last even couple of years there have been a number of new medicines that are all fairly expensive right now. Insurance tends to pay for them as long as you've tried a few other medicines first, but it's definitely an exciting time to be in the field as a provider of headache medicine, and it's been a great opportunity for me to help patients as well.

Interviewer: Yeah. That's pretty cool. I know headaches can really be debilitating to some people. It can really just really affect the quality of their life, their ability to enjoy life, their ability to do what they have to do. Headache School. So what is Headache School?

Dr. Bartell: So Headache School is a program that we are offering at the University of Utah, and in collaboration with Danielle Henry Foundation to educate patients and their loved ones about headache in terms of treatment and what causes them and just every aspect of headache.

Interviewer: And it's virtual and online, and you can find back episodes on YouTube. So there are a lot of different kinds of headaches. Why would somebody with a headache want to come to the Headache School or watch some of these videos? Why wouldn't they just say, "Just give me some aspirin. Tell me what it is I need to do to solve my headache"? Why are you finding people who are finding this interesting, and coming and showing up?

Dr. Bartell: So they're really a lot of headaches that . . . So you can think about just little everyday headaches that most people get as being responsive to an over-the-counter medicine like aspirin or ibuprofen or Tylenol. But unfortunately, a lot of people have much more severe headaches that really don't respond to those types of medicines. And that actually can get worse with chronic use of things like aspirin or Tylenol. And it can actually cause something called a rebound headache or a medication overuse headache. For people that have chronic migraine or chronic tension type headache or various other types of even more unusual headaches, those types of over-the-counter medicines aren't as helpful. And so educating patients on the different types of treatments, whether that's medicines or non-medication therapies can be really helpful in treating their headache condition overall.

Interviewer: Talked to one of your colleagues, Dr. Pippitt, and she is an expert with headaches as well. And she says that for the most part, a primary care physician can take care of most people's headaches. So it sounds like Headache School is for somebody who has really struggled and hasn't found that answer to their headache because they do have more of an unusual headache and this gives them access to some experts that might just specialize in that particular type of headache. Is that correct?

Dr. Bartell: Yeah. I think so. I think that's a good way of thinking about it. Most primary care providers are excellent in treating headaches. Sometimes it takes 2, 3, 4, or 5, 10 medicines until you really find the right medication fit for that person's headache. Everybody's headaches are a little bit different. Even if you have migraine, for instance, you can have 10 migraine patients lined up and all of their headaches are a little bit different. And the physiology of their migraine can all be a little bit different such that different medicines work for some people and not for others.

Interviewer: So somebody that might have gone through the process of trying to find some satisfaction or some treatment for their headache really could benefit from Headache School. I'm looking at, man, you've got so many episodes already. Just to cover some of them, the cognitive behavioral therapy treatment for headaches, yoga, for headache and migraine, contraception options in migraine, headache, the basics, acupuncture self-care for a headache, pathophysiology of migraine. Sounds like you cover a lot of ground. And what benefit does this help with somebody then if they hear the lecture? What does that information usually do? How does that impact somebody?

Dr. Bartell: So, in Headache School, we have the benefit of having a number of different speakers coming from different backgrounds talking about their view of what headaches are, how to treat them, we have a pharmacist that has given us several talks, we have multiple different providers that treat patients clinically that have their own medical background to provide. You could do a bunch of your own personal research online, which you might find various blogs and find anecdotal ideas as to what to do and what your headaches are caused by and different things you can try. But really looping into how doctors think about your headaches and how a pharmacist might think and how a psychologist might think about headaches can really be helpful in better managing your headaches.

There have been many years, decades and decades of research into headaches and it's not all intuitive. So you might think that you can treat all of your headaches with Tylenol, you take Tylenol three times a day. And this seems to knock down your headache just a little bit. But as it turns out, somewhat counter-intuitively, that can worsen your headaches. It can cause rebound headaches, it can cause some other problems, it can cause liver problems. Different medicines can do things like that, but it's really helpful just to touch base with the headache medical establishment to know what Western medicine thinks about headaches. We do try to incorporate alternative ideas too, and there are many talks on not just true Western medications and that type of thing, but also these alternative therapies that are available.

Interviewer: I love that you have all sorts of experts. I never really thought of that as an advantage, I just thought, "Well, you go to a doctor." Maybe you go to a doctor who's an expert with headache. But as you said, you've got pharmacists, you've got people like psychiatrists or people that can help teach you a cognitive behavioral therapy, or you have people that know about how exercise impacts headaches. So just a lot of different opinions on how to maybe reduce the impact of your headache or the frequency of your headache. So that's pretty awesome.

It's also pretty awesome too because many people they don't live in Salt Lake City, they don't have access to one of these specialists. They can just make an appointment, but they can go to the Headache School and they can watch the lectures and it sounds like they can interact with that individual. At the end, it's not recorded, they could ask them questions and boy, just really making yourself available.

Dr. Bartell: It's true. We see our clinic, especially now more than ever, patients from all across the region. We see people in Nevada and Wyoming, Montana, Colorado. And this resource especially it's on YouTube, so anyone can see it. You could live in a different country and you have all of the videos available for free at your own pace. One thing that you may not realize is that with YouTube videos, you can actually adjust the speed of them too.

Interviewer: Yeah. It gives you access to these experts. It gives you access to this great expert information. Briefly, I want to hit on the skill building session. So you say you have some skill building sessions. What do those look like on Headache School? I get a lecture, what's the skill building session?

Dr. Bartell: So we have a number of talks on various issues, things like progressive muscle relaxation, breathing exercise, guided relaxation. As of today, those are the most recent talks, but there are a number of courses that talk about these non-medicine options to treat headaches that you can just do on your own. You could do these multiple times a day, depending on what they are. And they can really help to have some synergy with the rest of the treatment that you're undergoing. It's one thing just to take a pill every day, but it's another thing to change your lifestyle in certain ways to really help to solidify the changes that your brain is undergoing as you're treating these headaches.

Interviewer: Headache school, it sounds like such a great resource and we will put a link to the University of Utah Health Headache School in the description for this particular podcast episode. Dr. Bartell, thank you very much for telling us a little bit more about Headache School. It's a great resource. Appreciate it.

Dr. Bartell: Thanks, Scot. Happy to be here. Appreciate it.

Dr. Jones: For some women, menopause is tough. We have this hormone thing going on, but we're also aging, and our joints hurt. And our teens are trouble, and that makes us cranky. So what are the options and therapy for the menopausal transition? This is Dr. Kirtly Jones from obstetrics and gynecology at University of Utah Health, and this is The Scope.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Although hot flashes are the signature symptom of menopause, there are a number of other physical and emotional symptoms that are common for women in their 50s. Insomnia, anxiety, joint aches, and headaches come to mind. Some of these are clearly related to the loss of estrogens, but some are not so clearly related to hormones. Whatever we think the biological cause might be, women don't feel well.

How do we take the women as a whole person and not just the sum of her symptoms? And what are some of the options? Today in The Scope studio we're talking with Dr. Lisa Taylor-Swanson. She's an assistant professor in the College of Nursing and an expert in acupuncture. Lisa, thank you for joining us to help us think this through.

So give us some thoughts about the care of women in menopausal transition thinking about all of these symptoms. You know, women certainly can wander their way through the traditional health care system. They can get estrogen for their hot flashes, they can get a triptan for their migraine, they can get sleeping pills for their insomnia, they can get Ibuprofen for their joints, they can get Prozac for their anxiety. But women don't want to think of themselves like that. They don't see themselves siloed in so many pill prescriptions. So what do we do?

Dr. Taylor-Swanson: That's something I've thought a lot about. And I know as a clinician practicing traditional East Asian medicine including acupuncture and Chinese herbal medicine, I've always been drawn to thinking about the whole person. And in that tradition the way we diagnose, for example, a hot flash in woman A would really depend on how her sleep is, her bowels, her mood, and depending upon compared to say woman B who has no problem sleeping but does have hypertension, I would use different acu-points and different herbal prescriptions to treat the same, say primary concern of hot flashes, because we have to understand the whole person.

So that whole person view is literally at the theoretical foundation of East Asian medicine. And that's why I study that. It's really very interesting.

Dr. Jones: So I would say coming from the church of Harvard medicine, that although I want to know about a woman's hypertension and the way her bowels work, the dose that I would give for her hot flashes would be more just to her hot flashes and not to her guts I'd say?

Dr. Taylor-Swanson: Absolutely. And that's exactly not how East Asian medicine is practiced. And so those symptoms really inform one another, and then, of course, we look at the tongue and feel the pulse as well to have additional signs that we look at.

Dr. Jones: Look at the tongue?

Dr. Taylor-Swanson: Yeah, absolutely. Top and bottom.

Dr. Jones: Okay, ladies you're going to have to wash your mouth out and brush your teeth before you go.

Dr. Taylor-Swanson: But don't brush your tongue.

Dr. Jones: Don't brush your tongue, okay, okay. So what are some of the options in the field of alternative and complementary medicine that women might choose to pursue? I know women are already making these choices, because when they come to see me, they've got bottles of supplements. They've got dong quai. They've got some Chinese herbal medicines, I say I don't know that they . . . these Chinese herbal medicines may not actually have estrogen in them, so I'm always worried about what they're taking with these bags that they're going through.

But I can't stop them. You know, and I probably shouldn't, and I shouldn't negate their efforts to make themselves feel better through options other than my office. So what should we be thinking about and what are the choices?

Dr. Taylor-Swanson: There are many choices. Definitely, acupuncture is one to consider again for the whole person perspective. And what's interesting is that not only kind of clinically or intuitively we can imagine, say if someone receives acupuncture and her hot flashes are better, and then her sleep is a little better, and then her moods a little better that makes sense certainly.

But the fascinating thing as a researcher is that we have basic science, types of data that demonstrate how that happens. So we have changes in our serotonin production and re-uptake. We have changes in our muscles, changes in the connective tissue around the muscles, other changes in the central nervous system, peripheral nervous system changes, etc. And those all happen simultaneously. And so I think it's fascinating to consider. I know you asked what are the various options. But one is acupuncture, and that we know all those symptoms are affected simultaneously and we know more about why.

There's other good options too. There's definitely Ayurvedic medicine, traditional medicine from India that treats the whole person much in the same sort of way. Definitely massage therapy can be helpful for those joint aches and pains, and it's very relaxing and might help a woman sleep better. Reiki healing touch. I mean there are so many options nowadays, and most of them have been investigated to try to find out really do they work. But I think another really important message for our listeners is that acupuncture I can say for sure is safe. It doesn't hurt. It's very relaxing.

Dr. Jones: It doesn't hurt.

Dr. Taylor-Swanson: I know, right? Who would think that?

Dr. Jones: Well, I'm not needle phobic, and you mentioned that you started as an acupuncturist. I'm not needle phobic, but I know perfectly well when I have needles put in my skin, because I'm also a seamstress, so I poke myself with little needles and it's usually my finger, the most sensitive place to poke. But it hurts.

Dr. Taylor-Swanson: So these are different. One they're tiny. They're literally the size of about two hairs, 40 gauge, 36 gauge, for those of you clinicians out in the audience. And they're solid and the interesting thing is blind acupuncturist several hundred years ago figured out if they had a tube around the acupuncture needle, one, to help them locate the points and be safe clinicians because they couldn't see, but two, it was less painful.

So the Japanese tradition of acupuncture and that we've pretty much adopted in the U.S. is to use these guide tubes. So first the patient will feel the pressure of the tube, and what's happening is it sets up those little [node receptors 00:06:21], so they perceive pressure, and then you pop in the needle and you hardly even notice it for the most part.

Dr. Jones: Kind of like when you're giving a horse a shot, if you slap them three times on their skin and then you give them a shot, they don't feel a shot. Okay, okay. Well, I'm feeling better already. I'm feeling more calm about having needles put in my skin.

Dr. Taylor-Swanson: Most people do fall asleep. Or they go to this . . . a colleague of mine calls it acu land. And you just kind of drift off to this really mellow, quiet, relaxing place. Usually, the clinician will turn the lights down and have some nice music, and you're cozy with the needles in place. So it's really a very surprisingly comfortable experience.

Dr. Jones: Well, it sounds like it's a total time out from your week experience. It's not just hopping up on a table and getting poked a couple places. You're actually having some little time out. I can't say . . . well, sometimes the doctor's office, I get to look at magazines I would never ever buy at the store, but if people in the doctor's office are upset, I kind of, you know, while I'm waiting and wanting to say I'm not in a clinic and, you know, I'm just having a quiet time. But other people's moods while I'm waiting affect me. When I get in the room as much as I love my doctors, there's this third patient in the room called the computer that seems to get all my doctor's attention.

Dr. Taylor-Swanson: Well, and I think for women going through the menopausal transition and for midlife women overall there's this sandwich generation phenomenon where often women are working, taking care of kids, like you said in your intro, taking care of parents sometimes, and so to have that little time out just an hour once a week, once every couple weeks it can make a world of difference.

Dr. Jones: Well and when we talked before the interview, we talked about the fact that in medicine sometimes we silo women's symptoms so they get this for this problem, and this for that problem, and that prescription for that. But you talked about the spider web. Can you talk a little bit about that?

Dr. Taylor-Swanson: Absolutely. It's my favorite metaphor for how, again the theory and also the intervention of acupuncture in East Asian medicine works. If you were to imagine a woman as a spider web and say for example, that spider web includes her symptoms, it includes all of her body systems, so the endocrine system, all of your hormones, your digestive system, etc. And also includes your social life, so caring for kids, your friends, your church, your work, etc.

And so if there's a tug on one end of the web, say you're caring for an aged parent and she or he falls, then that's going to affect your whole spider web, your whole person. It's not just that, "Oh, gosh I have to schedule my time differently." But you're probably going to be worrying, and [perseverating 00:09:03], and scheduling appointments, and not sleeping as well.

So I think to really consider a woman as her whole self, not only all of the symptoms, it's great that science is moving that way. We talk about symptom clusters now instead of only a single symptom. But it's a real whole person phenomenon that includes her social life, her work life, her body as well, and not only the symptoms.

Dr. Jones: Well, we're just making you the poster child of our Seven Domains of Health. Because here, The Scope radio we believe in the seven domains, meaning there are many parts of us that have to be well for us to feel well. But I like the Native American, particularly Navajo tradition of the Spider Woman who weaves the web of life into this sense of wholeness. So who should a woman go to if she wants this particular approach?

Dr. Taylor-Swanson: Well, the good news is nowadays acupuncture is regulated by state departments of health in all but just a handful of states in the country, so you can just go to the website for your local Department of Health, look up an acupuncturist in your area. They're absolutely going to be board certified nationally, and they're absolutely going to have a master's degree. They might also have a doctoral degree either in acupuncture or something else. So you can be confident they'll be well trained and properly licensed.

Dr. Jones: Do you go and see if they're a good fit, or do you ask your friends because some might be really good for sports therapy and joint problems, but they don't get women.

Dr. Taylor-Swanson: Right. Well, and modern life definitely most of my patients when I practiced in Tacoma, Washington, where I just moved from most of my patients were either referred from their primary care or other specialty care practitioners or from their friends, and that's always a good way to find an acupuncturist. And modern life most acupuncturist have websites too. So you can check the web and get a sense of who they are from their website.

Dr. Jones: And see if they put midlife women transition kind of stuff.

Dr. Taylor-Swanson: Yeah.

Dr. Jones: Well, we're waiting for you to hang out your shingle now that you're here in town and for you continue your research in the area of midlife women now that you're here at this College of Nursing. And we're here because getting old isn't for sissies. And 50 isn't even old. Many of us want to take an approach to our midlife concerns that helps our body and our mind. And we're grateful for Lisa for coming to help us think about it. And thanks everybody for listening on The Scope.

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Interviewer: What are the methods that physical therapists use to treat pain? It's more than just movement exercises. We'll talk about that next on The Scope.

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Interviewer: Tamara Dangerfield is a physical therapist at University of Utah Health Care, and she specializes . . . her branch of physical therapy is pain management. That's what she does. And it might surprise you to find out that there are different ways that physical therapists can help you manage pain. I want to find out more about those. So let's talk about that.

Tamara: There are many things that all physical therapists do. There are other things that some physical therapists do. The things that all physical therapists tend to do that can be very effective, they use electrical stimulation, a TENS unit. A lot of people have tried various forms of electrical stimulation on their own. In the physical therapy, that's often in conjunction with something we do. Yeah, it's just . . .

Interviewer: Those little pads that kind of send those pulses to you.

Tamara: Yeah. But it feels like a little tingly pulse that goes through your skin, and it interrupts the pain signals to your brain, so it's a useful way to treat pain. They use traditional modalities at times, heat based modalities, cold based modalities. There are lots of categories within that. There are laser treatments that are used. There's ultrasound that's used.

Interviewer: Really?

Tamara: There are different technologies to deliver heat or cold, and all of those things tend to have effect at the cellular level, and really, we believe most of what they do is improve blood flow or cellular regeneration to the region, and that's largely how they treat pain. About two years ago in the state of Utah, we now have the option to do dry needling, which is a form of treatment that treats myofascial trigger points. So literally sticking a needle in a trigger point in a muscle.

Interviewer: Is that like acupuncture?

Tamara: The needle is like what they use in acupuncture, but it is very different than acupuncture, primarily because physical therapists are not acupuncturists, and the training and the assessment tools and the treatment tools and techniques that an acupuncturist use are very different than what I would use.

Interviewer: Got you.

Tamara: When I use dry needling, I use that as a way to just get a trigger point and a muscle to release. You can use manual pressure to get trigger points and muscles to release, and different massage types of techniques can also be very helpful. Trigger points cause a lot of pain and a lot of movement restriction, so when you can get those to let go, you restore both of those things. It helps with pain and restores movement.

Interviewer: And if you have a muscle therapist that does manual trigger points and that's not quite working, is the needle like the next step up for those stubborn ones?

Tamara: Yeah. I think typically, that's how it's used. A lot of times, the movement therapies alone work well enough. Sometimes you need to add some manual therapy to that, and when all else fails, you can stick a needle in it. Sometimes it's good to start with that too. It just gets deeper. It allows you to get deeper into the tissues then in a shorter amount of time. But I would just like to add, that all of the modalities, all of the, you know, bells and whistles and things that we use to help treat pain, ultimately need to restore movement, because that is your body's way to treat pain.

Movement is how you keep things functioning in your body, and so if you're using those modalities, again, as some type of opioid or some way to avoid movement and restoring normal movement to a region. So range of motion, strength, flexibility, all of those things that you need to restore normal movement. And sometimes just being aware of the pattern. Those are the things ultimately, that you really need to have your body take care of its own pain.

Interviewer: That sounds a little counterintuitive, right? One would think that if I'm experiencing pain I should not move and let that rest and let it recover, but really movement in a lot of cases helps.

Tamara: Yes. And that's what science has learned more and more. Literature repeatedly points to movement as the way to address chronic pain problems. In the very acute stages of pain, after a surgery, right after an injury, pain is a signal to your body that something's wrong and you should be careful with it, but that doesn't mean that you shouldn't ever move it again. And when the initial injury has healed, it is critical that you start moving again, or else you're just going to end up aggravating something else.

Interviewer: So it sounds like you have a lot of different ways that you can help somebody with their pain if they come to a physical therapist, especially somebody that specializes in it, such as yourself.

Tamara: A lot of different ways.

Interviewer: The goal is to get rid of that pain so you can restore your normal movement which then ultimately helps the pain continue to be managed.

Tamara: Absolutely.

Interviewer: And you find a lot of your patients have success with these methods.

Tamara: Yes. They do. And the other thing that I just would like to add as a pain management physical therapist, and this is not something that you might always find within physical therapy, but I think you'll find more and more is mindfulness based techniques, mindfulness and the use of relaxation techniques, diaphragmatic breathing, even mindfulness meditation, to help keep the nervous system kind of quieted down as you work on restoring movement. Sometimes, movement just becomes so highly associated with pain that people are very afraid of it, and I think that's probably the biggest driver as to why people might stop moving or avoid moving, as they're just afraid of the pain and they haven't learned how to make the movement as comfortable as they can, and to actually figure out how to listen to their body, and how much is okay.

Interviewer: So lean into it a little bit.

Tamara: Lean into it a little bit. Don't be afraid to move, but don't be afraid to change it up a little bit if it's not working. You know, if one type of movement or one type of exercise or something isn't working for you, you can change it. There's different ways.

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Dr. Miller: EMG. It's easier than you think. We're going to talk about that next on Scope Radio.

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Dr. Miller: I'm Dr. Tom Miller and I'm here with Dr. Daniel Cushman. He's a sports medicine physician who uses electromyelography, or EMG. And, Dan, it's easier than people might think it is. I think there's some news out there from the past experiences of folks who say that it's painful. You hear about this on blogs and websites that you read. And I think that some patients come in and they're very nervous about having this procedure because they think it's pretty onerous, from what they've read. Talk about that. It's a lot different now.

Dr. Cushman: Definitely. I think this is one thing that I do where every day, when someone comes in, I have to talk them down before we even get started.

Dr. Miller: Really? Because they've looked it up online?

Dr. Cushman: They hear from their friends is the most common thing. Their friend will say, "Oh, I had this done to me. It was the worst thing ever."

Dr. Miller: And they're usually talking about an experience that was some time ago?

Dr. Cushman: Correct. Exactly.

Dr. Miller: So what is EMG? Let's talk about that first and then go into how you do it and why it's less painful or stressful?

Dr. Cushman: So EMG talks about electromyography, which is looking at the electrical signals from the muscle. And the point of that is really to examine how well the muscles are working, how well the nerves are working, that go to those muscles. And there are two parts to the test. One is called the nerve conduction study. And what happens there is a small probe is placed on the nerve, on the surface of the skin, and a small shock is sent down the nerve. Just like in a wire, we can see how well that nerve is working by sending a signal down it. That's the first part.

Dr. Miller: Now, that sounds . . . you know, when somebody hears they're going to get shocked, they obviously think, "Uh-oh, this might be incredibly uncomfortable."

Dr. Cushman: Exactly. And so the way it works is that we just basically go up slowly on the electricity until they start even feeling it. They don't even feel it at the beginning. And then after they get . . . usually, the first one is the worst one. Then after that, they get used to it. It's kind of like when you rub your feet on carpeting, you touch something metal, nobody likes that sensation. But if you were to do that to yourself four times, by the fourth time, you'd be like, "Oh, I'm used to this."

Dr. Miller: It's like a little static shock.

Dr. Cushman: That's exactly it. Yeah.

Dr. Miller: So it's not like touching something coming out of a wall socket.

Dr. Cushman: Not at all.

Dr. Miller: Not at all.

Dr. Cushman: No.

Dr. Miller: Okay. Now, what about the needles? You use needles occasionally . . .

Dr. Cushman: Exactly.

Dr. Miller: . . . when you're doing EMGs.

Dr. Cushman: So the second part of the test is the actual EMG portion. And that's using a small needle about the size of an acupuncture needle, so really thin. And all we do is, we don't use any electricity, we just put it into different muscles along, in the body, depending on the test. So when we put that needle into the muscle, we can hear how the nerves are talking to the muscle. This part, on average, the pain level for people is somewhere in the range 3 out of 10. That's the most people will say it is. It doesn't really hurt. It feels more like a crampy sensation.

And when we do this, this gives us a lot of information. It can help us find if there's a pinched nerve, even though we're not really doing anything with the nerves. We're only doing the muscles. It can tell us a lot of information. It can tell us how old the problem is, if there's a new problem, if there's damage to the nerve, or if there's not damage to the nerve, and if things are getting better or have not started healing yet.

Dr. Miller: Talk about some of the common conditions where you use EMG to back up your clinical diagnosis.

Dr. Cushman: The most common that I do is probably carpal tunnel syndrome in the wrist. That's probably the most common. And then I would say the second most common would be a pinched nerve either in the neck or in the back.

Dr. Miller: So, basically, if you have . . . I mean, most of your patients are probably referred. Is that right?

Dr. Cushman: Yeah, most are.

Dr. Miller: And so you're getting patients from their referring providers who think they might have the right diagnosis, but they come to you to back up that diagnosis.

Dr. Cushman: That's correct. A good example would be a hand surgeon who . . . somebody might come in and say, "My fingers hurt," or, "My wrist hurts," or, "My hand hurts." And the surgeon can't particularly tell if that's coming from a pinched nerve in the neck or a pinched nerve in the wrist. And so, this test would help differentiate those.

Dr. Miller: So, obviously, not all patients need an EMG, but perhaps just a percentage of patients where the diagnosis is unclear.

Dr. Cushman: Correct.

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