Is Acupuncture Safe After Knee Replacement

Dry Needling And Post Knee Replacement Surgery Pain

Earlier we talked about a study that suggests dry needling can help lessen post-surgery pain in total knee replacements. Fascinating, right?

Heres what we know: the study observed 40 patients undergoing a total knee replacement. The 40 subjects were unknowingly randomized to a true dry needling group or to a sham group where the procedure mimicked a dry needling intervention, but was not true dry needling. Each of the participants were examined for myofascial trigger points by an experienced physical therapist 45 hours before surgery.

Immediately following anesthesiology and before surgery started, subjects in the true group were dry needled in all previously diagnosed trigger points, while the sham group received no treatment in their myofascial trigger points. This is where it gets good. The results concluded that subjects in the true group had less pain after their surgery and showed significant differences in the need for immediate post-surgery opioids.

So that begs the question, why isnt dry needling more commonly recommended to individuals undergoing a total knee arthroplasty? The answer is simple. Awareness!

Acupuncture Electrotherapy After Knee Replacement Associated With Reduced And Delayed Opioid Use

Date:

The JAMA Network Journals

Summary:

An analysis of drug-free interventions to reduce pain or opioid use after total knee replacement found modest but clinically significant evidence that acupuncture and electrotherapy can potentially reduce and delay opioid use evidence for other interventions, such as cryotherapy and preoperative exercise, had less support, according to a new study.

An analysis of drug-free interventions to reduce pain or opioid use after total knee replacement found modest but clinically significant evidence that acupuncture and electrotherapy can potentially reduce and delay opioid use evidence for other interventions, such as cryotherapy and preoperative exercise, had less support, according to a study published by JAMA Surgery.

Inadequate postoperative pain management has profound effects. Long-term influences of poor pain management include transition to chronic pain and prolonged narcotic consumption, which can result in opioid dependence, an epidemic in the United States. There is increased interest in nonpharmacological treatments to reduce pain after total knee arthroplasty . Yet, little consensus supports the effectiveness of these interventions.

Several limitations of the study are noted in the article.

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Reasons Why Physiotherapy Is Important After A Total Knee Replacement:

1. We can assess your current abilities and pain level.

• What is your current range of motion? Is it adequate for specific goals? Will you be able to walk, climb stairs, or sit on a toilet with this range of motion, or do we need to work on it?
• How much pain do you have? Is this normal? Do you need strategies to improve the pain?
• Are you walking safely? Do you need to use a walker or a cane? Are you using a walker or a cane but could be using it less?
• Did your body create any compensations that need to be addressed? Does your hip also hurt? Are your calves weak from walking less for the months prior to surgery?
• The answers to these questions are highly individualized, and we can assess your specific status.

2. We can answer your many questions.

• A knee replacement is a BIG surgery, and you probably have some questions. As time goes on, and as hospital funding changes, you will be encouraged to leave the hospital as soon as possible post-operatively even if you feel unprepared for whats ahead. Thats where we come in! Ask questions, be curious. Learn.
• Is it safe to walk without your cane?
• When can you drive your car again?
• Did you wake up with a red, hot, swollen and extremely tender calf muscle and wonder what you should do about it? ANSWER: GO DIRECTLY TO THE HOSPITAL THIS COULD BE A BLOOD CLOT
• Again, questions are individualized and we can gear the answers to your specific case!

3. We will help you improve the range of motion of your knee.

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Selection Of Studies And Qualitative Evaluation Of Data Collection

Two raters appraised and filtered related studies on the basis of their titles and abstracts. When the two raters differed in their appraisal results, a decision was made by a third expert . Research data entries included research characteristics , research sample characteristics , methodology characteristics , measurement of results , adverse events, turnover, and follow-ups.

According to the Standards for Reporting Interventions in Clinical Trials of Acupuncture , research analysis must include data on acupuncture points, depth, frequency, and acupuncture methods. The main research design should be an RCT, and a control group must be included.

Whats The Difference Between Dry Needling And Acupuncture

Like dry needling, acupuncture is a form of Instrument Assisted Soft Tissue Mobilisation . It uses similar anatomically specific filiform needles to help reduce pain. However, the approach and ideologies of the procedures are where we start to see the similarities fade.

• Dry needling involves the insertion of a needle into soft tissues with the aim of decreasing muscle tissue tension and improving musculoskeletal function.

• Acupuncture, on the other hand, uses needles to manipulate the balance and flow of the bodys energy meridians. Doing this stimulates the body to produce its own pain-relieving endorphins, which help to promote healing and restore health.

IASTM after knee replacement can be a great way to speed up your recovery time and help with knee replacement pain for months and years to come.

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Efficacy And Safety Of Acupuncture Treatment As An Adjunctive Therapy After Knee Replacement

• Study Details

Reasons Why Physiotherapy Is Important After A Knee Replacement

Getting a new knee may seem straightforward: take old knee out put new knee in. Done. Sometimes, its nice to think about how much easier some aspects of being a human would be if we were like cars. Mechanical in nature. Easily modifiable.

Part not working? Great, replace it, and function better than ever before!

Unfortunately , were biological in nature. That is, humans are living, breathing, entities that mold, change, grow, and vary based on the demands theyre faced with.

Are the demands placed on the body slow, progressive, purposeful, and goal driven ? If yes, the body will slowly, progressively, and purposefully adapt to accomplish the goals it sets out to accomplish. Has the body been dealing with pain, and poor function for weeks, months, years? If yes, the body will likely adopt compensatory mechanisms like limping for example. Maybe pain and dysfunction have been so high that activity is highly limited so we sit and rest we do nothing. Doing nothing = no demand and no demand = no improvement .

Its not all bad of course! Like I said, the body is biological, and it will adapt. It just needs to learn the optimal environment for doing so. Thats where we come in. Physiotherapists are experts at helping you teach your body how to optimally adapt to its imposed demands.

Aside: If you want to know all the ins and outs of a Total Knee Replacement surgery check out this blog on the Must Know Knowledge!

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Description Of The Condition

Total knee arthroplasty , the most common surgical technique to treat severe knee osteoarthritis and rheumatoid arthritis, is a highly successful procedure to improve knee function and pain., However, pain after TKA remains a major symptom, and rehabilitation, which is commonly performed following the procedure, is closely associated with pain management., Moreover, since opioid analgesics are in wide use for acute postoperative pain regulation, severe adverse effects relating to their use are frequently reported., Therefore, the gold standard for postoperative pain management remains unclear.

Dry Needling Vs Opioid Use

Compared to opioid pain medication, dry needling is a safe and effective alternative to controlling musculoskeletal pain especially in chronic pain patients. Opioids have a long list of side effects and can lead to spiraling dependencies.

Opioids work by binding to receptors in the brain and body, however, there are limits to the number of receptors that can be utilized. Once every receptor has something bound to it, any additional increase in dosage has no effect. Steadily increasing the dosage level means that the medication is not working and other options need to be explored.

Studies have found longer relief of pain is best managed through dry needling as compared to wet needling and medication. The use of dry needling is just one component in controlling pain. A skilled therapist will use needling to remove any painful trigger points but also direct the patient in a beneficial exercise program to continue to decrease and control pain.

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Can You Use Tens For Total Knee Replacement Pain

Using a TENS unit for pain control after total knee replacement surgery is a common protocol for many orthopedic surgeons.The use of a TENS unit after a total knee replacement can decrease the patients pain and opioid consumption.

A study, Transcutaneous electrical nerve stimulation for postoperative pain control after total knee arthroplasty published in the US National Library of Medicine confirms that patients receiving a TENS unit after total knee surgery experience less pain and a decreased need of opioid medications.

Just the reduction in opioid medication is well worth the investment in time and money.

Opioid medications come in various strengths.Many of the total knee replacement patients I see in their own homes a day or two after surgery have been issued two different strengths.

The two most common opioids I see issued my total knee patients on discharge from the hospital are:

• Oxycodone or Norco, two powerful break-through opioids prescribed for severe pain.
• Tramadol, a less strong opioid that is used as the primary pain control medication

I will use the Tramadol and Norco in the following explanation, however, your surgeon may prescribe different-named opioids, but the principle remains the same.

It is not uncommon to find my patients taking the break-through pain medication on a time-contingent basis instead of the pain-contingent basis.

Acupuncture Instead Of Surgery Or While On The Waiting List

Acupuncture may reduce the symptoms and delay the need for surgery. In 2012 researchers from UK investigated how acupuncture can help patients with osteoarthritis of the knee. They recruited 90 patients who were waiting for knee surgery. Following the course of acupuncture, patients reported

• Less pain
• Less stiffness
• Could walk easier, or climb the stairs.

Of these 90 patients, at least 31 improved enough so that they didnt need the knee replacement for at least two years. Clinically, we would recommend repeating the course of acupuncture at that point, hoping that we can delay the surgery for another couple of years.

In other studies, acupuncture had a greater effect on both pain and knee function than analgesics or usual care.

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When Can I Get Back To My Usual Activities

Typically, patients can return to their usual activities such as work and exercise after six months. However, you mustnt push yourself too hard during this period because your body needs time to heal.

This expected recovery time is obviously variable and depends on several factors such as the skills and experience of your surgeon, how well you follow medical advice, and whether or not there were any complications during surgery.

Acupuncture As An Alternative Treatment For Musculoskeletal Pain

There has been an increased interest in acupuncture as an alternative to traditional treatment methods for musculoskeletal pain, including the symptoms related to osteoarthritis, and research into the mechanisms of how it works has been undertaken. The analgesic properties of acupuncture stimulation have now been speculated to at least be correlated with ERK phosphorylation following acupuncture needling¹ and, therefore, could explain why patients report a decrease in their pain symptoms. In addition, improved microcirculation coupled with analgesic effects of needle stimulation¹¹ could bring about long-term improvements.

See also, cold laser therapy for knee OA pain.

Studies have shown the anatomical presence of tiny myelinated and unmyelinated nerve fibers, arterioles, venules, and lymphatics at acupuncture points.¹² According to Thomas Myers study on myofascial lines, myofascial meridians are postulated to occur along body paths where connective tissues not only have anatomical continuity but also exhibit only a gradual change in tissue orientation along the entire pathway. This anatomical configuration conceptually allows the strain to be transmitted across the structures in a given myofascial meridian. Further, this concept may explain why a distal acupuncture point, such as on the leg, can affect the shoulder or vice versa, as well as why points on the upper body can affect myofascia in the lower body .¹³

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More Knee Replacement Recovery Tips

The most important thing to do is to work with your therapist on a knee replacement pain management protocol. But there are also many things you can and should think about incorporating into your everyday practice.

• Wear your knee brace if applicable

• Keep your knee straight as much as possible

• Exercise 20-30 minutes a few times a day

• Walk 20-30 minutes a few times a day

For people who did not have dry needling treatment for knee pain, doing these activities could be difficult. Your therapist will help set up a reasonable training regiment, and help you prepare for life after physical therapy.

Its your knee. Being able to recover with minimal pain is the best way to get to where you feel like yourself again.

Acupuncture Effective Safe For Pain Management Post Total Knee Replacement

Acupuncture is safe and effective for pain management of patients following total knee replacement surgery, according to the authors of a systematic literature review published in Pain Medicine.

Although systematic reviews of acupuncture treatment for knee osteoarthritis have been conducted previously, data are lacking on the effectiveness of acupuncture for alleviation of pain post total knee replacement. Researchers therefore conducted a systematic literature review of randomized controlled trials in 5 English and 5 Chinese medical electronic databases, to evaluate whether patients who undergo total knee replacement benefit from acupuncture following surgery.

Of 598 studies identified, 7 studies with 470 participants were included in the final meta-analysis. These randomized controlled trials included 470 participants . Average patient age ranged between 28 and 81 years. Five studies were conducted in Eastern countries and 2 studies were conducted in Western countries.

Four studies explained only their research randomization methods and did not include details on the random allocation or group division methods, and 1 study did not provide a description of its randomization methods. Five studies did not indicate the concealment methods used to maintain privacy following randomization. All 7 studies selected presented their research results clearly, according to the researchers.

Evaluations indicated an absence of publication bias.

Reference

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Acupuncture For Osteoarthritis Of The Knee

Can acupuncture for arthritic knee serve as an alternative to knee replacement surgery? All you need to know.

Have you been diagnosed with knee osteoarthritis? Are you considering surgery?

Did you know that specialists recommend acupuncture before resorting to knee replacement?

In this article, you will learn about acupuncture as a safe and effective alternative to knee surgery. When done correctly, it may also slow down the osteoarthritis.

And if you had the surgery already, acupuncture can help speed up your recovery. Especially reduce the post-surgery pain that may last longer than you expect for up to 6 months!

Of course, we will back this up with studies.

Acupuncture For Joint Replacement

Conventional medical technology has been advancing in leaps and bounds over the past twenty years. There have been especially great strides in joint replacement as materials and surgical procedures continue to become more successful in efficiency as well as longevity. To compliment these advancements traditional medicine has also stepped up to peripherally provide relief and strengthening beyond many conventional approaches such as anti-inflammatory, anti-bacterial and muscle relaxant pharmaceutical fixes. This is particularly true for the use of acupuncture for joint replacement. By embracing a regimented acupuncture program for pre and post joint replacement one may experience more beneficial results that includes less pain and better ROM .

A Bionic Populous by 2030A recent report presented at the 73rd Annual Meeting of the American Academy of Orthopedic Surgeons by Steven M. Kurtz, PhD, director of the Philadelphia office of Exponent Inc., an engineering and scientific consulting firm stated that:

the number of procedures for primary total knee replacement would jump by 673 percent to 3.48 million in 2030. The number of primary total hip replacements, the authors estimate, will increase by 174 percent to 572,000 in 2030.

Even though with many people joint replacement is avoided at all costs and only considered as a last option, these statistics may be sobering.

These are the 4 phases of acupuncture treatment that address joint replacement issues:

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