The use of acupuncture in the Breathlessness Intervention Service

Transcription

1 The use of acupuncture in the Breathlessness Intervention Service

2 What is acupuncture?

3 TCM theory

4 Scientific evidence Positive evidence: chronic back pain (NICE) dental pain pain and discomfort during gastrointestinal endoscopy headache nausea and vomiting after an operation pain and discomfort during oocyte retrieval (a procedure used during IVF) Osteoarthritis of the knee

5 Scientific evidence Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases Claudia Bausewein et al, 2009 Can a standardized acupuncture technique palliate disabling breathlessness: a singleblind, placebo-controlled crossover study. Lewit et al, 2004 Acupuncture for the relief of cancerrelated breathlessness. Filshie et al, 1996 Systematic review 47 trials- 5 Acupuncture and acupressure Low strength evidence that acupuncture helps (mostly COPD) Single blinded, randomised, 6 sessions No specific efficacy in disabling nonmalignant breathlessness, but those entered into the study did experience clinically significant benefit from both treatments. 70 % patients reported marked symptomatic benefit from treatment; (VAS scores of breathlessness, relaxation and anxiety significant reduction in respiratory rate). The therapeutic value of acupuncture in the management of breathlessness requires further evaluation.

6 Acupuncture use in BIS Complex patients anxiety related breathlessness Poor results with traditional BIS intervention 4 /5 weekly sessions acupuncture+acupressure Patient to use acupressure point Lu11 to control sob during sessions

7 Acupuncture use in BIS So far... 71% of patients reported a definite improvement 28% of patients reported no difference What do patients say: I can feel that I want to panic but my body won t do it. When using the acupressure point, I could really feel my breathing calming down. It felt strange, it was as if my lungs were opening up, allowing me to breathe properly

8 Case Study Mrs L. 40 years old lady Married, lives with husband and two teenage daughters Administrative job in school, works across the road Hobby sailing with husband, owns a boat

9 Referred to BIS in July 2013: Developed unexplained bilateral pulmonary emboli in September 2012 whilst awaiting left knee cartilage tear repair. Troubled since with unexplained persistent exertional breathlessness.

10 Investigations past 6 months: Repeat CT Pulmonary angiogram Repeat echocardiogram 6 minute walk test Cardiopulmonary exercise test Conclusion: No structural cause for breathlessness? Hyperventilation

11 BIS initial assessment: Had started to develop panic attacks Reduced working hours to allow midday nap as unable to cope No longer able to go on shopping trips to town with daughters Breathlessness on minimal exertion such as going up the stairs Had given up taking the boat out as too breathlessness- no longer wanting to go to the sea side, too stressful Problems sleeping, on sleeping tablets for past 3 months

12 Outcome measures Initial assessment Breathlessness 5/10 Anxiety 7/10 Confidence 3/10

13 Treatment 5 sessions, 20 min Needling: Li 4, Lu7, Li 11, St 36, Li 3 Acupressure: Lu 1, Lu 11, BL 13

14 Treatment Went on holidays after session 1, went on walks with family, used her fan to manage SOB Went sailing between session 2 and 3 and stopped sleeping tablets At 4th session had done a 2,5 miles walk without experiencing breathlessness

15 Last session Reports feeling very well Has had to deal with very stressful situations at work but feels that her breathing has not been affected Working full time Referred to exercise scheme, awaiting assessment

16 Outcome measures: Initial assessment Final assessment Breathlessness 5/10 0/10 Anxiety 7/10 1/10 Confidence 3/10 10/10

17 Malika Harboun (Physiotherapist)

18 Discussion / interaction