Acupuncture at Lyndhurst 25 Years On
Article featured in SCI Ontario’s Outspoken Magazine Winter 2018 Issue
Thanks to two insightful physiotherapists, acupuncture for pain management has been available to inpatients at Lyndhurst Centre, Toronto’s spinal cord injury rehab hospital, since 1992.
When Irene Biemann and Betsy Mustard told me in 1989 that many of their SCI patients at Lyndhurst could benefit from acupuncture, I was skeptical. They had concluded this after the first day of their first Acupuncture Foundation of Canada introductory course. Luckily, they were right and I was wrong.
A former General Practitioner or ‘GP’, I had been like a kid in a candy store after my first AFC course in 1974. It was so exciting to take away pain, get stiff necks and shoulders moving and unplug ragweed-induced stuffy noses (the first one I treated, in August that year, remained unplugged for two weeks). During the following years, I got used to obtaining improvements with my needles that others called miracles. But spinal cord injury pain? How could that work?
It took research, for me, and more acupuncture training for the physios, before we launched a successful campaign to convince the Lyndhurst Centre Medical Advisory Committee (MAC) to authorize a six-month acupuncture pilot project. We were supported by then by Lyndhurst Chief of Medicine, Dr. Joanne Bugaresti. Bringing in the late Dr. Joseph Wong to treat some patients on the ward convinced the medical staff to support the project.
The conditions for the project were to:
Have a team in place to actualize the project;
report to the MAC after six months; and
only treat pain.
The team required a staff physiatrist, a medical acupuncture expert and an AFC-trained physiotherapist to assess each patient prior to treatment, and to follow them weekly. The treatment would be done by the physio during the week. At that time, I had 18 years of experience using acupuncture in a medical practice, and taught for the AFC, but had no SCI expertise.
Dr. Nimmi Bharatwal generously took on the role of team physiatrist, took AFC courses and passed an introductory acupuncture exam. Dr. Bugaresti also attended at least one course with AFC and learned the value of acupuncture.
Within two weeks of opening the clinic to inpatients on June 1st, 1992, we were being called “Miracle Workers” around the hospital. It was true that we were helping most of our patients with their pain, often dramatically, but we had not yet found a treatment protocol to relieve the generalized burning pain that so many people with SCI feel below their level of injury. In fact, many of the first individuals we treated did not tell us about their burning pain because they strongly believed that nothing could help it. This was years before the advent of drugs for neuropathic pain.
By a stroke of luck, four spinal surgeons from China arrived at Lyndhurst Centre for a two month visit in early September 1992, to observe good SCI rehab. They worked at the China Rehabilitation Research Center in Beijing, where they did top level spinal surgery but did not yet have standardized physiotherapy for rehabilitation for people with SCI. They brought with them a videotape about their institution. Not being a speaker of Mandarin, I could not understand the voice-over, but I noticed a doctor on the tape who was doing acupuncture on the tops of patients’ heads. “That is for the burning pain,” was the answer to my query about what he was doing.
That answer was the key to our future success in treating this particular painful condition.
We tried their technique on a willing inpatient whose neck pain had responded well to our acupuncture but it had no effect on his generalized burning pain below the level of his C5 complete SCI. To our and his surprise and delight, his burning pain dropped from 7/10 to 3-4/10 in five minutes after the treatment.
We went on to modify this treatment and in 2003, published a case series of 36 patients for whom our burning pain protocol had been the first acupuncture intervention for their pain.¹ Two thirds of them responded to our protocol, half of them to our first treatment.
Over the following years we came to appreciate that:
SCI pain responds well to acupuncture.
Individuals with complete tetraplegia may respond better to acupuncture than the average person without an SCI.
Treating acupuncture points below the level of the spinal cord lesion can relieve pain above it.
Myofascial pain arising from “trigger points” in muscle in SCI follows the referred pain patterns that Travell and Simons² describe for able-bodied people, although this is not reported in their books to date.
Trigger points in muscle may be palpable below the level of injury, meaning that the examiner can feel a knot in the muscle.
When we reported to the Lyndhurst MAC after six months, we had treated 20 people. There were no side effects or complications and 16/20 of them had good to excellent results with a variety of pain problems. The MAC suggested that perhaps we could design a study that would have some sort of control built into it. Everyone we discussed this with said that it would be difficult to blind a study at Lyndhurst and because SCI is so complex it is hard to match controls, which would have to be at another facility. In 1995, we presented a paper at the American Spinal Injury Association (ASIA) meeting in Orlando, reporting on 61 patients, 75% of whom had good to excellent results with zero complications.³ The paper was very well received, the MAC no longer worried about acupuncture, and gradually it became another tool for trained physios to use for people with SCI.
25 years on, at Lyndhurst we have never had a serious complication from acupuncture in treating several hundred patients, and have benefited the majority.
Rapson LM, Wells N, Pepper J, Majid N, Boon H. 2003 Acupuncture as a promising treatment for below-level central neuropathic pain: a retrospective study. J Spinal Cord Med. 2003 Spring;26(1):21-6.
Travell J and Simons DG. Myofascial Pain and Dysfunction the Trigger Point Manual Williams and Wilkins, 1983; Ibid Volume 2 1992.
Rapson LM, Biemann IM, Bharatwal ND, Pepper J, Mustard BE. Acupuncture Treatment of Pain in SCI. Abstract only. J of Spinal Cord Medicine Vol.18, No.2, April 1995.
