How Could Acupuncture Help Spinal Cord Injury?
Article featured in SCI Ontario’s Community Magazine Fall 2018 Issue
An interesting review paper on this topic was recently published in the peer-reviewed Journal of Acupuncture and Meridian Studies. The title is “Spinal Cord Injury: How Could Acupuncture Help?” It is freely available online.¹
When acupuncture was introduced to Toronto's Lyndhurst Hospital in 1992, The Medical Advisory Committee wisely restricted our treatment to the management of pain. Obviously, if we were to try to cure paralysis with our needles, everyone would want treatment.
We had no such intentions and our outcomes treating pain were good from the start. We reported results for our first 61 patients to the ASIA meeting in 1995, reporting that 75% had good to excellent results with zero complications. In 2003, we published a case series reporting that 24 of 36 individuals with below-level central neuropathic burning pain responded to an acupuncture protocol of four points on the midline of the head stimulated electrically.² We have done a randomized trial using this treatment and are writing up the results.
Since the 1970s, when I started learning acupuncture, basic research into what happens when thin, solid, stainless steel needles are inserted into particular points on the body has revealed many intriguing scientific facts that may explain and support clinical claims. For instance, animal research showing that electroacupuncture (EA) can improve motor neurons in various ways offers scientific explanations for why improvement of function in SCI might be possible.³ However, to be clear, that does not mean that acupuncture can cure paralysis.
Over the past decade or so, the scientific literature includes clinical trials that suggest that acupuncture has potential to manage various post-SCI complications and improve outcomes. A “more rigorous systematic review and bias-adjusted meta-analysis of clinical studies,” published in 2015, in the Journal of Neurotrauma reported that, “Pooled analyses showed that acupuncture may have a beneficial effect on neurological recovery.”⁴ However, the authors also state, “The studies were generally of poor quality and publication bias favouring positive studies was evident.”
This is not to suggest that acupuncture has been proven to improve function in SCI. However, there is basic scientific research that shows complex effects using acupuncture as a treatment tool in spinal cord injury.
Clinical trials of various qualities indicate that acupuncture has a role to play in the management of several complications of SCI, including neurogenic bladder and bowel, in addition to pain. These common problems are the focus of this article.
Neurogenic bladder affects 69-92% of patients with SCI and neurogenic bowel affects 50%. Since the advent of the Magic Bullet, bowel treatments may have become less onerous, but the cost of intermittent catherization (IC) equipment and bowel meds are still issues for both consumers and insurance companies.
A recently published study by the China Academy of Chinese Medical Sciences in Beijing involved 16 individuals with acute or subacute SCI due to Transverse Myelitis (TM)⁵. TM is the inflammatory disorder of the spinal cord that produces symptoms and signs of SCI and can lead to complete paralysis. They all had stable bladder dysfunction caused by the TM and received electroacupuncture treatment bilaterally to three acupuncture points over their sacrums. The treatments were done five times a week for four weeks, three times a week for the next four weeks and participants were followed up for six months.
Results were carefully monitored using a variety of measures. Pre-treatment, all participants had abnormal voiding that required assisted measures to empty their bladders including abdominal pressure or intermittent catherization (IC) >50% of the time.
After the eight-week series of acupuncture treatments, 5 of 16 patients resumed normal voiding, 6 of 16 were able to void with pressure on the bladder instead of IC and 5 had no change. Those who used pressure on the bladder were tested for reflux by voiding cystourethrography and none was found. Nine patients had provided post-void residual urine volume (RUV) data at baseline that ranged from 33-600 ml. Three had normal RUVs at the start (33-80 ml) and 6 had abnormal levels (150-600 ml). Post treatment all were normal (12-20 ml and 25-100 ml).
Neurogenic bowel, a condition that affects more than 50% of patients with SCI, is a problem for many individuals. A 2003 paper from Taiwan reported a randomized clinical trial involving 100 acute traumatic ASIA “A” or “B” SCI patients who got either acupuncture and regular rehab therapy or rehab alone.⁶ The acupuncture was initiated in the ER or soon after admission. It consisted of a combination of four surface electrodes (TENS) on acupuncture points on the hands and ankles and needle treatment of four acupuncture points related to the spinal cord in the outer ears. Assessments at admission, discharge and one year post-injury showed significant improvements in the acupuncture group overall, with a higher percentage of patients in the acupuncture treatment group recovering to a higher ASIA impairment level than they had at the beginning. There was also a statistically significant improvement in “bowel functional independence measures” one year after SCI, compared with the no acupuncture group.
An observational study of 14 chronic patients with SCI showed that after two months of acupuncture with electrical stimulation, 4 of 14 patients resumed normal bowel movements (P=0.025%), 5 reduced dependence on “supplementary 7 defecation methods” and 5 had no changes.⁷As with all of the studies, there were no complications from the acupuncture treatments.
Back in the ‘90s, at my clinic, we treated a man with a complete SCI, using a neurogenic bladder acupuncture protocol developed by Dr. Sona Tahan, the Director of Education for the Acupuncture Foundation of Canada and Dr. Richard Cheng, a urologist who was studying acupuncture with AFC. Our patient had a baseline urodynamic study at Lyndhurst’s Robson Clinic prior to treatment. After a few acupuncture treatments, the patient noted significant changes and his next scheduled urodynamic test showed improvement in several parameters.
The Tahan bladder protocol uses points that stimulate the sacral nerves to the bladder and some traditional acupuncture points. It has been used clinically with success in Canada and abroad for more than two decades, mostly with non-SCI bladder dysfunction.
In fact, one of the traditional acu-points, just above the ankle, is now used by urologists for irritable bladder and is referred to as the “posterior tibial nerve stimulation point” rather than “Spleen 6” or its Chinese name, “San Yin Jiao”.
Fan et al. Spinal Cord Injury: How Could Acupuncture Help?. J of Acupuncture and Meridian Studies 2018;11(4):124-132.
Rapson LM, Wells N, Pepper J, et al. Acupuncture as a promising treatment for below-level central neuropathic pain: a retrospective study. J Spinal Cord Med. 2003 Spring;26(1):21-6.
Fan et al. pp 125, 128-129.
Ma R et al. The impact of acupuncture on neurological recovery in spinal cord injury: a systematic review and meta-analysis. J Neurotrauma 2015;32(24):1943-57.
Wu J et al. Effects of electroacupuncture on bladder and bowel function in patients with transverse myelitis: a prospective observational study. Acupunct Med 2018;36:261-266.
Wong AM et al. Clinical trial of acupuncture for patients with spinal cord injuries. Am J Phys Med Rehabil 2003 Jan;82(1):21-7.
Liu Z et al. Electroacupuncture improves bladder and bowel function in patients with traumatic spinal cord injury: results from a prospective observational study. Evid Based Complement Alternat Med 2013; 543174.
