Got a spinal cord injury? Get acupuncture!

Why it’s important to include it in your patient’s care

By Narda Robinson, DO, DVM

This past July, the National Institutes of Health released a report outlining results from a study showing how non-invasive electrical stimulation of the low back restored some function in men with complete motor paralysis. This work, led by Yury P. Gerasimenko et al,2 builds upon previous research involving direct spinal cord stimulation through a surgically implanted device.

In the current study, researchers stimulated the cord and associated nerves transcutaneously, i.e., across the skin of the lower back.

As stated by the director of the NIH’s National Institute of Biomedical Imaging and Bioengineering, Roderic Pettigrew, Ph.D., MD, “These encouraging results provide continued evidence that spinal cord injury may no longer mean a life-long sentence of paralysis and support the need for more research.

“The potential to offer a life-changing therapy to patients without requiring surgery would be a major advance; it could greatly expand the number of individuals who might benefit from spinal stimulation. It’s a wonderful example of the power that comes from combining advances in basic biological research with technological innovation.”

This methodology, while seemingly novel and remarkable, is in many ways similar to what veterinary medical acupuncturists have been doing for years for their patients, small and large.

They have not only been saving animals from a lifetime of paralysis but also, often, rescuing them from the one last resort of euthanasia.

As the numbers of acupuncturists grow, documented cases of para- and quadriplegic animals regaining the ability to walk are likewise multiplying. Some dogs who have reportedly lost the ability to perceive deep pain, widely considered an indicator of poor prognoses, have regained motor function.3

The fact that so many patients whose owners were unwilling or unable to pursue surgery or euthanasia recovered and are once again walking emphasizes the importance of including acupuncture in their care.

Acupuncture provides meaningful treatment through neuromodulation — the same scientific terminology explaining both the mechanisms of acupuncture and “non-invasive electrical stimulation of the spinal cord.” Furthermore, veterinary medical acupuncturists have evidence to back them up.

There is, in fact, more clinical evidence supporting the application of acupuncture and related techniques in dogs than for humans, as outlined in previous columns.4, 5, 6, 7

How does electroacupuncture compare to the spinal cord stimulation discussed above?

In the human study, transcutaneous electrical stimulation was delivered in three-minute bouts to the midline of the back between the spinous processes of T11 and T12 or over the coccyx as cathodes and symmetrically upon the skin overlying the iliac crests as anodes.

The stimulation was increased to the point of inducing stepping-like movements in each subject. Sessions took place weekly. Similarly, medical acupuncture practitioners target injured spinal cord segments by placing acupuncture needles (which become de facto electrodes) proximal and distal to the site of injury.

They connect the electrodes to deliver electrical stimulation across the involved segments, recognizing that spinal nerve branches will ferry somatic afferent stimulation to the dorsal horn of the spinal cord to induce neuromodulation — again, this is the same process appreciated by spinal cord injury researchers in the NIH study.

Acupuncturists treat patients one or more times weekly over a period of one or more months and typically witness, as Gerasimenko and colleagues did, functional recovery of the use of the limbs. Many often combine electroacupuncture with other physical medicine modalities and pharmacologic support if needed.

The convergence of medical acupuncture and neurotrauma recovery research highlights the benefits that acupuncture can offer patients.

Unfortunately, many “conventional” or “scientific” practitioners dismiss acupuncture because they have only heard it described by Traditional Chinese Medicine enthusiasts who use terms such as “Chi” or “energy” to explain how it works.

In contrast, medical acupuncture explains how point stimulation invokes neuromodulatory changes locally, regionally and system-wide that aid the body in recovery of function and restoration of homeostasis.

For spinal cord injury in particular, medical acupuncturists seek to “open new functional connections among brain-spinal cord networks,” just as Gerasimenko and colleagues did, finding these “functional connections [to be] highly dynamic and interactive.”

And while the bioengineering researchers claim to have “developed a novel method of noninvasive transcutaneous spinal cord stimulation delivery using a special form of electrical pulses at a high frequency,” electroacupuncture is not new at all, having been invented in the mid-20th century in China.

One could argue that acupuncture, working in a “percutaneous” (i.e., through­ the skin) fashion, more accurately “pinpoints” relevant neural targets (muscles or spinal nerve branches) in comparison to the “transcutaneous” (i.e., across the skin) stimulation studied by the NIH group.  Nonetheless, both effectively neuromodulate spinal locomotor circuitry and can result in benefit to spinal cord injured patients.

In the words of Gerasimenko and colleagues, “Together the most logical interpretation of our findings is that there are networks above, within and below the lesion in a significant number of individuals with complete, chronic paralysis that can be transformed into a functional state by receiving a certain critical level of spinal activation. … A number of anatomical as well as physiological reports have demonstrated the presence of some residual circuitry across the lesion in many individuals clinically classified as having been completely paralyzed for years.

“We now know that there is a new potential for recovery of sensorimotor function after a severe SCI; that includes improved locomotor function with some voluntary control. The reported results combined with our previous reports in animals and humans make it virtually undeniable that significant levels of plasticity can occur in the nervous system of individuals even after years of complete paralysis due to SCI.

“These findings have significant implications for expanding the range of interventional strategies within an evolving clinical toolbox from which the best approach for a given individual can be selected.”

The time has come to include acupuncture as standard of care for spinal cord injury, not only in the acute phase, but also in chronic cases.

Perhaps, to facilitate its acceptance, we may just have to call it “functional, non-invasive electrical stimulation” instead of acupuncture. Then we’ll be good to go.

References

  1.  Anonymous. Paralyzed men move legs with new non-invasive spinal cord stimulation.  National Institutes of Health, News & Events.  July 30, 2015.  Accessed at http://www.nih.gov/news/health/jul2015/nibib-30.htm on 08-27-15.
  2.   Gerasimenko YP, Lu DC, Modaber M, et al.  Noninvasive reactivation of motor descending control after paralysis.  Journal of Neurotrauma.  2015;32:1-13 (Month X, 2015).  DOI:10:1089/neu.2015.4008. [Epub ahead of print].
  3.   Personal experience of the author through cases treated as well as discussions with colleagues that perform medical acupuncture.
  4.   Robinson, N.  Non-surgical options for IVDD?  Keeping hope, and dogs, alive.  Veterinary Practice News.  May 23, 2011.  Accessed at http://www.veterinarypracticenews.com/May-2011/Non-Surgical-Options-For-IVDD-Keeping-Hope-And-Dogs-Alive/ on 08-27-15.
  5.   Robinson NG. Laser therapy may work on TL IVDD.  Veterinary Practice News.  March 11, 2010.  Accessed at http://www.veterinarypracticenews.com/March-2010/Laser-Therapy-May-Work-On-TL-IVDD-0/  on 08-27-15.
  6.   Robinson NG.  An emerging standard of care for TL IVDD. Veterinary Practice News.  May 21, 2013.  http://www.veterinarypracticenews.com/Medicine/An-Emerging-Standard-Of-Care-For-TL-IVDD/ on 08-27-15.
  7.   Robinson NG.  Evidence points to acupuncture for disk disease.  Veterinary Practice News.  June 10, 2009.  Access at http://www.veterinarypracticenews.com/June-2009/Evidence-Points-To-Acupuncture-For-Disk-Disease-0/ on 08-27-15. 

Originally published in the October 2015 issue of Veterinary Practice News. Enjoyed this article? Then subscribe today! 

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