C O M P L E M E N TA R Y

MEDICINE
referrals
This is the first item in a new column to help
guide practitioners in considering and using
referrals in various specialties. The next in the
series will cover the basic process in all referrals.

Acupuncture
Narda G. Robinson, DO, DVM, Diplomate ABMA, Fellow AAMA, Colorado State University

What Is “Acupuncture”? culatory, and mental–emotional improve- musculoskeletal problems, gastrointestinal and
Most often, the term acupuncture refers to ments. Endogenous opioid peptides (e.g., hepatobiliary disorders, and neurologic dys-
the insertion of thin metal acupuncture nee- endorphins) and monoamines (e.g., serotonin function.1,2
dles into specific sites on the body for treat- and norepinephrine) play a prominent role in
ment or prevention of diseases and pain. analgesic relief resulting from electro- Be aware that there are veterinarian acupunc-
However, it may also refer to other types of acupuncture. Additional relaxation of muscle turists who refuse to treat animals that are
stimulation of these same sites, such as injec- tension comes about by the ability of receiving concurrent treatment with steroid
tion of fluid (e.g., vitamin B12) into a point, acupuncture to reduce the output of α-motor medications or opioids, mistakenly believing
called “aquapuncture”; electrical stimulation neurons. that these products will negate the effects of
of an acupuncture needle, called “electro- treatment. Others may not treat an animal
acupuncture”; low-level laser light stimulation, Research evidence for acupuncture in humans with cancer, based on the unsubstantiated
called “laser acupuncture”; or local heating is strong and continually increasing. A quick fear that acupuncture will promote metastasis
with a smoldering herb, called “moxibustion.” search on PubMed (www.pubmed.com) using because of its beneficial effects on circulation.
Some veterinarians perform “gold bead the words “acupuncture” and the disease In fact, acupuncture provides important
implantation,” which is potentially risky and process of interest will probably return a long advantages to oncology patients, including
unsupported by controlled research studies, list of references. While many of the studies pain reduction, elimination of nausea, and
as discussed below. done overseas lack rigor and controlled condi- improved glandular function following radia-
tions, well-done studies showing benefits do tion therapy.3
Why & When to Try Acupuncture exist for a wide range of disorders, including
In considering acupuncture for a patient, there Questionable Approaches
are two main questions to be considered: • Gold bead implants became popular in the
1980s in veterinary acupuncture as a form
• Is there a valid physiologic justification for of “permanent acupuncture.” This tech-
suggesting acupuncture to the client? nique involves implanting fragments of gold
• Does evidence support use of acupuncture jeweler’s wire, gold-plated pellets, or mag-
for this clinical condition? nets. The most common applications include
arthritis, degenerative myelopathy, wob-
Being familiar with the types of physiologic bler’s syndrome, and epilepsy. While some
changes acupuncture produces allows one to advocates claim up to 98% success with
better assess whether it is suitable for a given gold bead implantation in conditions such
problem in a particular patient. Studies involv- as hip dysplasia, two double-blind, con-
ing functional brain imaging reveal changes in trolled studies evaluating the effectiveness
A cat with an acupuncture needle on the top of its
thalamic, cerebellar, and cortical function that head, in a point called Governor Vessel 20, that is c o n t i n u e s
may relate to endocrinologic, autonomic, cir- used for calming

re fe r ra l s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N AV C c l i n i c i a n’s b r i e f. . . . . a p r i l . 2 0 0 5 . . . . . 2 1
referrals CONTINUED

of gold bead implants found no treatments (twice-weekly is pre-

benefit over placebo.4,5 Risks of
gold bead implantation include
migration of the metal frag-
ments into the nervous system,
infection6 (especially if nonster-
ile beads are used7), and celluli-
tis.8,9
• “Color” acupuncture involves
the practitioner shining colored
lights on acupuncture points.
“Sound” acupuncture or “merid-
ian therapy” involves using tun-
ing forks or “specific sound fre-
quencies.” These and other spin-
offs of acupuncture do not have
physiologic, evidential, or histor-
ical studies to back them.
Practitioners should consider
using them carefully as the Treating a patient that recently had an amputation for cancer. This photo
shows that acupuncture can and should be relaxing for the animal (as well as
American Veterinary Medical
the provider).
Law Association’s White Paper
on the Law and Complementary and
Alternative Veterinary Medicine states that
“All veterinarians—conventional and
C.A.V.M.—must use scientifically reliable
treatments and therapies.”10
• Diagnostic techniques that involve applied
kinesiology refer to procedures in which the narian and the acupuncturist.
practitioner tests the strength of the client
(referred to as an “energy conduit”) while
simultaneously touching the patient to pick
up “transmitted” diagnostic information.
These techniques do not have scientific
research support, especially when per-
formed with the client or practitioner as a
diagnostic “surrogate” for the actual
patient.
What Information to Supply
Veterinarian acupuncturists require the same
amount and type of historical, physical, and
diagnostic information as any other veterinary
specialist would. They should be supplied with treatment for severe dysfunction. Acute illness
a complete list of all supplements and med-
ications that the owner is giving the pet.
Some of these may be prescribed by the refer-
ring veterinarian but the owner should also be
encouraged to be all-inclusive when supplying Follow-up Communication
this information for both the primary veteri-
What to Ask for
Expect the same sort of feedback from a vet-
erinary acupuncturist that you would from any herbal, nutraceutical, homeopathic, or other
other veterinary specialist, including a prelimi- recommendations made by the acupuncturist
nary treatment schedule and outcome goals.
The acupuncturist should be able to describe
her or his assessment and treatment of the
patient in clear, unambiguous terms.
ferred) for a total of four sessions.
Some veterinary acupuncturists
require clients to initially commit to
at least eight sessions. Patients that
are likely to respond favorably to
acupuncture usually do so within the
first few treatments; however, at first
the benefits may last only 1 to 2
days. The goal is to build a cumula-
tive and longer-lasting effect by
delivering frequent sessions at the
outset. Once a satisfactory level of
improvement occurs, the acupunctur-
ist will usually increase the time
interval between sessions to that
which allows sustained improvement
with the fewest treatments.
Chronic problems often require
longer start-up times, and patients
may need prolonged and perhaps
lifelong maintenance (e.g., monthly)
or pain and swelling from recent trauma or
surgery usually resolve more quickly—perhaps
with only a few treatments.
If a new problem develops while the patient is
under the care of the veterinary acupuncturist,
he or she should alert the referring veterinari-
an and ensure that the patient returns to the
primary care provider for further workup. Any
should be discussed with the primary care vet-
erinarian before instituting, especially in cases
in which herb–drug interactions may result. ■
See Aids & Resources, back page, for
Patient Outcomes & Length references, contacts, and appendices.
of Treatment
A typical trial period of acupuncture involves a
“start-up” routine of twice- or once-weekly

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