East meets West as hospitals offer inpatients the healing power of acupuncture

New division provides more pain-relief options

Photo:Visual Art Services

Anesthesiologist Emily Ratner administers acupuncture treatment for back pain. Ratner and Brenda Golianu co-direct the new division of medical acupuncture, which now provides both inpatient and outpatient services at Stanford’s two hospitals.

Afraid of needles? The work of two medical center anesthesiologists could change your mind. They’ve seen firsthand that acupuncture can ease pain and help patients relax – not exactly the reactions most people associate with the sight of sharp, glinting steel.

Brenda Golianu, MD, assistant professor of anesthesia, and Emily Ratner, MD, associate professor of anesthesia, are co-directors of the Department of Anesthesia’s new division of medical acupuncture. One of their primary goals is to give patients at Stanford’s two hospitals access to the healing power of needles.

Acupuncture, which consists of putting needles into strategic spots on a person’s skin, can complement Western procedures, Ratner said. Studies have shown that acupuncture often relieves common post-operative problems such as nausea, vomiting and pain, and may also alleviate post-operative ileus, a condition in which the intestines temporarily stop working after an operation. At Lucile Packard Children’s Hospital, Golianu and others are studying whether acupuncture can help children require fewer sedatives while intubated.

Acupuncture, which the Chinese have practiced for thousands of years, is designed to restore the balanced flow of energy, or chi, in the body. It remained relatively unknown in the United States until 1972 when a New York Times reporter in China had to have his appendix removed. Treated post-operatively with acupuncture, he was impressed with the results and wrote a front-page article about the experience, sparking widespread interest in the subject.

In 1997, the National Institutes of Health released a consensus statement listing specific conditions that acupuncture had been proven to treat effectively and stating that “further research is likely to uncover additional areas where acupuncture interventions will be useful.”

“That statement really opened the doors for the use of acupuncture because it paved the way for a number of insurance companies to cover acupuncture treatments,” Golianu said.

Although Western researchers now agree that acupuncture works for certain conditions, they have yet to discover why. Imaging studies reveal that needling certain points changes blood flow in the brain, and others have shown acupuncture causes the release of endorphins, the body’s natural painkillers. But, said Golianu, “there’s still a black box in terms of the mechanism of action.”

“People say to me, ‘How can you do that because you don’t even know how it works?’ And I say, well, nobody knows how general anesthetics work either,” Ratner said. “But obviously we’d like to understand the basis of how it works.”

Golianu first became interested in acupuncture while in college when she spent her junior year studying in Taiwan and the People’s Republic of China. Intrigued by her observations of the efficacy of acupuncture, she returned several times during medical school to Taiwan and studied at the China Medical College. She also spent six months in a clinic in Japan. She completed an intensive acupuncture certification program for physicians offered through UCLA and began to practice it along with the techniques she’d learned in medical school.

As for Ratner, she had an epiphany while on sabbatical. “I came to this realization that there are a lot of patients that fall between the cracks in Western medicine,” she said. On returning to Stanford she called Golianu, who invited her to observe treatments at the Center for Integrative Medicine. Ratner eventually completed the UCLA course as well. “It became pretty clear to me that this was a whole avenue where we could make a huge difference in the lives of multitudes of patients,” she said.

An example, Golianu said, is a 20-year-old man she treated recently who is dying of graft-versus-host disease, a complication of bone marrow transplants in which the donated bone marrow attacks the recipient’s organs and tissues. He was hospitalized because he was on high doses of opiates to control back pain, but was also taking valium and experiencing breathing difficulties. “Then one day I stuck in six needles with some electrical stimulation and he was comfortable for the first time in months,” she said.

Golianu and Ratner hope to bring similar relief to other patients. “You can look at it as East meets West,” Ratner said. “We’re looking to provide the best of both traditions to patients who are in the hospital receiving complex medical care.”

“Acupuncture therapy has been used for centuries and has been largely ignored by Western medicine,” said Ron Pearl, MD, PhD, professor and chair of the Department of Anesthesia. “Our pain-management physicians have used acupuncture for at least a decade, but what’s new is creating a structured program to expand its use. One of the things we can offer at Stanford is to learn more about when acupuncture works, how it works and what we can do better.”

Acupuncture treatments were already available to outpatients at Stanford through the Center for Integrative Medicine, and to patients at Lucile Packard Children’s Hospital through the Pediatric Pain and Integrative Medicine clinic. Since the division’s official launch in July, it has also put a physician on call five days a week for acupuncture consultations for inpatients at both Packard and Stanford hospitals.

Eventually, Ratner and Golianu would like to expand the division to include more patient services, acupuncture education for medical students, residents and doctors, and an expanded research component.