Telemedicine Resources for Acupuncturists Part II: A Focus on Mental Health

Part two in a series of blog post, this installment explores mental health related treatment options that acupuncture providers can offer with the use of telemedicine.

As referenced in part 1 of this series, many providers and patients may not have considered telemedicine as an option for chronic pain management. Yet, think of what acupuncturists “do” in a typical in-person treatment – pain management requires more than just needles! Providers often focus on the foundations of Traditional East Asian Medicine (TEAM): rest, diet, exercise, mental health, and if needed other modalities such as self-acupressure and breath work. In this post we explore the importance of assessing and addressing mental health for patients with chronic pain.

When working with patients who experience chronic pain, providers should assess general well-being and ask about current mental health on a regular basis. Research suggests this population has a higher prevalence of anxiety, depression, catastrophizing and suicidal ideation and may be more susceptible to COVID-19.1Shanthanna H, et al. Caring for patients with pain during the COVID-19 pandemic: consensus recommendations from an international expert panel. Anaesthesia. 2020;75(7):935-44.

Below are a few resources to better assist you in evaluating and assisting the mental health of your patients.

  1. OHA Behavioral Health Services: Provides a list of services available through the Oregon Health Authority (such as young adult (age 14-25) mental health services)
  2. Oregon Trauma Informed Care Resources: Provides resources and educational training options on trauma and trauma informed care
  3. If you suspect a patient is in crisis, the following offer immediate resources:

A recent article from an international panel of experts highlights recommendations for the management of chronic pain during COVID.2Shanthanna H, et al. Caring for patients with pain during the COVID-19 pandemic: consensus recommendations from an international expert panel. Anaesthesia. 2020;75(7):935-44. This panel calls for multidisciplinary therapies and online programs for exercise, sleep hygiene, pacing and healthy lifestyle. As practitioners of TEAM, acupuncture providers often focus on similar foundations. Namely, TEAM-related lifestyle options that enhance the active involvement of patients in their recovery. In addition to the resources listed above, see below for examples of how to support the mental health of your patients with telemedicine:

  • The Need
    • The inferior physician attends to the form, the superior physician attends to the Shen (-Neijing). This famous axiom demonstrates that acupuncture providers strive to treat the “whole-person” and how this is a core tenet of treatment planning for patients with chronic pain.
  • Some Data
      • Patients with chronic pain have increased incidence of anxiety, depression, catastrophizing and suicidal ideation3Shanthanna H, et al. Caring for patients with pain during the COVID-19 pandemic: consensus recommendations from an international expert panel. Anaesthesia. 2020;75(7):935-44.
      • During COVID, there are increased levels of anxiety and social isolation.4Smith BJ, et al. How the COVID-19 pandemic is focusing attention on loneliness and social isolation. Public Health Res Pract. 2020;30(2).
      • Loneliness is an independent risk factor for mortality; comparable with well-established risk factors (e.g. smoking).5Holt-Lunstad J, et al. Loneliness and social isolation as risk factors for mortality: a meta-analytic review.Perspect Psychol Sci. 2015;10(2):227-37.
    • Sleep problems are more likely to affect patients with psychiatric disorders than people in the general population.6Sleep deprivation can affect your mental health. Sleep and mental health https://www.health.harvard.edu/newsletter_article/sleep-and-mental-health. Accessed March, 15, 2021.
      • Poor sleep is also associated with increased pain sensitivity and decreased immune function.7Sivertsen B, et al. Sleep and pain sensitivity in adults. Pain. 2015;156(8):1433-39.
    • Select Treatment Options
      • Exercise (online or outdoors)
        • Tai Chi & Qi Gong
          • A review suggests they may be helpful in the treatment and prevention of mental health disorders.8Abbott R, et al. Tai Chi and Qigong for the treatment and prevention of mental disorders. The Psychiatric clinics of North America. 2013;36(1):109-19.
          • Two meta-analyses suggest they may improve symptoms in patients with chronic low back pain.9Zhang Y, et al. The Beneficial Effects of Traditional Chinese Exercises for Adults with Low Back Pain: A Meta-Analysis of Randomized Controlled Trials. Medicina (Kaunas). 2019;55(5).,10Han JW, et al. The Effects of Forest Therapy on Coping with Chronic Widespread Pain: Physiological and Psychological Differences between Participants in a Forest Therapy Program and a Control Group. International journal of environmental research and public health. 2016;13(3).
        • Walking mindfulness (Forest therapy)
          • A recent trial suggests this can help improve psychological and physiological symptoms of chronic pain, enhance overall QOL and boost immunity.
          • 11Murphy SL, et al. Self-Administered Acupressure for Chronic Low Back Pain: A Randomized Controlled Pilot Trial. Pain Med. 2019;20(12):2588-97.Sleep hygiene
          • Reinforce the importance of a regular sleep schedule and exercise
          • Suggests self-administered acupressure and herbal formula as needed
        • Acupressure (Self-administered)
          • Research suggests it may reduce chronic LBP12Murphy SL, et al. Self-Administered Acupressure for Chronic Low Back Pain: A Randomized Controlled Pilot Trial. Pain Med. 2019;20(12):2588-97., enhance sleep and reduce anxiety
          • 13Monson E, et al. Beyond Pills: Acupressure Impact on Self-Rated Pain and Anxiety Scores. J Altern Complement Med. 2019;25(5):517-21.Application: Consider what key acupoints you would use in an acupuncture treatment; guide the patient through location and technique

 General Reminders for Telemedicine Visits

  • The patient & acupuncturist must be located in same state
  • The acupuncturist must maintain an Active status license (in same state as patient)
  • Telemedicine must meet the standard of care for the particular patient and condition being treated
  • Chart documentation is same as in-person services; note that consent was obtained
    • Verbal consent OK, so long as costs are discussed

References

  1. Shanthanna H, et al. Caring for patients with pain during the COVID-19 pandemic: consensus recommendations from an international expert panel. Anaesthesia. 2020;75(7):935-44.
  2. Smith BJ, et al. How the COVID-19 pandemic is focusing attention on loneliness and social isolation. Public Health Res Pract. 2020;30(2).
  3. Holt-Lunstad J, et al. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015;10(2):227-37.
  4. Sleep deprivation can affect your mental health. Sleep and mental health https://www.health.harvard.edu/newsletter_article/sleep-and-mental-health. Accessed March, 15, 2021.
  5. Sivertsen B, et al. Sleep and pain sensitivity in adults. Pain. 2015;156(8):1433-39.
  6. Abbott R, et al. Tai Chi and Qigong for the treatment and prevention of mental disorders. The Psychiatric clinics of North America. 2013;36(1):109-19.
  7. Zhang Y, et al. The Beneficial Effects of Traditional Chinese Exercises for Adults with Low Back Pain: A Meta-Analysis of Randomized Controlled Trials. Medicina (Kaunas). 2019;55(5).
  8. Qin J, et al. Effect of Tai Chi alone or as additional therapy on low back pain: Systematic review and meta-analysis of randomized controlled trials. Medicine. 2019;98(37):e17099.
  9. Han JW, et al. The Effects of Forest Therapy on Coping with Chronic Widespread Pain: Physiological and Psychological Differences between Participants in a Forest Therapy Program and a Control Group. International journal of environmental research and public health. 2016;13(3).
  10. Murphy SL, et al. Self-Administered Acupressure for Chronic Low Back Pain: A Randomized Controlled Pilot Trial. Pain Med. 2019;20(12):2588-97.
  11. Monson E, et al. Beyond Pills: Acupressure Impact on Self-Rated Pain and Anxiety Scores. J Altern Complement Med. 2019;25(5):517-21.