Telemedicine Resources for Acupuncturistsm, Part III: A Focus on Breath
September 21, 2021 | Evidence in Integrative Healthcare
Part three in a series of blog post, this installment explores the importance of the breath and treatment options that acupuncture providers can offer with the use of telemedicine.
As referenced in part I 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. This post will explore the importance of assessing breathing patterns for patients with chronic pain (cPain).
Note: 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.
A recent article from an international panel of experts highlights recommendations for the management of chronic pain during the COVID-19 Pandemic. 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 breathing exercises that enhance the active involvement of patients in their recovery. See below for examples of how to support your patients with Telemedicine:
- The Need
- The diaphragm performs both postural and breathing functions; disruption in one function can negatively affect the other
- Poor diaphragm function is linked to chronic Low Back Pain (cLBP)
- cLBP is #1 cause of cPain
- Thoracic Dominant Breathing or Paradoxical Breathing is a common breathing pattern disorder (BPD); abdomen draws in during inhalation, out on exhalation
- Equates to limited diaphragmatic involvement
- Often associated with stress or an emotional response to a traumatic event
- Are you observing the breath of your patients? Evaluation and treatment of BPDs may be a missing component in the treatment of cPain.
- Some Data
- BPDs are an independent risk factor for cLBP (N.B. cLBP is #1 cause of cPain)
- Patients with cPain have increased incidence of anxiety, depression, catastrophizing and suicidal ideation
- During the COVID-19 Pandemic, there are increased levels of anxiety and social isolation.
- All of the primary acupuncture meridians pass through the diaphragm; regulate breath = regulate the meridians
- The Zhunag Zi speaks of, “The Authentic being breathes from the heels, the Commoner from their throat.”
- Select Treatment Options
- Are your patients breathing from the abdomen? If needed, have them place a hand on their chest & abdomen to evaluate while you observe.
- Exercise (online or outdoors)
- Simple 6 step technique (standing, seated or supine):
- 1. Grounding: Observe your heels
- 2. Belly: Breath from the belly
- 3. No tension: Make it more comfortable
- 4. Track: 4 phases of breath
- 5. Pause: Pause in the space/stillness after the exhale
- 6. Repeat…
- Tai Chi & Qi Gong
- Two meta-analyses suggest they may improve symptoms in patients with chronic low back pain.
- Acupressure (Self-administered)
- Research suggests it may reduce cLBP, enhance sleep and reduce anxiety
- Consider adding additional key acupoints to release the diaphragm; guide the patient through location and technique
- Diaphragm (Ge) primary acupoints: BL-17 (Ge Shu) & BL-46 (Ge Guan); use a ball on the wall to apply direct pressure
- Diaphragm attachment points: LR-13, GB-25, CV-14
- Associated muscles:
- Illio-psoas: GB-28
- QL: BL-23/52
- Transverse abdominus: GB-26
- Obliques: GB-26, SP-21
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