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Alumni
in the Field Treating Chronic Pain in Two Distinct Hospital Settings - East and West: What We Can Learn By Jason Bazilion In the last issue of Oriental Medicine, I related coping mechanisms utilized for the management of stress by two unique patient populations. As promised, in this issue I will be comparing the same two populations by discussing further several factors that can benefit our own independent practice of acupuncture and Chinese medicine here in the United States. The first patient group is comprised of both in-and out-patients at Knollwood Hospital in Riverside, California - a chemical dependency and chronic paint center which integrates western medicine, acupuncture and Chinese medicine, psychological counseling, psychiatry, and a 12-step approach. The second patient population comes from the integrated eastern/western medical hospital in Changsha, Hunan Province of China where I trained in the Fall of 1998. At Knollwood Hospital, in-patients are treated with acupuncture and Chinese medicine three to five times each week. Initially, patients come down to the alternative medicine department with some kind of acute or chronic pain issue such as lumbalgia, failed back syndrome, arthritis/arthralgia, headache/migraine, or a fracture, strain or sprain. Commonly, eight to 15 needles are inserted for a 15 to 20 minute duration. The in-patients are also going through the detoxification process and coming off, in many cases, years of chemical/substance abuse. The initial five to ten day detoxification period presents a serious challenge for both patient and physician, one in which patients are also trying to cope with insomnia, depression, muscular spasm, chills or fever, shakes, hallucinations, and general mental, emotional and physical instability. Here in the United States, the addicted-pain population can be extremely manipulative. The majority of these patients have secondary goals that motivate them to bend the truth or exaggerate the magnitude of their condition. Whether they are trying to cope with or simply dull the physical or emotional pain, their initial medication-seeking behavior, thoughts and actions often take priority over any attempt at recovery. Familial, social, mental-emotional, physical and work-related issues all feed in to their overall lack of daily balance and health, as well. For many of the in- and out-patients as Knollwood Hospital, a long, steady and consistent treatment plan is necessary and most effective. Supplementing regular treatment with acupuncture points known to be useful in calming the mind is also of great benefit. Such appropriate points include Yintang, Heart-7, Kidney-1, and ear Shenmen. In China, at the integrated eastern and western medical hospital in Changsha, patients are commonly seen one to three times each week at the acupuncture ward for chronic pain conditions. More needles are typically used with these patients (as many as 20 to 30) than are used with patients in the United States, and the needles remain for a longer period of time (35 to 50 minutes). In addition, manual manipulation and electrical stimulation of the needles are considerably stronger and more intense. The simple way in which these two very unique patient populations view health as a whole is fascinating and something from which one can gain insight and apply to new populations in a culturally-sensitive way. At Knollwood Hospital, the addicted/chronic pain patients tend to look at their condition through a clouded lens - not seeing and end in sight. Rather than focusing on recovery, medication-seeking behavior along with a lack of compliance and cooperation stand in the way of returning to an improved state of health and well-being. These patients also tend to use their present condition as an excuse to avoid some of their current social, financial, familial, and other responsibilities. In comparison, at the integrated eastern and western hospital in China, patients are generally much more informed and in touch with their physical health. Communicating symptoms such as heat, coldness, sharpness or dullness comes more easily, due in part to greater physical self-awareness and to prior education fr om their doctors and extended families. While the patient population at Knollwood Hospital in Riverside may not be as familiar with communicating their symptoms openly and honestly nor of the typical methods and modalities involved in Chinese medicine and acupuncture, there is an opportunity to educate them and demonstrate the benefits that can be achieved through a regular course of acupuncture treatments they receive as in-patients. Patience and an open ear can provide the right opportunity to begin to really reach to the patient and ultimately treat his or her emotional, as well as physical, health. Listening and observing carefully and calmly to the patient can build a foundation upon which we as practitioners can then more accurately separate fact from fiction in gathering and/or discarding symptoms that help frame our pattern and diagnostic discrimination. Being grounded in our receptiveness in a Yin characteristic. Especially in cases where chemical/substance abuse is an underlying issue, or where psychological, mental-emotional factors play a large role, our ability to capture and decode information is crucial. Even before physical treatment ever occurs, this Yin aspect of calmly listening and observing transcends the cultural boundaries that currently distinguish the two patient populations compared here. Remaining calm, open and receptive, or in essence, nourishing our own Yin, is a natural starting point by which to best aid our patients. Paying close attention to each patient as a unique individual with physical and emotional symptoms is crucial. Whether we are treating a chemically-dependent, chronic pain patient here in the United States, or any number of other conditions in China or our own practice, our ability to listen and determine the underlying truths on a case-by-case basis is of great importance. Observing and questioning - even prior to treatment - can clearly lead us to an appropriate prognosis and treatment plan. if we are able, in addition, to educate our patients about how to communicate physical and emotional sensations experienced with treatment - starting, for example, with how to describe their aches and pains more specifically - we are practitioners will be able to provide a higher level of care.
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