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ABSTRACT
4
ACUPUNCTURE
MANAGEMENT
OF OSTEOPOROTIC FRACTURE PAIN
By
M. Truett Bridges, Jr, M.D.,
Medical Acupuncture/Pain Managernent/Holistic
Medicine,
Atlanta, Georgia
EDUCATIONAL
OBJECTIVE
Present a multi-modal
treatment of a common medical problem and
its sequelae.
PROBLEM
Chronic pain
of musculoskeletal origin and subsequent debility.
CHIEF COMPLAINT
Pain in low
back, buttocks, and left ischial area.
HISTORY
OF PRESENT ILLNESS
A very active,
72-year-old white female was doing her usual
treadmill exercise in May, 1997, when she
experienced acute, severe left groin pain.
Although it was assumed to be muscle strain,
she experienced no improvement with analgesics
and muscle relaxants. After meeting with an
orthopedic surgeon in July, 1997, X-rays revealed
a fracture of the left pubic bone. She was
given NSAID'S and hydrocodone for pain, referred
to physical therapy, and advised to do as
much as the pain would allow.
By mid-August, 1997,
she began having what she described as acute
sciatic pain on the right side; she was adamant
that this was secondary to her "favoring"
the left side due to pain. She was hospitalized
for I week; blood work, bone scan, MRI and
CT scans revealed no evidence of occult malignancy
or metastatic disease. She had osteoporotic
fractures of the left sacrum, and left superior
and inferior pubic rami. The patient continued
to be in "excruciating pain," but was discharged
from the hospital. She was essentially non-ambulatory,
requiring a wheelchair and assistance in all
activities of daily living. Pain medications
at this time were Percocet (oxycodone/acetominophen),
6 per day, and Aleve (naproxen), 3 per day.
She presented for
acupuncture consultation in October, 1997,
with resolution of the right sciatic pain,
but with continuing severe left groin and
low back pain, pain over the left hip, and
pain of the ischial tuberosity at the level
of the inferior gluteal fold.
PAST
HISTORY
Thyroidectomy, 1954.
FAMILY/SOCIAL
HISTORY
Retired business
owner, married to retired CEO. Very active,
large extended family, extensive travel.
ALLERGIES
NKDA
MEDICATIONS/SUPPLEMENTS
Percocet, 2-6 per
day; Aleve, 3 per day. Premarin/Provera, Synthroid,
Paxil, Vitamin E, Juice Plus.
REVIEW
OF SYSTEMS
Coffee, 2 cups per
day; alcohol, 2 drinks per day. Myopia since
childhood. History of mild depression. Menopause,
age 54. Night sweats and constipation (while
on narcotics).
DIAGNOSTIC
TESTING
Bone, CT, and MRI
scans. Findings as above.
PHYSICAL
EXAM
Gray-haired, grimacing
white female; appeared younger than her stated
age. Gait was halting and slow. Multiple areas
tender to palpation over low back: SI joints,
buttocks, left hip, and left ischium. No neurological
deficit. Pulses weak in Yin positions, especially
at Kidney. Tongue pale with a thin coat at
the rear, and a small Spleen crack.
DIAGNOSIS
Pelvic osteoporosis
with multiple fractures and chronic musculoskeletal
pain syndrome. Deficiency of Kidney Yin and
Yang, (Shao Yin/Tai Yang, Water deficient).
TREATMENT
Total of 11 sessions
over 12 weeks; twice per week for 3 weeks,
then, every 10- 14 days at patient's discretion.
Treatment varied, emphasis on tonifying Kidney
(and Spleen), opening dorsal Tai Yang zone,
including use of Du Mo; deactivation of multiple
seeondary trigger points in low back, buttocks,
thigh adductors; percutaneous electrical nerve
stimulation to lumbo-sacral area; periosteal
stimulation. Rationale was French Energetic,
TCM, neuroanatomic, and trigger orAh Shi point
therapy. Duration of sessions approximately
I hour.
Needles: generally
36g, 1.5 to 2 inch. Occasionally, 32g to 30g,
3 to 5 inches.
ASSOCIATED MODALITIES
Referred for massage
therapy. Given Chinese Modular Solutions "Marrow
Matters" to strengthen bone through Kidney
support. Given homeopathic Arnica Montana
at the end of each treatment session.
OUTCOME
/ SUBJECTIVE
After the first session,
the patient discontinued Percocet. Within
a week, she had reduced her medications to
occasional ibuprofen or acetominophen. Her
evaluation is that the acupuncture was extremely
effective, worked quickly, and continued to
improve her symptoms over time. She reported
sleeping quite well, and is back to her former,
gratifying regimen of daily exercise.
OUTCOME
/ OBJECTIVE
Her gait was brisk,
steady, and no longer halting. Her affect
much improved. There was decreased muscle
tightness over the low back and buttocks,
and minimal tenderness to palpation of the
hip and ischial tuberosity.
COMPLICATIONS
None
FOR
ADDITIONAL READING
1.Baldry, PE. Acupuncture, trigger points
and musculoskeletal pain. Edinburg: Churchill
Livingstone, 1993.
AUTHOR
INFORMATION
Dr. M. Truett Bridges, Jr. specializes in
Medical Acupuncture, Pain Management, and
Holistic Medicine in Atlanta, Georgia. His
affiliations include Diplomate, American Board
of Anesthesiology; member, American Academy
of Medical Acupuncture.
M.
Truett Bridges, Jr., M.D.
4920 Roswell Road, Suite 36
Atlanta, GA 30342
Phone: 404-843-3400 Fax: 404-843-8101
Email: TruettB@mindspring.com
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