Acupuncture for the Pediatric

Patient: Ancient Approaches for

Modern Ailments
Danielle M. Graff, MD, MSc, FAAP
Co-Fellowship Director- PEM
Pediatric Acupuncture
Division of Pediatric Emergency Medicine
Department of Pediatrics
 What Children Think
Acupuncture Entails…
When In Reality, This Is
Acupuncture…
 Overview
① History of Acupuncture

② Theories on Mechanisms

③ Current Research

④ Techniques and Clinical Applications

 Background
Franklin Bache, MD

George Soulié de Morant

Paul Nogier, MD

James Reston
 Traditional Schools

Offer
ACAOM 3 years
degrees

Texas Health and Science University- Austin

 Medical Acupuncture

American Academy of Medical Acupuncture

American Board of Medical Acupuncture

9 Current ABMA accredited programs

How Does Acupuncture Work?
 Eastern Medicine

Energy Movement Connection

Flows Coupled to
Primary a specific
energy: Qi along organ
“chee” meridians system

Acupuncture used to balance the flow of Qi

 Different Techniques
Classical Interventions
Chinese Electroacupuncture
Japanese Cupping
Energetics Trigger Point
Korean Acupressure
Moxibustion
Laser
Gua Sha
 Western Medicine
“Acupuncture points and meridians, in
the traditional sense, do not exist”
- Felix Mann

Complex and plastic interaction

Neurotransmitters
Opioid peptides
 Western Medicine
Fascia
Basis
Nerves fMRI

Gate Primo
Control Theories Vascular
Theory System
Gate Control Theory

https://www.naturesenergieshealth.com/natural-therapies/acupuncture/
Nerve Theory
Nerve Theory
 Primo Vascular

Will the Primo Vascular System Finally Solve the Mystery of Acupuncture?
McDonald MJ, Medical Acupuncture Feb, 2015, 27(1): 33-37
 Overall Concept

“A needle-induced multifactorial
modification occurring in the body
related to opioids, neurotransmitters,
various central nervous system
structures and the movement of fascia”
Does It Work In Children?

Will Children Tolerate

Acupuncture?

Is It Safe For Children?

 Research
Lin, Y.C., Aimee B., Lee, A, Acupuncture for the
management of pediatric pain: a pilot study. Med
Acupuncture, 2003,14:45-6
Vickers et al, Acupuncture for chronic pain. Arch
Int Medicine, 2012, 172 (19): 1444-53

McDonald, MJ, Acupuncture and acupuncture

related therapies are well-tolerated and can
effectively provide pain relief in the pediatric
population. Med Acupuncture, 2015, 27(6): 481-6.
 Research

…“it seems acupuncture is a safe

complementary/alternative
medicine modality for pediatric
patients on the basis of the data we
reviewed.”
 Research

“Conclusion. Pediatric patients with

chronic, severe pain found
acupuncture treatment pleasant and
helpful.”
Research
Show Me How It Is Done!!!
(and what for)
Needling
Electrical Stimulation
 Heat Therapy
Moxibustion Heat Lamp
Auricular
Low Level Laser
Cupping
Gua Sha
Scar Deactivation
WHY NOW?
 Limited Effective
Medication

Opioid
Patients’ Desires
Epidemic
 Clinical Sites
Inpatient Consultations
Emergency Department
Outpatient Clinic
Outpatient Clinic
 Conditions
Anxiety Nausea and vomiting
Back pain Neck pain
Biliary colic Pain in dentistry
Bladder dysfunction Periarthritis of shoulder
Chronic cough Plantar fasciitis
Constipation Postoperative pain
Depression Rash/skin lesions
Dysmenorrhoea Renal colic
Epigastric pain Rheumatoid arthritis
Facial pain Scar pain
Fibromyalgia Sciatica
Fracture pain (trauma pain) Sinus pressure
Headache/Migraine Sprain/Strain
Joint pain Weight loss
Muscle tightness
 Referrals

Neurology Neurosurgery Rheumatology

PMD ED Hospitals

Pain Current
Management patients
 Focus of Attention

① Migraines

② Pain management
 Focus of Attention

BUT…
① Beyond the scope of this talk

② Discuss a more immediate tool

Ear Homunculus
 Possible Mechanisms

Innervation Acupoints
• Auricular branch of the • Myelinated and
vagus unmyelinated fibers
• Auriculotemporal branch • Neurohormonal release
of the trigeminal
• Great auricular nerve
from C2, C3
• Facial nerve
• Glossopharyngeal nerve
Auricular Acupuncture
 Migraines

Complex
True unclear etiology
Average of 4.4 to 5.3 hours in ED

https://migraineagain.com/how-to-improve-acute-treatment-for-pediatric-
migraine/
Auricular Acupuncture
Auricular Acupuncture
 Pediatric Emergency Care

“With all subjects showing improvement or resolution of migraine

headache, this pilot study introduces an alternative intervention to

pediatric migraine management. Further studies are needed to

evaluate the duration of symptom resolution and comparative

effectiveness; auricular acupuncture seems to be a valid alternative.”

 Results
10

6
VAS Score

5
Pre-VAS
4 Post-VAS

0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Subject Number
Location of Darts
Battlefield Acupuncture
 Auricular Acupuncture

Easy

Effective Confidenc
e

Protocol
Muscle Pain

Surface Release
 Where We Are Now
A Randomized trial comparing auricular
acupuncture and intravenous migraine
medications in the treatment of status
migrainosus in the pediatric emergency
department.
 Kentucky State Laws
“The law’s requirement that individuals
who are not licensed as physicians obtain
an acupuncture license prior to engaging
in the practice of acupuncture”
Effective in pediatric patients

Safe in pediatric patients

Tolerated in pediatric patients

Easy to implement into practice

 References
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A standard international acupuncture nomenclature: memorandum from a WHO meeting. Bull World Health Organ. 1990;68:165–169.
Shang C. Prospective tests on biological models of acupuncture. Evid Based Complement Alternat Med. 2009;6:31–39.
Lin YC, Aimee B, Lee A. Acupuncture for the management of pediatric pain: a pilot study. Med Acupunct. 2003;14:45–46.
Pintov S, Lahat E, Alstein M, et al. Acupuncture and the opioid system: implications in management of migraine. Pediatr Neurol. 1997;17:129–133.
Allais G, Romoli M, Rolando S, et al. Ear acupuncture in the treatment of migraine attacks: a randomized trial on the efficacy of appropriate versus
inappropriate acupoints. Neurol Sci. 2011;32(Suppl 1):S173–S175.
Romoli M, Allais G, Airola G, et al. Ear acupuncture in the control of migraine pain: selecting the right acupoints by the “needle-contact test”. Neurol Sci.
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Hershey AD, Winner P, Kabbouche MA, et al. Use of the ICHD-II criteria in the diagnosis of pediatric migraine. Headache. 2005;45:1288–1297.
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Noseda R, Burstein R. Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading
depression, sensitization, and modulation of pain. Pain. 2013;154(Suppl 1):S44–S53.
Espinosa-Sanchez JM, Lopez-Escamez JA. New insights into pathophysiology of vestibular migraine. Front Neurol. 2015;6:12.
Acupuncture for Pediatric Emergency Department Migraines
Biella G, Sotgiu ML, Pellegata G, et al. Acupuncture produces central activations in pain regions. Neuroimage. 2001;14:60–66.
Dhond RP, Kettner N, Napadow V. Neuroimaging acupuncture effects in the human brain. J Altern Complement Med. 2007;13:603–616.
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Takeshige C, Sato T, Mera T, et al. Descending pain inhibitory system involved in acupuncture analgesia. Brain Res Bull. 1992;29:617-34.
Graff, D and McDonald, M, Auricular acupuncture for the treatment of pediatric migraines in the emergency department. Peds Emer Care, 2015.
Helms, J. Acupuncture energetics. Medical Acupuncture Publishers. Berkeley, California. 2007