| |
|
|
CASE
REPORT
40 Years Of Unexplained
Knee Pain
Treated With Acupuncture
Tapan K. Chaudhuri, MD
ABSTRACT
Background Patients may present with multi-system symptoms of
unclear etiology. Acupuncture is an appealing therapeutic modality in
such circumstances because its efficacy has been validated in syndromes
involving most organ systems.
Objective To describe the outcome of a patient with pain unexplained
by conventional medicine who was treated with acupuncture.
Design Case report.
Setting Physician acupuncturist's practice.
Patient A man with a 40-year history of knee pain and sequelae
affecting his quality of life.
Intervention Treatment with acupuncture to disperse excess Fire,
tonify the controlling element, and release Internal and
External Dragons.
Main Outcome Measures Subjective assessment of knee pain, related
insomnia, and sexual dysfunction.
Results After 1 month, the patient reported an 80% reduction
in his knee pain, better sleep, and an improvement in his sexual function.
This improvement was noted during a 10-month follow-up period.
Conclusion Acupuncture successfully alleviated knee pain and
its sequelae in this patient. Acupuncture may be considered as a
therapeutic alternative in patients with symptom complexes that cannot
be treated satisfactorily with available modalities
in conventional medicine.
KEY WORDS
Acupuncture, Chronic Knee Pain, Auricular Therapy
INTRODUCTION
The following report describes a patient with unusual medical symptoms
in which an allopathic diagnosis was not possible. This patient's condition
failed to improve with conventional medical therapy, but dramatically
responded to acupuncture.
CASE
REPORT
A 61-year-old man presented with a 40-year history
of intense pressure and pain in both knees. Symptoms began as a teenager
without a history of preceding injury or concomitant illness. Initially,
the diagnosis was "growing pains" and later on, gout was suspected.
Treatment produced no relief of his symptoms.
The pressure sensation continued for almost 40 years,
which intensified significantly during the last 2 years. The patient
began to have right elbow and shoulder discomfort. Pressure would start
to build up in his knees around 10 p.m. and continue until about 2 a.m.
The pressure became so intense that he walked to achieve mild relief.
When the pain slowly subsided in the early morning hours, he was able
to sleep. A complaint of a "clicking noise" on movement was
reported to be intermittent in both knee joints. Analgesics, anti-inflammatory
drugs, tranquilizers, and oral narcotic drugs were prescribed without
benefit. Physical therapy produced no substantial improvement. The patient
consulted internists, rheumatologists, and orthopedists. He underwent
exhaustive investigations, none of which were remarkable except a positive
HLA-B27 test result. An arthritis panel (including erythrocyte sedimentation
rate, uric acid, antinuclear antibody, and rheumatoid factor) produced
no significant findings. Radiological studies revealed questionable
narrowing of both knee joints. The lumbosacral spine was normal. Magnetic
resonance imaging (MRI) of the right knee revealed a "questionable
area on the medial meniscus."
Arthroscopy of both knee joints revealed identical
findings of large suprapatellar plica and degenerative tears of the
posterior horns of the medial meniscus. The joint surfaces were normal
and synovitis was absent.
A partial medial meniscectomy and resection of medial
plicae were carried out in both knees. The patient reported an improvement
in the clicking noise but in the next 4 months, no change in the knee
pain. He was then referred for acupuncture.
The patient's review of systems was remarkable for
an insidious onset of impotence and insomnia for many years. The psychosocial
evaluation revealed that as a teenager, his mother's nocturnal alcoholic
episodes were a source of severe embarrassment for him, and remained
well into adulthood. The patient denied using alcohol and tobacco. A
review of the patient's medical and surgical histories was unremarkable.
Clinical examination did not demonstrate evidence of synovitis, effusion,
tenderness, or pain on manipulation of the knee or elbow joints contrary
to the patient's complaint of pain and pressure in the elbows and both
knee joints. There was mild tenderness over the superior aspects of
the bicipital grooves of both shoulders. The rest of the clinical examination
was negative.
Allopathic
Medicine Diagnosis
No diagnosis could be established.
Acupuncture Diagnosis
1. Excess Fire in Jue Yin-Shao Yang axis (spasm-like
pain, insomnia, aggravation at the time of highest flow of Ron Qi through
Gall Bladder and Liver meridians).
2. Significant emotional trauma related to mother's
nocturnal alcoholism - External Dragon, and perpetuation of the problem
secondary to Internal Dragon. Knee pain occurred exclusively in the
evening.
Rationale
for Treatment
1. Disperse excess Fire.
2. Tonify the controlling element.
3. Release of Internal and External Dragons.
Treatment
The patient received 6 acupuncture treatments over
6 weeks:
Week 1: N, N+1 in the Jue Yin-Shao Yang circuit. LR 3, LR 5,
MH 6, TH 5, and GB 3, 4, all in dispersion.
Week 2: Same as above + GV 20 + bilateral eye of the knee points
+ 3 tender points along the LI meridian of the right upper arm and shoulder
region, including LI 14.
Week 3: Five-Phase treatment KI 3(-) - KI 7(+) (4-Hz tonification
for 15 minutes). SP 9(-) - LI 11(+) (4-Hz tonification for 15 minutes).
LR 2, MH 6, GV 20, all in dispersion.
Week 4: Internal Dragon treatment CV 14, ST 25, 32, and 41, all
left in dispersion. The patient also received auricular stimulation
of the 5 Master Points, elbow - knee points (Phase 1). The auricular
stimulation was done bilaterally using 10 Hz for 20 seconds each.
Week 5: External Dragon treatment GV 20, BL 11, 23, and 61 for
15 minutes. BL 11(-) - BL 23(+) were tonified (4 Hz). Auricular stimulation
was done as in the fourth session.
Week 6: Internal Dragon and auricular stimulation as in the fourth
session.
RESULTS
After the 2nd week, the patient's sleep improved and there was a slight
decrease in the intensity of knee pain. After the 3rd week, sleep continued
improving. He also had 1 completely pain-free night. However, on the
day preceding the 4th week, the patient again had severe pain. During
the next 2 visits, he reported steady improvement in pain and sleep.
The pain in his right shoulder and elbows was completely resolved.
After a 1-month follow-up, he reported an 80% reduction in his knee
pain and an improvement in his sexual function. No relapse was reported
during 10 months of follow-up visits.
DISCUSSION
Acupuncture may activate the body's pain-modulating system, thereby
changing the processing and perception of noxious information at various
levels of the nervous system.1 This may involve elaboration of endogenous
opioids2,3 and their effects on peripheral, central, and autonomic nervous
systems.4,5 However, transient increases in the level of endorphins
and/or transient changes in the nervous system may not explain how the
symptoms were relieved after 6 short sessions, and improvement maintained
for a minimum of 10 months.
CONCLUSION
Any speculation regarding the actual mechanism of action of the acupuncture
treatment in this particular patient is beyond the scope of this article.
This case demonstrates how acupuncture successfully relieved an unusual
symptom complex of bilateral knee pain of more than 40 years' duration. The patient's shoulder and elbow
pain, insomnia, and sexual dysfunction also improved. Acupuncture should
be considered as a therapeutic alternative in patients with symptom
complexes that cannot be explained in terms of allopathic medicine or
treated satisfactorily with available modalities in conventional medicine.
ACKNOWLEDGMENT
The author thanks Pakhi Chaudhuri, MD, Richard Niemtzow, MD, and Roz
Royal for manuscript assistance.
REFERENCES
1. Helms J. Acupuncture Energetics: A Clinical Approach for Physicians.
Berkeley, Calif: Medical Acupuncture Publishers; 1995:42-54.
2. Pomeranz B, Chiu D. Naloxone blockade of acupuncture analgesia:
endorphin implicated. Life Sci. 1976;19:1757-1762.
3. Clement-Jones V, McLoughlin L, Tomlin S, et al. Increased
beta-endorphin but not met-enkephalin levels in human cerebrospinal
fluid after acupuncture for recurrent pain. Lancet. 1980;2:946-949.
4. Mann F. Acupuncture: The Ancient Chinese Art of Healing and
How It Works Scientifically. New York, NY: Random House; 1971:5-26.
5. A neurologic basis of acupuncture. Acupuncture Electrother
Res. 1976;1:210.
AUTHOR
INFORMATION
Dr Tapan K. Chaudhuri is in the private practice of Internal Medicine,
and has incorporated acupuncture extensively in his practice in Kansas
City, Missouri. Dr Chaudhuri has served as a preceptor for the physicians
training program organized by Helms Medical Institute, and was recently
inducted as a Fellow of the American College of Physicians.
Tapan
K. Chaudhuri, MD, FACP, FRCP(C)*
5819 Norfleet
Kansas City, MO 64133
Phone: 816-356-3930
Fax: 816-737-8505
E-mail: stchaudhuri@sprintmail.com
*Reprint requests
|
|
|
|