Education Requirement by Oregon State Board of Nursing (OSBN)
The Oregon State Board of Nursing (OSBN) is responsible for checking and monitoring the education requirements of the registered nurses. There is a standard pain management requirement for every licensed health care provider in the state of Oregon regarding pain management. It has been made mandatory to complete seven hours of pain management. Out of which one hour should be of course offered by Oregon Pain Management Commission. This course is available online.
Selected Method for Pain Management
The method of pain management selected for discussion here in the paper is Acupuncture. This treatment has been used in various parts of Asia for centuries and has had some popularity in the world recently. While some are skeptical to this treatment, there are also many others who say the pain and symptoms of the disease have at least greatly reduced. It is often used to help people quit smoking, overcoming constant allergy problems, managing symptoms of menopause and reduce the intensity with which he presented severe headaches such as migraine.
Acupuncture is a very small number of needles that are inserted into the body with great skill and care in certain special points, stimulating the area so that it redirects or blocks the flow of vital energy through our bodies (known by "chi" or "Ki") (Siedentopf et al., 2002). In this paper the methods used for acupuncture, theories related, related literature, advantages and disadvantages will be discussed.
During this treatment, fine needles are put in at particular points in the body, to stimulate certain nerves in the spinal cord. This assists in releasing of particular pain reducing neurotransmitters, which relieve the pain effectively. Acupuncture is one of the pain management techniques. Acupuncture has been proved to relieve pain of approximately 70% of the patients. Only a few percent of the patients have shown less or no results during the acupuncture treatment. Some people (and animals) have little or no response at all to acupuncture. Research shows that acupuncture works for three reasons: (1) due to the placebo effect, (2) it initiates the discharge of endorphins in the body, and (3) it makes alterations in the nervous system (Siedentopf et al., 2002). Most traditional acupuncture points are useless. A point on the hand has proved especially efficient for relieving pain. The effect of acupuncture can be doubled if the needles are rotated continuously or connected to a source of electrical stimulation.
Acupuncture and Pain
The application of acupuncture has been widely demonstrated as enormous potential therapeutic option for pain management. Acupuncture is one of the earliest methods of treatment included in Chinese Medicine which is basically the insertion of needles of different sizes and gauges in certain parts of the human body for therapeutic purposes. It has been calculated that around 10 to 15 million U.S. citizens pay approximately $500 million a year on acupuncture treatments for pain relief and treatment of drugs addiction and fighting AIDS. From the Western point-of-view there are nervous and humeral theories that explain how acupuncture works in pain remission (Schnyer, Allen, 2002).
Among the most famous theories are the theories of Control Gate, Endorphin Theory and Thalamic Integration.
Theory of the "Control Gate"
Proposed by Melzack and Wall in the second half of last century as it suggests that the placement of acupuncture needles and subsequent stimulation of acupuncture points produces signals of touch, pressure or "fine pain" borne A beta fibers that are fast. This stimulation is brought to the gelatinous substance in laminae II and III of the dorsal horn of the spinal cord, arousing and causing inhibition of the first broadcaster of spinothalamic tract cells (T cells), blocking the pain impulse transmission or closing the gateway. The painful stimulus is conducted by A delta and C. fibers which are fine fibers and are slower (Hopwood, Lewith, 2003).
Importantly, the threshold response of A beta fibers is less than the response threshold of delta fibers and C, so that the stimulation level must be above the threshold of the fibers A beta which corresponds to cramp threshold, but below the threshold of A delta and C. fibers which would correspond to the threshold of pain, being called to the area between the two thresholds specific therapeutic area.
Thalamic Integration Theory
Thalamic integration theory (by Zang-1976) is a more novel theory that states that before a painful stimulus nociceptive discharges occurs in the parafascicular nucleus of the thalamus, which are sent to the centromedian nucleus and hence continues the information through other nerve fibers to the cortex brain. By stimulating acupuncture points, centromedian thalamic nucleus under the influence of inhibitory stimuli sends endorphins to the parafascicular nucleus, thus closing the transmission of pain.
Endorphin Theory is based on the release that occurs at different levels of endogenous morphines nervous system when acupuncture stimuli of different frequency and intensity is applied, and this is called the opiate of acupuncture. It is now known that around a dozen of endogenous opioid peptides in different parts of the nervous system, all products of degradation of 3 large protein molecules: the pro-opiomelanocortin, pro-enkephalin and pro-dynorphin, are the most important for its antinociceptive action are the B-endorphin, met-enkephalin, leu-enkephalin and dynorphin. (MacPherson et al., 2002).
In the light of present knowledge it is known that the acupuncture produces increased levels of endogenous opioid peptides modifying the perception of pain. When performing low frequency stimulation and high intensity level of ACTH beta-endorphins is released to the hypothalamic pituitary and while in the midbrain and spinal cord only enkephalins. But when you invest the intensity and frequency of stimulation is released only at the midbrain and spinal cord enkephalin and serotonin at frequencies below 100 Hz, the stimulus has shown higher release of dynorphin and GABA in the cerebrospinal fluid (MacPherson et al., 2002).
Kaptchuk says that the application of acupuncture has produced conflicting results in the treatment of chronic pain, this technique has been found to activate the mechanism of opioid peptides and stimulates gene expression of neuropeptides. He states that the nuclear magnetic resonance suggests that the acupuncture produces measurable effects on important brain structures. (Kaptchuk, 2002) For all the foregoing it can be said that Endorphin neurons are undoubtedly involved in the cerebral dispensation of painful stimuli. Endorphins change pain perception in the spinal cord, midbrain, thalamus and cerebral cortex, and therefore play an important role in analgesia related to acupuncture.
In the last decade, a lot of trials of acupuncture method of pain management technique have shown significant increase in the quality of life of people and has proved to b an efficient method for treating neck pain, arthritis, and back pain fibromyalgia. Additionally, practical treatment regularity and time interval of a number of the new studies have shown more positive results (Schnyer, Allen, 2002). A great deal of work still needs to be done, especially when dealing with the authenticity of this treatment method. Efforts have been made to maintain a standard procedural method of acupuncture so that it can implemented in a proper clinical set up.
Studies have shown that acupuncture can cure some stages of diabetes (MacPherson et al., 2002). Even people with cancer have reported that they have been able to deal with the pain and nausea often caused by cancer during traditional remedies such as chemotherapy or radiation. It has also been reported that due to acupuncture treatment the unrest in the cancer patients also decreases to a manageable level without taking huge doses of painkillers (Hopwood, Lewith, 2003). The results of acupuncture treatment method while applied on patients with AIDS are also encouraging. It is really essential for all patients to trust the professionals and really believe in Chinese medicine.
Advantages of Acupuncture
The advantages of using acupuncture treatment method are:
There are no contraindications for use except for some treatments in pregnant patients.
Side effects are extremely low.
Is accomplished by curing or alleviating painful diseases in a high percentage of patients.
Get the remission of pain in patients who have not experienced improvement with other treatments.
The effect of acupuncture is cumulative and becomes more effective after several treatments.
A very significant advantage and important note is that, in contrast to popular belief, the process is quite painless. The advantage is that by inserting small needles through the skin may also stimulate internal organs and muscles, without the need for an open incision or body surgeries.
In most cases, people experience no side effect in acupuncture and even many people through treatment find that they no longer need to use medication or analgesics used before and if side effects caused undesirable. It is therefore ideal for those who prefer alternative medicine and other drugs (MacPherson et al., 2002).
Disadvantages of Acupuncture
The disadvantages of using acupuncture treatment method are: