As a young physician, Dr. Patrick LaRiccia was bothered by the fact that so many prescription pain-relievers cause side-effects. He began exploring non-chemical pain-relief methods that he felt were "effective and safe," such as biofeedback, hypnosis and acupuncture. Over a decade ago, these alternatives were considered outside the medical mainstream.
Today alternative therapies are inching closer to the mainstream, and LaRiccia is a clinical associate in rehabilitation medicine at the Penn Medical Center where he staffs an acupuncture clinic.
Acupuncture, a relatively painless and safe ancient Chinese method of treating pain by inserting thin needles slightly under the skin at certain points along the patient's body, has been available in the United States for more than a century. In the 1970s, interest in the procedure was sparked when New York Times editor James Reston wrote an article about his experience with acupuncture. Reston was covering Richard Nixon's visit to China when Reston needed an emergency appendectomy, and acupuncture was used as an anesthetic.
Acupuncture is based on a theory that certain points on the body are higher in energy. These points are connected by meridians, which facilitate an uninterrupted flow of energy. When the flow is interrupted, a patient might experience pain or dysfunction. LaRiccia noted that recent Western studies prove that these high-energy points do, in fact, have greater degrees of electro-conductivity.
Acupuncture has gained visibility, LaRiccia said, because, as more patients find relief through it, more are willing to try the procedure. Another boost for acupuncture's gradual move into mainstream medicine came from the National Institutes of Health, which recognized the value of acupuncture and other non-traditional therapies when it opened its Office of Alternative Medicine in 1992.
LaRiccia is the director of the Acupuncture Pain Clinic at HUP, which was founded in 1982. He and his associate, Dr. Yong Kak Kim, clinical assistant professor of rehabilitation medicine, spend three half-days at the clinic each week and treat 30 to 40 patients. Both doctors are convinced that acupuncture is one of the best ways to manage chronic pain and can be used to treat asthma and insomnia often.
Though the use of acupuncture has grown in the United States, it has been met with some skepticism. "It is not quite accepted as a mainstream treatment," Kim noted. One reason, LaRiccia explained, is that double-blind experiments, in which one group receives the treatment being tested and a control group receives placebo treatment, are difficult to perform with acupuncture.
But an increasing amount of research, largely done on laboratory animals, does support acupuncture's viability as a credible medical therapy. Biochemical studies, for example, show that acupuncture stimulates the body's own pain-killers, the endorphins.
LaRiccia is currently working on a study with Dr. Abass Alavi, professor of radiology and chief of nuclear medicine, to image the brain before and after acupuncture. In another study, LaRiccia is examining how acupuncture can ease pain for AIDS patients.
Both LaRiccia and Kim are hopeful about the increase in awareness of the effectiveness of acupuncture. "The public is more aware," Kim said. "There are more physicians who know acupuncture technique." Through the Acupuncture Pain Clinic, LaRiccia expects to bring acupuncture to the "frontline" of pain management. His hope is that patients will begin seeking acupuncture therapy in the beginning of their treatment, instead of as a last resort.
LaRiccia and Kim are not alone on the acupuncture frontier in American medicine, however. Beth Israel Hospital one of Harvard's teaching hospitals, for example, recently decided to open a Center for Alternative Medicine Research to study alternative treatments such as acupuncture and homeopathy. This is considered a major step forward. "At one time people would be blackballed if they did acupuncture research," Dr. LaRiccia said.