An Overview of Integrative Care Options for Patients with Chronic Wounds
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Acupuncture can be employed as a component of more comprehensive TCM diagnostics (eg, pulse, tongue inspection, smelling, inquiry) and intervention2 or as a stand-alone approach. TCM also may include assessing and balancing the five elements of wood, fire, earth, metal, and water and the eight principles of yin/yang, heat/cold, deficiency/excess, and external/internal aspects of healing.
Two different forms of acupuncture are recognized by the National Institutes of Health: one incorporates TCM principles and diagnostics along with needling, and the other involves needling of acupuncture meridians. In 1971, acupuncture became more well recognized in the US after a New York Times reporter traveling with the Nixon administration in Peking, China wrote how integrative Chinese medicine, including acupuncture, was used to reduce his postoperative appendectomy pain. Soon thereafter, licensed allopathic physicians in the US were allowed to perform acupuncture without advanced acupuncture training. Nevada became the first state to license nonphysicians as acupuncturists in 1973. Acupuncture delivered without traditional TCM diagnostics has become the more popular option in the US.14
Yoga. Yoga integrates exercise, deep breathing, mental control, and an aspect of spirituality and may be indicated for relaxation in the chronic wound patient experiencing pain. Many forms of yoga are practiced today, including anusara, ashtanga, hatha, kriya, kundalini, sivananda, hot yoga, and laughter yoga, to name a few. The most common form, hatha yoga, involves a discipline of postures and breathing exercises designed to improve overall health and prepare the mind for meditation,15 which can be helpful for the ambulatory chronic wound patient for emotional relaxation. It is important to vet wound patients with yoga masters before commencing the class to alleviate concerns about yoga positions harming the actual wound.
Posadzki et al16 conducted a systematic review of randomized controlled trials involving yoga for any type of pain management, not necessarily related to patients with chronic wounds (ie, labor pain, osteoarthritis, carpal tunnel syndrome, migraine, irritable bowel syndrome, low back pain). Yoga interventions included hatha, viniyoga, iyengar yoga, and integrated yoga, and concluded that yoga may alleviate some types of pain better than others. More well-designed studies are needed to assess yoga’s place in therapy for all types of pain described in this review.
One component of yoga — deep breathing (or belly breathing) — for relaxation and the reduction of postoperative pain helps calm and focus the person on the present through a meditative state. The technique involves slow inhalation, filling up the lower lungs over 10 seconds or longer, and slow exhalation over the same amount of time. Deep breathing quiets the mind and is influenced by a person’s hypnotic susceptibility.17
Miller18 conducted a small pilot study among 15 patients undergoing coronary artery bypass surgery to examine pain management involving deep breathing on the second postoperative day. Outcome measures included changes in blood pressure, pulse rate, respiratory rate, facial tension, crying, pain score via linear pain scale, and the patient’s self-report of pain. Miller reported positive improvements in five objective parameters (including blood pressure, pulse rate, respiratory rate, and pain score scale 0-10) after deep breathing. The author does not disclose the number of breaths or time period of the procedure over which most of the objective improvements were realized for each patient or on average.
Biofeedback. Biofeedback has been studied in combination with relaxation techniques to assist healing in patients with diabetic foot ulcers.