“Acupuncture is not an alternative, it is another tool in medicine”

Interview with Dr. Beltran Carrillo, geriatrician and acupuncturist

There’s been a lot of talk lately the efficacy of acupuncture and whether or not to engage in so-called pseudoscience. Beltrán Carrillo is a geriatrician and a Master in Acupuncture from the Complutense University of Madrid. He chairs the Spanish Society of Medical Acupuncture (SAME) and holds the position of ambassador for Spain of the Society for Acupuncture Research (SAR).

In his clinic, authorized by the Ministry of Health of the Community of Madrid, he performs various treatments using this ancient technique, typical of traditional Chinese medicine.

– How would you define acupuncture and how would you explain its action?

– This is a therapeutic tool that consists of inserting single-use hollow metal needles into various points on the skin to elicit a response from the nervous system. Basically what we do is stimulate a specific point on the skin called an acupuncture point. We know that this is an area of ​​the human body, which is in the skin, where the largest number of natural and neuroactive components are concentrated, which will transmit the mechanical stimulus of the needle in a more powerful way to the central nervous system.

With this stimulus that we do, we will produce a series of local changes that will be transmitted through various supraspinal pathways and they will be projected onto the areas of the nervous system that have to do with sensitivity, movement, cognition, visceral symptoms, sleep, emotions. .. Therefore, we will have access to these areas of the brain.

In both animals and humans, when we insert the needle, we will notice changes at the neurobiochemical and neuroimaging levels. We will see different activity in brain areas if we put the needle in place or not. If we insert the needle well, the benefit will last much longer, and if we leave it in for a longer time, it will be more effective for the patient. Likewise, if we do the stimulus without pain, it varies from if we do it with pain, and we see that on MRI.

So is it an alternative to medicine?

– Acupuncture is not an alternative, it is another tool in medicine to help people with problems. As another tool, sometimes it’s listed, sometimes it’s not, and sometimes it’s combined, but we don’t like the alternative term.

Needles with which acupuncture is practicedPaula Arguelles

What diseases do you treat most often?

– The area where we have more evidence is pain in almost any of its forms (acute, neuropathic, chronic, somatic), so perhaps acupuncture should always be used almost as a first option. It is common in headaches, osteoarthritis, low back pain… There is also a lot of evidence about dental pain after extraction to such an extent that many dentists want to know about it and recommend their patients to come. The same goes for postoperative pain, which is usually acute.

With acupuncture we treat headaches, osteoarthritis, low back pain, post-operative pain or psychological problems, among many other ailmentsBeltran CarrilloMaster in Acupuncture from the Complutense University of Madrid

There are also psychiatric treatments, mainly anxiety or depressive mood disorders. Up to 1/3 of my patients come to me with this as a primary or associated cause. Addictions are common: tobacco, obesity and alcohol are the most common. Also to improve fertility, in both men and women, to the point that assisted reproduction services refer patients to acupuncture. In the USA, for example, assisted reproduction cannot be understood without acupuncture.

It is also used in rather strange pathologies, such as neurodegenerative disorders. There is a lot of evidence that acupuncture delays Alzheimer’s or Parkinson’s. Similarly, stroke survivors who undergo acupuncture have a reduction in dementia of between 30 and 50%, according to cohort studies from Taiwan.

Then there is a potpourri of diseases for which it is also effective, such as insomnia, allergies, dermatitis, some pathologies related to nausea and vomiting during pregnancy or children, which come from the buttocks and are reversed with acupuncture.

– Is anyone suitable for acupuncture treatment?

– A contraindication for acupuncture is if the patient is hypotensive or febrile, although there are studies that we are doing that are available for patients in the intensive care unit. Contraindication as such does not exist, other is that the patient is not in the conditions or that it is not indicated at this time. What there are are techniques that cannot be done under some conditions. For example, if you have an abscess or a burn on your hand, you cannot prick in that place, just as during pregnancy you cannot prick in some places.

– Are there any side effects?

– Acupuncture side effects can be classified into two groups. Some are inherent to the technique, meaning if I put a needle in you it will hurt, and when you take the needle out, you’re likely to bleed at some point. Drowsiness after treatment is also inherent: this is something that can be uncomfortable for the patient, but is ultimately desirable because it means that something positive has been done with the treatment. This type of side effect can occur in about 10% of cases. Then there are the potentially serious and life-limiting ones that occur when the person doing the acupuncture is not a professional. Among them, that the patient has a vagal reaction [activación que se produce del nervio vago, que causa un descenso de los latidos cardíacos y una bajada de la tensión arterial] and you pass out or start convulsing.

– How long does it take to take effect?

– If acupuncture works, it will do so in a short time. You will begin to notice a change (perhaps not a complete cure) after four to six sessions. If the patient does not notice an improvement, it is best to stop the treatment. If it works, the sessions will be separated in time and depending on the case it will be seen if it needs some kind of maintenance or not.

– Can anyone be an acupuncturist or do you need a specific degree?

-In Spain, to train as an acupuncturist, you have to be a doctor. Know the same thing that every other doctor in the medical career knows. I recommend you major. It is widely used among anesthesiologists, geriatricians, traumatologists, rehabilitators, internists, psychiatrists, neurologists…

There are many unauthorized centers where physical therapists and nurses perform acupuncture without permission

Centers that perform acupuncture are included in “unconventional therapy” centers. For this, the doctor must be responsible for conducting the treatment. This means that there are many unauthorized centers where physiotherapists and nurses (who are not doctors) perform acupuncture without permission. From THE SAME, we have notified all the ministries of health of the autonomous communities and all the medical associations and many of them have not even responded.

We have to counter this obsession with a very small group of doctors who are the SAME. We are almost all there, but not all, there are many who live by the effort without even being connected. From SAM we fight to protect, explain, protect the patient.

– Is there university training in acupuncture?

– Until now, we had master’s degrees in many cities, but with the pseudoscience campaign we closed them all. We’ve gone into some kind of denial fad that I don’t understand because the evidence for the benefits of acupuncture is publicly available.

– Does it already apply to social security?

-yes Where we are most established is in Andalucia where the portfolio of board services at hospital level includes acupuncture in pain units. At the level of private hospital centers, such as those of Sanitas or Quirón, we also have a strong presence. Outside of Spain this is the norm, as in France, Germany, Italy, Brazil, Uruguay, USA….

Ramon Mel

Why is there this widespread rejection?

I would say it is ignorance. When I present to the authorities the documents that prove the efficacy of acupuncture, they are surprised. There is also a touch of denial and lack of transparency. They didn’t want to talk to the experts on the subject, we offered ourselves in every way, and they didn’t want to. They argue that there is a lack of evidence that acupuncture works. However, for usual interventions there are 10% who have evidence that it is effective and safe, 24% moderate evidence, 50% no evidence at all and between 3 and 5% who say it can even be used.harm. And yet they apply.

– Does anything depend on who is in charge?

-In Andalusia, the one who approved the inclusion of acupuncture in the portfolio of services was the current Minister of Finance, María Jesus Montero, who was then the Minister of Health and is now in a government that wants to ban us. The current executive’s pseudoscientific movement is heavily influenced by Carmen Monton [primera titular del Ministerio de Sanidad del mandato de Sánchez que duró tres meses y dimitió por plagiar el máster]. This woman is from a city where the headquarters of the association for the protection of patients from pseudo-therapies is located. They convinced the minister to initiate this plan.

– Why do you put homeopathy in the sack?

-I do not know. I know nothing about natural medicine: I am a geriatrician and I have a technique. They confuse us a lot and I think it’s a mistake. I don’t like it and the homeopaths want to persecute us because they have no evidence. They are completely different fields.

Why did you decide to start practicing acupuncture?

-In Spain it has been introduced for centuries, there is a history of the Jesuits for example. In the 1970s, when my father went to study internal medicine in Canada, he learned this technique and incorporated it into his daily routine, even though he was still an internist. I was a child, I was five or six years old, when I started seeing my father going to courses. He has a very positive character and when he sees that something is working well, he is very enthusiastic, so when we came to Madrid on holiday, we saw him break through the whole family. I have always seen acupuncture included in medicine.

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