Acupuncture and Surgery: Relieve Anxiety Before and Reduce Discomfort After

By Constance M. Chen, MD, MPH

Acupuncture is part of an ancient system of Chinese medicine that has been used for more than 2,500 years to treat disease and relieve pain by restoring balance to the flow of energy (“qi”) through the body. Acupuncture theory believes that this qi moves throughout the body along twelve main channels (“meridians”) that represent the major organs and functions of the body and that applying thin needles to specific points achieves pain relief and other beneficial effects.

Acupuncture is one of the better known types of alternative medicine. Its acceptance has grown as physicians have come to see that it can be effective, and it is sometimes incorporated into conventional healthcare. In particular, acupuncture has shown promise when used in ‘perioperative care,’ in findings that its use before and after surgery can improve the clinical outcome and speed recovery.

Surgery affects the body in many different ways, depending on the type and location of the surgery, the aftereffects of anesthesia, and the patient’s overall health. Beyond these variations, however, all surgery is trauma to the body – the entire body – and generates a stress response beyond the immediate surgical site. This stress response causes hormonal and metabolic changes that can weaken the immune system, disrupt the gastrointestinal tract and leave the body more vulnerable to infection. In some studies, perioperative acupuncture has been found to reduce stress and anxiety before surgery, reduce the need for opioids during surgery, and decrease both pain and post-operative nausea and vomiting after surgery. Acupuncture can effectively reprogram the body to switch from the ‘fight-or-flight’ stress response to rest and relaxation. The precise mechanism that causes this effect isn’t known but it may be due to acupuncture increasing the body’s production of endorphins, the natural hormones that counteract inflammation, pain and stress.

The primary goal of preoperative acupuncture is to reduce the anxiety and stress that can make surgery riskier and anesthesia management more difficult. Anxiety before surgery can also lead to sustained postoperative anxiety as well as increased sensitivity to postoperative pain and longer recovery time. In multiple studies, acupuncture applied thirty minutes before administering anesthesia induced a relaxation response. There are indications that it can also act therapeutically to stabilize blood pressure and blood sugar.

During surgery, acupuncture in combination with conventional anesthesia can reduce the dose of opioids needed and provide a more comfortable post-operative experience than anesthesia alone. After surgery, acute pain can delay wound healing, prolong recovery, and increase the risk of postoperative infection. Acupuncture can help alleviate pain and reduce the amount of medication needed to control it. Post-operative acupuncture may also promote the recovery of the immune system, bladder function, and the gastrointestinal tract.

The most common and most thoroughly studied use of acupuncture in surgical practice is to control postoperative nausea and vomiting. About one-third of patients undergoing surgery with general anesthesia suffer postoperative nausea and vomiting in the 24-48 hours following surgery. Nausea and vomiting are triggered in the brain, which receives signals via neurotransmitters – chemical messengers that transmit stimuli from various parts of the body to the brain. After surgery those stimuli might include pain, fear, and anxiety, or reactions to anesthetics and drugs such as opioids that are used to control pain. Some patients find postoperative nausea and vomiting more unpleasant and distressing than post-operative pain and it can impede recovery from anesthesia and surgery as well. Medications to control nausea and vomiting are of limited efficacy and may have adverse side effects, making acupuncture an appealing and effective alternative.

The use of acupuncture has become increasingly common pre- and post-surgery. The World Health Organization includes the prevention and treatment of postoperative nausea and vomiting and the treatment of pain as conditions that may benefit from treatment with acupuncture. Our goal is to make every patient’s surgery and recovery as comfortable as possible. Some patients find that acupuncture plays a part in achieving that goal.

Constance M. Chen, MD, is a board-certified plastic surgeon with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine. www.constancechenmd.com