Pins Against Pain

For at least 21 millenniums, Chinese physicians have used acupuncture to relieve pain and treat conditions ranging from arthritis to impotence. Practitioners in recent years have found an important new use for the ancient art of inserting needles at selected points in the body--as an operating-room anesthetic. It is in this form that acupuncture is finally beginning to attract serious attention in the U.S.

American physicians visiting China last year were amazed to see patients remaining awake and even cheerful during major surgery. While there is still a good deal of skepticism in the U.S. about acupuncture, a few doctors have been quietly experimenting on themselves, their colleagues and members of their families. Last week two medical teams in New York reported that they had successfully used their new knowledge on surgical patients as well.

The first announcement came from the Hospital of the Albert Einstein College of Medicine, where doctors used acupuncture to anesthetize William Rosner, 65, who was undergoing a skin graft. According to Dr. Louis Orkin, chairman of the department of anesthesiology, needles were placed in the inner corners of Rosner's eyes, his left hand and leg. The sites were selected by following Chinese acupuncture texts.

Rosner, who had agreed to the procedure, suffered no pain during the hour-long operation. "If I felt anything," he said later, "it was just a tingling sensation when they cut the skin."

Another patient was Frederic Newman, 23, a medical student who underwent acupuncture anesthesia for an operation performed last month. Dr. James Fox of the State University of New York's Downstate Medical Center in Brooklyn anesthetized Newman's throat by inserting needles in his hands and feet. With assistants, Fox then rotated the needles for 20 minutes while the patient gradually lost feeling. A small benign growth was then painlessly removed from the left tonsil. According to Newman, similar surgery performed several months earlier under a conventional topical anesthetic had caused him "excruciatingly sharp pain."

Despite its effectiveness, acupuncture remains a scientific mystery, even to modern Chinese experts. Some researchers have reported that variations in the skin's electrical resistance seem to follow the twelve pathways or meridians of the acupuncture charts. Others claim that the skin at acupuncture points is less dense than at other spots on the body. J.R. Worsley, a prominent English acupuncturist (but not a doctor), resorted to the ancient explanations last week when he demonstrated his art on a nearly nude young woman on WNET, New York's educational television station. He had been treating the patient, Worsley said, for digestive complaints and mental disorientation. The "cure" was accomplished, he said, by regulating the flow of energy to various organs.

Nerve Circuits. Worsley's sort of explanation and his claims of success hardly satisfy the scientifically minded. Dr. Pang Man, director of research at the Northville (Mich.) State Hospital and a participant in the Einstein operation, subscribes to the neurological approach put forward by Professor Ronald Melzack of McGill University. Called the "gate control theory" of pain, it holds that certain nerve cells in the spinal cord can either inhibit or intensify the flow of pain impulses to the brain. If the theory is correct, implantation of acupuncture needles could prevent pain in two ways: first, by blocking the transmission of pain sensations from peripheral nerves to the spinal cord and thus to the brain; second, by shutting down the pain reception center in the brain itself. Since various nerve "circuits" control the organs, acupuncture relieves pain even when needles are inserted into areas other than those under treatment.

Whatever the explanation, a growing number of doctors are convinced that acupuncture is a potentially valuable procedure. Yet virtually no extensive research has yet been undertaken in the U.S., though the National Institutes of Health recently offered to finance such work.

Until thorough studies are made, acupuncture in the U.S. is likely to remain a rarity. Even some acupuncture enthusiasts warn that would-be pin stickers should exercise caution. Dr. Samuel Rosen, a noted New York ear surgeon who visited China last year, points out that the Chinese spend years learning the method and doubts that Americans can master it in less time.

Rosen's warning is well taken. Some of acupunctured 365 points lie close enough to major blood vessels and nerve passageways to make an inaccurate insertion perilous. Nor are acupuncture's anesthetic effects the same for all patients. Einstein's doctors admit that their success has been tempered by failure. They had used acupuncture to anesthetize a patient undergoing hernia surgery. A third of the way into the operation, the patient began experiencing pain, causing the physicians to fall back on a conventional anesthetic.

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