Does Acupuncture Work? with Tim Sobo, LAc

Podcast Transcript

John Horton:

Hello, and welcome to another Health Essentials Podcast. I'm John Horton, your host.

Why would anyone willingly be stuck with needles? As it turns out, there are lots of reasons, which explains why acupuncture has been around for 3,000-plus years. This ancient practice is routinely used as a supplemental therapy to address chronic pain and various other health issues. But how exactly does a needle prick relieve pain? We're going to explore that concept today with licensed acupuncturist, Tim Sobo. He is one of the many experts at Cleveland Clinic who visit us weekly to help demystify medicine. So with that, let's learn about the positive points of acupuncture.

Welcome back to the podcast, Tim. We always appreciate repeat customers.

Tim Sobo:

Well, thank you for having me — very much looking forward to our conversation today.

John Horton:

Well, yeah, and you're here with us today to talk about acupuncture, and I understand you kind of got interested in this form of treatment after experiencing what it can do while recovering from an injury. Can you kind of share that story?

Tim Sobo:

Yeah, to make a long story short, I was in college training for a Taekwondo tournament and I tore my meniscus in my right knee in three places.

John Horton:

Ooh, that does not sound good.

Tim Sobo:

No, it was not fun. That ended my Taekwondo competition days pretty much right there on the floor. So after that injury, I got my MRI, did all the standard conventional medicine, and following the knee surgery and the physical therapy, my knee was more or less the same as far as pain goes and function. I knew a little bit about acupuncture just through my own personal interest in martial arts and that kind of thing. I tried it as a patient, it worked very well for me. Fast forward, finished college, off to grad school, here I am in my 13th year of clinical practice, I think, right now.

John Horton:

Yeah. Well, sounds like a little desperation kind of took you over to it and-

Tim Sobo:

…yeah, so I mean, the pain in my knee wasn't excruciating, but it was constant, dull, nagging, hard to go up and down stairs. I couldn't jump very well. I was like, "All right, well, what else can I try?" And I tried it and holy moly it worked really well. And after I finished college, it was like, "All right, this is now kind of what I want to look into doing." And then I went into grad school, have my master's in acupuncture, I've been doing it ever since.

John Horton:

Wow. Well, I'll tell you, that's a great story to try to convince people, "Hey, this is something to look at."

Tim Sobo:

Yeah, it does work.

John Horton:

All right, well, let's dive into this and let's start with the basics. And that's just, what is acupuncture and just how does this work?

Tim Sobo:

Yeah, so there's two answers to that question. The first one is the answer that's entirely in traditional Chinese medicine [TCM]terms about energy through your body, yin yang, various organs, and all of those answers. And then, there's the physiologically, "What happens when I put a needle in here?"

John Horton:

All right, well, let's start with the energy one because that's always a little fascinating. So what's going on there?

Tim Sobo:

So in Chinese medicine, that, again — we'll keep this broad — it starts with everything is a yin and a yang. And then you have various systems throughout your body that are in charge of things. So if you go to traditional Chinese medicine or acupuncture and they say something like you have Liver Qi Stagnation or Kidney Yin Deficiency or things like that, first, you have to remember they're not talking about biologically your organs. So your kidney is fine, your liver is fine. That's not what they mean. They mean these energetic principles and kind of the function that they have inside their body. And acupuncture's goal is to get those to work in balance together. Everything in TCM is a pattern unto itself. This organ or this energy is in excess, this one's in a deficiency in relationship to it. So this causes your health problem. We want to make them all level and balanced out.

John Horton:

So the idea is you put these needles in and it kind of redirects the energy where it needs to go?

Tim Sobo:

And it redirects your body's energy flow. Like, "Oh, it's not flowing through this channel, this meridian correctly. Let's work on breaking through that barrier, that dam, so your energy flows smoother." That would be like your stagnation patterns.

John Horton:

All right, so it's like little traffic cops that you're putting in?

Tim Sobo:

Yeah.

John Horton:

All right.

Tim Sobo:

And other ones are, "Oh, it's not moving through this one fast enough, that's your deficiency. Let's traffic-cop that along," and move people through that highway a little bit quicker.

John Horton:

Quicker. All right. All right. So that's the traditional energy, that whole thing, so what about-

Tim Sobo:

…yeah, energy pathway, energy sense, getting your body back to that balance between yin and yang, which is great and it's cool — it's a great conversation to have, but it's very hard to have that conversation with a person who doesn't have a background in Chinese medicine or Chinese theory or Chinese philosophy about yin and yang. Go into an orthopaedic surgeon's office and say, Hey, "Your patient has stomach Qi Deficiency," it's not going to mean anything to them.

John Horton:

It doesn't say a lot for your knee, right? It's like-

Tim Sobo:

…exactly.

So physiologically, what happens when needles go in? Lots of different things happen. So I always like to use my arm as the example just because I can touch it. So I'm talking to patients, they can see it. So you get a needle that goes in locally right here.

John Horton:

OK, right here, and you're pointing at your ... because we have some people who are listening-

Tim Sobo:

…I'm just picking a random spot on my arm.

John Horton:

Anywhere on your arm? All right, needle going in.

Tim Sobo:

This can be treating knee pain, back pain, shoulder pain, digestive problems, whatever you might be treating. When that needle goes in somewhere locally, you get a localized immune system response. Yes, the needles are all single-use, sterile and disposable.

So the needle itself isn't a problem, but your body's immune system's going to want to know what is this thing now sticking into it. So you get a local immune system response. So you get an increase of blood supply, you get a vasodilation, you get a histamine response, you get more red and white blood cells going to that area where that needle is and then that ... I'm going to anthropomorphize the body a little bit too much, but that kind of allows your body to go, "Oh, look at all this tissue that's injured, inflamed, damaged," whatever it might be. And then it can work on repairing that tissue.

John Horton:

OK.

Tim Sobo:

The red blood cells are bringing in your oxygen, your nutrients and whatever else you need. And your white blood cells are there to take away the dead, damaged, dying cells or any other problems that might be there. And that can allow your body to start to heal that muscle, joint, soft tissue, whatever it might be.

John Horton:

All right. So it sounds like the idea is, I mean, you have this injury and you almost injure it more with these little pinpricks.

Tim Sobo:

Yes.

John Horton:

And that's sending more troops in to kind of help the body get better.

Tim Sobo:

Help that out. Yeah, that is one of the theories of how acupuncture works or introducing new microtraumas to the area to kind of tell your brain that this knee pain you're experiencing is new, not something you've had for years, "You should look into this and try to fix it." So that's that immediate where the needle is going.

But then, you also have the surrounding area. Obviously, the needle is in your knee, your elbow, your back, but it affects more than just that pinpoint area. Pardon the puns, I'm going to be using a lot of them today. You get this effect that goes to an adjacent area, a couple inches up and down and around that. So I always describe it as” here's what your muscle fibers should look like, flat, smooth, even, all go in the same direction.” You get an injury, you get trauma, you get something and they twist and knot on themselves.

John Horton:

Get out of whack, yeah.

Tim Sobo:

This is your muscle knot, this is what you can feel when you're like, "Oh, what is this thing right here?" That's your tissue curling it around on itself. And acupuncture needles will go into that and it can help break that up manually. So think of a massage therapy. You're rubbing, rubbing, rubbing on it, trying to force it to do that again. The needle gets to go directly into those fibers and work on it from the inside out, for lack of a better expression.

John Horton:

How many needles get put in? I mean, I have visions of somebody just turning into a pin cushion. I mean, is this just a couple or does it vary?

Tim Sobo:

It varies person to person and condition to condition. Broadly speaking, you're looking at 20-ish, depending on the condition. Is it one-sided or both-sided? Is it both knees? Is it just your left knee? And then things will also change based on provider preference. Are they a person who's going to do a lot of heavy needle manipulation and they might use less needles or they're going to put in, "You know what? I'm going to put more needles in to get the same effect." But 20 is a good number here or there. Typically, you're not going to get four, but you're typically also not going to get 40.

John Horton:

OK.

Tim Sobo:

So 20 is pretty normal. Most commonly, when you see something in a TV show or a movie and the person's lying down and just covered in needles, that's so it comes up on camera.

John Horton:

OK, all right. That's what we all have in our mind here.

Tim Sobo:

So those who can actually see it, this needle is about as thick as one human hair.

John Horton:

Wow, that is thin.

Tim Sobo:

And they're bendable and flexible. So you can see I'm bending it and it'll spring back into place.

John Horton:

Holy cow, man. I can't believe they bend like that.

Tim Sobo:

Yeah, so this is your standard needle. Some of them might be a little bit longer, a little bit thicker, but typically they're about as thick as one human hair and this one is an inch-long needle.

John Horton:

OK, yeah, that doesn't look scary.

Tim Sobo:

No, this is the most common-

John Horton:

…and I don't like needles.

Tim Sobo:

Yeah, this is the most common type of needle. The biggest difference between this and the needle you get your blood drawn with is there's no hole in this needle. It's a filiform needle. So you're going to get your blood drawn, your flu shot, whatever, is a hypodermic needle. There's a hole in it to introduce medication or to draw out blood. I can fit about four or five of my needles inside the hole of your standard hypodermic needle-

John Horton:

…wow.

Tim Sobo:

…to give you, just how small these needles really are.

John Horton:

Yeah. OK, well, and this gets to the one question that I know everybody has and that is, does this hurt? I mean, you're talking about getting stuck with a needle and that's unpleasant to anybody. I mean, does it hurt?

Tim Sobo:

That's the first question patients as … that's the first question, I tell people is, does acupuncture hurt? Broadly speaking, no.

John Horton:

OK.

Tim Sobo:

However-

John Horton:

…however. I knew there was a but coming there.

Tim Sobo:

There's always a however. It's still a needle going in, so it may pinch or be uncomfortable. But as far as the uncomfortableness of getting your blood drawn or a flu shot comparably, it's nothing like that. Most of the time, when people say acupuncture's painful, it's the shock that they felt anything. I'll put four or five needles in, you won't feel a thing. And then, "Ooh, I felt that one." And it's that sudden pinch out of nowhere that's painful, and that usually goes away in a matter of seconds.

John Horton:

And the anticipation. Because we all know waiting for the needle is the worst part.

Tim Sobo:

So when I see patients, I talk about anything with them, "Hey, did you watch the Cavaliers game last night? Did you watch the Guardians last week? Did you see the Browns play this weekend? Any plans this weekend?" Just so they're not thinking about, "Oh God, there's a needle about to go into my shoulder, foot, back," wherever it might be. And then I put one into people like, "Oh, that was it? That was nothing."

John Horton:

Well, to be honest, when you compare it to the pain of Cleveland sports, any needle is not going to be as bad as what [inaudible 00:11:53]. That's a whole other podcast we could do.

So these needles, you put them in, you've got your 20 needles that you're kind of sticking in around this injured spot.

Tim Sobo:

Yeah, and so needles aren't just going to go where that injury is-

John Horton:

…OK, around it, yeah.

Tim Sobo:

Yeah, they're going to go in your knee. There'll be … some might be in your foot, some might be in your hand.

John Horton:

That far away?

Tim Sobo:

They're going to be systemic, they're going to be everywhere in the body.

So to go on the last part about how acupuncture works is it also has a systemic effect. So it affects every system in your body. So yes, you had knee pain or back pain or whatever, and yes, the predominant number of needles will be where you hurt, but you'll get some distally and those are there to kind of help. If you think of your muscle is this long, I'm going to put needles that whole length of it. So your pain might be up here, but it's still this muscle down here.

So if your quadriceps, your hip all the way down to your knee … so we're going to have to treat that whole length. And then, you have connective tissue that kind of wraps around your body and we're going to treat that as well. And that doesn't really start or stop any one particular spot. It's just kind of everywhere. So the imagery I give people is, think about when you're making your bed and you just throw all the covers on and there's one part up near the top that's just all twisted on itself.

John Horton:

Always. Yeah.

Tim Sobo:

You can go right to it, fix it that way, that's the local needling. Or it can go to the foot of the bed, pull on the sheet a couple of times and it also resolves that kind of ball of fabric up top. It's that same thing with muscle tissue and connective tissue that's knotted up. I want to stretch it its whole length. So that's not just needles in your shoulder. That might be needles all the way down your arm. That's not just needles in your lower back, it might be at your knee. So that's to stretch that connective tissue out.

John Horton:

But you had mentioned even if your pain's in your knee, you may have a needle in your arm-

Tim Sobo:

…in your hand, yeah.

John Horton:

How do you know where those connections are? I mean, is there a map? Do you have an acupuncture map that's like pain here, put needle here?

Tim Sobo:

The boring answer is that's what school's for. That's what you learn in school, like where to put them and why you're putting them there. And they're all to try to elicit a body's healing response. So some of them help your body to release more serotonin, dopamine and endorphins. So that's a whole-body systemic effect. So endorphins are your body's natural painkillers. So acupuncture is helpful for shoulder pain, foot pain, migraine pain, digestive pain, back pain — it doesn't matter because the way your brain handles pain is with an endorphin release.

John Horton:

And there's a plan, it sounds like, though. You're not just dartboarding on people.

Tim Sobo:

Yeah, it's not just boom, boom, boom, where do I stick the needle? There is a plan that is individualized to every patient, not even just every condition. So you can come in with back pain and your younger or older brother comes in with back pain and you'll be treated differently because your back pain is caused by different things. His is or hers is just muscular, yours is more disk-related. You have numbness and tingling, he doesn't have numbness and tingling and all of those kinds of HPI, history of present illness, kind of influenced what we're going to treat you with, how we're going to do it and what the approach is going to be.

John Horton:

It's so fascinating, and this gets into I think a lot of why people are so interested in acupuncture because you hear this and it sounds bizarre. You think, how's getting a needle in your hand going to help your knee? But it sounds like there's a lot of evidence behind it and a lot of years of this sort of treat.

Tim Sobo:

Yeah, so acupuncture, Chinese medicine as a whole, has a roughly 2,500-odd-year history of something that we can document and go, "Hey, this is Chinese medicine." And it's just been kind of clinically ongoing since. Acupuncture has been kind of clinically studied in the West since the mid-'70s when Nixon reopened trade with China. James Reston was a New York Times reporter on that trip and he needed emergency appendectomy surgery in China and they actually used acupuncture with modern anesthetics for his surgery. And ever since then, he kind of started writing about acupuncture and that stimulated generalized American interest in acupuncture. And that was 1975, '74, I don't remember the year off hand.

John Horton:

Yeah, you're a medical guy, not a history guy, so that's all right. Do you find … are there a lot of just kind of myths and misunderstandings around acupuncture, where people just have these things in their head?

Tim Sobo:

Yeah, the biggest one is people who just come and say, "Oh, I don't believe in acupuncture." And I'm like, "You don't have to believe in it to work." Now, does a positive mindset help? Yes, of course.

John Horton:

Always a good thing, yeah.

Tim Sobo:

Always a good thing. If you come into any therapy and go, "This is never going to help me, it's not going to help me at all," I mean, it's probably not going to help you. Especially something subjective like pain. If you're convinced, "My shoulder's going to hurt no matter what they do," your shoulder's going to hurt.

But no … so acupuncture, the biggest misconception is that you need to believe in it to work, followed up closely by there's no science behind it, what we would consider modern medical science behind it. Both of those aren't true. You can go online onto PubMed, like legitimate medical research things, and you can read the acupuncture studies that were done and how they were done and the blinding they went through and as rigorous acupuncture studies so they can make them just like any other kind of Western medical. Those are the two biggest misconceptions.

John Horton:

OK, so it's not pixie dust, we've kind of established that.

Tim Sobo:

It's not pixie dust, it's not me just sticking needles in, waving some hands and saying, hoping that it works. There is definitely a specific approach that is used for every condition, and we just were talking about pain, but acupuncture can treat a whole host of things.

John Horton:

Right, well we're going to get to that in a second here. But on the pain front, because I know that is the most common use of it, how effective is it? I know you had it and it sounds like it did wonders for you. Do most people have that sort of experience where it can really just kind of ease that?

Tim Sobo:

Yeah, the unfortunate answer is it depends. So things depend on what condition are we treating. And I'll use back pain again as the example. It'll stick with Cleveland. If you hurt your back shoveling snow, that has a far better chance of resolving very quickly than, "Oh, I have spinal stenosis and four herniated disks."

John Horton:

That makes sense.

Tim Sobo:

Just because the underlying physical structure has changed, that doesn't mean acupuncture is not helpful. It just means the conversation changes and becomes goal-oriented, that's not just pain being zero.

John Horton:

It's not going to change your bones, is what-

Tim Sobo:

…it's not going to change your bones, no.

John Horton:

...muscle issues.

Tim Sobo:

Nothing's going to change that, yeah.

So the conversation shifts and becomes like, "What is your goal of care? What do you want to get out of care? What do you want to end up doing?" And obviously, the answers always are less pain and more function. And that's very doable with acupuncture. We want to decrease the pain that you're in, whether it's, "Oh, I'm in a constant pain of a seven and I can't walk the dog around the block." We want to change that to, "I'm in a constant pain of a two or a three, but I can take the dog for a walk, I can play golf, I can go in the garden, I can sit, I stand and my pain is just less and manageable." That's a different treatment outcome than, "Oh, I hurt my back two days ago shoveling snow and it's completely muscular." So it depends on what's being treated, kind of determines the outcome of care.

John Horton:

OK, so it sounds like for most people, they kind of come in with some sort of injury, is when you see it. They do something like you said, shoveling snow, you tore up your knee, something along those lines. And obviously, those are two very different things.

Tim Sobo:

Very different things. It doesn't have to just be an acute injury, but the chronic conditions are those conversations where we want to make your pain less and your function more. And your typical kind of acupuncture treatment will be starting once a week for five, six weeks, depending on the person. And then we gradually want to make them farther and farther apart. So coming in weekly, then two weeks and once a month as you're just getting that healing going, feeling better, so you're not coming in to see me every single day or every single week.

John Horton:

So what you just described, that's like, if you have more of an injury, like your knee injury, where you're coming in for a treatment plan.

Do people come in if they just, like you said, they hurt their back shoveling snow and maybe it's something that's-

Tim Sobo:

…typically, those kinds of acute injuries, they're a much shorter treatment, like, "Oh, you hurt your back shoveling snow last week, come in once or twice a week for two, three weeks and you'll be fine and discharged from care." "Oh, I've had this back pain for years and years," that's going to be a ... I don't want to say a long-term treatment plan, where, I mean, I'm seeing you over and over again. But it's going to be something where I'm going to treat you when you're in an acute, a lot of pain, and as you're in less pain, treat you less and less often. With, hopefully, being you have more function, you're taking less medication, if you're taking any at all, and you generally feel better, as kind of vague as that sounds. A lot of people, when they get started with acupuncture, they're like, "Oh yeah, my back still hurts, but I'm just so much better with it." That they can do more and they just overall feel better.

John Horton:

Can you get too much acupuncture? Is there a point where you get pricked so much it doesn't work anymore?

Tim Sobo:

I mean, no. You can more or less, I think, it's doing too much with acupuncture at one time. What I mean by that is, let's say you come in complaining of, "I have headaches and neck pain and lower back pain and my right foot hurts and I have digestive problems and I have trouble sleeping," all of those things individually acupuncture can help with.

Once you start trying to do them all at once, you kind of get diminishing returns. What I mean by that is, open up your internet browser and quickly open up six different web pages. They all will open, but they're just going to take a little bit longer. If I just treated one and then treated the second one, they'll get better faster. "Yes, I can treat those six things that you mentioned. Let's focus on one or two of them until they're feeling better. Then, we will treat the other thing you were complaining about," and kind of keep doing it that way.

John Horton:

Now, when people have chronic pain that's lasting and lasting and lasting, do they have acupuncture treatments for just, I mean, can they have them for years, are you talking?

Tim Sobo:

So the goal is not to be kind of … though I'm seeing you every week over and over and over again. I have chronic pain patients who I see once every six weeks. It's enough to keep their pain at a two or a three and the occasional Tylenol™ is all they need now. But before they started acupuncture, they were doing Tylenol every day and now they're doing it twice a week and acupuncture once every six weeks. That, of course, takes time to get to. But it is definitely an achievable goal.

John Horton:

Well, it seems like it can take the edge off a little bit and it can just lessen it?

Tim Sobo:

Yeah. In the beginning, it takes the edge off, and then you kind of get those soft tissue, that muscle, to heal better and that takes more of the edge off, then you can do more. And then, whether you're in physical therapy, now you could do more of that, so then that muscle builds itself stronger faster, and then we're keeping the inflammation down and it makes this cycle that just you heal faster, you feel better and you're doing more.

John Horton:

Yeah, it sounds like it's one of the tools in the toolbox that you can use that people can use to feel better and deal with this pain.

Tim Sobo:

Yes. That's what I tell people. I never want to express to a patient that it's acupuncture or something else. This is a tool in the toolkit to get you, the patient, feeling better, whether it's "I need surgery and then I need acupuncture after it," or "I need an oral medication and I need acupuncture" — it's a tool in the toolkit. It's another thing to try when you're in … whether it's pain or you have headaches or you have digestive problems. It's an option to try and use and ideally, it's going to be integrated and synergistically used with whatever you're taking or doing to decrease the need for all of that care, decrease the medication you need to take because you're not quite as symptomatic, which means we can decrease the acupuncture we're doing and we just make that cycle go.

John Horton:

All right, now, we've kind of been focused on the whole pain management part of this thing, but I know acupuncture is also used for a whole host of issues. We can just run through some of them. I saw where it can be used for menopause, true or false?

Tim Sobo:

Yeah.

John Horton:

Okay.

Tim Sobo:

It's not going to stop menopause, it's going to ease menopausal symptoms. The most common ones are the hot flashes and night sweats that acupuncture can ease. So again, making up an example, "I have four a day," now you have one a day. Instead of being, "I'm soaking wet," you're just kind of moist and damp. And then you make the transition less chaotic, less abrupt and just make it a little easier to handle.

John Horton:

Yeah, that's kind of wild because then you're dealing with body hormones, so the acupuncture will even help get those in line or-

Tim Sobo:

…get those that changed and goes ... yeah.

So the easiest way to help think about acupuncture is its goal, in the most basic level, is to return your body to homeostasis, keep you balanced. You have too much of this going on, we want to lower it down this way. You have not enough of this going on, we want to raise it up to being here. That's the most easiest way to explain it, it's get your body to be in balance.

So the symptoms or any problems you have are within reason and less and less. So menopausal symptoms, migraines, headaches, autoimmune diseases, rheumatoid arthritis being the most common, osteoarthritis problems, nausea vomiting due to chemotherapy, nausea vomiting due to pregnancy, pregnancy-induced lower back pain — all of those things are things that I treat on a pretty standard basis here in the office.

John Horton:

I also saw where they had acupuncture could possibly help with infertility. I can't even imagine how that would work, but does it?

Tim Sobo:

It does and it can. “Yes” is the answer to that question — that is not my area of expertise — but yes, if you look and read the studies of it, acupuncture can help get the hormones of pregnancy in balance again. So irregular periods can be more balanced. So your chances of releasing your egg on time and being fertilized on time go up, increase uterine blood supply and the strength of uterine walls so the egg implants better and stays and helps to get your hormones in balance so it can happen.

John Horton:

Wow. It's amazing to me that putting these slivered needles in can do all of that.

Tim Sobo:

Yeah, it's fascinating. It really is.

John Horton:

Yeah, it's mind-blowing, to be honest. And I … you had mentioned this — I just think we need to emphasize it a little bit more, too — like you said, acupuncture is very much of a supplemental therapy. It is not a substitute for a cancer treatment or some sort of digestive treatment.

Tim Sobo:

No. It's not a substitute for your cancer treatment. It's not going to be a substitute for your hypertensive medication. It's not a substitute for going to your doctor regularly. It's none of those things. It's a tool in the toolkit.

So going back to the pain because the easiest one to talk about, "Hey, I take Tylenol every day. Now, I take it every other day." That's kind of what the medication change would be. You can get on a lower lesser dose. "I don't need to take my migraine medication as often because I don't have as many migraines." To the point of you might not take any anymore. But I'm not saying, "Oh, stop taking them now because doing acupuncture." No, keep them and use them if you need to, that's fine. Our goal is to decrease the frequency at which you might need to take a pain medication or an abortive migraine medication or things like that.

John Horton:

Now, I know acupuncture is rooted in traditional Chinese medicine, but with all the stuff that we've been talking about, and you keep bringing up anecdotal things where people say, oh, they feel better, they don't have to take as many meds maybe or the pain goes down, but is there scientific proof that acupuncture does the job?

Tim Sobo:

Yeah, so that's kind of where I was talking before about those hormone, that neurotransmitters that get released, that serotonin, that dopamine, that endorphins, that has come from the modern acupuncture studies. How is acupuncture helping this person in pain? Let's figure it out. And they've done things like fMRI studies and they see where the part of the brain that lights up during acupuncture is kind of your limbic system and how you help regulate your emotions and how you manage and deal with pain in different ways. That area of your brain lights up, "Hey, acupuncture has helped stimulate that area of your brain."

Then, they do things like blood draws where they check to see what hormones are in your blood as it happens. And that's kind of where the science has come to. They've done some research and they go and then it becomes, "Oh, acupuncture does help release endorphins, so it's good for all these types of pain. Acupuncture does help release serotonin dopamine, so it is good for anxiety, depression, trouble sleeping, high stress, and all of those things," and it just kind of builds on itself from there.

John Horton:

It's so fascinating. So you hear all this and it sounds great. Are there certain people who are just ideal candidates to try acupuncture?

Tim Sobo:

I mean, I would say anybody's an ideal candidate, that if you have any kind of medical condition that you're still suffering from or it's relatively new and you want to explore all your options, try it. I'm not just saying that as an acupuncturist, but the risks of acupuncture are extremely minimal and the rewards are very high.

John Horton:

Yeah. Are there any risks? I mean, other than you got those little bitty needles coming in or…?

Tim Sobo:

Yeah, so there are risks of acupuncture, like anything else. But I'll explain all, and they're very, very mild. So if you go online and ask Dr. Google that question, you're going to get four results that typically come back. Two of them are extreme examples that are by no means common. They're a huge kind of mistake somewhere happened, and the other two are, "Oh, that makes perfect enough sense because what's going on."

John Horton:

OK, well, what are the two mistake ones?

Tim Sobo:

Yeah, the first one of those is a pneumothorax, which where a needle punctures the lungs.

John Horton:

OK, wow. That seems like it shouldn't go in that deep.

Tim Sobo:

Yeah. So first of all, to reach the lungs on your average adult person, you're talking a needle almost three inches long. And then you have to find a space between the patient's ribs and then just goes straight all the way in.

John Horton:

OK, so somebody really overshoots to do that.

Tim Sobo:

Yeah. Can that happen. Sure. Does that happen when acupuncture is done correctly? No. For multiple reasons, but we don't use needles that long over the chest cavity and we have enough knowledge of anatomy to "Yeah, let's not go straight in."

The other one that doesn't happen, again, is an infection. Needles are all single use — they're sterile, they're disposable, they're used just on that one patient. The risk of infection with acupuncture is about the same as when you get your teeth cleaned or your blood drawn. It's basically zero. But acupuncture isn't done in a sterile operating room, so there's always the chance of something going wrong. But there's alcohol swabs beforehand and the needles are all single-use.

John Horton:

What are the two other ones that you said were kind of like, "Oh yeah, that makes sense"?

Tim Sobo:

They're bleeding and bruising.

John Horton:

Well, yeah, and obviously, not a ton of bleeding or a ton of bruising.

Tim Sobo:

Yeah, you're not squirting blood across the room. It's one drop of blood, one cotton ball, wiped right up, and even if you're on blood thinner medications, it's two drops of blood and it stops right away. There's no need for a Band-Aid™, no need for gauze. You wouldn't even know you were bleeding unless I tell you, "Oh, hold on. There's blood on your foot. Don't get up yet."

John Horton:

All right.

Tim Sobo:

And the other one, bruising would be a blood draw bruise.

John Horton:

All right. So if people have just heard those couple things and they're like, "All right, I'm still in," what's the process to get acupuncture treatment? I mean, is it something you kind of have to request, you have to seek out? How do you even go about doing it?

Tim Sobo:

So that depends on your insurance. I mean, some insurances will require a referral to acupuncture — some do, some don't. If you don't, you just pick up the phone, find the acupuncturists and give us a call and you make the appointment.

John Horton:

Is there something you should look for when you're looking for an acupuncturist? Because overall, if somebody's just like, "Hey, I've got a bunch of needles. I'll give this a whirl," I take it you want to stay away from?

Tim Sobo:

So every acupuncturist that you're going to find by doing an online search, they're going to be nationally board-certified, it's the NCCAOM. They'll be licensed by whatever state you're in. Those are the big things to look for.

And then it becomes what you're being treated for. I deal with a lot of sports medicine, orthopaedics things. If that's what you have, you're going to read my bio and find that out through my training and through my blurb about me. If you're like, "Oh no, I have more menopausal symptoms," there's colleagues at the clinic who, oh, women's health issues are their thing, and you'll go to them instead. Like any other kind of specialist you would find, what you want to get treated will determine who you go see. But the broadest one is to make sure they're licensed, make sure they're nationally certified, which are all available to find online.

John Horton:

All right. Well, I'm guessing that worry about needles or kind of doubt about the effectiveness of acupuncture, you had mentioned the whole that it's some mystical thing, that those are the sort of things that scare people off from giving it a try. What would you say to anyone who's feeling hesitant about the treatment or thinking about it, but just on the fence?

Tim Sobo:

Yeah. The first thing is call and have a conversation with an acupuncturist and explain why you're afraid of XYZ or what you're nervous about and they'll walk you through the process basically. Most people are … it's the fear of needles. They hear “a needle,” they think their blood draw, their flu shot and a cortisone injection, something that, I don't want to say, hurts, but it's something that is uncomfortable.

John Horton:

We're all a little afraid of it. Yeah, a lot of people.

Tim Sobo:

Yeah. There's a lot of people who are afraid of a needle going in and, "Now you're going to tell me I'm going to lie down and you're going to stick 20-ish of them into me? No thanks. No thanks, no thanks." But once you see what a needle looks like, they walk you through it, most people very quickly go, "Oh, that's what I was so nervous about? That's no big deal." And they come back and do it again and again.

John Horton:

You do a fabulous sales job on acupuncture and what it might do. So it sounds like if anyone's at that spot where you've got this pain, you've got some issue and just nothing seems to work, give it a shot.

Tim Sobo:

Give it a shot, yeah.

John Horton:

All right. Well, Tim, thank you so much for coming in. This has been just, like I said, an incredible conversation and one of those things that, man, you're always curious about, and you filled in a lot of answers for people. So thank you very much.

Tim Sobo:

It was my pleasure. Thank you for having me.

John Horton:

Could inserting thin needles into specific spots on your body relieve pain or help resolve other health issues? There's enough evidence out there to say it might, which sounds like reason enough to give acupuncture a try if you're searching for solutions.

If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.