According to the National Center for Complementary and Integrative Health (NCCIH), a branch of NIH, pain is the most common reason for seeking medical care (Pain: Considering Complementary Approaches published by National Center for Complementary and Integrative Health, 2019)¹. There is a rising clinical interest in Integrative medicine for non-pharmacologic treatment options as our healthcare system faces a crisis of pills and opioid use ( Monson, 2019)².

A few days ago, I saw an elderly patient who walked in with 8/10 shoulder pain. The patient had fallen in his home a few weeks ago and had suffered a shoulder contusion. An x-ray showed no fractures, yet his shoulder pain was severe and unrelenting. He was on pain medications but still could not sleep at night.

Through further questioning and testing, I discovered that most of his pain was not in the joint itself but in the general area of the deltoid muscles and that he also had developed symptoms of secondary proximal biceps tendinitis. The patient was very anxious and upset due to the high pain and lack of sleep at night. I decided to use an Integrative approach to address the patient’s shoulder pain and Anxiety.
Thermotherapy is used in rehabilitation to reduce pain and stiffness, and to increase mobility. It helps to relax muscles and increases circulation to the affected area, thus reducing pain and stiffness³. I combined thermotherapy using an application of a hot pack on the patient’s shoulder with mindful breathing and gentle pressure on two potent Acupressure points CV 17 ( center of the chest ) and Yintang (EX-HN 3) , which is in the center of the forehead between the eyes.

Within a few minutes the patient reported feeling more relaxed, his pain levels improved to 4/10, and we were able to apply several interventions to improve his shoulder joint mobility. As part of his home program, I gave him instructions on gentle self-stretching and range of motion exercises within his pain threshold, mindful breathing and an Acupressure self-care program with specific points listed for daily practice.

Anxiety is a very common psychiatric symptom and can also occur in many physical conditions. Due to the limitations of conventional pharmacotherapy, the discovery of nonpharmacologic treatments that alleviate anxiety effectively is clinically important. Yintang (EX-HN 3), an acupoint located between the eyebrows, is known to have a mentally stabilizing effect in Traditional Chinese Medicine⁴.

Acupressure has been studied extensively as a method for pain management. A meta-analysis of 15 studies showed that Acupressure is effective for relieving a variety of pains including dysmenorrhea, labor pain, low back pain, chronic headache, and other traumatic pain⁵ and it is an effective Complementary and Alternative Medicine (CAM) therapy.

Acupressure derives its roots from Acupuncture which is part of Traditional Chinese Medicine (TCM). It involves applying pressure to specific Acupuncture points that lie along meridian lines to improve the flow of Qi in the body. This Qi can also be defined in our western scientific perspective as the bio-electric energy that flows through a vast network of interstitial connective tissue connecting the peripheral nervous system to the central viscera⁶.

As the evidence continues to grow, both medical providers and patients are seeking effective non-pharmacological approaches for symptom relief. Clinically Acupressure shows promising results and adds value to an Integrative approach to Rehabilitation wherein we can combine holistic mindful based interventions into our best evidence- based practices.