Gold Bead Implantation (GBI) in Dogs - Good Medicine or Malpractice?
By Phil Rogers MVB, MRCVS,
1 Esker Lawns, Lucan, Dublin, Ireland
1 Esker Lawns, Lucan, Dublin, Ireland
In an article in 2007 (10), Dr Narda Robinson (reference 40) cited an old paper that I published originally in 1981. I wish to comment on her conclusions, which I believe to be incorrect.
Paraphrasing the GBI section in Dr. Robinson's article, ... GBI involves the implantation of small pieces of gold wire ("beads") around the hip of a heavily sedated animal … implantation usually is done at acupoints GB29, GB30, and BL54, which lie near the hip joint … In contrast to the safe and effective techniques of dry needling and electroacupuncture, GBI is an ineffective and possibly harmful technique that warrants serious re-evaluation … accordingly, Dr. Robinson agrees with (my) statement that one “must surely question the scientific and medical competence of practitioners who employ this dangerous method 40”. Reference 40 was to an old article of mine (12). I updated that article in 1998 (12).
My original article referred to the dangerous practice of implanting cut-off acupuncture needles in the tissues. Such implants can be dangerous if they migrate, or are accidentally driven by trauma, to vital structures, such as the brain or spinal cord. In my opinion, that procedure (implanting cut-off acupuncture needles) constitutes malpractice; no acupuncture society that I know condones it. My updated article (12) said specifically:
Notes added September 1998: This article was written in 1981, before implantation of 1 mm diameter gold beads, or 2 mm lengths of 1 mm diameter 24 carat gold wire, became commonplace in veterinary acupuncture. This technique is used widely to treat hip dysplasia, chronic arthropathy and other chronic diseases in animals, especially dogs. The implants are inserted, under general anaesthesia, into acupoints near, or related to, the affected joint, organ, or area. Personal communications with veterinarians who have used the technique suggest that the clinical results are excellent and that migration of the implants from the original sites of insertion is minimal. However, great care must be taken to avoid insertion of those implants in, or near, joint capsules. In very rare cases, such implants may accidentally enter the joint-space and exaggerate the pain and stiffness. Should that happen, the offending implant(s) must be removed surgically.”
In a more recent article (11), Dr Robinson infers that veterinarians who use GBI are guilty of malpractice. She concluded: “Gold bead therapy offers no proven benefit over regular acupuncture and poses substantial potential for injury. The fact that implantation is regarded as malpractice in human medicine should come as a wake-up call to the veterinary profession.”
In my opinion, both of those conclusions are incorrect. As discussed below, many clinicians find GBI to be both safe and clinically effective in many conditions in humans and animals. See examples of the implants.
Paraphrasing the GBI section in Dr. Robinson's article, ... GBI involves the implantation of small pieces of gold wire ("beads") around the hip of a heavily sedated animal … implantation usually is done at acupoints GB29, GB30, and BL54, which lie near the hip joint … In contrast to the safe and effective techniques of dry needling and electroacupuncture, GBI is an ineffective and possibly harmful technique that warrants serious re-evaluation … accordingly, Dr. Robinson agrees with (my) statement that one “must surely question the scientific and medical competence of practitioners who employ this dangerous method 40”. Reference 40 was to an old article of mine (12). I updated that article in 1998 (12).
My original article referred to the dangerous practice of implanting cut-off acupuncture needles in the tissues. Such implants can be dangerous if they migrate, or are accidentally driven by trauma, to vital structures, such as the brain or spinal cord. In my opinion, that procedure (implanting cut-off acupuncture needles) constitutes malpractice; no acupuncture society that I know condones it. My updated article (12) said specifically:
Notes added September 1998: This article was written in 1981, before implantation of 1 mm diameter gold beads, or 2 mm lengths of 1 mm diameter 24 carat gold wire, became commonplace in veterinary acupuncture. This technique is used widely to treat hip dysplasia, chronic arthropathy and other chronic diseases in animals, especially dogs. The implants are inserted, under general anaesthesia, into acupoints near, or related to, the affected joint, organ, or area. Personal communications with veterinarians who have used the technique suggest that the clinical results are excellent and that migration of the implants from the original sites of insertion is minimal. However, great care must be taken to avoid insertion of those implants in, or near, joint capsules. In very rare cases, such implants may accidentally enter the joint-space and exaggerate the pain and stiffness. Should that happen, the offending implant(s) must be removed surgically.”
In a more recent article (11), Dr Robinson infers that veterinarians who use GBI are guilty of malpractice. She concluded: “Gold bead therapy offers no proven benefit over regular acupuncture and poses substantial potential for injury. The fact that implantation is regarded as malpractice in human medicine should come as a wake-up call to the veterinary profession.”
In my opinion, both of those conclusions are incorrect. As discussed below, many clinicians find GBI to be both safe and clinically effective in many conditions in humans and animals. See examples of the implants.
The implants can be 1-2mm spherical gold-plated beads (Fig 1), or 2-3mm pieces of gold wire, cut across to have basically blunt ends (Fig 2 and 3). In practice, GBI migration in tissues is minimal (16) and poses a very small risk of migration into joint capsules or other vital structures (Fig 4).Sharp cut-off needles are much more likely to move (or be moved by outside trauma) in tissues than gold mini-cylinders or spherical beads.
Indications for GBI in humanshttp://www.gold-implant-clinic.com/egoldimp.htm and 7, 8) include patients who need pain relief but cannot be treated successfully by other means. Specific indications include chronic pain, for example, arthritis of the neck, lumbar region, hip, knee, hand or ankle joint. They also include patients with active trigger points in scar tissue, resulting from disc prolapse operations or those with disc prolapse who cannot be operated due to the location of the prolapse.
GBI does not interfere with MRI: Dr Robinson suggests that GBI may pose serious problems to MRI. However, Ben Yakir (1) and at least 2 published papers (13, 14) report that GBI interferes little, if at all, with MRI. This contrasts with well documented MRI interference due to the injection of gold salts.
Clinical efficacy of GBI:Gold implants are used widely in human dentistry, surgery and medicine (2). Ben-Yakir (1) summarised the scientific basis of GBI. In a personal communication to me (October 2008), he stated that more than 30000 humans in Europe have had GBI recently to treat chronic diseases. The gold implants are circa 2mm long, cut from 24 carat gold wire 1mm in diameter.
A double-blind trial in canine hip dysplasia compared the clinical benefit of GBI with that of a single needling of points near the hip (4). There was no significant difference in clinical outcomes to GBI versus needling of points near the hip but both groups of dogs showed marked clinical improvement.
That result is not unexpected because many acupuncture research papers show that minimal stimulation in the same nerve segments as “verum acupoints” can elicit physiological and / or clinical effects similar to those elicited by “verum acupuncture”. Indeed, the clinical efficacy of low-level laser therapy (LLLT) at relevant acupoints in many human and animal conditions confirms that minimal stimuli (imperceptible in the case of LLLT) can activate marked clinical responses.
At the 2009 ICMART Congress, Thessaloniki, several speakers commented that stimulation of “sham acupoints”, or of points near “verum acupoints”, is an invalid control in acupuncture research. I agree with that viewpoint and argue that future acupuncture research should compare the outcome to verum acupuncture with the outcome of a true negative control (no treatment) and / or a true positive control (for example state-of-the-art western medical or surgical treatment).
That said, a recent paper on GBI for hip dysplasia in dogs (6) concluded “The present study revealed that the pain-relieving effect of GBI observed in the blinded study continued throughout the two-year follow-up period.” This agrees with the clinical experience of many veterinarians, and recently some human therapists (9), who report useful clinical results in the weeks and months after implantation in a variety of chronic diseases.
In the 1970's, Drs Grady Young (deceased) and Terry Durkes were the first veterinarians to perform gold bead implants in dogs. Since then Dr. Durkes has treated thousands of dogs for a wide range of chronic and difficult conditions, including allergic dermatitis, arthritis, asthma, certain types of paralysis, faecal incontinence, hip dysplasia, intervertebral disc disease, long term injuries, lick granulomas, non-healing fractures, seizure activity - epilepsy, sensory neurodermatitis, spondylo-arthritis, traumatic nerve injury and urinary incontinence.
Recent papers showed that GBI in epileptic dogs significantly decreased seizure frequency and seizure severity (3) and significantly accelerated ulnar fracture healing in rats (15).
Veterinarians interested in further information on GBI may read "Permanent Acupuncture with Gold Bead Implants" at http://www.himmlisch.com/goldbeads.htm. Those not yet trained may consider taking the Basic Course in veterinary acupuncture (IVAS, 5).
I agree with Dr Robinson that further well-controlled studies of GBI are warranted. Meanwhile, if trained clinicians need to do so, I encourage them to use GBI for the indications listed above.
Personally, unless the client lives far away and finds repeat visits a serious inconvenience, I prefer to use simple acupuncture for most cases in which GBI may be applicable.
In summary, Dr Robinson’s citation of my 1981 reference to denigrate the scientific and medical competence of practitioners who use GBI is inappropriate and out of context. I do NOT regard GBI in the same light as implanting cut-off acupuncture needles in the tissues. GBI is a very safe procedure if performed by trained acupuncturists using surgical preparation and heavy sedation or short-acting general anaesthetic. It is useful to elicit long-term stimulation of acupoints in chronic diseases of humans or animals.
Indications for GBI in humanshttp://www.gold-implant-clinic.com/egoldimp.htm and 7, 8) include patients who need pain relief but cannot be treated successfully by other means. Specific indications include chronic pain, for example, arthritis of the neck, lumbar region, hip, knee, hand or ankle joint. They also include patients with active trigger points in scar tissue, resulting from disc prolapse operations or those with disc prolapse who cannot be operated due to the location of the prolapse.
GBI does not interfere with MRI: Dr Robinson suggests that GBI may pose serious problems to MRI. However, Ben Yakir (1) and at least 2 published papers (13, 14) report that GBI interferes little, if at all, with MRI. This contrasts with well documented MRI interference due to the injection of gold salts.
Clinical efficacy of GBI:Gold implants are used widely in human dentistry, surgery and medicine (2). Ben-Yakir (1) summarised the scientific basis of GBI. In a personal communication to me (October 2008), he stated that more than 30000 humans in Europe have had GBI recently to treat chronic diseases. The gold implants are circa 2mm long, cut from 24 carat gold wire 1mm in diameter.
A double-blind trial in canine hip dysplasia compared the clinical benefit of GBI with that of a single needling of points near the hip (4). There was no significant difference in clinical outcomes to GBI versus needling of points near the hip but both groups of dogs showed marked clinical improvement.
That result is not unexpected because many acupuncture research papers show that minimal stimulation in the same nerve segments as “verum acupoints” can elicit physiological and / or clinical effects similar to those elicited by “verum acupuncture”. Indeed, the clinical efficacy of low-level laser therapy (LLLT) at relevant acupoints in many human and animal conditions confirms that minimal stimuli (imperceptible in the case of LLLT) can activate marked clinical responses.
At the 2009 ICMART Congress, Thessaloniki, several speakers commented that stimulation of “sham acupoints”, or of points near “verum acupoints”, is an invalid control in acupuncture research. I agree with that viewpoint and argue that future acupuncture research should compare the outcome to verum acupuncture with the outcome of a true negative control (no treatment) and / or a true positive control (for example state-of-the-art western medical or surgical treatment).
That said, a recent paper on GBI for hip dysplasia in dogs (6) concluded “The present study revealed that the pain-relieving effect of GBI observed in the blinded study continued throughout the two-year follow-up period.” This agrees with the clinical experience of many veterinarians, and recently some human therapists (9), who report useful clinical results in the weeks and months after implantation in a variety of chronic diseases.
In the 1970's, Drs Grady Young (deceased) and Terry Durkes were the first veterinarians to perform gold bead implants in dogs. Since then Dr. Durkes has treated thousands of dogs for a wide range of chronic and difficult conditions, including allergic dermatitis, arthritis, asthma, certain types of paralysis, faecal incontinence, hip dysplasia, intervertebral disc disease, long term injuries, lick granulomas, non-healing fractures, seizure activity - epilepsy, sensory neurodermatitis, spondylo-arthritis, traumatic nerve injury and urinary incontinence.
Recent papers showed that GBI in epileptic dogs significantly decreased seizure frequency and seizure severity (3) and significantly accelerated ulnar fracture healing in rats (15).
Veterinarians interested in further information on GBI may read "Permanent Acupuncture with Gold Bead Implants" at http://www.himmlisch.com/goldbeads.htm. Those not yet trained may consider taking the Basic Course in veterinary acupuncture (IVAS, 5).
I agree with Dr Robinson that further well-controlled studies of GBI are warranted. Meanwhile, if trained clinicians need to do so, I encourage them to use GBI for the indications listed above.
Personally, unless the client lives far away and finds repeat visits a serious inconvenience, I prefer to use simple acupuncture for most cases in which GBI may be applicable.
In summary, Dr Robinson’s citation of my 1981 reference to denigrate the scientific and medical competence of practitioners who use GBI is inappropriate and out of context. I do NOT regard GBI in the same light as implanting cut-off acupuncture needles in the tissues. GBI is a very safe procedure if performed by trained acupuncturists using surgical preparation and heavy sedation or short-acting general anaesthetic. It is useful to elicit long-term stimulation of acupoints in chronic diseases of humans or animals.
References
- Ben-Yakir Sagiv (2008) GBI - the scientific basis. Proceedings of the International Veterinary Acupuncture Association (IVAS) Annual Congress, Keystone, CO, pp 193-194.
- Demann ET, Stein PS, Haubenreich JE. (2005) Gold as an implant in medicine and dentistry. J Long Term Eff Med Implants. 15(6):687-98.
- Goiz-Marquez G, Caballero S, Solis H, Rodriguez C & Sumano H. (2009) Electroencephalographic evaluation of gold wire implants inserted in acupuncture points in dogs with epileptic seizures. Res in Vet Sci, 86 (1), 152-161.
- Hielm-Bjorkman A, Raekallio M, Kuusela E, Saarto E, Markkola A, Tulamo RM. (2001) Double-blind evaluation of implants of gold wire at acupuncture points in the dog as a treatment for osteoarthritis induced by hip dysplasia. Vet Rec 149(15):452-6.
- IVAS (International Veterinary Acupuncture Society) Homepage. http://www.ivas.org/
- Jaeger Gry T, Larsen Stig, Soli Nils and Moe Lars. (2007) Two years follow-up study of the pain-relieving effect of gold bead implantation in dogs with hip-joint arthritis. Acta Vet Scand. 2007; 49(1): 9.
- Kjerkegaard Hans MD < [email protected] > Gold-Implantation: A New Method for Treating of Chronic Arthritic Pain, at: http://www.icmart.org/icmart04/abstract04.pdf and http://www.icmart.org/icmart05/abstract05.pdf
- Kjerkegaard Hans MD: The Positive Effect of Gold Implantation in Chronic lumbar pain, at: http://tinyurl.com/lxosfa
- Nejrup K, de Fine Olivarius N, Jacobsen JL, Siersma V. (2008 ) Randomised controlled trial of extraarticular gold bead implantation for treatment of knee osteoarthritis: a pilot study. Clin Rheumatol. May 24. [Epub ahead of print].
- Robinson NG. (2007) Veterinary Acupuncture - An Ancient Tradition for Modern Times. Alternative & Complementary Therapies, Oct, pp 259-265; http://www.liebertonline.com/doi/abs/10.1089/act.2007.13506
- Robinson NG. (2008) Gold Bead Implants – Medicine or Malpractice?: http://csuvets.colostate.edu/pain/Articlespdf/GoldBeadImplants.pdf
- Rogers P. Serious complications of acupuncture-or acupuncture abuses? Am J Acupunct 1981:9; 347-351. Updated in 1998:http://med-vetacupuncture.org/english/articles/apabuse.html
- Schrom T, Thelen A, Asbach P, Bauknecht HC. (2006) Effect of 7.0 Tesla MRI on upper eyelid implants. Ophthal Plast Reconstr Surg. Nov-Dec;22(6):480-482.
- Thelen A, Bauknecht HC, Asbach P, Schrom T. (2006) Behavior of metal implants used in ENT surgery in 7 Tesla magnetic resonance imaging. Eur Arch Otorhinolaryngol. 263 (10):900-905.
- Kim HY, Sohn BY, Seo UK, Lee H, Hahm DH, Shim I. (2009) An exploratory study of gold wire implantation at acupoints to accelerate ulnar fracture healing in rats. J Physiol Sci. 2009 May 2. [Epub ahead of print]. Dept of Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, TX, 77555-1069 USA. By causing long-term stimulation, gold wire implantation at acupoints is used empirically to prolong the effects of acupuncture. This study shows that subcutaneous gold wire implantation at acupoints has long-term effects on bone regeneration in the rat ulna bone defect model. PMID: 19412656 [PubMed - as supplied by publisher]
- Miller JM, Rossi EA, Wiesmair M, Alexander DE & Gallo O. Stability of gold bead tissue markers. Journal of Vision, 6 (5), 616-624.
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