Medical acupuncture in the treatment of pain (Proceedings)

Medical Acupuncture and Chinese Acupuncture

1.         Acupuncture is the act of placing a needle into the body at a specific point in order to get a desired effect.

2.        Medical acupuncture is an evidence-based approach to acupuncture based on contemporary biomedical descriptions of scientifically based anatomy, physiology and pathology.

a.        It is the integration of biomedical principles with Chinese medical traditions

b.        Acupuncture has been evolving over the past 3000 years.  Medical acupuncture is the next logical step in it's evolution.

3.        The oldest surviving text is from the Han Dynasty, over 2000 years ago

a.        Unfortunately acupuncture was suppressed by both Chinese and colonial powers in the 1800

b.        The focus was to “modernize” so the emphasis was on Western Medicine

c.        In the 1940's there was a lack of Western trained doctors after the occupation by Japan.  Lay people called “Barefoot Doctors” were trained in the rudimentary skills of acupuncture. 

d.        In 1958, with the encouragement of Mao Tse-Tung, “Traditional” Chinese Medicine was born .

What are acupuncture points

1.        Where nerve bundles penetrate fascia

2.        Near major blood vessels that are surrounded by small nerve bundles

3.        Where nerves enter or exit a muscle

4.        Major Nerve trunks

5.        Superficial Nerve trunks

6.        Emergence of nerves through cranial foramina

7.        Where there are mixed nerves (i.e. sensory, motor and autonomic)

8.        Sites of nerve bifurcation

9.        Periarticular structures

10.     Cranial Sutures

Physiology

1.        Acupuncture relieves pain and restores physiologic homeostasis

a.        You cannot acupuncture something in the “wrong direction”

2.        Insertion of a needle leads to biomechanical coupling caused in part by surface tension in the tissue and by electrical affinity between the metal needle and the charges within the connective tissue

3.        Frictional forces are generated when the acupuncturists rotates the needle.  This rotation deforms the extracellular matrix.

a.        This tugging (da chi in TCM) leads to a range of biomechanical and conformational cellular changes that alter the extracellular environment , leading to healing.

b.        Microtrauma, neurovascular reactions, gene expression and protein synthesis occurs

c.        Release of substance P and histamine

d.        Stimulation of ascending influences on the CNS

e.        Stimulation of descending changes via axon reflexes

4.        Local effects of acupuncture

a.        Capillary dilation and immune activation

b.        Tissue repair activation

c.        Local and supraspinal control

                                             i.            Reduction in inflammation

                                            ii.            Normalization of circulation

5.        Neuromodulation

d.        Functional MRI brain imaging allows detailed study of the supraspinal effects of acupuncture showing changes in key pain areas including the thalamus and anterior cingulate cortex.

6.        Effects on muscle tissue

a.        Muscle pain might be present for several reasons:  acute trauma, chronic trauma, referred pain from viscera and related joints

b.        Acupuncture lessens muscle pain and tension

7.        Immunologic Effects

a.        Micro trauma causes degranulation of mast cells

b.        This activates portions of the blood coagulation system including Factor XII which subsequently activates the immune system

c.        Mast cells release peptides which cause vascular dilation, and increased release of immune mediated cytokines.

d.        After needle removal tissue repair begins coordinated by neurohumoral mechanisms

                                             i.            The inflammation activates the hypothalamus which in turn controls inflammation

e.        Hypthalmic-Pituitary-Adrenal Axis is stimulated from afferent somatic and vagal nerves, cognitive-emotional stimuli, chemosensory inputs and integration of all of these signals within the hypothalamus itself.  This results in output through at least 5 efferent pathways

                                             i.            Humoral

                                            ii.            Neural

                                          iii.            Sympathetic Autonomic Neural Pathway

                                          iv.            Parasympathetic Autonomic Neural Pathway

                                            v.            Central Descending Pain Inhibition Pathway

Analgesia by means of spinal segmental approach

1.        First, nerve roots supplying the nerve function to the painful area are selected

2.        Points related to segmental innervations of skin, muscles, bones and viscera are selected

3.        Homeostatic points related to autonomic function helps deactivate pain processing centers in the brain

Examples of treatable areas

1.        GI problems including diarrhea, vomiting, colic, IBD

2.        Skin issues including lick granulomas, allergies, and wound healing

3.        Dental disease

4.        Miscellaneous conditions such as KCS  Asthma, Epilepsy

5.        Musculoskeletal and Neurological conditions such as arthritis, IVDD, FCE, nerve injuries, back pain, lameness, laminitis, tendon injuries

6.        Osteoarthritis

Western Medicine is a must

1.        Vital for proper diagnosis.  Medical acupuncture is NOT based on diagnosis of problems via tongue and pulse.  It requires lab work, rads and ultrasound

Acupuncture Benefits

1.         Clients are offered additional treatment options, with minimal side effects

2.        Patients get better pain control, decreased healing times and the advantage of integrative medical treatments

3.        Practitioner has additional source of income, clients and tools to treat medical issues