Commonly asked questions derived from the attendees of MPE's last 17 Pain Management seminars

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Prediction of a positive response to Acupuncture Rx.

Immediate

  • Warming of the affected area
  • Warming of the periphery ( Hands and feet )

Delayed (after a few treatment sessions)

  • Return to sleep
  • Increased range of movement
  • Decreased Trigger Point tenderness
  • Diminishing drug intake
  • Reluctance to undergo further treatment - needle aversion.

The positive results of "Acupuncture" accrue over time. Many patients who are helped with a course of Acupuncture go on to being greatly helped over time. Return to sleep and increased range of movement are indicators of incipient success.

A transient aggravation of the condition following the first couple of treatments, especially when the painful area warms following treatment is a good sign. This reaction is thought to be due to re-perfusion related release of free radicals. (If this reaction is florid it can be ameliorated by using more distal points and less local points.)
Patients with marked coldness of the affected area accept this reaction readily if they are pre-warned.
Marked aggravation of sciatica can indicate the presence of a disc prolapse. The aggravation comes from removing muscle splinting - guarding.

Headache that markedly intensifies following acupuncture needs to be assessed carefully.

Needling trigger Points

It is not necessary to reproduce the patient's pain when needling the major trigger point each time. However reproduction of the Myofascial patient's complaint with needling reassures both the patient and the practitioner that the correct point is being treated.

When needling a trigger point the practitioner can perceive a feeling of resistance ( Like a chopstick pressing on a balloon.) just before penetrating the trigger point.

Following penetration it is sufficient to obtain needle grasp ( Objective Deqi / DeChi ). Needle grasp is due to the tightening of the local muscle around the needle - catching the fish. Further manipulation of the needle following the arrival of objective Deqi results in the patient experiencing sensations, soreness, swelling, numbness etc. collectively termed subjective Deqi.

Chinese authorities pay significant attention to this reproduction of the complaint, using expressions such as "propagated sensation" and "Qi reaching the affected area."

However many patients resent experiencing strong needling sensations and worthwhile results are obtained by stopping needle manipulation on the arrival of objective Deqi.( Needle grasp ) Many practitioners obtain results using techniques that involve heavy afferent input provoked by mechanical distortion of the skin resulting in proprioceptive and mechano-receptor activity that is almost without subjective sensation.

Whatever else is done

The initial penetration of the skin must be painless.

The acupuncturist is usually judged by his patients, by his ability to painlessly insert the needle and rightly so.
Painful skin insertion provokes non-compliance, sympathetic outflow, and a lesser result / failure. The guide tube method for the inexperienced is ideal.

Frequency of Treatment

Chronic pain syndromes usually respond well to treatment twice weekly.

A usual course of treatment in China would entail treatment twice per week for 5 weeks, a weeks rest and then evaluation and re-treatment if necessary.

Worthwhile results can be obtained using lighter treatment schedules, however resolution of the pain state can be delayed. Some patients require maintenance treatment. This usually occurs where the damaged tissue producing the pain state cannot be repaired. eg. Osteo-arthritis.

Acute pain syndromes may require several treatments in one day until the pain is controlled. Eg Ureteric colic. An acute stuck back may need daily treatment for a couple of days. Neoplastic pain patient's requirements vary markedly, from daily to weekly treatment.

Herpes zoster (Shingles) when treated on alternate days does not progress to post herpetic neuralgia. ( Post herpetic neuralgia is difficult to treat, especially in the absence of coldness in the area of perceived pain).
NB. At present in Australia you cannot legally raise the acupuncture item number more than once per day, even if a different condition is treated and if Acupuncture has been used, that day, then only the acupuncture item can be raised.

This ruling was enacted by the Health Department around 1974, to prevent several medical Practitioners, ( Who are well known but shall remain nameless) from charging long consultations for multiple patients with needles in situ at the same time. Many of the above now espouse laser acupuncture!

Does the Patient's attitude matter?

The new patient

Apprehensive patients should be reassured.
Explanation of what you are going to do is helpful.
A trial insertion of just one or two needles can be an effective way to dispel fear.
Children respond well at times to seeing you insert a needle into yourself or their parent.
Naive patients should be supervised when they have needles left in situ. ( The provision of a signalling device, bell, buzzer etc. is a sensible and perhaps medico-legally necessary anxiety reducing strategy)

The Dubious Patient

Acupuncture works equally well on the believer and the non-believer.
Belief in Acupuncture is useful as it is usually associated with a willingness to attend for the required number of treatments.

What to tell the patient?

Informed consent - Patient information leaflet. Please apply for copy.

"Acupuncture works by normalising the reflex or restoring blood flow to the tissue, causing your pain. Blood heals."

" I do not expect marked improvement in your condition for several treatments. In fact I will not even ask how you are going until you have had several treatments."

The Patient with multiple problems.

Treat the most acute contra-indication to health first. Eg. If the patient has an acute pain condition treat that before going on to treat his other problems.

Patients with multiple problems eg sore knees, plus neck pain etc can usually have their problems addressed at the same time without diminution of the results. Accessibility is the key factor.

There is a finite number of points and needles that should be used. It is unusual to exceed 12 needles per session.

Miscellaneous

Du 20?

Most pain syndromes have a component of anxiety or sleep disturbance.

Chronic fatigue syndrome. ( My experience is limited.)

Immune boosting points,
antidepressant techniques,
sleep restoration.

Fibromyalgia

Treat the myofascial element in its own right.
Address the autonomic component.
Sleep restoration.

Lymphoedema

Diuretic points, use motor muscle points with electrical stimulation.
RSI Is a specific myofascial syndrome. Treat it as such.
Re-education of posture, job task and emotion is useful.

Cold Bi

Injury can result from:

Trauma,
Exposure to cold and damp,
Chilling of fatigued muscles,
Overuse including posture and job task.
(Nanking School of Traditional Chinese Medicine. Course notes 1978.)

Injury causes pain, pain causes spasm*, vascular and muscular.

Spasm leads to ischaemia,metabolite build-up, more pain, more spasm.

* Contracted muscle due to non-release of myofibrils. Electrically silent.

Mechanism ? A vicious circle.

Pain IN sympathetic activity OUT.

C and A delta input causes:

Muscle motor activity.

Segmental sympathetic outflow.

"Spasmed" ischemic muscle fibres generate Trigger Points.

Trigger points excite sympathetic outflows.

Ischemia causes pain.

The T.C.M. condition of Cold Bi, due to obstruction of Qi and blood.
(Textile process workers have Neck and Arm pain associated with ischaemic trapezious muscles.)
(The trapezious trigger points , GB 21, and SJ 15 are frequently found to reproduce some or all of Neck and Arm ( CBS) patient's pain complaint.)
( Trigger points can be objectified: site, sensitivity etc.)
(Sympathectomy abolishes trigger points activity.)
(Naloxone reverses the positive effects of Trigger Point injection.)

Acupuncture has two main effects in this setting:

Manipulation of the bodies endogenous analgesic mechanisms.
Manipulation of the Autonomic outflows particularly the sympathetic nervous system.
The Near and Far method of Acupuncture is designed to address both these effects.

It is at least two thousand years old.
It is used in China today.
It is cost effective and possess a high degree of scientific probity.
It is virtually painless and has a high efficiency index.
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