Where East meets West
Acupuncture-Trigger Point Links

By Simon Strauss MBBS

"Where there is a painful spot, there is an Acupuncture point" from the Neijing- The Yellow Emperor's Classic -500 B.C.

"When pressed on the Patient winces, or suddenly starts and exclaims AAGH Is The POINT!" From Acupuncture a Comprehensive Text: Shanghai College of Traditional Chinese medicine.

"Ah Shi - Oh Yes!" as the patient's pain complaint is reproduced by palpation. Nanking College of Traditional Chinese Medicine, Nanking, China 1978.

Traditional Chinese Medicine groups Myofascial Pain Syndromes now defined as pain states arising from the activity of one or more trigger points under the heading of Cold Bi syndromes.

Cold Bi syndromes have these common characteristics: Inhibition of blood supply, fondness and alleviation of pain with warmth and a worsening of pain severity with cold and damp.

Traditional Chinese Medicines aim in the treatment of Cold Bi is to remove the obstruction to the flow of Chi and blood and warm and nourish the tissues.

In Western terms, remove the trigger point and its associated muscle spasm/shortening, diminish the over active sympathetic outflows and thereby restore normal blood flow.

The Near and Far method of Acupuncture, where the tender point/trigger point, plus distal analgesia producing and or sympatholytic acupuncture points found below the elbow or knee are needled with the Bu technique, is an ancient method for the treatment of Myofascial pain syndromes that is currently used in China today.

The Bu needling technique or the warming method, where the needle is painlessly inserted and gently manipulated until needle grasp is obtained provokes stimulation of large sensory nerve fibres. The consequences of large fibre afferent activity are inhibition of small fibre activity (pain gate), relaxation of segmental muscle tone (muscle gate), and inhibition of sympathetic segmental outflow (sympathetic gate).

The exact effects of trigger point needling are not known. Relaxation of 'stuck' myofibrils, motor point ablation (microsurgery), segmental release of endogenous opiods (dynorphin, encephalin), and localised trauma induced vasodilatation have all been postulated to explain the return to normal of an exquisitely tender circumscribed muscle area.

The effect of needling the analgesia producing distal points (points that are either muscle motor points or have dense cutaneous / muscle nerve innervation) has been well researched. The analgesic effects are mediated by the Endogenous Opiod substances as well as a host of other neurotransmitters and modulators including 5HT, and Nor Adrenaline. The sympatholytic effects of Acupuncture have also been well detailed and have been shown to be associated with decreased pain scores in both sympathetically maintained and trigger point related pain states.

The success of the Near and Far Acupuncture technique and indeed of most treatment techniques that target the trigger point relies on the accurate localisation of the relevant trigger point. Consequently a rigorous physical examination including palpation must be carried out.

The practitioner's level of skill and training also appear to be influential as does the adherence to classical treatment schedules. These factors seem to have been alluded to by Richardson and Vincent in their review article "Acupuncture for the Treatment of Pain: a Review of Evaluative Research" PAIN, 24 (1986) 15 - 40, when discussing the long term pain relieving effects of acupuncture; "The controlled study by Coan et al., where traditional acupuncturists were given the freedom to follow their normal practices, presents a more promising picture- with improvements in 58% of the initial sample of low back pain patients being maintained at a 10 month follow-up." That these factors may be of lesser importance in the short term effectiveness of Acupuncture may be deduced from their statement, "The above review indicates that there is good evidence from controlled studies for the short-term effectiveness of acupuncture in relieving clinical pain in each of the areas examined. The extent of the therapeutic effects produced has varied from study to study but the proportion of patients helped has commonly fallen in the 50 - 80% range. This applies to both acute and chronic painful conditions." as many of the trials surveyed utilised Acupuncture regimes that bear little resemblance to Acupuncture as it is practiced in China today.

Simon Strauss MBBS. Dip. Acupuncture Nanking School TCM, Nanking, China. FAMAS. Licentiate Australian Assoc. Musculoskeletal Medicine, Scientific Adviser Physicians International Association of Acupuncture.