Continue Education Course of@Advanced Acupuncture,
Inc.2007Acupuncture Pain ManagementPart I: Theory Overview of
scientific bases of acupuncture Mechanisms of pain management
Current researches and clinical trials Pain Scores and evaluation
methods Scientific Bases of Acupuncture Neurohumoral Morphogenetic
Nerve Reflex Theory The gate control theory of pain Endorphin
Neurohumoral Approach Acupoint-brain-organ Acupuncture stimulates
to brain cortex and nerve system, then control the chemical or
hormone release to the disordered organs.Morphogenetic Theory
(Shang C. China, 1989) Acupuncture points are singular points in
surface bioelectric field The role of electric field in growth
control and morphogenesis Organizing centers have high electric
conductance Acupuncture points originate from organizing
centers
Nerve Reflex Theory (Ishikawa and Fujita et al, Japan,
1950s)
Autonomic nervous system extending thru the internal organs
Viscera-mutinous reflex Cutanous Viscera reflex Acupuncture utilize
these reflexes for restoring the homeostasis of the body and
acceralate the healing process.Endorphin Theory(Dr. Pomeranz,
Canada, 1996)
Natural Morphine Acupuncture trigger the release of endorphin
into the central nervous system Only deal with pain Corticoids and
Substance P also released along with endorphin
Therapeutic Mechanisms of Acupuncture
Acupuncture Mechanisms of Action
Conduction of electromagnetic signals Activation of opioids
systems Changes in brain chemistry-release of neurotransmitters and
neurohormones.
Acupuncture Pathways
Meridian-Cortex-Viscera Correlation Hypothesis
1. The meridian system is and connected the nervous system to
the cerebral cortex.2. It acts through neurohumoral mechanisms3.
Acu-point-Brain-organ model: stimulates the brain cortex/nervous
system, then controlling the chemical or hormone release to the
disordered organs for treatment.
Morphogenetic Singularity Theory
Acupuncture points are singular points in surface bioelectric
field Converging points of surface current for change in electric
current flow. Abrupt transition from one state to another. Eg:
BaiHui (Du 20)
Physical characteristics of the acupuncture points-WHO
Points are corresponds to the high electrical conductance points
on the body surface High density of gap junctions at the epithelia
of the acupuncture points. Gap junctions are hexagonal proteins
that facilitate intercellular communication and increase electric
conductivity.
Research on Auricular points
WHO found 43 points have proven therapeutic value Therapeutic
effect can be achieved by needling, temperature variation, laser,
ultrasound, and pressure.
Effects of Acupuncture on the Brain
UCI-Use functional MRI to investigate the mechanisms of
acupuncture analgesia Stimulates Li 4 revealed activation of visual
cortex. Needling Tin Hui revealed auditory cortex activation
Effects of acupuncture on the Brain-auditory cortex
Why acupuncture has fewer side effects?
May indirect adjust the process and restore normal function by
activating the network of organizing centers in the organism The
activation of the self-organizing activity is less likely to cause
the side effects resulted from directly antagonizing a pathological
process which often overlap with other normal and beneficial
physiological processes.
The role of electric field in growth control and
morphogenesis
Enhanced cell growth toward cathode and reduced cell growth
toward anode in electric fields of physiological strength Fast
growing cells tend to have relative negativity polarity. The
polarity is due to the increased negative membrane potential
generated by mitochondria at high rate of energy metabolism
Efficacy, effective, safety and costs of acupuncture for chronic
pain
Evaluated 304,674 patients over 10,000 physicians and received
10+ acupuncture for pain Results: acupuncture was an effective and
safe treatment The effects attributed to specific or nonspecific
mechanisms and depend on the diagnosis-results a large research
initiative.
Mechanisms of acupuncture for Pain relief Polymodal receptors
(PMRs) in the acupuncture points are sensitized for the immediate
action. Action mediated by endogenous opioids Potent stimulus for
activating the analgesic systems
Therapeutic Mechanisms of Acupuncture-Dr.D. Kendall, 1980
1. Inserting a needle provokes an acute defensive inflammatory
response 2. Afferent nociceptive (pain) neurons distribute to the
dorsal horn of the spinal cord3. Trigger the gamma loop efferent in
the ventral horn and activate neurons that cross over the spinal
cord to the brain4. Activate somatic motor nerves5. To muscles, and
autonomic motor nerves to peripheral blood vessels and to the
internal organs
Acupuncture Pain Management
Part II: Clinical applicationsDifferential diagnosis and
treatment for Headache & migraines, Trigeminal neuralgia,
Carpal Tunnel Syndromes, Arthritis, Neckpain, Fibromyalgia, lumbago
and sciaticneuralgia.
Etiology of Headache
Blood Vessels that become dilated enlarged or constricted
Muscles in the neck and head become tight or tense Muscles around
the eyes the become strained due to overwork Sinuses became swollen
due to allergies or infections Nerves that transmit abnormal pain
signals Joints in the jaw and neck are overused or damaged.
Types of Headache(Western Medicine)
I. Vascular headache (Migraines) II. Muscle contraction headache
III. Combined vascular & muscle contraction headacheIV.
Headache of nasal vasomotor reactionsV. Headache of delusional
conversion or hypochondriacal states
Migraine Headache
Classic Migraine Common migraine Cluster headache Hemiplegic and
ophthalmoplegic migraine Lower half headache
HeadachePrinciple acupuncture points G 20 Taiyang Li 4 GV 20 Liv
3 G 8 T 3
TCM Classification of headache
1. Headache due to invasion of pathogenic wind into the channels
and collateral: Headache occurs often, especially on exposure to
wind. The pain may extend to the nape of the neck and back region.
Tongue white coating, pulse floating
2. Headache due to upsurge of liver-yang: Headache distension of
the head, irritability, hot temper, dizziness, blurred vision,
Tongue red with thin and yellow coating Pulse thin wiry and
rapid.
3. Headache due to deficiency of qi and blood: Lingering
headache, dizziness, blurred vision, lassitude, pale complexion
Tongue pale with thin white coating Pulse thin and thread
Trigeminal Neuralgia (TN)
Causation:-blood vessels compressing the Trigeminal nerve root
as it enters the brain stem Peripheral pathology-neurovas
compression Central pathology- hyperactivity of the trigeminal
nerve nucleus
Classifications of TN
TN-Pathogenic Wind & Cold
Clinical manifestation:1. Acute onset 2. Usually affects V1
sensory3. Aversion of wind & cold or aggravated by4. Pain like
cutting, boring and electric shock but transient ( few minutes)s5.
Wind cold or wind heat symptoms
TMJ-Tempro mandibular jointDysfunction syndrome
Symptoms: Grinding teeth, Joint pain, Headache Ringing in the
ears Unable to open his or her month wide or hear a pop upon
opening
TN-acupuncture treatment
Li 3 or Li 4 plus Temporal branch: Taiyang, G 3 & G 14
Maxillary branch: G1, St2, SI18, and ST3 Mandibular branch: St6, St
5, and G2
TMJ (TMD)
TMJ-Etiology
1. Muscle spasm- pain Masseter & temporalis 2.
Meniscus-cartilage, buffer between the jaw and skull. Caused
pop
TMJ-Acupuncture points
ST 7 SI 19 T 17 Li 4 Osteoarthritis
Arthritis due to destruction of the cartilage, bone and
ligaments Causing deformity of the joints Damage to the joints can
occur early in the disease and be progressive
Rheumatoid Arthritis
Auto-immune disease Chronic inflammation of the tissue around
joints , organ and body Body tissues attacked by own antibodies in
the blood level which causes inflammation. Women to men: 3:1
Osteoarthritis
90% of arthritis Destruction of the cartilage, bone and
ligaments causing deformity of the joints Damage to the joints can
be progressive
Principle Acupuncture Points for Arthritis
Temporo-mandibular ST7, SI 19, T 17, Li 4Shoulder joints:LI 15,
T14, SI 11, T3,G 34Elbow joints:Li 11, T10, Li 4Wrist & joints:
T5, Li 10., LI. 4
Lumbar spinal joints:Huatuoparaspinal acupoints, UB37 and UB
40LumbosacraJoints:GV3, B30, B 25, B40 B 60Sacroiliac Joints: B 27,
B28Hip joints:G 30, G 29, G34, G39
Hip joints: G30, G 29, G34, G39Knee joints: St 34,St 36, Sp 9, G
34Ankle joints:ST 41, T 40, K3, B50, G 35 K8Metatarsophala-ngeal
joints:Sp 4, B 65, G 38, Sp 5
Causation of Carpal Tunnel Syndrome
Painful neuropathies of the hand and wrist are from nerve
compression, most often compression of the median nerve in the
carpal tunnel.
Diagnosis of CTS
Numbing pain in the distribution of the median nerve but not
limited to it. Phalens sign positive Tinels sign positive Light
touch/vibratory touch positive Muscle weakness and atrophy EMG:
slowed conduction velocity across the CT.
Etiology of CTS
Median nerve compression by tendonitis Usually due to repetitive
motion of the wrist and hands.
Carpal Tunnel SyndromePrinciple acupuncture points
P 6 P 5 T 4 T 5
Cervical SpondylosisPrinciple acupuncture points
SI 3 G 39 B 64 B 11 G 21 GV 16 T 10 B 10
Rotator Cuff SyndromePrinciple acupuncture points
Li15 Si 11 T14 Li 16 Li12 Li4 L 7 L 9 T 9 T 4
DX of Lateral Epicondylitis (Tennis elbow) History of tennis
elbow use Pain just distal to the prominence of the lateral
epicondyle Radiological study negativeKnee Tendonitis
Achilles Tendonitis
Runners injury
Lower back pain-Etiology
Herniated Disk (bulging) Facet joint syndrome Sacroilliac joint
syndrome Myofascial syndrome
Referred and Interactive Low Back Pain
Referred and Interactive Low Back Pain The frequent referral of
somatic pain into the limbs Cause of the cause: Identify the source
of symptoms. Make realistic prognosis based on the stage, severity,
stability and irritability of the dysfunction
Referred and interactive- Low Back Pain
Low back painPrinciple acupuncture points
B 40 & K2 (basic) L5, B 40, G34, B 65, B 60, B 34, K7, L 5,
Li 11, Li 4, Sp6, Liv. 2, Li 10.
Sciatic NeuralgiaPrinciple acupuncture points
B 23 B 30 G 30 B 36 B 37 B 40 G 34
Traumatic Injury-Brain-TBI
Clinical manifestations:1. Altered mental status2. Communication
disorders3. Emotional and psychitric disorders4. Related paralysis
or paresthesia Dx: Refer to physician for further
investigation.
Diagnosis of Fibromyalgia
1. Widespread aching > 3 months2. Skin roll tenderness &
hyperemia 3. Disturbed sleep with morning fatigue and stiffness4.
Absence of lab. Evidence of inflammation or muscle damage5.
Bilateral tender points in at least 6 areas.