pain management by acupuncture borjis holistic health clinic dr. ansari
TRANSCRIPT
Pain Management by Acupuncture
Borjis Holistic Health Clinic
Dr. Ansari
Acupuncture Pain Management
Part 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
Neuro-humoral Approach
Peripheral nervous system to be crucial in mediating the acupuncture analgesia
Meridian-Cortex-Viscera correlation hypothesis
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 TheoryShang 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.
The Gate Control Theory Drs Melzack and Wall, 1965
Model for acupuncture pain relief
Specific nerve fibers that transmit pain to the spinal cord (substantia gelatinous)
Balance between Stimulation & inhibitory fibers
Short term block pain by acupuncture ( did not explain the prolong effect)
Endorphin TheoryDr. 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 mechanisms 3. 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 cord
3. Trigger the gamma loop efferent in the ventral horn and activate neurons that cross over the spinal cord to the brain
4. Activate somatic motor nerves
5. 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
TCM Classification of headache
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.
TCM Classification of headache
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
Western Medicine:
1. Typical
2. Atypical
3. Pre-TN
4. MS-related TN
5. Secondary or tumor related
6. TN neuropathy
7. Post traumatic TN
Eastern Medicine1. Pathogenic wind and cold
2. Ascending of Liver and stomach fire
3. Deficiency heat due to liver yin deplete
4. Damp/heat or damp cold accumulation
TN-Pathogenic Wind & Cold
Clinical manifestation:1. Acute onset
2. Usually affects V1 sensory
3. Aversion of wind & cold or aggravated by
4. Pain like cutting, boring and electric shock but transient ( few minutes)s
5. Wind cold or wind heat symptoms
Tx-TN Pathogenic wind & cold
Acupuncture: Yang bai, (GB14) Taiyang, (extra) Zan Zhu (Bl 2) Wai guan (SJ5) He Gu (Li 4) Herbal formula:
Jin Fang Bai du San plus Ginger
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
Differential Dx of RA/OA
Principle Acupuncture Points for Arthritis
Temporo-mandibularST7, SI 19, T 17, Li 4
Shoulder joints:
LI 15, T14, SI 11, T3,G 34
Elbow joints:
Li 11, T10, Li 4
Wrist & joints:
T5, Li 10., LI. 4
Lumbar spinal joints:
Huatuoparaspinal acupoints, UB37 and UB 40
Lumbosacra
Joints:
GV3, B30, B 25, B40 B 60
Sacroiliac Joints:
B 27, B28
Hip joints:
G 30, G 29, G34, G39
Hip joints: G30, G 29, G34, G39
Knee joints:
St 34,St 36, Sp 9,
G 34
Ankle joints:
ST 41, T 40, K3, B50, G 35 K8
Metatarsophala-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.
Anatomy of CTS
Diagnosis of CTS
Numbing pain in the distribution of the median nerve but not limited to it.
Phalen’s sign positive Tinel’s 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 Release
Surgery:
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 negative
Knee Tendonitis
Patellar Tendonitis
Achilles Tendonitis
Runner’s injury
Lower back pain-Etiology
Herniated Disk (bulging)
Facet joint syndrome Sacroilliac joint
syndrome Myofascial syndrome
Low Back Pain-diagnosis
Clinical history Physical examination Pain sensitive
structures Pain generators Radiological studies
Low Back Pain-X-ray
Low Back Pain-MRI
Imaging study to evaluate the entire lumbar bones, discs, soft tissues and nerves.
CT, myelography, and discography use to complement MRI
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.
Cause of Neck Pain
Radiological Findings of Neck Pain
Diagnosis of Fibromyalgia
1. Widespread aching > 3 months
2. Skin roll tenderness & hyperemia
3. Disturbed sleep with morning fatigue and stiffness
4. Absence of lab. Evidence of inflammation or muscle damage
5. Bilateral tender points in at least 6 areas.