Pain Management by Acupuncture

Continue Education Course of

@Advanced Acupuncture, Inc.
2007

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-CortexViscera 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 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.

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 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 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 selforganizing 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 applications
Differential diagnosis and treatment for
Headache & migraines, Trigeminal neuralgia,
Carpal Tunnel Syndromes, Arthritis, Neck
pain, Fibromyalgia, lumbago and sciatic
neuralgia.

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
headache
IV. Headache of nasal vasomotor reactions
V. Headache of delusional conversion or
hypochondriacal states

Migraine Headache

Classic Migraine
Common migraine
Cluster headache
Hemiplegic and
ophthalmoplegic
migraine
Lower half headache

Headache
Principle acupuncture points

G 20
Taiyang
Li 4
GV 20
Liv 3
G8
T3

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 pathologyneurovas compression
Central pathologyhyperactivity of the
trigeminal nerve nucleus

Classifications of TN
Western Medicine:

Eastern Medicine

1.
2.
3.
4.
5.
6.
7.

1.
2.

Typical
Atypical
Pre-TN
MS-related TN
Secondary or tumor related
TN neuropathy
Post traumatic TN

3.
4.

Pathogenic wind and cold

Ascending of Liver and
stomach fire
Deficiency heat due to liver
yin deplete
Damp/heat or damp cold
accumulation

TN-Pathogenic Wind & Cold

Clinical manifestation:
1.
2.
3.
4.

5.

Acute onset
Usually affects V1 sensory
Aversion of wind & cold or
aggravated by
Pain like cutting, boring and
electric shock but transient
( few minutes)s
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 joint

Dysfunction 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
Temporomandibular

Shoulder joints: Elbow joints:

LI 15, T14, SI
Li 11, T10, Li 4
11, T3,G 34

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

Hip joints:
G 30, G 29, G34,
G39

Hip joints:
G30, G 29, G34,
G39

Knee joints:
Ankle joints:
St 34,St 36, Sp 9, ST 41, T 40, K3,
B50, G 35 K8
G 34

ST7, SI 19, T 17, Li 4

Sacroiliac
Joints:
B 27, B28

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.
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 Release

Surgery:

Carpal Tunnel Syndrome

Principle acupuncture points

P6
P5
T4
T5

Cervical Spondylosis
Principle acupuncture points

SI 3
G 39
B 64
B 11
G 21
GV 16
T 10
B 10

Rotator Cuff Syndrome

Principle acupuncture points

Li15
Si 11
T14
Li 16
Li12
Li4
L7
L9
T9
T4

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
Runners 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 interactiveLow Back Pain

Low back pain

Principle 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 Neuralgia
Principle acupuncture points

B 23
B 30
G 30
B 36
B 37
B 40
G 34

Traumatic Injury-Brain-TBI
Clinical manifestations:
1.
2.
3.
4.

Altered mental status

Communication disorders
Emotional and psychitric
disorders
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.