Pain, 1977 Feb: 3(1): 3-23, Melzack, Stillwell and Fox correlated trigger points and acupuncture points based on spatial distribution and associated pain patterns and found a 71% correspondence. This close correlation suggests that although the two systems of bodywork originated independently, there may be a mutual etiology for muscle pain and an effective system for how to treat it. In JAMA 1975 Jun 16; 232(11): 1133-5, Lee PK, Anderson TW, Modell JH, Saga SA's studied the treatment of chronic pain with acupuncture with 261 patients and found a substantial number of patients stated that they had relief immediately following a series of four acupuncture treatments. It did not matter whether the needles were placed in the traditional meridian locations or in arbitrary fixed control points. Four weeks following treatment, 65% of the patients reported little or no reduction in the intensity of their pain, 17% reported a 50% reduction, and 18% at least a 75% reduction. In another study by this same group with 533 patients, 276 (52%) reported excellent (greater than 75%) pain relief immediately after the last treatment, and 103 (19.3%) still reported excellent pain relief on a 4-week follow up questionnaire. In March 1975, the authors contacted 87 of these 103 patients. Sixty-three reported that they still had excellent pain relief 3 to 18 months after therapy, 3 patients reported that their pain still was relieved 50%, and 21 patients said their pain had returned to the same intensity as before therapy. Thus, 12% of 533 patients who received acupuncture treatment for chronic pain had a significant degree of pain relief at least 3 months after therapy. In another study on chronic neck by David J, Modi S, Aluko AA, Robertshaw C, and Farebrother J, at the Royal Berkshire Hospital NHS Trust showed that chronic neck pain whether treated with acupuncture or physiotherapy both improved and that acupuncture was slightly more effective in patients who had higher baseline pain scores. In another study using electrical stimulation at trigger point sites or acupuncture points for prolonged relief of pain, Pain 1975 Dec; 1(4): 357-73, Melzack, showed that the technique provided a powerful method for the control of some forms of severe pathological pain.

Pain is a complicated condition stemming from mechanical and psychological stresses to nutritional and metabolic inadequacies. In the process of addressing the phenomenon of muscle pain, it is vital that that gestalt of a persons pain syndrome be taken into consideration. One of the most effective techniques for resolving muscle pain is to generate a release in the muscle fiber body through trigger point therapy, support skeletal re-alignment with manipulation and marry the techniques with therapeutic touch.

A Brief Listing of Acupuncture Articles and Research

Brain Scan Confirms Acupuncture Relieves Pain

December 1, 1999
from The Medical Tribune – and article by Allan Sison:

Using a new form of brain imaging, researchers have confirmed that acupuncture does in fact relieve pain.

They also found electro-acupuncture to be more effective than manual acupuncture.

resonance imaging (fMRI). The results showed decreased brain activity in four of the seven subjects (57 percent) who received manual acupuncture and in all five subjects who received electro-acupuncture, compared to the level of brain activity measured during pain stimulation.

Scientists led by Dr Huey-Jen Lee, chief of neuroradiology at the University of Medicine and Denistry of New Jersey – New Jersey Medical School in Neward, used both manual acupuncture, in which a needle is inserted into the skin and twisted by hand, and electro-acupuncture, in which a low-level electrical current is passed through the needle. The researchers focused on Hegu acupoint – located between the thumb and the index finger – one of 401 acupoints on the human body.

Neck Pain and Back Pain

May 15, 2000 (New York, NY) – One out of three Americans will experience neck pain, and up to 90 percent will suffer lower back pain at some point in their lives. For those who find their neck in knots and lower back in a twist, the American Academy of Medical Acupuncture (AAMA) recommends a modern version of an ancient therapy – medical acupuncture – to relieve common back and neck pain.

"Stress is the number one reason people experience back and neck pain. Most people don't realize how much tension they carry in their body," said Robert Schulman, M.D., a Board member of the AAMA with a private practice in Manhattan. "Some people tend to hold the muscles in their lower back and neck so tightly they mistake it for a medical condition. What they don't consider are the external stressors in their lives – perhaps unhappiness at work, marital problems, or repressed emotions," he said.

Dr. Schulman, a Clinical Assistant Professor of Rehabilitation Medicine in Surgery at the Weil Medical College of Cornell University and clinical affiliate of the New York Presbyterian Hospital, said half of the patients he sees are frustrated after having tried traditional methods of treatment with no success. "Medical acupuncture helps some patients feel better instantly because it relaxes the patients, loosens muscles and stimulates endorphin levels in the body – in essence recharging the body's battery – which decreases the sensation of pain," said Dr. Schulman. Stress is not the only condition treatable by medical acupuncture. Automobile accident victims and those who frequently lift heavy loads are also likely candidates for this treatment.

"By the end of a series of treatments, patients often notice a marked decrease in neck and back pain and a lessened dependency on medication," said Dr. Schulman. "Some are even able to eliminate medications altogether as acupuncture decreases pain, increases blood flow to tissues, and stimulates anti-inflammatory effects."

Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation. Giles LG, Muller R. Spine. 2003 Jul 15;28(14):1490-1502.

National Unit for Multidisciplinary Studies of Spinal Pain, The University of Queensland, The Townsville Hospital, Townsville, Queensland, and the dagger School of Public Health and Tropical Medicine, James Cook University, Townsville, Queensland, Australia.

Study Design: A randomized controlled clinical trial was conducted.

Objective: To compare medication, needle acupuncture, and spinal manipulation for managing chronic (>13 weeks duration) spinal pain because the value of medicinal and popular forms of alternative care for chronic spinal pain syndromes is uncertain.

Summary of Background Data: Between February 1999 and October 2001, 115 patients without contraindication for the three treatment regimens were enrolled at the public hospital's multidisciplinary spinal pain unit.

Methods: One of three separate intervention protocols was used: medication, needle acupuncture, or chiropractic spinal manipulation. Patients were assessed before treatment by a sports medical physician for exclusion criteria and by a research assistant using the Oswestry Back Pain Disability Index (Oswestry), the Neck Disability Index (NDI), the Short-Form-36 Health Survey questionnaire (SF-36), visual analog scales (VAS) of pain intensity and ranges of movement. These instruments were administered again at 2, 5, and 9 weeks after the beginning of treatment.

Results: Randomization proved to be successful. The highest proportion of early (asymptomatic status) recovery was found for manipulation (27.3%), followed by acupuncture (9.4%) and medication (5%). Manipulation achieved the best overall results, with improvements of 50% (P = 0.01) on the Oswestry scale, 38% (P = 0.08) on the NDI, 47% (P < 0.001) on the SF-36, and 50% (P < 0.01) on the VAS for back pain, 38% (P < 0.001) for lumbar standing flexion, 20% (P < 0.001) for lumbar sitting flexion, 25% (P = 0.1) for cervical sitting flexion, and 18% (P = 0.02) for cervical sitting extension. However, on the VAS for neck pain, acupuncture showed a better result than manipulation (50% vs 42%).

Conclusions: The consistency of the results provides, despite some discussed shortcomings of this study, evidence that in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short-term improvement than acupuncture or medication. However, the data do not strongly support the use of only manipulation, only acupuncture, or only nonsteroidal antiinflammatory drugs for the treatment of chronic spinal pain. The results from this exploratory study need confirmation from future larger studies.

Acupuncture Management of Osteoporotic Fracture Pain By M. Truett Bridges, Jr, M.D., Medical Acupuncture Journal, Spring / Summer 1998 – Volume 10 / Number 1

Educational Objective
Present a multi-modal treatment of a common medical problem and its sequelae.

Problem
Chronic pain of musculoskeletal origin and subsequent debility.

Chief Complaint
Pain in low back, buttocks, and left ischial area.

History of Present Illness
A very active, 72-year-old white female was doing her usual treadmill exercise in May, 1997, when she experienced acute, severe left groin pain. Although it was assumed to be muscle strain, she experienced no improvement with analgesics and muscle relaxants. After meeting with an orthopedic surgeon in July, 1997, X-rays revealed a fracture of the left pubic bone. She was given NSAID'S and hydrocodone for pain, referred to physical therapy, and advised to do as much as the pain would allow. By mid-August, 1997, she began having what she described as acute sciatic pain on the right side; she was adamant that this was secondary to her "favoring" the left side due to pain. She was hospitalized for I week; blood work, bone scan, MRI and CT scans revealed no evidence of occult malignancy or metastatic disease. She had osteoporotic fractures of the left sacrum, and left superior and inferior pubic rami. The patient continued to be in "excruciating pain," but was discharged from the hospital. She was essentially non-ambulatory, requiring a wheelchair and assistance in all activities of daily living. Pain medications at this time were Percocet (oxycodone/acetominophen), 6 per day, and Aleve (naproxen), 3 per day. She presented for acupuncture consultation in October, 1997, with resolution of the right sciatic pain, but with continuing severe left groin and low back pain, pain over the left hip, and pain of the ischial tuberosity at the level of the inferior gluteal fold.

Past History: Thyroidectomy, 1954.

Family/Social History: Retired business owner, married to retired CEO. Very active, large extended family, extensive travel.

Allergies: NKDA

Medications/Supplements: Percocet, 2-6 per day; Aleve, 3 per day. Premarin/Provera, Synthroid, Paxil, Vitamin E, Juice Plus.

Review of Systems: Coffee, 2 cups per day; alcohol, 2 drinks per day. Myopia since childhood. History of mild depression. Menopause, age 54. Night sweats and constipation (while on narcotics).

Diagnostic Testing: Bone, CT, and MRI scans. Findings as above.

Physical Exam: Gray-haired, grimacing white female; appeared younger than her stated age. Gait was halting and slow. Multiple areas tender to palpation over low back: SI joints, buttocks, left hip, and left ischium. No neurological deficit. Pulses weak in Yin positions, especially at Kidney. Tongue pale with a thin coat at the rear, and a small Spleen crack.

Diagnosis: Pelvic osteoporosis with multiple fractures and chronic musculoskeletal pain syndrome. Deficiency of Kidney Yin and Yang, (Shao Yin/Tai Yang, Water deficient).

Treatment: Total of 11 sessions over 12 weeks; twice per week for 3 weeks, then, every 10- 14 days at patient's discretion. Treatment varied, emphasis on tonifying Kidney (and Spleen), opening dorsal Tai Yang zone, including use of Du Mo; deactivation of multiple secondary trigger points in low back, buttocks, thigh adductors; percutaneous electrical nerve stimulation to lumbo-sacral area; periosteal stimulation. Rationale was French Energetic, TCM, neuroanatomic, and trigger orAh Shi point therapy. Duration of sessions approximately I hour. Needles: generally 36g, 1.5 to 2 inch. Occasionally, 32g to 30g, 3 to 5 inches.

Associated Modalities: Referred for massage therapy. Given Chinese Modular Solutions "Marrow Matters" to strengthen bone through Kidney support. Given homeopathic Arnica Montana at the end of each treatment session.

Outcome/Subjective: After the first session, the patient discontinued Percocet. Within a week, she had reduced her medications to occasional ibuprofen or acetominophen. Her evaluation is that the acupuncture was extremely effective, worked quickly, and continued to improve her symptoms over time. She reported sleeping quite well, and is back to her former, gratifying regimen of daily exercise.

Outcome/Objective:
Her gait was brisk, steady, and no longer halting. Her affect much improved. There was decreased muscle tightness over the low back and buttocks, and minimal tenderness to palpation of the hip and ischial tuberosity.

Complications: None

Is acupuncture for pain relief in general practice cost-effective? Lindall S., Acupuncture Med. 1999;17:97-100.

Sixty-five patients with pain, mainly musculoskeletal, were offered acupuncture. Most had little relief from usual medical therapies and sought orthopedic referral, which was denoted as granted should acupuncture fail. Trigger-point acupuncture was used, with some distal points (usually LI 4/LR 3). A visual analog scale of 0-10 (10 being normal) was used, and 7 or more set as a positive result of therapy. The average response rating was 7.6. A table is given of savings, comparing acupuncture cost with cost of referral to specialty care, plus 1 averted knee surgery. The acupuncture cost of $10,943compared with an estimated $26,783 in referral costs saved money. There were 46 successful therapies and 14 failures. The author adds a cautionary word, as patients were highly selected. Only those he believed from past experience might benefit were offered this option. Acupuncture was a cost addition for the 14 who did not respond to acupuncture and went on to referral.

The use of acupuncture for pain relief in a Chinese hospital clinic. Ip VUY., Acupuncture Med. 1999;17: 101-109.

The author took a 6-week medical school teaching elective in Tianjin. The TCM hospital there has been awarded national prizes for its good results and expertise; it has trained students from 40 countries. Therapy "is based on holistic patterns, causal relationships, non-linear logic, non-reductionist views, and empirical evidence." The author studied outcomes using a visual analog scale from 0-5 for 45 patients with pain in various areas. Pain level fell from an average of 2.5 to 1. Most patients were of middle to upper class socioeconomic status, as acupuncture expense cannot be afforded by those with lower incomes. Patients might have been biased by emotional need to experience acupuncture positively. A sterility problem was noted in a country with a high level of hepatitis B. Disposable needles were not used, and needles were cleaned simply by soaking in alcohol for 4 hours. Local people seek the TCM treatment for chronic illnesses, believing that standard (Westernized) medicine does not seek the root of the problem. Comment: A folksy article, more a picture of life in a TCM hospital clinic than objective data regarding results of therapy.

Treatment of 86 cases of facial spasm by acupuncture and pressure on otopoints. Li Y, Peng C. , J Tradit Chin Med. 2000;20:33-35.

Eighty-six patients were put in a combined group; 38 had acupuncture only, and 40 had only pressure on otopoints. The groups were similar in age, sex, and disease condition. Muscle tics had developed to include all muscle groups on one side of the face. Local facial points involving the tic areas of the ST, TE, SI, and LI meridians, plus Yintang were used. Three treatment courses of 10 days separated by 5-day rests were given, 20 minutes daily with stimulation to tolerance. Otopoints included Shenmen, KI, GB, LR, brain, cheek, eye, and mouth, alternating sides with vaccaria seed pressure. Thirty-eight percent of the combination group was cured, with no relapse for 1 year, 16% of the acupuncture group, and 5% of the otopoint-only group had the same outcome. Twenty-six percent, 39%, and 45%, respectively, were improved. Routine treatment with anticonvulsants or block often showed relapses in a short time, unlike the treatment with acupuncture.

Comment: Results are important, but again, to emulate Chinese data, we will have to develop ways to involve group efficiency, enabling more treatments at less cost. Three tables are given; therapeutic results, comparison of total effective rates, and comparison of cure rates do not match well in this article.

Segmental dysfunction. Watkin H. , Acupuncture Med. 1999;17:118-123.

Segmental dysfunction is impaired or altered function of skeletal, arthrodial, and myofascial structures related to the level, with vascular, neurological, and lymphatic components. A problem in the function of a spinal segment can cause symptoms without obvious physical pathology. Physical and/or emotional stress as well as visceral disease can produce a reaction at the dysfunctional segment more easily than at normal ones. Segmental acupuncture is well accepted by some experts and is detailed in the text Medical Acupuncture, A Western Scientific Approach. Pain could be caused by dysfunction of an innervating segment (as heel pain could result from L5-S1 dysfunction). Such etiology should be sought, especially where no evidence of local pathology can be detected. Detecting the correct segment necessitates keen palpatory skill. Tenderness, asymmetry, range of joint motion, and tissue texture abnormality must be sought. Sympathetic activity can be mapped. These modes of approach are discussed. The root cause can be trauma or even microtraumas. Faulty movement patterns or even visceral disease can increase the ultimate effect. Secondary segmental dysfunction can occur, just as secondary trigger points result from primary ones. Animal experiments show that dorsal root damage produces a sustained discharge only when there is pre-existing minor chronic injury. Local released acetylcholine causes muscle spasm in the area sensitized to the compound. This occurs in a segmental pattern. Other life factors can alter pain perception. "Convergence-facilitation" is discussed. Noxious input leads to substance P and calcitonin gene-related peptide, activating N-methyl D-aspartate in the dorsal horn, inducing potentiation where a stimulus response can rise to 20 times normal. Abnormal discharge can subside in the spine but remain in the thalamus (phantom pain). Long-term segmental dysfunction can thus become a response to a central nervous system pattern. Two illustrative cases are presented. The author ends by stating this is a rich field for research.

Abstract
Background Acupuncture has been widely used for the management of musculoskeletal pain, but relatively little information is available regarding its effect on functionality.

Objectives: To determine if acupuncture is effective for the management of pain, and to determine if it provides benefits to patients' functionality.

Design: Retrospective chart review and follow-up telephone survey.

Setting and Patients: A total of 135 consecutive patients seen in outpatient physical medicine, rehabilitation, and pain management clinics for low back pain/radiculopathy, myofascial pain syndromes, fibromyalgia, and other conditions. Follow-up data were available via telephone for 64 patients.

Interventions: All patients received acupuncture for pain relief.

Main Outcome Measures: Perceived pain on a 10-cm visual analog scale, functional status using a 10-point activity scale, and work status. Overall global improvement was measured using self-assessed "percentage improvement."

Results: The mean (SD) duration of pain prior to acupuncture was 75 (107) months. The mean number of acupuncture treatments was 5 (range, 1-13). At the conclusion of treatment, the mean (SD) self-rated percentage improvement was 53% (34%). Pain scores decreased from a mean (SD) of 6.6 (2.0) to 4.76 (2.54) (P<.01). Activity scores also showed significant improvement, from a mean (SD) of 6.61 (2.72) to 7.04 (2.70) (P<.05). Patients with long-term follow-up reported the following: overall improvement (mean, 38%), pain scores (mean, 5.52), and activity scores (mean, 6.81). These did not change significantly compared with their respective short-term outcome measurements.

Conclusions: Acupuncture appears to provide sustained pain relief and functional improvement in patients with a variety of pain syndromes, both acute and chronic.

Physicians Successfully Treating the Most Common Arthritic Disease with Medical Acupuncture

Working outside in the sweltering heat of summer can be a nuisance. Yet, washing the car, mowing the lawn and weeding the backyard garden, although boring, are relatively quick and easy tasks. But to the 20.7 million Americans suffering from osteoarthritis, swollen and deformed fingers, feet, knees, hips, and spines can turn even the simplest summer tasks into more than just a pain in the neck. Aging, stress, and joint trauma can hasten the deterioration of joint cartilage in osteoarthritis sufferers, leaving the ends of the bone within the joint unprotected. The resulting swollen knees, morning stiffness, and muscle spasms can make it hurt to move. Even climbing the stairs can become a challenge.

Hiroshi Nakazawa, M.D., a member of the American Academy of Medical Acupuncture (AAMA) with a private practice in Baltimore, M.D., uses medical acupuncture to relieve osteoarthritis pain, a treatment practiced by trained, licensed physicians that combines conventional Western medicine with acupuncture techniques.

"Medical acupuncture helps improve the natural mental and physical balance in the body within six to 12 sessions, and can decrease or eliminate dependency on pills, steroids and injections." said Dr. Nakazawa. "Inserting acupuncture needles into points on the body helps relieve local joint pain by increasing blood supply and releasing endorphins."

Dr. Nakazawa's osteoarthritis therapy also includes patient diet and exercise plans. "Weight control and a healthy, active lifestyle prevents added stress on weight-bearing joints and improves muscle strength and flexibility," he said.

Frequently Asked Questions?

How many sessions does it take?
If you are going to be helped by acupuncture, you will know in two to three sessions! However, the number of sessions until resolution to the condition varies with each person and each situation.

What kind of needles do you use?
Disposable, stainless steel, surgically pre- sterilized ultra-thin needles.

Does it hurt?
The acupuncture experience is different for each individual. When the delicate pins are inserted, a range of sensations may initially include a tingling sensation, pressure or an energetic feeling; this phase is quickly followed by a quality of deep relaxation and rest.

What are the risks?
There may be some bruising on occasion.