36 – Acupuncture for Pain

Question 1

What is acupuncture?

Answer 1

• Act of placing a solid needle into a body at specific points to affect a response

Question 2

Acupuncture points

Answer 2

• Lie along meridians (aka channels)
• Located by anatomical description and body measurements (‘cun’: width of 2nd last rib of the animal you are working on)
• Largely transposed from human acupuncture maps

Question 3

Traditional Chinese veterinary medicine (TCVM) theory

Answer 3

• Focuses on flow of Qi (energy of life)
• Qi flows along meridians
  o Meridians on body surfaces are connected with inner organs
• Blockage of Qi results in disease and discomfort
• *manipulation of Qi achieved by acupuncture along meridians

Question 4

Acupuncture meridians

Answer 4

• Pathways along which Qi and blood circulate
• Connect internal organs with external body
• Maintain harmony and equilibrium due to smooth Qi flow
• 12 parried meridians corresponding to 12 organs (6 Yin, 6 Yang)
• 2 additional non-paired meridians: governor vessel (dorsal midline) and conception vessel (ventral midline)
• *used for diagnosis and treatment

Question 5

Acupuncture points in TCVM

Answer 5

• Specific points along meridians
• Different types of points
• Some ‘special’ points lie outside meridians (usually species specific)
• *TCVM utilizes Diagnostic Acupuncture Point Exam (“DAPE”)

Question 6

Yin and Yang in TCVM

Answer 6

• Theory: homeostasis between internal and external state
• Opposite and interdependent
• Yin: fluids including blood
  o ‘cold, dark, SOLID, heart, spleen, lungs, kidney
• Yang: nourishment an metabolism (Qi)
  o Light, HOLLOW, SI, stomach, LI

Question 7

What is the 5 element theory in TCVM?

Answer 7

• Categorize organs, tissues, senses and emotions into a ‘SOMA’
• 1. Earth
• 2. Water
• 3. Fire
• 4. Wood
• 5. Metal
• Ex. bomb dog: metal and fire

Question 8

TCVM diagnosis

Answer 8

• DAPE exam
• Yin and Yang theory
• 5 element theory
• *unique treatment regime developed
• *most combine it with Chinese Herbal Therapy
• Might see in small animals: tongue (each area represents a certain meridian) diagnosis and pulse examination (people)

Question 9

Western theory intro

Answer 9

• Incompatible with TCVM system
• Requirement for measurable outcomes
• *Acupuncture proven to influence somato-motor and sensory nerve system
• May (and doss) influence neuro-humoral pathways with CNS
• “neuromodulation” theory

Question 10

Where are many acupuncture points in the Western Theory located?

Answer 10

• Where nerve bundles penetrate the fascia
• In close proximity to major blood vessels, surrounded by small nerve bundles (NAV bundle)
• At motor points, where nerves enter or exit muscle

Question 11

Needle insertion results in

Answer 11

• Microtrauma and neurovascular reactions
  o Release of substance P and histamine
• Stimulates ascending influences on CNS
• Stimulates descending changes (ex. axon reflex)
  o Humans and animals with on hair may feel warmth and have a red flare around needle

Question 12

What are local effects of needle insertion? (western theory)

Answer 12

• Capillary dilation and immune activation
• Tissue repair activation
• Local and supraspinal control
  o Reduce inflammation
  o Normalize circulation

Question 13

What are the systemic effects of needle insertion? (western theory)

Answer 13

• Insertion and manipulation influences myelinated A-beta fibers and unmyelinated C fibers
• Effect on pain perception/modulation
• Release of met-enkephalin, B-endorphin, dynorphins
• Increased serotonin levels

Question 14

Western theory: gate theory

Answer 14

• Acupuncture acts at several levels to modulate peripheral and CNS response to painful stimulus
• ‘gate is closed’=dampening of pain signals to the CNS
  o ‘also push gate shut from above’

Question 15

Acupuncture end result

Answer 15

• Pain relief, decreased inflammation
• Modification of other neuro-humoral pathways?
• Modification of organ function?
• *could it be useful in other ‘states’ and not just pain states

Question 16

What are the different acupuncture techniques?

Answer 16

• *Dry needling: TRUE
• *Electroacupuncture: TRUE
• Para-acupuncture techniques
  o Acupoint injection
  o Moxibustion
  o Laser

Question 17

Dry needling

Answer 17

• Placed at certain points chosen after general physical, lameness evaluation, diagnostic acupuncture point exam +/- TCVM
• Needles left in place for 10-30 mins
• Needle manipulation (ex. twisting, set depth)

Question 18

Electroacupuncture

Answer 18

• Needles placed and low power, variable frequency current applied between needles with electro stimulator
• *electrostimulation for 15-120mins
  o Hard to imagine it stands still or 2 hrs
• Enhances effect
  o Especially pain relief?

Question 19

Acupoint injection

Answer 19

• Hypodermic needles placed at acupuncture points and a substance injected
  o Saline (aquapuncture) mixed with Vitamin B12 solution
  o Low dose drug (pharmacopuncture)
• Enhance, prolong effect of acupuncture
• Reduce effective dose, risk of adverse effects of some drugs?

Question 20

Moxibustion

Answer 20

• Needles placed at acupunctures points
• Moxa (dried leaves of ‘mugwort’) placed on needle and ignited
• Some burn moxa sticks over acupuncture points w/o needles
• Heat may enhance acupuncture effect?

Question 21

Laser

Answer 21

• Low energy laser used on acupuncture points (LLLT)
• Non-invasive, easier and faster than conventional needling
• Very popular for athletic horses with muscle soreness and stiffness (not just at acupuncture points)

Question 22

What are some acupuncture complications in horses (large animals)?

Answer 22

• *Adverse behaviour
• Broken needles (put in large muscles)
• Infection (rarely!)

Question 23

What are some acupuncture complications in small animals?

Answer 23

• *Ingestion of needles
• Pneumothorax (if doing points along the chest, usually not a huge problem)
• Broken needles
• Infection

Question 24

What are some common painful conditions treated with acupuncture?

Answer 24

• *Back, neck pain (large and small animals)
• Adjunctive therapy in rehab
• Acute lameness
• Chronic lameness
• Post surgical pain
• Colic pain in horses

Question 25

What is good scientific evidence?

Answer 25

• Randomized, controlled, blinded
• *adequate numbers
• Study can be independently replicated

Question 26

What is the take home message about evidence-based acupuncture?

Answer 26

• Some evidence to help alleviate pain in horses and small animals (especially soft tissue pain)
• Little or NO good evidence that it is helpful in disease or conditions for which it is routinely prescribed in equine or small animal practice
• Much more research needed!
• *do not employ it w/o a thorough physical exam and appropriate imaging to arrive at a diagnosis