Chapter 23 Acupuncture Flashcards
KEY POINTS 1. AP and related techniques trigger a sequence of events that involves the release of endogenous opioid-like substances, monoamine neurotransmitters (e.g., serotonin and norepinephrine), expression of c-fos in CNS, and potential reversal of neuroplasticity in animal models. 2. EA of 2 Hz accelerates the release of enkephalin, beta-endorphin, and endomorphin, while EA of 100 Hz selectively increases the release of dynorphin. 3. PENS and AP-like TENS may present potential applicati
Acupuncture (Jin jiu)
consists of mechanical stimulation via needle insertion and thermal input by moxibustion. AP on the body surface is known as external therapy in
contrast to internal therapy by intake of medication
Taoist philosophy
Tao is the source of all creation and acts through
two opposing but balancing forces: the yin and the yang.
the yin and the yang
Yin implies dark, cold, rest, passivity, inward, decrease, wet, and female. Yang means bright, hot, activity, outward, increase, dry, and male. People exist within the tensions created by these two forces in a dynamic interaction with nature. Illness occurs when yin and yang fall out of balance and harmony. AP restores the balance by promoting yin and yang energy within organ systems.
qi (vital energy)
is fundamental to the
practice of classic AP. Qi is the energy that flows through different “meridians” or channels that connect the internal
body with the external environment
different types of qi that serve functions such as
hereditary, protective,
and nourishing energy
Meridians
The network of meridians
runs around the body while each meridian is associated
with an organ system. There are 12 paired principal, 2 unpaired, and 8 extra meridians
Obstruction of qi may
result in
disequilibrium of yin and yang that may manifest as pain or illness
The meridians emerge at the surface of body via
acupuncture points (acupoints) where external stimulation may modulate the qi
six pathologic factors that cause disease in TCM (traditional Chinese medicine)
including wind, cold, heat, dampness, dryness, and fire
The four steps in assessing a patient’s symptoms are
observation; listening and smelling; palpation; history taking. The goal is to assess balance of yin and yang, and to gain insight into other symptoms
Eight diagnostic principles for symptom classification including
yin or yang, external or internal, cold or hot, and deficiency or excess
TECHNIQUE
The skin is wiped
with an alcohol pad and stretched prior to needle insertion to minimize discomfort. Tubular guides can assist needle
insertion. The usual angle of insertion is perpendicular
or oblique
Acupoints
sites of low skin resistance and accessible for stimulation
An acupoint is identified by its
meridian, a Chinese name and number
Acupoints are located
through anatomic landmarks such as
bony structures, muscles, and external features
The cun
a defined unit of measurement to locate acupoints via specific
landmarks, is the distance between the joint creases of
interphalangeal joints of a patient’s flexed middle finger or equivalent to the width of patient’s thumb
The insertion of the needle is usually accompanied by
“deqi” (obtaining qi) described as soreness, heaviness, and
numbness around the site
The disposable stainless
steel needle
consists of a body or shaft with a handle. Common sizes are 30 to 32 gauge with lengths ranging
from 20 to 125 mm. Manipulation of needle depends on either an excess or deficiency state of the qi
Proposed Mechanism of AP
cause release of various endorphins and monoamine neurotransmitters in both the peripheral nervous system and central nervous system (CNS). AP activates sensory nerve fibers in muscles and sends signals to the spinal cord. This activates other centers in the midbrain and hypothalamic–pituitary axis that cause the release of neuropeptides.
Effect of the neuropeptides and neurotransmitters
Enkephalin and dynorphin are released at the level of the spinal cord and may block afferent pathways. Enkephalin produced at midbrain may stimulate
the inhibitory raphe descending system and release monoamines
serotonin and norepinephrine. These neurotransmitters
may further block pain transmission in the spinal
cord. Beta-endorphin released from the hypothalamic– pituitary axis may result in analgesia through both the systemic circulation and CSF
Functional MRI (fMRI)
a noninvasive technique that depends on differences in the relative concentration of oxygenated to deoxygenated hemoglobin within the brain in response to stimuli
Hypothesizes on how AP works
Fang and colleagues hypothesized that AP mediates analgesia,
anxiolysis, and other therapeutic effects via an
intrinsic neural circuit that plays a central role in the affective and cognitive dimensions of pain as well as in the regulation and integration of emotion and memory processing and autonomic, endocrine, immunologic, and sensorimotor functions.
Kim and colleagues proposed that needle manipulation enhanced analgesia by suppression of the transcription of pain-related genes
Indications of AP
AP and stimulation were effective in the short-term management of low back pain (LBP), neck pain, and osteoarthritis of the knee
Common adverse effects of AP
bleeding or hematoma, pain, and vegetative
symptoms. pneumothorax and injury to the CNS.
PRECAUTIONS AND RELATIVE
CONTRAINDICATIONS
Pregnancy is a relative contraindication due to potential induction of premature labor. Bleeding diathesis and anticoagulant
therapy may result in bleeding and hematoma
formation. Steroids should be discontinued prior to therapy if possible due to attenuation of AP effects. Heavy meals and alcohol prior to AP is imprudent due to risk of vasovagal symptoms. Caution should be exercised when
performing AP over the thoracic region in compromised patients. Care should be taken to avoid electromagnetic interference associated with EA and pacemakers
AP is most likely to benefit patients with
back pain, neck pain, tension headache, migraine, and knee
osteoarthritis (OA), acute migraine attacks
AP-like TENS is superior to conventional TENS because
it produces prolonged
analgesia and thus does not have to be used continuously.
One 30-min treatment session a day (or twice a week) is sufficient therapy using AP-like TENS for chronic pain
Relationship between trigger points and acupuncture
trigger points and acupuncture points for pain, although discovered independently and labeled differently, represent the same phenomenon and can be explained in terms of the same underlying neural mechanisms
