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Trigger Points and Classical Acupuncture Points: Part 3: Relationships of Myofascial Referred Pain Patterns to Acupuncture Meridians
Abstract
Background: In the first part of this study, myofascial trigger point regions were demonstrated to have strong (93.3%) anatomic correspondences with classical acupuncture points. The second portion of this study examined the clinical correspondences of trigger point regions and classical acupuncture points in the treatment of both pain and somatovisceral disorders, and found they had ∼ 97% correlation for treating pain conditions and over 93% correlation in treating somatovisceral conditions. Objective: To examine the relationships of myofascial trigger point regions' referred-pain patterns to the meridian distributions of their anatomically corresponding classical acupuncture points. Methods: The 238 anatomically corresponding trigger point region - classical acupuncture point pairs in part one of this study were analyzed to compare the distributions of their myofascial referred-pain patterns and acupuncture meridians in order to determine if their distributions correlated. Results: Seventeen of the 238 anatomically corresponding trigger point regions had no described myofascial referred-pain. In the remaining 221 trigger point region-classical acupuncture point pairs, 180 (81.5%) demonstrated complete or near-complete correlation, and another 9.5% of point pairs partially showed correlations regarding the distributions of their myofascial referred-pain patterns and associated acupuncture meridians. Conclusions: Only 9% of point pairs showed little or no consistency of their referred-pain patterns and acupuncture meridians. The strong (up to 91%) consistency of the distributions of trigger point regions' referred pain patterns to acupuncture meridians provides a fourth line of evidence that trigger points most likely represent the same physiological phenomenon as acupuncture points in the treatment of pain disorders.
... There has been controversy since the 1970's regarding whether any anatomic, clinical and/or physiologic relationship exists between these "most common" mTrPs described by Travell and Simons (and other MPS researchers) and the classical acupuncture points and primary channels described by Traditional Chinese Medicine millennia previously (20)(21)(22)(23)(24)(25)(26)(27)(28). If those mTrPs and classical acupoints can be shown to be similar anatomically, clinically, and/or physiologically, this not only would allow integration of ancient and contemporary clinical and research databases to optimally treat MPS and other nonpain conditions, but also would have potential importance in elucidating acupuncture's mechanisms. ...
... The only systematic comparison of the complete MPS trigger point database as delineated in the 1 st edition of the Trigger Point Manual to classical acupoints was published in a 3-part series in 2008-2009 by Dorsher and Fleckenstein (12,13,(25)(26)(27). This database was developed in 2006 comparing all 255 of the "most common" mTrPs illustrated in the 1 st edition of the Trigger Point Manual to classical acupoints, including their anatomic locations, their clinical (pain and non-pain) indications, and their physiologic relationships (myofascial referred-pain to primary channel distributions). ...
... The 2006 database also examined the relationships of mTrP myofascial referred-pain distributions illustrated in the Trigger Point Manual to those of the primary channels for each of the 238 anatomically corresponding "most common" trigger point-acupuncture point pairs found (12,13,27). 17 of those mTrPs ("cardiac arrhythmia", "belch button", and "causes diarrhea" mTrPs) have no referred-pain patterns described by the Trigger Point Manual (12). ...
... A 2022 review found that ''the 255 most common trigger points illustrated in the first edition of the Trigger Point Manual are fundamentally similar to classical acupuncture points. . '' 25 Moreover, a 3-part study [26][27][28] reported an anatomical correlation of 93.3%. ...
Background
Pain management is a great burden on society; therefore, cost-effective and nonaddictive treatments for pain are urgently required. Needling of painful spots has been applied in acupuncture along with dry needling <DN) to treat pain without opioids at minimal costs. However, no attempt has been made to examine DN, trigger point(TrP) physiology, and acupuncture to identify potential areas for pain-management research. This review compares the modalities of acupuncture and DN based on the current research on TrP physiology and diagnostics to advance both modalities.
Methods
A narrative review of the literature on TrP physiology, its associated diagnostics, and the techniques of DN and acupuncture was performed.
Results
Diagnostic imagery may benefit the study and treatment of TrPs using needling. Acupuncture and DN techniques are similar in their applications. However, the warm needling technique is established in acupuncture but not in dry needling. Additionally, translational difficulties have inhibited crossdiscipline learning.
Conclusions
Historical evidence suggests a need to examine the use of heat in needling further. Additional research should be conducted on TrP categories to determine if a relationship with the needling technique can be established. Furthermore, interdisciplinary communication would benefit both modalities.
... [16,17] According to the latest acupuncture textbook statistics, the human body has a total of 361 meridian acupoints. [18][19][20] The types of acupuncture treatments included: body acupuncture, scalp acupuncture, auricular acupuncture, electroacupuncture, and acupressure. [21,22] The control group included placebo, sham acupuncture, conventional therapies, or other treatments. ...
Background:
A Hiccup is a common disease that often occurs along with other chronic or acute conditions. At present, there is a lack of feasible therapies for hiccups, and acupuncture is a treatment method with enormous clinical practice worldwide.
Methods:
Based on a pre-defined search strategy, we searched seven databases and screened them by two independent investigators, without language and publication status restriction from inception to date. We use the pre-set form to incorporate data and utilize Revman software to synthesize data. We will evaluate the risk of bias in the inclusion of the study based on the Cochrane 'Risk of bias' assessment tool. The quality of the evidence will be evaluated according to the GRADEpro software.
Results:
This systematic review will evaluate the efficacy and safety of acupuncture treatment for hiccups. The entire process will be referred to the Cochrane handbook recommended by the Cochrane Collaboration.
Conclusion:
This review will provide systematic evidence to summarize whether acupuncture is an effective intervention in the treatment of hiccup.
... Diese lokalen Effekte lassen sich über Faszienverbände hinweg beobachten. Myofasziale Schmerzen wiederum strahlen entlang der beschriebenen Leitbahnverläufe aus [6] und sind mit der Ausbreitung des De-Qi-Gefühls entlang der Leitbahnen vergleichbar. Die "anatomische Übereinstimmung" zwischen einem myofaszialen Triggerpunkt und einem klassischen Akupunkturpunkt betreffend die muskuläre Zielstruktur bei ausreichender Stichtiefe bei einem gedachten Zielareal mit einem Durchmesser von 3 cm liegt bei über 90 % [5]. ...
Although the fascia has been studied for a long time, science has only recently begun to pay more attention to the exploration of this network in our bodies. The essential role the fascia plays for body perception and the mobility of body structures is now being explored. After a brief look at the fascia as a specialized connective tissue, we introduce six of the most important current research areas. These are sports science, myofascial pain research, evolutionary biology, molecular biology, biomechanics, and functional anatomy. The abundance of research areas demonstrates our growing understanding of fascial connective tissues and suggests hope for new clinical approaches, such as in the treatment of lower back pain and in cancer research. © 2018, Springer Medizin Verlag GmbH, ein Teil von Springer Nature.
... Diese lokalen Effekte lassen sich über Faszienverbände hinweg beobachten. Myofasziale Schmerzen wiederum strahlen entlang der be-schriebenen Leitbahnverläufe aus [6] und sind mit der Ausbreitung des De-Qi-Gefühls entlang der Leitbahnen vergleichbar. Die "anatomische Übereinstimmung" zwischen einem myofaszialen Triggerpunkt und einem klassischen Akupunkturpunkt betreffend die muskuläre Zielstruktur bei ausreichender Stichtiefe bei einem gedachten Zielareal mit einem Durchmesser von 3 cm liegt bei über 90 % [5]. ...
Obwohl schon lange mit Faszien gearbeitet wird, schenkt die Wissenschaft erst seit Kurzem der Erforschung dieses Netzwerks in unserem Körper zunehmende Beachtung. So wird die wesentliche Rolle erforscht, die Faszien für die Körperwahrnehmung und die Beweglichkeit der Körperstrukturen spielen. Nachdem wir einen kurzen Blick auf die Faszie als spezialisiertes Bindegewebe geworfen haben, stellen wir 6 der wichtigsten aktuellen Forschungsbereiche vor. Diese finden sich in den Sportwissenschaften, in der myofaszialen Schmerzforschung, im Bereich der evolutionären Biologie sowie der Molekularbiologie ebenso wie in der Biomechanik und der funktionellen Anatomie. Die Fülle an Forschungsgebieten demonstriert unser wachsendes Verständnis von faszialen Bindegeweben und lässt auf neue klinische Ansätze z. B. bei Kreuzschmerzen und in der Krebsforschung hoffen.
... As reported by Melzack et al. (1977), Melzack (1981) and Dorsher (2006), there is a high degree of correspondence (71% based on their analysis) between published locations of TrPs and classical acupuncture points for the relief of pain. However, while some authorities believe that TrPs are nearly always acupuncture points, especially in pain management (Dorsher & Fleckenstein 2009), another well-known Treatment of acute biceps femoris muscle pain 2014 Acupuncture Association of Chartered Physiotherapists acupuncturist (Birch 2003) maintained that, at best, there is only an 18-19% overlap. ...
Pain conditions rank among the top reasons for seeking medical care. The Huangdi Neijing (~200 BCE) first described focal painful muscle sites as well as “classical” acupoints and their therapeutic needling. The Trigger Point Manual (1983) introduced the concept of myofascial trigger points (mTrPs), illustrating their clinically “most common” locations and their treatment using dry needling or local anesthetic injection. In 1977, the first study comparing the use of mTrPs and classical acupoints in treating pain disorders was published, finding for the 58 mTrPs examined, 100% had a proximate acupoint that had a similar pain indication in 71% of comparisons. Our 2008 study extended this analysis to all the Trigger Point Manual's 255 most common mTrP locations, finding that those mTrPs had > 93% anatomic and > 94% pain indication correspondences to classical acupoints. Subsequent publication of new mTrP data and digital 3D anatomy references allow an enhanced ability to explore acupuncture and trigger points' clinical relationships.
The aim of this study was to examine the anatomic correspondences of the most common mTrP locations in the Trigger Point Manual with those of classical acupoints using 3D anatomic references and to explore their clinical correspondences in treating pain conditions.
To allow examination of their spatial relationships, the 361 classical acupoint and 255 most common mTrP locations were placed on their anatomically relevant 3D muscle images using Adobe PhotoshopTM (San Jose, CA). Proximate acupuncture and trigger points entering the same muscle region were defined as anatomically corresponding point pairs. Each point pairs’ clinical pain indications were examined for similarities. Seven new mTrP regions introduced in the Trigger Point Manual (third edition) were analyzed similarly.
Overall, 248 (95%) of the 262 most common mTrP locations anatomically correspond to a classical acupoint location. Anatomically corresponding mTrP–acupoint pairs had similar pain indications in > 97% of comparisons. The statistical odds that these correspondences occurred by chance were calculated to be essentially zero.
This study’s findings of 95% anatomic and > 97% clinical pain indication correspondences between the Trigger Point Manual's most common mTrP and those of classical acupoints provide strong evidence these points are describing the same clinical phenomenon in the treatment of pain.
BACKGROUND: Myofascial trigger points have been widely applied in clinical rehabilitation and tissue pain field in the United States and Europe countries, and they have been recognized as the common cause of clinical musculoskeletal pain, joint function limitation, tissue injuries and muscle fatigue by many physiotherapists abroad. However, in China, many experts still have some mistaken ideas and limitations to understand the pathological mechanism and to diagnosis and treat myofascial trigger points. OBJECTIVE: From the aspects of the etiology, pathological mechanism, diagnosis and positioning, treatments, to elaborate the method issues and the clinical experience of treatments of myofascial trigger points. METHODS: PubMed, ScienceDirect, EBSCO and CNKI databases were searched by the keywords of “myofascial trigger points, myofascial pain syndrome” in Chinese and English, respectively, in the titles and abstract to retrieve relevant articles published from the time of database construction to August 2014. RESULTS AND CONCLUSION: It is concluded that a child has myofascial trigger points in some skeletal muscles after age of 4 years. The main causes of myofascial trigger points include issue trauma, the wrong posture, bone and joint degeneration, nutrition deficiency, mental stress, chronic infection and so on. The pathological mechanism of myofascial trigger points remains unknown, but what has been widely accepted is the integrated trigger point hypothesis introduced by Simons. And how to find and position myofascial trigger points is the key point to treat this disease successfully. The application of myofascial trigger points techniques is important for the rehabilitation of clinical tissue pain and the occurrence and spread of bone and joint injuries, myofascitis, muscle pain, muscle fatigue and so on. © 2014, Journal of Clinical Rehabilitative Tissue Engineering Research. All rights reserved.
Written by two leading experts in the field, Acupuncture in Neurological Conditions aims to improve patient care by combining Western and Traditional Chinese Medicine (TCM) concepts of treatment. The language of TCM is uniquely combined with that of evidence-based clinical reasoning to provide an approach relevant to both acupuncture and physiotherapy clinical practice. All major types of neurological conditions encountered in clinical practical are examined. Chinese medical patterns relevant to the application of acupuncture are described, as well as key patterns of dysfunction based on a Western medical perspective. The place of acupuncture within the overall management of different neurological conditions is also discussed. Clinical reasoning options from both TCM and Western medical perspectives are provided, and illustrated by real cases from clinical practice forming a sound platform for true integrated medicine.
Background
Through the surprising outcome of “sham“ acupuncture in the German GERAC trials, physicians concluded that acupuncture of a neurological segment has benefits similar to the needling of traditional TCM points. Nevertheless, practical experiences with precise and specific needling in microsystems and the traditional meridian system teach us that precise needling on the activated `very point´ results in additional benefit, such as immediate alleviation of acute pain. What implications does this observation have regarding our theories of the mechanisms behind acupuncture?AimDescription and discussion of the benefit of precise needling and its scientific implications.Method
Examples for and accounts of precise acupuncture in literature and experience are documented, and implications are discussed.ResultsMultiple examples taken from literature and own observations suggest that precise needling in microsystems as well as in the acupuncture points of the traditional meridian system produce an additional benefit by immediate alleviation of acute pain.DiscussionAlthough the German GERAC trials reported a significant benefit of needling in the neurological segment, many questions regarding the specifity and effect of acupuncture points have not yet been answered sufficiently. In consequence, the well-known effect of treatment of the neurological segment is discussed for acupuncture therapy. The additional benefit of precise needling in microsystems and traditional Chinese acupuncture with immediate alleviation of acute pain indicate, on the other hand, that we must hypothesize further mechanisms and ways of the effect of acupuncture.
Early written medical sources like the unearthed documents of the tombs of Ma wang dui as well as the classical textbook Huang Di Neijing, appr. 2300 resp. 2000 years old, are investigated to put light on the diverse early acupuncture traditions and their predecessors. The first part of this historical investigation looks particularly at the systems of the main channels/meridians, which were probably preceding the knowledge of singular effective loci. There are no certain but various possible historical explanations for the development of these systems.In the second part we are looking at the ideological base for the existence of 12 meridians and their names. The meaning and function of certain types of tools is described which can only partly be compared to modern day needles. They demonstrate the development of acupuncture, in a quest to move the Qi, from a broader methodology which contained elements of surgery.
Background: Acupuncture methodology has evolved over millennia with the introduction of new technologies. Modern laser "needle" systems can transmit light energy deep enough through the skin to influence channel acupoints and trigger points. Objectives: To compare whether musculoskeletal pain treatment outcomes with acupuncture are clinically equivalent whether using laser or traditional metal needles; and to determine statistical power estimates of cohort size for future double-blinded studies. Design: Prospective nonblinded cohort study using neuroanatomically based point selection in a crossover protocol alternating between laser and metal needles. Setting: Outpatient clinic at Mayo Clinic Florida in Jacksonville, FL. Participants: Thirty adults with degenerative joint or spine pain whose pain did not respond to allopathic interventions and were receiving metal needle acupuncture. Intervention: Laser stimulation at prescribed neuroanatomically based acupoints was alternated at successive treatments with metal needles at the same points for 4 treatment sessions. Main Outcome Measures: Visual analog scale (VAS) (0-10) pain rating, patient preference (metal vs laser), and treatment complications. Results: For shoulder and knee arthritis pain, metal needle treatment pain VAS was 5.9 vs laser VAS of 3.1 (mean difference, 2.8; P < .001). For degenerative spine pain, metal needle VAS was 3.7 vs laser VAS of 2.95 (mean difference, 0.75; P = .05). Ninety percent (9/10) of participants with joint arthritis pain preferred laser treatments and reported more pain relief than similar treatments using metal needles; 80% (16/20) of spine pain participants reported the laser treatments provided at least as much pain relief as similar metal needle treatments. No laser treatment complications were noted. Conclusions: This pilot study of participants with chronic refractory musculoskeletal pain demonstrates that when used in neuroanatomical acupuncture treatments, laser stimulation is preferred and provides superior pain relief compared with metal needle treatments of the same acupoints. The laser "needles" appear to be clinically equivalent to metal needles.
Dry needling is a common treatment technique in orthopedic manual physical therapy. Although various dry needling approaches exist, the more common and best supported approach targets myofascial trigger points. This article aims to place trigger point dry needling within the context of pain sciences. From a pain science perspective, trigger points are constant sources of peripheral nociceptive input leading to peripheral and central sensitization. Dry needling cannot only reverse some aspects of central sensitization, it reduces local and referred pain, improves range of motion and muscle activation pattern, and alters the chemical environment of trigger points. Trigger point dry needling should be based on a thorough understanding of the scientific background of trigger points, the differences and similarities between active and latent trigger points, motor adaptation, and central sensitize application. Several outcome studies are included, as well as comments on dry needling and acupuncture.
Though separated by different millennia, languages, levels of scientific advancement, and views of human physiology, both prehistoric and modern cultures have expressed concepts of evaluating and treating human illness that have remarkable overlap with those of Traditional Chinese Medicine (TCM). These similarities suggest these healing traditions likely are expressing a common, fundamental aspect of human anatomy and/or physiology. Prehistoric, ancient Egyptian, TCM, Mayan, myofascial pain, and myofascial meridian concepts of health and healing are discussed. Anatomical, clinical, and physiologic evidence is presented that suggests neuroanatomy is likely the common thread that unites these ancient and modern healing concepts. These findings should lead to an increased understanding of the anatomical and physiologic substrates of the beneficial clinical effects of acupuncture in treating pain and visceral disorders. This, in turn, should lead to novel, safer treatment techniques that combine modern technologies with ancient clinical acumen.
Background:
Back and neck pain are important health problems with serious societal and economic implications. Conventional treatments have been shown to have limited benefit in improving patient outcomes. Complementary and Alternative Medicine (CAM) therapies offer additional options in the management of low back and neck pain. Many trials evaluating CAM therapies have poor quality and inconsistent results.
Objectives:
To systematically review the efficacy, effectiveness, cost-effectiveness, and harms of acupuncture, spinal manipulation, mobilization, and massage techniques in management of back, neck, and/or thoracic pain.
Data sources:
MEDLINE, Cochrane Central, Cochrane Database of Systematic Reviews, CINAHL, and EMBASE were searched up to 2010; unpublished literature and reference lists of relevant articles were also searched. study selection: All records were screened by two independent reviewers. Primary reports of comparative efficacy, effectiveness, harms, and/or economic evaluations from randomized controlled trials (RCTs) of the CAM therapies in adults (age ≥ 18 years) with back, neck, or thoracic pain were eligible. Non-randomized controlled trials and observational studies (case-control, cohort, cross-sectional) comparing harms were also included. Reviews, case reports, editorials, commentaries or letters were excluded.
Data extraction:
Two independent reviewers using a predefined form extracted data on study, participants, treatments, and outcome characteristics.
Results:
265 RCTs and 5 non-RCTs were included. Acupuncture for chronic nonspecific low back pain was associated with significantly lower pain intensity than placebo but only immediately post-treatment (VAS: -0.59, 95 percent CI: -0.93, -0.25). However, acupuncture was not different from placebo in post-treatment disability, pain medication intake, or global improvement in chronic nonspecific low back pain. Acupuncture did not differ from sham-acupuncture in reducing chronic non-specific neck pain immediately after treatment (VAS: 0.24, 95 percent CI: -1.20, 0.73). Acupuncture was superior to no treatment in improving pain intensity (VAS: -1.19, 95 percent CI: 95 percent CI: -2.17, -0.21), disability (PDI), functioning (HFAQ), well-being (SF-36), and range of mobility (extension, flexion), immediately after the treatment. In general, trials that applied sham-acupuncture tended to produce negative results (i.e., statistically non-significant) compared to trials that applied other types of placebo (e.g., TENS, medication, laser). Results regarding comparisons with other active treatments (pain medication, mobilization, laser therapy) were less consistent Acupuncture was more cost-effective compared to usual care or no treatment for patients with chronic back pain. For both low back and neck pain, manipulation was significantly better than placebo or no treatment in reducing pain immediately or short-term after the end of treatment. Manipulation was also better than acupuncture in improving pain and function in chronic nonspecific low back pain. Results from studies comparing manipulation to massage, medication, or physiotherapy were inconsistent, either in favor of manipulation or indicating no significant difference between the two treatments. Findings of studies regarding costs of manipulation relative to other therapies were inconsistent. Mobilization was superior to no treatment but not different from placebo in reducing low back pain or spinal flexibility after the treatment. Mobilization was better than physiotherapy in reducing low back pain (VAS: -0.50, 95 percent CI: -0.70, -0.30) and disability (Oswestry: -4.93, 95 percent CI: -5.91, -3.96). In subjects with acute or subacute neck pain, mobilization compared to placebo significantly reduced neck pain. Mobilization and placebo did not differ in subjects with chronic neck pain. Massage was superior to placebo or no treatment in reducing pain and disability only amongst subjects with acute/sub-acute low back pain. Massage was also significantly better than physical therapy in improving back pain (VAS: -2.11, 95 percent CI: -3.15, -1.07) or disability. For subjects with neck pain, massage was better than no treatment, placebo, or exercise in improving pain or disability, but not neck flexibility. Some evidence indicated higher costs for massage use compared to general practitioner care for low back pain. Reporting of harms in RCTs was poor and inconsistent. Subjects receiving CAM therapies reported soreness or bleeding on the site of application after acupuncture and worsening of pain after manipulation or massage. In two case-control studies cervical manipulation was shown to be significantly associated with vertebral artery dissection or vertebrobasilar vascular accident.
Conclusions:
Evidence was of poor to moderate grade and most of it pertained to chronic nonspecific pain, making it difficult to draw more definitive conclusions regarding benefits and harms of CAM therapies in subjects with acute/subacute, mixed, or unknown duration of pain. The benefit of CAM treatments was mostly evident immediately or shortly after the end of the treatment and then faded with time. Very few studies reported long-term outcomes. There was insufficient data to explore subgroup effects. The trial results were inconsistent due probably to methodological and clinical diversity, thereby limiting the extent of quantitative synthesis and complicating interpretation of trial results. Strong efforts are warranted to improve the conduct methodology and reporting quality of primary studies of CAM therapies. Future well powered head to head comparisons of CAM treatments and trials comparing CAM to widely used active treatments that report on all clinically relevant outcomes are needed to draw better conclusions.
Background
Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Treatments for neck pain are varied, as are perceptions of benefit. Acupuncture has been used as an alternative to more conventional treatment for musculoskeletal pain. This review summarises the most current scientific evidence on the effectiveness of acupuncture for acute, subacute and chronic neck pain. This update replaces our 2006 Cochrane review update on this topic.
Objectives
To determine the effects of acupuncture for adults with neck pain, with focus on pain relief, disability or functional measures, patient satisfaction and global perceived effect.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Manual, Alternative and Natural Therapy Index System (MANTIS), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Index to Chiropractic Literature (ICL) from their beginning to August 2015. We searched reference lists, two trial registers and the acupuncture database Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS) in China to 2005.
Selection criteria
We included published trials that used random assignment to intervention groups, in full text or abstract form. We excluded quasirandomised controlled trials (RCTs).
Data collection and analysis
Two review authors made independent decisions for each step of the review: article inclusion, data abstraction and assessment of quality of trial methods. We assessed study quality by using the Cochrane Back Review Group ’Risk of bias’ tool. We used consensus to resolve disagreements, and when clinical heterogeneity was absent, we combined studies by using random-effects meta-analysis models.
Main results
Of the 27 included studies, three represented individuals with whiplash-associated disorders (WADs) ranging from acute to chronic (205 participants), five explored chronic myofascial neck pain (186 participants), five chronic pain due to arthritic changes (542 participants), six chronic non-specific neck pain (4,011 participants), two neck pain with radicular signs (43 participants) and six subacute or chronic mechanical neck pain (5,111 participants). For mechanical neck pain, we found that acupuncture is beneficial at immediate-term follow-up compared with sham acupuncture for pain intensity; at short-term follow-up compared with sham or inactive treatment for pain intensity; at short-term follow-up compared with sham treatment for disability; and at short-term follow-up compared with wait-list control for pain intensity and neck disability improvement. Statistical pooling was appropriate for acupuncture compared with sham for short-term outcomes due to statistical homogeneity (P value = 0.83; I² = 20 %). Results of the meta-analysis favoured acupuncture (standardised mean difference (SMD) – 0.23, 95 % confidence interval (CI) –0.20 to –0.07; P value = 0.0006). This effect does not seem sustainable over the long term. Whether subsequent repeated sessions would be successful was not examined by investigators in our primary studies. Acupuncture appears to be a safe treatment modality, as adverse effects are minor. Reported adverse effects include increased pain, bruising, fainting, worsening of symptoms, local swelling and dizziness. These studies reported no life-threatening adverse effects and found that acupuncture treatments were cost-effective. Since the time of our previous review, the quality of RCTs has improved, and we have assessed many of them as having low risk of bias.
However, few large trials have provided high-quality evidence.
Authors’ conclusions
Moderate-quality evidence suggests that acupuncture relieves pain better than sham acupuncture, as measured at completion of treatment and at short-term follow-up, and that those who received acupuncture report less pain and disability at short-term follow-up than those on a wait-list. Moderate-quality evidence also indicates that acupuncture is more effective than inactive treatment for relieving pain at short-term follow-up.
Background: Data from a recently published study suggest that substantial anatomic, clinical, and physiologic overlap of myofascial trigger points (mTrPs) and acupoints exists in the treatment of pain disorders. Objective: To evaluate the anatomic relationships between classical acupoint locations and those of mTrPs both qualitatively and quantitatively. Methods: Graphics software was used to demonstrate the different muscle layers of a virtual, digitized human cadaver. The locations of 255 "common" mTrPs described in the Trigger Point Manual were superimposed as a separate layer to these graphics as were the locations of the 361 classical acupoints and the meridians they exist on. The relationships of the anatomic locations of acupoints and meridians to those of muscles and common mTrPs could then be directly visualized. Classical acupoints and mTrPs that entered the same muscle regions and were physically closest to each other, as confirmed by acupuncture and human anatomy references, were termed "anatomically corresponding" point pairs. A quantitative analysis of these anatomically corresponding mTrP-acupoint pairs was also performed. Results: Of 255 common mTrPs, 238 (93.3 %) had anatomically corresponding classical acupoints. Quantitatively, 89 (37 %) of these 238 corresponding mTrP-acupoint pairs were estimated to be within 1 cm of each other, 107 point pairs (45 %) within 1-2 cm of each other, and another 32 point pairs (13 %) within 2-3 cm of each other. Trigger-acupuncture point correspondences would rise to 95.7 % if six other common mTrPs are considered anatomically corresponding. Conclusions: Analysis of the relationships of the anatomic locations of mTrPs and acupoints while adhering to the modern conceptualization of myofascial pain as a regional muscle disorder demonstrates ≥ 93.3 % anatomic correspondence of common mTrPs to classical acupoints.
A review is made of recent studies on myofascial trigger points (MTrP) and their mechanism is discussed. Clinical and basic science studies have shown that there are multiple MTrP loci in a MTrP region. A MTrP locus contains a sensory component (sensitive locus) and a motor component (active locus). A sensitive locus is a point from which tenderness or pain, referred pain, and local twitch response can be elicited by mechanical stimulation. Sensitive loci (probably sensitised nociceptors) are widely distributed in the whole muscle, but are concentrated in the endplate zone. An active locus is a site from which spontaneous electrical activity can be recorded. Active loci appear to be dysfunctional endplates since spontaneous electrical activity is essentially the same as the electrical activity reported by neurophysiologists as that recorded from an abnormal endplate. A MTrP is always found in a taut band which is histologically related to contraction knots caused by excessive release of acetylcholine in abnormal endplates. Both referred pain and local twitch response are mediated through spinal cord mechanisms, as demonstrated in both human and animal studies.
The pathogenesis of MTrPs appears to be related to integration in the spinal cord of response to the disturbance of nerve endings and abnormal contractile mechanism at multiple dysfunctional endplates. There are many similarities between MTrPs and acupuncture points including their location and distribution, pain and referred pain patterns, local twitch responses (de qi), and possible spinal cord mechanism.
An abstract is not available.
Background: Anatomic comparisons of the locations of myofascial trigger points (mTrPs) to those of classical acupuncture points in the first part of this study showed that at least 238 (93.3 %) of 255 "common" mTrPs described by the Trigger Point Manual have proximate, anatomically corresponding classical acupoints that anatomy references document enter the same muscle regions of those mTrPs. Objectives: To determine whether these correlated common mTrP-classical acupoint pairs have similar indications for treating pain and somatovisceral disorders. Methods: The clinical indications of the 238 anatomically corresponding classical acupoints were examined in acupuncture references to determine whether they include indications for treating pain and/or somatovisceral disorders that are comparable to those described for their correlated common mTrPs by the Trigger Point Manual. Results: 93 % (221/238) of the correlated common mTrPs have pain indications described by the Trigger Point Manual. Of their anatomically corresponding classical acupoints, 208/221 (94 %) have similar regional pain indications described, and another 6 (3 %) of these acupoints have indications for painful conditions in the distributions of their correlated mTrPs' described referred-pain. Only 7 classical acupoints that anatomically corresponded to common mTrPs had no comparable pain indications. The Trigger Point Manual describes somatovisceral effects for 60 (24 %) of its common mTrPs. Of their anatomically corresponding classical acupoints, 82 % (49/60) have "definite" and another 11 % (7/60) have "probable" clinical correspondences of their somatovisceral effects. Conclusions: The marked correspondences of the pain indications (up to 97 %) and somatovisceral indications (up to 93 %) of anatomically corresponding common mTrP-classical acupoint pairs provide a second, clinical line of evidence that trigger points and acupuncture points likely describe the same physiologic phenomena.
Akupunktur gehört in Deutschland zu den
am häufigsten in Anspruch genommenen
komplementärmedizinischen Therapieverfahren.
Seit 2000 wurden 3 große Projekte
(Modellvorhaben nach SGB V) durchgeführt
mit dem Ziel, Wirksamkeit, Sicherheit
und Wirtschaftlichkeit der Akupunktur bei
Patienten mit chronischen Kopfschmerzen,
LWS-Schmerzen und Arthroseschmerzen
zu untersuchen. Es zeigte sich eine Überlegenheit
der Akupunktur gegenüber konventioneller
Standardtherapie, einer Behandlung
ohne Akupunktur und gegenüber
einer Wartelistengruppe. Eine Überlegenheit
der Akupunktur gegenüber einer
Sham-Akupunktur fand sich nur bei Gonarthrose,
während bei anderen Indikationen
beide Akupunkturformen ähnlich erfolgreich
waren. Inwieweit Akupunktur primär
über spezifische oder unspezifische
Mechanismen wirkt, scheint somit diagnoseabhängig
und sollte weiter untersucht
werden.
In Germany, acupuncture is one of the most
frequently used complementary and alternative
therapies. In the year 2000, we initiated
three large projects in co-operation
with statutory health insurance companies
to assess the effectiveness, safety
and costs of acupuncture in patients with
chronic headache, low back pain and pain
due to osteoarthritis. Our findings showed
that acupuncture was more effective than
conventional standard treatment, treatment
without acupuncture or a waiting list
control. A significant difference between
acupuncture and sham acupuncture was
only seen for arthritis of the knee; for the
other diagnoses, both forms of acupuncture
showed similar effects. Whether the effects
of acupuncture are due primarily to
specific or unspecific mechanisms appears
to depend on the diagnosis and should be
investigated in further studies.
We present a novel point-based rendering approach based on object-space point interpolation. We introduce the concept of a transformation-invariant covariance matrix of a set of points to efficiently determine splat sizes in a multiresolution hierarchy. ...
Trigger points associated with myofascial and visceral pains often lie within the areas of referred pain but many are located at a distance from them. Furthermore, brief, intense stimulation of trigger points frequently produces prolonged relief of pain. These properties of trigger points--their widespread distribution and the pain relief produced by stimulating them--resemble those of acupuncture points for the relief of pain. The purpose of this study was to determine the correlation between trigger points and acupuncture points for pain on the basis of two criteria: spatial distribution and the associated pain pattern. A remarkably high degree (71%) of correspondence was found. This close correlation suggests that trigger points and acupuncture points for pain, though discovered independently and labeled differently, represent the same phenomenon and can be explained in terms of the same underlying neural mechanisms. The mechanisms that play a role in the genesis of trigger points and possible underlying neural processes are discussed.
Thirty-five RCTs covering 2861 patients were included in this systematic review. There is insufficient evidence to make any recommendations about acupuncture or dry-needling for acute low-back pain. For chronic low-back pain, results show that acupuncture is more effective for pain relief than no treatment or sham treatment, in measurements taken up to three months. The results also show that for chronic low-back pain, acupuncture is more effective for improving function than no treatment, in the short-term. Acupuncture is not more effective than other conventional and "alternative" treatments. When acupuncture is added to other conventional therapies, it relieves pain and improves function better than the conventional therapies alone. However, effects are only small. Dry-needling appears to be a useful adjunct to other therapies for chronic low-back pain.
The support for the principles of evidence-based medicine has increased within the field of complementary and alternative medicine (CAM). The objective of this chapter is to determine the effectiveness of CAM therapies compared to placebo, no intervention, or other interventions for acute/subacute and chronic non-specific low back pain (LBP). Results from Cochrane reviews on acupuncture, botanical medicine, massage, neuroreflexotherapy, and spinal manipulation have been used. The results showed that acupuncture is more effective than no treatment or sham treatment for chronic LBP but that there are no differences in effectiveness compared with other conventional therapies. Specific botanical medicines can be effective for acute episodes of chronic non-specific LBP in terms of short-term improvement in pain and functional status; long-term efficacy was not assessed. Massage seems more beneficial than sham treatment for chronic non-specific LBP but effectiveness compared with other conventional therapies is inconclusive. Neuroreflexotherapy appears to be more effective than sham treatment or standard care for chronic non-specific LBP. Spinal manipulation was more effective than sham manipulation or ineffective therapies, and equally effective as other conventional therapies. In summary, the results on CAM therapies for (acute episodes of) chronic LBP are promising but more evidence on the relative cost-effectiveness compared to conventional treatments is needed.
In Germany, acupuncture is one of the most frequently used complementary and alternative therapies. In the year 2000, we initiated three large projects in co-operation with statutory health insurance companies to assess the effectiveness, safety and costs of acupuncture in patients with chronic headache, low back pain and pain due to osteoarthritis. Our findings showed that acupuncture was more effective than conventional standard treatment, treatment without acupuncture or a waiting list control. A significant difference between acupuncture and sham acupuncture was only seen for arthritis of the knee; for the other diagnoses, both forms of acupuncture showed similar effects. Whether the effects of acupuncture are due primarily to specific or unspecific mechanisms appears to depend on the diagnosis and should be investigated in further studies.
Systematic review.
To determine the effects of acupuncture for individuals with neck pain.
Neck pain is one of the 3 most frequently reported complaints of the musculoskeletal system. Treatments for neck pain are varied, as are the perceptions of benefits. METHODS.: We searched CENTRAL (2006, issue 1) and MEDLINE, EMBASE, MANTIS, Cumulative Index to Nursing and Allied Health Literature from their beginning to February 2006. We searched reference lists and the acupuncture database TCMLARS in China. Any published trials using randomized (RCT) or quasi-randomized (quasi-RCT) assignment to the intervention groups, either in full text or abstract form, were included.
We found 10 trials that examined acupuncture treatments for chronic neck pain. Overall, methodologic quality had a mean of 2.3 of 5 on the Jadad scale. For chronic mechanical neck disorders, there was moderate evidence that acupuncture was more effective for pain relief than some types of sham controls, measured immediately posttreatment. There was moderate evidence that acupuncture was more effective than inactive, sham treatments measured immediately posttreatment, and at short-term follow-up (pooled standardized mean difference, -0.37; 95% confidence interval, -0.61 to -0.12). There was limited evidence that acupuncture was more effective than massage at short-term follow-up. For chronic neck disorders with radicular symptoms, there was moderate evidence that acupuncture was more effective than a wait-list control at short-term follow-up.
There is moderate evidence that acupuncture relieves pain better than some sham treatments, measured at the end of the treatment. There is moderate evidence that those who received acupuncture reported less pain at short-term follow-up than those on a waiting list. There is also moderate evidence that acupuncture is more effective than inactive treatments for relieving pain posttreatment, and this is maintained at short-term follow-up.
Yellow Emperor's Inner Classic
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(UK): Primal Pictures, Ltd; 2006.
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