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Use of Dr. Tan's Chinese Balance Acupuncture For Treatment of Chronic Neck–Shoulder Pain

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  • Clinic of Specialists in Integrative Medicine Rishon LeZion, Israel
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Use of Dr. Tan's Chinese Balance Acupuncture For Treatment of Chronic Neck–Shoulder Pain

Abstract and Figures

Introduction: Neck-shoulder pain is a common musculoskeletal problem that is often chronic or recurrent. The mechanism of the neck-shoulder pain musculoskeletal disorder is complicated, multifactorial, and sometimes unclear. Case Presentation: Seven patients presented themselves at an outpatient pain clinic with a chief complaint of chronic neck-shoulder pain that they had had for various time periods. Intervention: Treatment with 45-minute sessions of Dr. Tan’s Chinese Balance Acupuncture. Main Outcome Measures: Pain intensity, pain duration, and the quality of life in the treatment period, and the quality of life during the three-month follow-up after three acupuncture sessions. Results: After the 3rd session (1.5 weeks after the beginning of treatment), the patients reported a complete dissipation of pain or a significant reduction in pain intensity. Also, a substantial improvement in the quality of life during the treatment period and during the three-month follow-up was reported. Conclusions: To date, this is the first case report on the effectiveness of Dr. Tan’s Chinese Balance Acupuncture for treatment of chronic neck-shoulder pain. Studies to confirm the results of the present report are warranted.
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CASE REPORT
Use of Dr. Tan’s Chinese Balance Acupuncture
For Treatment of Chronic Neck–Shoulder Pain
Arkady Kotlyar, PhD, DiplAc, Rina Brener, MD, and Michael Lis, MD
ABSTRACT
Introduction: Neck–shoulder pain is a common musculoskeletal problem that is often chronic or recurrent.
The mechanism of the neck–shoulder pain musculoskeletal disorder is complicated, multifactorial, and
sometimes unclear.
Cases: Seven patients presented at an outpatient pain clinic, each with a chief complaint of chronic neck–
shoulder pain that these patients had had for various time periods.
Intervention: The patients were treated with 45-minute sessions of Chinese Balance Acupuncture per the
protocol of Richard Teh-Fu Tan, OMD, LAc.
Main Outcome Measures: Pain intensity, pain duration, and quality of life (QoL) were measured during the
treatment period, and the QoL was measured during the 3-month follow-up after three acupuncture sessions.
Results: After the third session (1.5 weeks after the beginning of treatment), the patients reported complete
dissipation of pain or significant reductions in pain intensity. There was also substantial improvement in QoL
during the treatment period and during the 3-month follow-up.
Conclusions: To date, this is the first case report on the effectiveness of Dr. Tan’s Chinese Balance Acu-
puncture for treatment of chronic neck–shoulder pain. Studies to confirm the results of the present report are
warranted.
Key Words: Pain, Complementary and Alternative Medicine (CAM), Dr. Tan’s Chinese Balance Acupuncture
INTRODUCTION
Neck–shoulder pain is a common musculoskeletal
problem that is frequently chronic or recurrent.
1
Mus-
culoskeletal pain often co-occurs with sleep disturbances.
2
The mechanism of the neck–shoulder pain musculoskel-
etal disorder is complicated, multifactorial, and sometimes
unclear.
3
However, it is known that changes in physical
activity and autonomic nervous system regulation may be
involved in the pathogenesis of chronic neck–shoulder
pain.
3
In an investigation conducted by Hallman et al. pa-
tients with neck–shoulder pain were rated to have higher
levels of stress and fatigue, and reduced sleep quality.
3
These patients also had elevated heart rates and reduced
heart rate variability (HRV), especially during sleep.
3
In
addition, the neck–shoulder pain group in this study had a
lower activity level.
3
Changes in HRV reflected an auto-
nomic imbalance associated with chronic musculoskeletal
pain.
3
Moon et al. reported that patients with congenital
monosegment synostosis between spinal levels C-2 and C-6
complained of neck–shoulder discomfort or pain.
4
It was
concluded that spondylosis at the mobile segments in a
synostotic spine is a fusion-related pathology rather than
solely age-related disc degeneration.
4
Although neck and shoulder pain are common, the presenting
symptoms of shoulder and neck pathologies overlap signifi-
cantly.
5
Medical history, physical examination, and imaging
Outpatient Pain Clinic, Kaplan Medical Center, Rehovot, Israel.
MEDICAL ACUPUNCTURE
Volume 28, Number 2, 2016
#Mary Ann Liebert, Inc.
DOI: 10.1089/acu.2015.1156
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studies are often nonspecific.
5
On radiographs and magnetic
resonance imaging (MRI), the absence of abnormalities in the
area of the expected pain source can lead to the conclusion that
symptoms have nonorganic etiology.
5
Yet, abnormal findings
on shoulder and spine images do not necessarily correspond to
the manifestation of pain.
5
Approximately1in25patientsseen
for a presumed shoulder or neck problem may have neck–
shoulder crossover, in which a pathology in one area may be
mistaken for or coexist with the other area.
5
The present case report describes the results obtained
using the Chinese Balance Acupuncture protocol of Richard
Teh-Fu Tan, OMD, LAc, to treat chronic neck–shoulder
pain. One of the unique features of this acupuncture method
is that it is fully based on the Meridian Theory—the diag-
nostic tool historically used in an ancient system for acu-
puncture treatment.
6
CASES
Patient 1
A 70-year-old Caucasian male presented at an outpatient
pain clinic with the chief complaint of chronic right shoulder–
neck pain that he had had for *1 year (Fig. 1). Based on his
X-ray, the patient was diagnosed with pain in the right
cervical facet irradiating to the shoulder, caused by degen-
erative changes in the cervical facet (Fig. 2). About 3
months before, he had already visited the outpatient pain
clinic. He was prescribed Traumeelointment three times
per day, a medial branches block C-3–C-6, and a right
cervical facet block C-5–C-7. None of these procedures
affected the pain. The patient was prescribed acupuncture
treatment.
Patient 2
A 65-year-old Caucasian male presented at an outpatient
pain clinic with the chief complaints of mostly right
shoulder–neck pain and weakness in both hands. The patient
had had these symptoms for *4 months. Based on his
computed tomography (CT) scan, he was diagnosed with
C-2–C-7 disc prolapse and cervical thecal sac compression.
An ultrasound showed tendinitis of the right shoulder and
right C-6 root lesion, and an electromyogram examination
revealed mild sensory axonal polyneuropathy. The patient
was prescribed 1 60-mg capsule of Duloxetine Delayed-
Release Capsules (Cymbalta) per day, 1 dose of acet-
aminophen (Rokacet Plus) 3 times per day, and a cervical
epidural steroid injection. The patient refused to receive the
epidural steroid injection and was prescribed acupuncture
treatment.
Patient 3
A 71-year-old Caucasian male was referred to the pain
clinic with the chief complaints of headache and chronic left
and right neck–shoulder pain that he had had for *1.5
years. Based on his CT examination, he was diagnosed with
diffuse idiopathic skeletal hyperostosis, stenosis in the
cervical region, and pain in the cervical facet. Prior to the
referral to treatment at the pain clinic, he was treated with
600 mg per day of oral etodolac, a nonsteroidal anti-
inflammatory drug (NSAID). During the treatment period of
20 days, the NSAID treatment decreased the intensity of his
pain to a certain extent. He was prescribed acupuncture
treatment.
Patient 4
A 41-year-old Caucasian male was referred to an outpa-
tient pain clinic with the chief complaint of chronic left
shoulder–neck pain that he had had for *15 years.
About 15 years before, this patient underwent surgery to
immobilize recurrent shoulder dislocation by screw fixation.
Postsurgery, pain in the left shoulder appeared and later
became exacerbated to neck–shoulder pain. About 6 years
later, the patient was operated on again twice to excise the
immobilizing screw. Based on a CT examination,
FIG. 1. The neck–shoulder area of pain shown by the patient (in
gray).
FIG. 2. The X-ray depicting neck facet degenerative changes of
Patient 1.
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performed after the third surgery, he was diagnosed with
adhesive capsulitis, also known as ‘‘frozen shoulder,’’
caused by severe degenerative changes in the shoulder joint
(Fig. 3). This patient was prescribed acupuncture treatment.
Patient 5
A 69-year-old Caucasian male was referred to an outpa-
tient pain clinic with the chief complaint of chronic pain in
both shoulders that he had had for *30 years. Based on his
ultrasound examination, he was diagnosed with rotator-cuff
syndrome of the right shoulder and allied disorders, tendi-
nitis and bursitis of the right shoulder, and a bilateral su-
praspinatus tear. In his medical history, it was noted that he
had pharmacologically balanced diabetes mellitus and hy-
pertension, aspirin-treated coagulation defects, ischemic
heart disease, congestive heart failure, and a pacemaker
defibrillator implanted *4 years before. The patient was
prescribed acupuncture treatment.
Patient 6
A 49-year-old Caucasian male was referred to an outpa-
tient pain clinic, with the chief complaint of chronic left
shoulder–neck pain that he had had for *6 months. About
1.5 years before, the patient underwent surgery to immo-
bilize recurrent shoulder dislocation. Postsurgery, left neck–
shoulder pain appeared and increased, especially during
shoulder movements. Based on his MRI, he was diagnosed
with rotator-cuff syndrome of the left shoulder and allied
disorders. An ultrasound examination revealed a partial left
supraspinatus tear. The patient was prescribed acupuncture
treatment.
Patient 7
A 55-year-old Caucasian female was referred to the pain
clinic with the chief complaint of chronic left and right
shoulder pain that she had had for *7 months. Based on her
CT examination, she was diagnosed with rotator-cuff syn-
drome of the right shoulder and allied disorders, and adhe-
sive capsulitis of the left shoulder. The patient was
prescribed 600 mg of daily oral etodolac. During the treat-
ment period of 20 days, the NSAID treatment did not affect
her pain. Thereafter, the patient was prescribed acupuncture
treatment.
METHODS
Outcome Measures
The outcome measures included pain intensity, pain du-
ration, and quality of life (QoL). Pain intensity was rated
using a numeric scale from 0 to 10, in which 0 was defined
as ‘‘no pain at all,’’ 1–3 as ‘‘mild pain,’’ 4–6 as ‘‘moderate
pain,’’ 7–9 as ‘‘severe pain,’’ and 10 as ‘‘the worst imag-
inable pain.’’
7
At baseline, the patients rated their pain in-
tensity as 10.
The outcome measures were documented from the be-
ginning of acupuncture treatment throughout the treatment
period. Prior to each session, all the details related to the
effect of the previous session were recorded carefully in the
patients’ files. After the pain had completely dissipated or its
intensity had significantly decreased, the patients were fol-
lowed up for 3 months.
Diagnostics and Treatment
As the first step, Dr. Tan’s Balance Acupuncture 1–2–3
diagnostics was used to determine the affected meridians.
6
The pain was determined as being a local problem involving
an imbalance of the Shao Yang (Gall Bladder [GB] and
Triple Energizer [TE; San Jao) and hand Yang Ming (Large
Intestine [LI]) meridians (Table 1). Chinese pulse diag-
nostics was used to confirm the involvement of the
diagnosed meridians. An oral informed consent for the
publication of the present case report was obtained from
each patient.
After the ‘‘sick’’ meridians were diagnosed, the second
step was to select two out of the five most popular and
effective Dr. Tan’s systems of meridian interrelations as the
most appropriate treatment. Namely, System 2, the Bie-Jing
(Branching meridian) was chosen to balance the LI and TE;
and System 3, the Biao-Li (Interior–Exterior pairs) was
selected to balance the GB (Table 1).
In System 2, the interrelation of the meridians is based on
their Chinese names. System 2 demonstrates the mutual at-
traction and balance of the Yin–Yang meridians. Foot me-
ridians balance hand meridians and vice versa. Specifically,
foot Jue Yin (Liver meridian [LR]) balances hand Yang Ming
FIG. 3. The computed tomography scan depicting severe de-
generative changes in the left shoulder joint of Patient 4.
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(LI), formerly called hand Jue Yang,andfootShao Yin (KI
meridian) balances hand TE.
System 3 represents the Zang Fu interior and exterior
counterparts. Namely, foot Jue Yin (LR) treats foot Shao
Yang (GB) and vice versa. The meridians defined by even
systems (2 and 4) are punctured either ipsi- or con-
tralaterally, while those defined by uneven systems (1, 3,
and 5) are punctured contralaterally only. Considering that
both an even and an uneven system were selected for
treatment, contralateral acupuncture was applied.
Finally, the third step was to determine the treating points
along the LR and KI meridians (Table 1). The Reverse
Mirroring Format, in which the foot–ankle mirrors the
neck–shoulder area and vise versa, was used (Fig. 4). In
other words, an image of the painful neck–shoulder area on
the foot–ankle area was expected to contain Ashi points
along the LR and KI meridians. The Ashi points were found
above the medial malleolus, approximately up to SP 6. They
were punctured using oblique insertion of 0.25·50–mm
silicone-covered, sterile acupuncture needles (Best Needles,
HaMillenium Chinese Medicine, Israel; Fig. 5). Acupuncture
sessions lasted at least 45 minutes, and three such sessions
were performed in the course of 1.5 weeks.
The data were analyzed using an analysis of variance:
two-factor without replication analysis. The value of
p£0.05 was considered significant.
RESULTS
The acupuncture treatment did not cause any pain or
discomfort. No adverse events occurred during or after the
acupuncture treatment.
Pain Intensity
A gradual dissipation of pain or a significant decrease of
its intensity in the neck–shoulder area was reported by the
patients following three acupuncture sessions (1.5 weeks
after the beginning of treatment; Fig. 6). According to the
patients’ reports, the improvement started during the first
Table 1. 1–2–3 Balance Acupuncture Summary
Steps Meridian(s) and points
1 Diagnosing the ‘‘Sick’’ meridian(s) GB, SJ, LI
2 Determination of ‘‘Treating’’ meridians
based on the 5 Systems
System 2: Biao-Li (Interior–Exterior pairs) LR, KI
System 3: Bie-Jing (Branching meridian)
3 Point selection Ashi points along LR and KI meridians,
above the medial malleolus of the
contralateral leg, *up to SP 6
GB, Gallbladder meridian; SJ, San Jao meridian; LI, Large Intestine meridian; LR, Liver meridian; KI, Kidney meridian; SP, Spleen meridian.
FIG. 4. Illustration of the neck–shoulder pain area projection to
the contralateral foot–ankle.
FIG. 5. Representation of oblique acupuncture of the Ashi
points covering the LR and KI meridians.
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session. Following the first session, the patients reported a
significant decrease in pain intensity from 10 to 5.5 0.5
(mean standard error [SE]; p=0.00002). After the second
session, an additional significant decrease of pain intensity
to 3.07 0.3 (mean SE; p=3.04E-
10
) was reported. Post
the third session, 1 patient reported a complete dissipation of
pain, and the rest of the patients reported significant de-
creases in its intensity to 0.88 0.09 (mean SE;
p=8.5E-
15
). No statistical difference among the results re-
ported by the patients post each session was found ( p>0.1).
In patient 1, no severe irreversible damage was diag-
nosed. Hence, the effect of the treatment was sustained and
long-lasting. During the follow-up period of *3 months
after the third session, patient 1 did not report any pain.
In the other patients, the pain was associated with severe
irreversible damage to anatomical integrity. A cervical root
lesion and sensory axonal polyneuropathy diffuse idiopathic
skeletal hyperostosis and stenosis in the cervical region, and
severe degenerative changes in the shoulder joint were di-
agnosed in patients 2, 3, and 4, respectively. Rotator-cuff
syndrome of the right shoulder was diagnosed in patients 5,
6, and 7. To keep the intensity of pain as low as possible,
these 6 patients continued treatment after the third session.
Pain Duration
Following the first two sessions, patient 1 (without severe
irreversible damage) reported a recurrence of pain with a
decreasing intensity, but the pain was not constant. Pain
duration decreased from constant before the beginning of
treatment to 7 1 hour (420 60 minutes) after the first
session, 30 15 minutes after the second session, and no
pain after the third session (Fig. 7).
To keep the duration of pain as short as possible for the
other 6 patients, they continued treatment after the third
session.
Quality of Life
Throughout the treatment period, starting post 1st session,
the patients reported a dramatic improvement in their
quality of night sleep as well as gradual, improved ability to
move their upper extremities and considerable improvement
in their QoL. During the follow-up period of *3 months
after the third session, no pain or a significantly decreased
intensity of pain was reported.
DISCUSSION
Chronic pain is a widespread problem that is a significant
burden on society.
8
The response of the healthcare system to
the issue of chronic pain can be generally divided into
several approaches. Among these approaches, the following
can be taken into consideration and discussed.
Invasive Treatment
Intravenous (IV) sedation analgesia is often used in pa-
tients with chronic spinal pain undergoing diagnostic spinal
injection procedures.
8
The drugs used for IV sedation an-
algesia produce varying degrees of sedation, amnesia, an-
xiolysis, muscle relaxation, and analgesia.
9
However, there
is no consensus with regard to the use of sedation analgesic
measures prior to controlled diagnostic blocks and the in-
fluence of these measures on the accuracy and validity of a
diagnosis.
9
The immediate pain relief caused by cervical
FIG. 6. The intensity of pain throughout the 1.5-week acupuncture treatment period, assessed by using a numeric pain-rating scale,
expressed as mean standard error. * Indicates statistical significance of the result.
CHINESE BALANCE ACUPUNCTURE FOR NECK–SHOULDER PAIN 5
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and lumbar-facet controlled nerve blocks is not enhanced by
IV sedation with midazolam or fentanyl.
9
This is especially
true if stringent outcome criteria are used, such as at least
75% pain relief combined with an increase in range of
motion for pain-limited movements.
9
Wu et al. investigated pulse radiofrequency stimulation
applied to the suprascapular nerve for adhesive capsulitis
lesioning.
10
The combination of pulse radiofrequency
stimulation with physical therapy provided better and faster
relief from pain, reduced disability, and improved passive
range of motion, an effect that persisted for at least 12
weeks.
10
Smith et al. investigated the use of cervical radio-
frequency neurotomy for symptoms associated with chronic
whiplash disorder.
11
The results of this study showed an
attenuation of the psychophysical measures of augmented
central pain processing and improved cervical movement.
11
Work by Fernandes et al. suggested that suprascapular
nerve block is reproducible, reliable, widely used in clinical
practice, and an extremely effective treatment method for
addressing chronic diseases that affect the shoulder.
12
Findings of a study performed by He et al. suggested that
coblation is an effective, safe, minimally invasive, and less-
uncomfortable procedure for treating discogenic upper-back
pain.
13
Noninvasive Treatment
Pain-management services focused on opioid pharmaco-
therapy represent one of the noninvasive approaches to
chronic-pain treatment.
8
However, for many patients with
chronic pain, the analgesic efficacy of long-term opioids is
limited.
8
Furthermore, chronic exposure to opioids can re-
sult in opioid misuse, addiction, and risk of overdose.
8
Therefore, nonopioid treatment options are warranted.
8
Novel pharmacologic nonopioid agents may eventually
prove to be the most effective method of ameliorating the
symptoms and adverse consequences of chronic pain.
8
The
pain-management approach of the future may use multi-
modal interventions that combine cognitive training regi-
mens with somatic therapies (e.g., physical therapy,
massage, and/or acupuncture).
8
In a study by Andersen et al., patients with chronic
nonspecific pain in the neck–shoulder region were ran-
domized to 10 weeks of 3 ·20 minutes of scapular function
training.
14
According to the results of the study, scapular-
function training is effective in reducing pain in adults with
chronic nonspecific pain in the neck–shoulder region.
14
Lidegaard et al. investigated the acute and longitudinal
effects of resistance training on occupational muscle ac-
tivity in office workers with chronic neck–shoulder pain.
15
Acute response to a single session of resistance training
appeared to generate an unfavorable muscle activity pat-
tern.
15
Only the changes following 10 weeks of resistance
training were beneficial in terms of longer and more fre-
quent periods of complete muscular relaxation and reduced
pain.
15
TCM Acupuncture
Every year, *3 million American adults receive Tradi-
tional Chinese Medicine (TCM) acupuncture treatment.
16
Chronic pain is the most common complaint for which TCM
acupuncture is known to have analgesic physiologic
FIG. 7. The duration of pain throughout the 1.5-week acupuncture treatment period, expressed in minutes as mean standard error
(SE). e, constant.
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effects.
16
However, there is no accepted mechanism by
which it could have persisting effects on chronic pain.
16
Although TCM acupuncture is widely used for chronic
pain, considerable controversy regarding TCM’s value for
addressing chronic pain still remains.
16
Vickers et al.
conducted a systematic review to identify randomized
trials using TCM acupuncture to treat chronic pain, in-
cluding nonspecific neck and shoulder pain.
16
The indi-
vidual patient data meta-analyses in this review were
conducted using data from 29 of 31 eligible trials, with a
total of 17,922 patients analyzed.
16
TCM acupuncture was
found to be effective for treating chronic pain and, there-
fore, is a reasonable referral option.
16
Significant differ-
ences between true and sham acupuncture indicated that
acupuncture is more than a placebo.
16
To summarize, TCM acupuncture continues to gain ad-
ditional data confirming its effectiveness for treating various
disorders.
Dr. Teh-Fu Tan’s Chinese Balance Acupuncture
Method
As opposed to TCM, Chinese Balance Acupuncture is
fully based on the Meridian Theory, which has been his-
torically used as a diagnostic tool for effective acupuncture
treatment.
6
In TCM acupuncture, the Zang Fu diagnosis of
Chinese Herbal Medicine is used.
6
This diagnosis includes
such notions as Liver Qi Stagnation, Spleen Qi Deficiency,
Blood Vacuity, and more.
6
Certainly, the method of treatment detailed in the present
case report is not the first and only instance in which Dr. Tan’s
Chinese Balance Acupuncture has been used successfully.
Actually, it is fully based on the IChing(Yi Jing or Book of
Changes) Balance Acupuncture. This ancient method relies
on the interrelations of the acupuncture meridians, an idea
first introduced by Dr. Chao Chen, LAc, Taiwan.
17
The
interbalancing relations of the acupuncture meridians are
summarized in the following five most efficient systems
6,17
:
1. Chinese meridian name sharing. The first system
is based on the pairings of the acupuncture layers (i.e., the
hand Tai Yang [SI] and the foot Tai Yang [BL] balance each
other). Consequently, the hand and foot Yang meridians
balance each other, and the hand and foot Yin meridians
balance each other. In this system, the acupoints are punc-
tured on the contralateral side of the body. Thus, balance is
created by the opposite side and opposite extremities. An
exception is the Du (GV) and Ren (CV) meridians, which
also balance each other.
2. Bie-Jing/Branching meridians. In the second
system, the meridians are paired by their Chinese names (i.e.,
the hand Tai Yin [LU] and the foot Tai Yang [UB] balance
each other). Consequently, the hand Yin and the foot Yang
meridians balance each other and vice versa. In addition, the
hand Yang and the foot Yin meridians balance each other and
vice versa. In this system, the acupoints are punctured on
either side of the body. Thus, balance is created by opposite
Yang–Yin polarity and opposite extremities.
3. Biao Li/Interior–Exterior pairs. In the third
system, the meridians are paired according to their Zang Fu
relationship (i.e., the foot Jue Yin (LR) and Shao Yang (GB)
balance each other. This is the only system in which the
hand Yin and Yang meridians balance each other, and the
foot Yin and Yang meridians balance each other. In this
system, the acupoints are punctured on the contralateral side
of the body. Thus, balance is created by the opposite side
and opposite Yang–Yin polarity.
4. The opposite of the Chinese clock. In the fourth
system, the meridians that are opposite on the Chinese clock
(Fig. 8) balance each other (i.e., the foot Tai Yin [SP] bal-
ances the hand Shao Yang [SJ] and vice versa). In this
system, the acupoints are punctured on either side of the
body. Thus, balance is created by the opposite Yang–Yin
polarity.
5. The neighbors of the Chinese clock. In the fifth
system, the hand meridians that are adjacent on the Chinese
clock (Fig. 8) balance the foot meridians and vice versa (i.e.,
the hand Tai Yin (LU) and the foot Jue Yin (LR) balance
each other). Several meridian pairs of the fifth system
overlap those of the first system. In the fifth system, the
acupoints are punctured on the contralateral side of the
body.
FIG. 8. The Chinese clock.
CHINESE BALANCE ACUPUNCTURE FOR NECK–SHOULDER PAIN 7
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Summary
As it can be seen from the above systems, Balance
Acupuncture is a very logical and straightforward method
that covers the whole body. Also, by definition, it is bal-
ancing rather than enforcing or dispersing. Therefore, the
application of this method does not have any contraindica-
tions. However, Balance Acupuncture has some limita-
tions.
6
Rapid and constant aggravation, severely damaged
anatomical integrity, and restricted treatment frequency
limit the efficacy of the method.
6
To strengthen the efficacy of acupuncture treatment, one
must first identify whether a disorder is local or global.
6
Disorders located in restricted areas and barely involving a
systemic response or not involving it at all are referred to as
being local and are treated by local balance acupuncture.
6
Disorders involving a systemic response are referred to as
being global and are treated by global balance acupuncture.
6
After this stage, Dr. Tan’s Balance Acupuncture is incred-
ibly convenient to apply, and its strategy is deducible. The
systematization of an implementation of the I Ching Bal-
ance Acupuncture, named by Dr. Tan ‘‘1–2–3 Acu-
puncture,’’ is one of the components that form Dr. Tan’s
Chinese Balance Acupuncture.
6
It is a three-step process
that includes:
First step—Determination of the involved or ‘‘sick’’
meridians.
Second step—Determination of the balancing meridi-
ans and the system to be used for treatment
Third step—Selection of the acupuncture points to be
punctured for treatment.
The meridians that are adjacent to the location of the
disorder (e.g., pain) are considered to be ‘‘sick.’’ The second
step is to reveal the most appropriate meridian(s) and sys-
tem(s) to be used for balance acupuncture. The third step
relies on whether the disorder is defined as local or global.
An additional factor to be taken into consideration for the
selection of the points to be punctured is anatomical struc-
ture similarity.
6
In the present report, the second step revealed the most
balancing meridians and systems. The cases of neck–
shoulder pain were defined as local disorders. Therefore, the
local balance approach was chosen for acupuncture treat-
ment.
6
Anatomical structure similarity and the results of the
second step led to finding the Ashi points at the anticipated
locations. The third step was implemented following the
detection of the Ashi points.
The efficacy of the above method is best characterized by
the Chinese saying, which translates as ‘‘put a pole under
the sun, and you should immediately see its shadow.’’
6
It
means that, if a disorder is diagnosed correctly and treated
appropriately, the results of the treatment shall appear im-
mediately.
6
The results described in the present case report
support the above. The effectiveness of Chinese Balance
Acupuncture, which is based on ancient Chinese philosophy
and is thousands of years old, is not yet explored.
CONCLUSIONS
To date, this is the first case report on the effectiveness of
Dr. Tan’s Chinese Balance Acupuncture for treatment of
chronic neck–shoulder pain. The method appears to be very
logical, effective, and safe. Although severe and irreversible
damage to the anatomical integrity limits the efficacy of this
method, no effective treatment without limitations or side-
effects is known today. Considering the fact that the method
is balancing rather than dispersing or enforcing, no side-
effects are expected to be related to it. Certainly, studies
validating the efficacy of Dr. Tan’s Chinese Balance Acu-
puncture treatment for neck–shoulder pain of various eti-
ologies are necessary. Also, the absence of any side-effects
caused by Chinese Balance Acupuncture has to be validated
and confirmed in additional studies. Further investigation of
the effectiveness of Dr. Tan’s Chinese Balance Acupuncture
for treatment of various disorders and the limitations of the
method is warranted.
ACKNOWLEDGMENTS
The first author treated the patient, analyzed the data, and
prepared the manuscript. The coauthors are mentors who
contributed equally to this work.
The present work was performed at the Outpatient Clinic
of Pain, Kaplan Medical Center, in Rehovot, Israel. The
authors wish to thank the patients for their willingness to
grant consent to the publication of this report. The authors
also express their gratitude to Dr. Tan, who performed de-
cades of meticulous work to establish a simple, logical, and
effective acupuncture method and now teaches it; and his
teaching assistant Delphine Armand, DVM, LAc.
The present case report is a tribute to Tan, who passed
away at the end of December 2015.
AUTHOR DISCLOSURE STATEMENT
The authors have no conflicts of interest to declare.
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Address correspondence to:
Arkady Kotlyar, PhD, DiplAc
Outpatient Pain Clinic
Kaplan Medical Center
Post Office Box 1
Rehovot 76100
Israel
E-mail: dr.kotlyar@chi-point.com
CHINESE BALANCE ACUPUNCTURE FOR NECK–SHOULDER PAIN 9
FOR REVIEW ONLY
NOT INTENDED FOR DISTRIBUTION
OR REPRODUCTION
... Intensity can be rated using a numeric scale from 0 to 10, in which 0 is defined as ''no disorder at all,'' 1-3 is a ''mild disorder,'' 4-6 is a ''moderate disorder,'' 7-9 is a ''severe disorder,'' and 10 is ''the worst imaginable disorder.'' 9 At baseline, patients are advised to rate disorder intensity as 10. ...
... The Uterus regulates menstruation, conception, and pregnancy, and thus is naturally expected to be involved in gynecologic disorders. 10 The frontal torsal meridians, the foot Shao Yin (KI), foot Yang Ming (ST), and foot Jue Yin (LR), cross the ovaries and Uterus at the same time (Fig. 7). ...
... 12 Yet, the foot Tai Yin participates in the Chong Mai Extraordinary Meridian (the Penetrating Vessel), which starts from the Uterus. 10 Thus, all four frontal torsal meridians can be affected by gynecologic disorders. Taking this into account and leaning on the five most effective Systems of Balance, the balancing meridians can be determined. ...
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Introduction: Acupuncture is one of the branches of Traditional Chinese Medicine dating back almost 5,000 years. Since its establishment, acupuncture treatment has undergone a long course of development and changes. Following a recommendation from the participants of the WHO Consultation on Acupuncture held in 1996, the “Acupuncture: review and analysis of reports on controlled clinical trials” report was published in 2002. The Balance Method of I Ching Acupuncture is fully based on I Ching (Yi Jing, or Book of Changes) and subordinates to the Meridian Theory. This ancient method relies on inter-relations among the acupuncture meridians and allows for effective acupuncture treatment. Discussion: The present review discusses the effect of The Balance Method of I Ching Acupuncture only on a limited number of disorders. However, the same effectiveness of this method is expected for a vast majority of disorders. To ascertain the effectiveness of acupuncture in general and of The Balance Method of I Ching Acupuncture in particular, large studies should be performed. Conclusions: According to a large volume of clinical data obtained by the practitioners of The Balance Method of I Ching Acupuncture, it appears to be a very straightforward, universal, and effective method. Additional meticulous research is required to investigate and reaffirm the consistency and therapeutic value of the reviewed method. KEY WORDS Complementary and Alternative Medicine (CAM), Balance Method of I Ching Acupuncture
... 9,10 Dr. Tan's Balance Method is a Chinese Balance Acupuncture protocol of Richard Teh-Fu Tan, OMD, LAc. 11,12 It is an acupuncture method based on the meridian theory. This protocol consists of 3 steps. ...
... The last step is to determine the points to be used for treatment. 11,12 CASE A 44-year-old woman visited a neurologist in February 2020 with numbness and a tingling sensation on her tongue, lower right lip, and lower right gum; slurred speech; and a dry mouth that worsened 2 weeks after an extraction of her wisdom tooth by an oral surgeon in February 2019. Her complaints worsened especially after she spoke a lot and were reduced with rest. ...
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Background: Third-molar extraction is a common oral surgical procedure that can cause complications. Although rare, nerve injuries that result in permanent neuropathy can occur and include a variety of complaints such as sensory disorders, taste-sensation disorders, speech articulation disorders, etc. Acupuncture is one of several nonpharmacologic therapies that has played a role in managing neuropathic lesions and has been proven to produce good results. Case: A 44-year-old woman with postodontectomy neuropathy developed paresthesia, dysarthria, xerostomia, dysgeusia, pain in the gums and lower right jaw, a chewing disorder, and cephalgia. Her numerical rating scale (NRS) results were: lower right gum pain, 3/10; numbness of the tongue, 4/10; and headache, 1/10. A physical examination revealed dysarthria, a decreased sense of sharpness and dullness in the right mandibular nerve branches, decreased right masseter muscle contractions, and tenderness on the right GB 20 point. Electromyography revealed partial functional lesions in the postganglion at the right fifth cranial nerve. She had body acupuncture therapy at GV 20, GB 20, ST 5, ST 6, ST 7, CV 23, LI 4, HT 5, ST 36, LU 7, and KI 6; ear acupuncture at the Parotid and Shenmen points; and treatment with the Tan Balance Method. Results: After 3 consecutive sessions of acupuncture therapy, this patient's symptoms were reduced. Conclusions: Acupuncture was helpful for reducing paresthesia, dysarthria, xerostomia, dysgeusia, gum and lower right jaw pain, a chewing disorder, and cephalgia in this patient with postodontectomy neuropathy. Clinical trials are needed to support the findings in this case.
... [5][6][7] The meridian balance method is based on the 6 systems of Dr. Tan deriving from 6 principles of traditional knowledge: (1) Chinese meridian name sharing; (2) branching meridians (Bie-Jing); (3) interior-exterior pairs (Biao-Li); (4) Chinese clock opposite; (5) Chinese clock neighbor; and (6) the same meridian. 1,[7][8][9] In 2017, a randomized controlled double-blinded study by Schroeder et al. demonstrated the efficiency of distal needling acupuncture for immediate pain reduction in patients with adhesive capsulitis. 2 However, Kotlyar published 4 clinical articles, 5,6,8,9 based on Dr. Tan's balance method, 1 reporting excellent immediate efficiency but usually requiring between 20 and 60 acupuncture sessions to treat a disease. Therefore, the balanced method acts more as a branch treatment than a root treatment, even when the selection of acupuncture points has been synergized using the Global Balance. ...
... [5][6][7] The meridian balance method is based on the 6 systems of Dr. Tan deriving from 6 principles of traditional knowledge: (1) Chinese meridian name sharing; (2) branching meridians (Bie-Jing); (3) interior-exterior pairs (Biao-Li); (4) Chinese clock opposite; (5) Chinese clock neighbor; and (6) the same meridian. 1,[7][8][9] In 2017, a randomized controlled double-blinded study by Schroeder et al. demonstrated the efficiency of distal needling acupuncture for immediate pain reduction in patients with adhesive capsulitis. 2 However, Kotlyar published 4 clinical articles, 5,6,8,9 based on Dr. Tan's balance method, 1 reporting excellent immediate efficiency but usually requiring between 20 and 60 acupuncture sessions to treat a disease. Therefore, the balanced method acts more as a branch treatment than a root treatment, even when the selection of acupuncture points has been synergized using the Global Balance. ...
Article
The association of acupuncture points requires realization of synergistic combinations to be as effective as possible while avoiding possible aggravations. To this end, the meridian balance method is an effective tool. It is based on the 6 systems of Richard T.-F. Tan, MD, which derive from 6 principles of traditional knowledge: (1) Chinese meridian-name sharing; (2) branching meridians (Bie-Jing); (3) interior-exterior pairs (Biao-Li); (4) Chinese clock opposite; (5) Chinese clock neighbor; and (6) the same meridian. However, the results seem to unstable over time, and, therefore, synergies with "root" treatment based on Japanese meridian therapy could help stabilize the therapeutic effects of the meridian balance method. Japanese meridian therapy uses pulse diagnosis to identify 4 basic primary patterns: (1) Liver Deficiency, generally treated with a combination of acupuncture points LR8-KI10; (2) Kidney Deficiency, treated with LU 5-KI 7; (3) Spleen Deficiency, treated with PC 7-SP 3; and (4) Lung Deficiency, treated with SP 3-LU 9. After reviewing the main principles of Japanese acupuncture, a nondogmatic approach coupling Japanese meridian therapy with Dr. Tan's balance method is proposed in order to use the best of each of the 2 methods in an integrative approach.
... Cela permet ainsi de traiter directement la zone atteinte par massage et mobilisation, et finir éventuellement par un traitement local en cas de contracture persistante [17], seulement s'il n'y a pas d'inflammation aiguë majeure risquant d'aggraver le patient [3-5, 15, 18]. Pour les systèmes avec un numéro impair (n° 1, 3 et 5), il est conseillé de les piquer de manière controlatérale à la symptomatologie si celle-ci est latéralisée, les systèmes de numéro paire (n° 2, 4 et 6) pouvant être piqués indifféremment à droite ou à gauche en fonction des indications révélées à la palpation (tableau 1) [3][4]19]. ...
... Il arrive parfois que l'organisme ne réagisse pas à la palpation des méridiens distaux par rapport à la zone lésée [15]. Dans ce cas il peut être utile d'utiliser les points source (yuan) des méridiens vides à la palpation, ou utiliser une approche basée sur la prise des pouls radiaux [ [8,19,34]. C'est dans une optique d'efficacité qu'il semble intéressant de coupler une approche générale fondée sur les zang fu à celle fondée sur l'équilibre dynamique entre les méridiens, éventuellement associée à l'action locorégionale sur les points détente musculaires (figure 1) [17,35]. ...
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L'association des points d'acupuncture nécessite la réalisation de combinaisons synergiques afin d'être le plus efficace possible tout en évitant d'éventuelles aggravations. A cette fin, l'acupuncture balancée basée sur les 6 systèmes de Richard Tan issus des connaissances traditionnelles (1 er grand méridien, 2 e couche, 3 e intérieur-extérieur, 4 e midi-minuit, 5 e cycle nycthéméral, 6 e méridien lésé) ou l'horloge chinoise (Sven Schroeder) représente un outil mnémotechnique utile en pratique clinique. Intégrée à l'outil des zang fu et aux points détente musculaire, elle permet une approche complète de la pathologie. Un cas clinique utilisant l'acupuncture balancée en analgésie thoracique est aussi présenté. Mots clefs: Acupuncture balancée-méridiens-jingluo-analgésie thoracique. Sumary: The combination of acupuncture points requires the realization of synergistic combinations in order to be as effective as possible while avoiding possible aggravations. To this end, balanced acupuncture based on the 6 systems of Richard Tan derived from traditional knowledge (1 rst chinese meridian name, 2 nd branching meridians, 3 rd interior-exterior pairs, 4 th opposite clock, 5 th neighbouring channels, 6 th affected meridian) or the Chinese clock (Sven Schroeder) represents an useful mnemonic tool in clinical practice. Integrated into the zang fu tool and trigger points, it allows a complete approach in pathology. A clinical case using balanced acupuncture in thoracic analgesia is also presented.
... 6 ( Fig. 3) After the ''sick'' meridians were diagnosed, balancing meridians were chosen from the five most popular and effective systems of meridian interrelations in ICBA. 7 Chinese pulse diagnostics was used to confirm the involvement of the diagnosed meridians as has been described by Tan. 8 Both patients were treated with 60-minute ICBA sessions twice per week. Acupuncture points were punctured, using 0.22 · 30mm, U.S. Food and Drug Administration-approved, sterile acupuncture needles with copper handles and silicone cooling. ...
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Background: Trigeminal neuralgia (TN) is the most common cranial neuralgia in adults, with a slightly higher incidence in women than in men. This chronic pain condition affects the trigeminal nerve, known as the 5th cranial nerve. It is one of the most deeply distributed nerves in the head. Antiepileptic drugs represent the main medical treatment of TN. However, TN is not the only source of facial pain. Background persistent idiopathic facial pain (PIFP) is also a chronic disorder, recurring daily for more than two hours per day over more than three months. PIFP occurs in the absence of a neurological deficit. The underlying pathophysiology of TN and PIFP is still unknown, and treatment options are not sufficiently evaluated. Nevertheless, neuropathic mechanisms may be relevant in both TN and PIFP. Cases: A 65-year-old Caucasian female suffering from left facial pain was diagnosed by a neurologist with TN ~2.5 years prior to turning to acupuncture treatment. A 42-year-old Caucasian female suffering from left and right facial pain was diagnosed by a neurologist with PIFP ~3 years prior to commencing acupuncture treatment. The cause of facial pain was treated with 60-minute sessions of I Ching Balance Acupuncture (ICBA) twice per week. Prior to each session, the effect of the previous session was carefully recorded in the patients' files. Results: A complete dissipation of pain was achieved after 29 and 60 ICBA sessions in the TN and the PIFP patient, respectively. Conclusions: The present article is the one of the first to demonstrate the efficacy of ICBA treatment for refractory facial pain. As it is shown in the present work ICBA treatment successfully affects facial pain of different types. However, additional larger-scale studies are necessary to validate the efficacy of ICBA in TN and PIFP treatment.
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Introduction: Surgical menopause is associated with symptoms that can significantly affect a woman's quality of life (QOL). These symptoms include migraines, insomnia, and depression. Case Presentation: A 45-year-old Caucasian female presented herself at the acupuncture clinic. Fourteen years before that, the patient was diagnosed with ovary carcinoma, underwent ovariectomy, and was prescribed hormonal replacement therapy (HRT). Deteriorating QOL caused the patient to seek acupuncture treatment for migraines, insomnia, and depression. Methods: The outcome measures included the intensity, duration, and frequency of migraines, insomnia, and depression, as well as the QOL. The outcome measures were estimated monthly throughout the treatment period. Each outcome measure was rated using a numeric scale from 0 to 10, in which 0 was defined as “the lowest possible” and 10 as “the worst imaginable”.‎ At baseline, the patient rated the intensity, duration, and frequency of each complaint as 10. The patient was treated with 60- minute I Ching Balance Acupuncture (ICBA) sessions once a week for seven months. Results: The acupuncture treatment did not cause any adverse events, pain, or discomfort. The outcome measures for migraines, insomnia, and depression decreased to a great extent. Also, the patient reported a massive improvement in the QOL. The improvement in the QOL was inversely related to the intensity, duration, and frequency of the patient’s complaints throughout the acupuncture treatment period. Conclusions: The patient reported a considerable improvement in all the outcome measures. The patient completed the treatment after feeling a great improvement in the QOL. Additional, larger-scale studies are warranted to investigate the effects of ICBA.
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Neck-shoulder pain (NSP) is a common work-related musculoskeletal disorder with unclear mechanisms. Changes in physical activity and autonomic nervous system regulation may be involved in the pathogenesis of chronic NSP. The aim of the current study was to investigate autonomic regulation in relation to physical activity and perceived symptoms during work and leisure time among workers with chronic NSP (n = 29) as compared to a healthy control group (CON, n = 27). Physical activity was objectively monitored for 7 days using accelerometry. Beat-to-beat heart rate was collected continuously for 72 h, with simultaneous momentary ratings of pain, stress, and fatigue. Duration of sitting/lying, standing and walking, number of steps, and energy expenditure were used as measures of physical activity. Heart rate variability (HRV) indices were extracted in time and frequency domains as reflecting autonomic regulation. Data were divided into work hours, leisure time, and sleep. The NSP group rated higher levels of stress and fatigue at work and leisure, and reduced sleep quality as compared to CON. Elevated heart rate and reduced HRV were found in NSP compared with CON, especially during sleep. The NSP group demonstrated a different pattern of physical activity than CON, with a lower activity level in leisure time. Higher physical activity was associated with increased HRV in both groups. Changes in HRV reflected an autonomic imbalance in workers with chronic musculoskeletal pain. This can be explained by reduced physical activity in leisure time. Intervention studies aimed at increasing physical activity may shed further light on the association between autonomic regulation and physical activity in work-related NSP.
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This study aims to determine if cervical medial branch radiofrequency neurotomy reduces psychophysical indicators of augmented central pain processing and improves motor function in individuals with chronic whiplash symptoms. Prospective observational study of consecutive patients with healthy control comparison. Tertiary spinal intervention centre in Calgary, Alberta, Canada. Fifty-three individuals with chronic whiplash associated disorder symptoms (Grade 2); 30 healthy controls. Measures were made at four time points: two prior to radiofrequency neurotomy, and 1- and 3-months post-radiofrequency neurotomy. Measures included: comprehensive quantitative sensory testing (including brachial plexus provocation test), nociceptive flexion reflex, and motor function (cervical range of movement, superficial neck flexor activity during the craniocervical flexion test). Self-report pain and disability measures were also collected. One-way repeated measures analysis of variance and Friedman's tests were performed to investigate the effect of time on the earlier measures. Differences between the whiplash and healthy control groups were investigated with two-tailed independent samples t-test or Mann-Whitney tests. Following cervical radiofrequency neurotomy, there were significant early (within 1 month) and sustained (3 months) improvements in pain, disability, local and widespread hyperalgesia to pressure and thermal stimuli, nociceptive flexor reflex threshold, and brachial plexus provocation test responses as well as increased neck range of motion (all P < 0.0001). A nonsignificant trend for reduced muscle activity with the craniocervical flexion test (P > 0.13) was measured. Attenuation of psychophysical measures of augmented central pain processing and improved cervical movement imply that these processes are maintained by peripheral nociceptive input.
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Background: Intravenous (IV) sedation analgesia is often employed in patients with chronic spinal pain undergoing diagnostic spinal injection procedures. The drugs used for intravenous sedation analgesia produce varying degrees of sedation, amnesia, anxiolysis, muscle relaxation, and analgesia. The very nature of these pharmacologic effects in altering the patient's level of consciousness, awareness, or response to a particular diagnostic stimulus invokes a sense of uncertainty about the results or response obtained from the diagnostic procedure. There is an ongoing controversy regarding the validity of controlled diagnostic blocks due to variability in sensitivity, specificity, and accuracy. Moreover, there is no consensus with regards to the use of sedation analgesic measures prior to controlled diagnostic blocks and their influence on the accuracy and validity of a diagnosis. Objective: To assess and update the clinically significant effects sedation analgesia procedures have on the diagnostic accuracy and validity of interventional spinal techniques. Methods: A comprehensive literature search using PubMed, EMBASE, and Cochrane Library review databases up to September 2012 was performed. The search included systematic and narrative review articles, prospective and retrospective studies, as well as cross-referencing of bibliographies from notable primary and review articles and abstracts from scientific meetings and peer-reviewed non-indexed journals. The search emphasized the effects of sedation analgesia on diagnostic spinal interventions. Conclusion: Based on a review of the available evidence, it appears that the administration of mild to moderate sedation does not confound the results or diagnostic validity of spinal injection procedures. Specifically, immediate pain relief after cervical and lumbar facet joint controlled nerve blocks is not enhanced by IV sedation with midazolam or fentanyl. This is especially true if stringent outcome criteria are employed, such as at least 75% pain relief combined with an increase in range of motion for pain limited movements.
Article
Background: The treatment of adhesive capsulitis (AC) is a well-known, complicated, and long process. Recent studies have shown that pulsed radiofrequency (PRF) lesioning of the suprascapular nerve (SSN) using a fluoroscopy- or computed tomography-guided technique can alleviate shoulder pain. However, there are no studies of PRF lesioning of the SSN in patients with AC using ultrasound-guided (UG) techniques, except for 2 case reports. In this study, we compared the effect of physical therapy alone with physical therapy and PRF lesioning of the SSN using a UG technique. Methods: Sixty patients with AC were included in the study. Patients were randomized into the following 2 groups: the intervention group containing patients who received 12 weeks of physical therapy after 1 treatment of PRF lesioning of the SSN, and the control group containing patients who received 12 weeks of physical therapy alone. All outcome measurements including visual analog scale (VAS), shoulder pain and disability index, and passive range of motion (PROM) were performed at 1, 4, 8, and 12 weeks after treatment. Results: Forty-two patients (21 patients in each group) completed the study. The intervention group had a notably shorter time to onset of significant pain relief (6.1 ± 3.4 vs 28.1 ± 9.2 days; P < 0.001) and noticeable reduction of VAS score at week 1 (40% vs 4.7%) than the control group (P < 0.001). All measured variables in the intervention group and most variables in the control group showed significant improvement from the baseline (P < 0.05). A comparison of the 2 groups indicated significantly greater improvement in the intervention group at all times in VAS and shoulder pain and disability index scores (all P < 0.05), and for most gain of PROM (P < 0.05). There were no serious adverse effects or complications in either group. Conclusions: This study indicates that the application of PRF lesioning of the SSN using a UG technique combined with physical therapy provided better and faster relief from pain, reduced disability, and improved PROM when compared with physical therapy alone in patients with AC, an effect that persisted for at least 12 weeks.
Chronic pain is a prevalent problem that exacts a significant toll on society. The medical system has responded to this issue by implementing pain management services centered on opioid pharmacotherapy. However, for many chronic pain patients, the analgesic efficacy of long-term opioids is limited. Moreover, chronic exposure to opioids can result in opioid misuse, addiction, and risk of overdose. As such, non-opioid treatment options are needed. This article first provides a selective review of cognitive, affective, and psychophysiological mechanisms implicated in chronic pain to be targeted by novel non-opioid treatments. Next, it briefly details one such treatment approach, Mindfulness-Oriented Recovery Enhancement, and describes evidence suggesting that this intervention can disrupt the risk chain linking chronic pain to prescription opioid misuse.