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The Comparison of trigger point acupuncture and traditional acupuncture

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Abstract

Trigger point (TrP) acupuncture (dry needling), the use of solid filiform needles at TrPs, has been developed from a comprehensive integration and adaptation of traditional acupuncture using current understandings of TrPs. During the past twenty years, the concept and technique continues to evolve, with a potential to expand to other conditions beyond myofascial pain syndromes that can be managed via stimulating TrPs. In this article, we compared TrP acupuncture and traditional acupuncture from the following aspects: points of needle insertion, needles and needling techniques, and therapeutic indications. Traditional acupuncture encompasses an abundance of methods and techniques in acupuncture practices and has been widely used and studied for a variety of disorders. With unique specific characteristics, TrP acupuncture further develops traditional acupuncture theories, especially the concepts of Ashi point. The location of TrPs, their distribution pattern and pain indication are similar to those of traditional acupoints; the selection of needles, depth of needle insertion, and manipulation techniques are part of traditional acupuncture. TrP acupuncture is thus an integral part of traditional acupuncture.
... 8 In traditional acupuncture, the depth of needling varies according to practitioner's preferences, disease conditions, needles used and methods used. 18 The acupuncture treatment for musculoskeletal pain involves the needling of ashi points which are painful spots or hyperirritable acupoints without predefined location. 8,18 During treatment, acupuncturists emphasises de qi sensation which is associated with stimulation of Aδ afferent nerves, important in mediating the therapeutic effects of acupuncture for pain. ...
... 18 The acupuncture treatment for musculoskeletal pain involves the needling of ashi points which are painful spots or hyperirritable acupoints without predefined location. 8,18 During treatment, acupuncturists emphasises de qi sensation which is associated with stimulation of Aδ afferent nerves, important in mediating the therapeutic effects of acupuncture for pain. De qi sensation includes local muscle twitches and propagation of sensation during needling. ...
... Acupuncturists oppose the practice of dry needling by physiotherapists as they perceive dry needling to be a form of acupuncture and express concern that physiotherapists and other practitioners such as chiropractors may endanger patient safety and wellbeing due to lack of adequate training and regulation. 8,18,20 In contrast, the physiotherapists claimed that dry needling is not acupuncture as dry needling is based on modern biomedical science rather than traditional acupuncture theories or terminology. Dry needling has become the de facto practice of physiotherapists in many countries and states across the US. 8 The APTA recognizes dry needling as being part of the physical therapist professional scope of practice whereby the performance of modern dry needling by physical therapists is based on western neuroanatomy and modern scientific study of the musculoskeletal and nervous systems, not based on ancient theories or tenets of TCM. ...
Technical Report
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Dry needling is a technique involving the insertion of solid filiform needles that physiotherapists and other healthcare professionals use to treat various painful conditions of the musculoskeletal system, typically myofascial pain syndrome. Acupuncture originated from China 2,000 years ago and has been widely practised across the world to treat a broad range of indications including musculoskeletal pain. Traditional acupuncture involves the stimulation of specific points on the body via penetration by solid filiform needles based on the meridian concept. Although dry needling and acupuncture overlap in terms of the use of solid filiform needles and most common indication (musculoskeletal pain), dry needling is based on modern biomedical science instead of traditional meridian theory. Due to growing evidence and lack of side effects, dry needling practice has become increasingly popular in the musculoskeletal field since the 2000s. The objective of this report was to assess the effectiveness, safety and cost-effectiveness of dry needling versus acupuncture for the management of musculoskeletal pain.
... As thoroughly demonstrated and discussed previously in the current research team's white paper, 8,9 Zhou et al, 5 Peng et al, 19,20 and Zhu and Most 21 reviewed DN history and a significant amount of literature since 1941 and identified the features of DN. They used these features to compare DN and acupuncture. ...
... Zhou et al 5 concluded that DN is a kind of Western acupuncture for treating myofascial pain. Peng et al 19,20 concluded that DN is TrP acupuncture, belonging to the category of Ashi-point acupuncture, which is one of the major acupuncture schools in traditional acupuncture. Traditional acupuncture encompasses an abundance of methods and techniques in acupuncture practices and has been widely used and studied for the management of a variety of disorders. ...
... However, because of a lack of adequate training and appropriate regulation, the safety of DN practice by PTs has been called into question. 5,8,9,[19][20][21] As the American Medical Association (AMA) policy on DN states, "DN is indistinguishable from acupuncture. " 22 As demonstrated and discussed previously by the current research team's white paper, [8][9][10] the Council of Colleges of Acupuncture and Oriental Medicine (CCAOM) 4 states, "DN has resulted in redefining acupuncture and reframing acupuncture techniques in Western biomedical language … these treatment techniques are the de facto practice of acupuncture, not just the adoption of a technique of treatment. ...
Context: In the United States. and other Western countries, dry needling (DN) has been a disputed topic in both the academic and legal fields. Objective: The research team intended to examine whether DN is a technique independent from acupuncture and also how nonacupuncturists, such as physical therapists (PTs), started practicing DN. Design: The research team completed research, examined critical issues related to DN, and published a white paper in 2017 that discussed evidence and expert opinions from academic scholars, for health care professionals, administrators, policy makers, and the general public that demonstrate that DN is acupuncture. This article continues that endeavor. Results: DN is not merely a technique but a medical therapy that is a simplified form of acupuncture practice. To promote DN theory and business, some commercial DN educators have recruited a large number of nonacupuncturists, including PTs, athletic trainers, and nurse practitioners, in recent years. PTs did not initiate the practice of DN and DN does not fit into the practice scope for PTs because it is an invasive practice. The national organizations of the PT profession, such as the American Physical Therapy Association and the Federation of State Boards of Physical Therapy, began to support the practice of DN by PTs in approximately 2010. Currently, more PTs are involved in DN practice and are teaching than any other specialty. Conclusions: Acupuncturists and physicians must complete extensive acupuncture training in accredited programs and pass national examinations to become licensed or certified to practice acupuncture. However, a typical DN course runs only 20-30 h, often in the course of 1 weekend, and the participants may receive a DN certificate without any national examination being required. For the safety of patients and professional integrity, the research team strongly suggests that all DN practitioners and educators should have to meet the same basic standards as those required for licensed acupuncturists or physicians.
... 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. ...
... Consistently, 0.5-mA ES in these muscles failed to suppress TNF and IL-6 production (Extended Data Fig. 11e-j). Notably, the gastrocnemius and semitendinosus muscles do not contain traditional acupoints and have often been used as non-acupoint controls 10,25,26 . For a positive prediction, it should be noted that PROKR2 ADV neurons are also enriched in cervical C6-8 DRGs innervating the forelimbs (Extended Data Fig. 2a, b). ...
Article
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Somatosensory autonomic reflexes allow electroacupuncture stimulation (ES) to modulate body physiology at distant sites1–6 (for example, suppressing severe systemic inflammation6–9). Since the 1970s, an emerging organizational rule about these reflexes has been the presence of body-region specificity1–6. For example, ES at the hindlimb ST36 acupoint but not the abdominal ST25 acupoint can drive the vagal–adrenal anti-inflammatory axis in mice10,11. The neuroanatomical basis of this somatotopic organization is, however, unknown. Here we show that PROKR2Cre-marked sensory neurons, which innervate the deep hindlimb fascia (for example, the periosteum) but not abdominal fascia (for example, the peritoneum), are crucial for driving the vagal–adrenal axis. Low-intensity ES at the ST36 site in mice with ablated PROKR2Cre-marked sensory neurons failed to activate hindbrain vagal efferent neurons or to drive catecholamine release from adrenal glands. As a result, ES no longer suppressed systemic inflammation induced by bacterial endotoxins. By contrast, spinal sympathetic reflexes evoked by high-intensity ES at both ST25 and ST36 sites were unaffected. We also show that optogenetic stimulation of PROKR2Cre-marked nerve terminals through the ST36 site is sufficient to drive the vagal–adrenal axis but not sympathetic reflexes. Furthermore, the distribution patterns of PROKR2Cre nerve fibres can retrospectively predict body regions at which low-intensity ES will or will not effectively produce anti-inflammatory effects. Our studies provide a neuroanatomical basis for the selectivity and specificity of acupoints in driving specific autonomic pathways. Neuroanatomical findings demonstrate why electroactupuncture at only specific acupoints can drive the vagal–adrenal axis and treat inflammation in mice.
... 15 Acupuncture needles may be inserted at traditional acupuncture points, which are described throughout the body, 16 or at ah shi points, which are referred to hyperirritable painful spots without a predefined location. 17 Although acupuncture appears to have originated from 'Traditional Chinese Medicine' (TCM), researchers with a Western view of health have demonstrated that it produces physiological effects through local axon reflexes, segmental, extrasegmental and central neuromodulation. 15 While the exact variable(s) that influence(s) these effects remain(s) equivocal, the analgesic properties of acupuncture make it a potential treatment for DOMS. ...
Article
Objective The aim of this study was to systematically review the literature on acupuncture for delayed-onset muscle soreness (DOMS) and report upon study quality and treatment outcomes. Design Systematic review. Data sources Searches were conducted in the following electronic databases from their inception to 31 March 2018: CINAHL, MEDLINE, Allied and Complementary Medicine (AMED) and SPORTDiscus. Reference lists of all included studies and relevant reviews were hand-searched for additional studies. Eligibility criteria for selecting studies Randomised controlled trials (RCTs) that evaluated the effectiveness of acupuncture in DOMS in adults measuring the pre-specified primary outcome (pain) were included. Data collection and analysis Data were extracted using pre-defined extraction forms and the Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) checklist. Quality of studies was evaluated based on the Cochrane risk of bias assessment. Results Five RCTs investigating laboratory-induced DOMS in the upper limbs with a total sample size of 182 healthy participants were included. Of the included studies, three reported superiority of acupuncture over no treatment in DOMS pain reduction as measured by visual analogue scale, pressure pain threshold or electrical pain threshold, while two studies yielded non-significant results. All studies demonstrated risk of bias in one or more areas, commonly lack of blinding of participants and personnel. Summary/conclusion There is conflicting to limited evidence to support the effects of acupuncture on the relief of pain associated with DOMS. The findings were confounded by methodological limitations and reporting insufficiency. More rigorous, high-quality, and well-reported RCTs are required to further evaluate the effectiveness of acupuncture for DOMS.
Article
Objectives The aim of this literature review is to describe the role of acupuncture for myofascial pain syndrome in interventional pain management. Content Myofascial pain syndrome (MPS) can be found at all ages. Approximately 30.0–93.0% of patients with musculoskeletal pain have MPS. Unsuccessful treatment can lead to dysfunction, disability, and a cost burden. We conducted a search of studies published in Google Scholar and PubMed databases from 2016 to 2021. Summary Acupuncture, combined with other therapies, is effective in reducing pain and improving physical function. Acupuncture can enhance endogenous opioids such as endorphins to relieve pain and enhance the healing process. Outlook Acupuncture could be considered as one of nonpharmacological options in Interventional Pain Management for MPS. Interventions with acupuncture are safe and have minimal side effects when performed by a trained and competent practitioner.
Article
Purpose: The aim of this study was to evaluate the effects of transcutaneous electrical nerve stimulation at acupuncture points versus trigger points on myofascial pain, moods, and sleep quality. Design: A randomized controlled study recruited 64 patients with spinal cord injury with myofascial pain. Methods: Outcomes of pain, moods, and sleep quality were measured and analyzed by the generalized estimation equation, analysis of covariance, and paired t test. Transcutaneous electrical nerve stimulation was applied for seven consecutive days at Hegu (LI4) and Daling (PC7) acupuncture points or myofascial trigger points. Finding: Significant differences were found in pain intensity from Day 3 forward, after controlling for confounders. Significant within-group differences were found in pain, moods, and sleep quality. Conclusions: Transcutaneous electrical nerve stimulation at acupuncture and trigger points effectively improved pain, moods, and sleep quality in patients with spinal cord injury with myofascial pain. Acupuncture points had superior improvement in pain intensity and slight improvement in sleep quality than did trigger points. Clinical relevance: Transcutaneous electrical nerve stimulation at acupuncture points could be applied for improving myofascial pain.
Article
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We think that all the methods of puncturing into the skin to prevent and treat diseases are belong to acupuncture science. In spite of its basic theory of meridian and acupoint, anatomy and physiology have been important parts of modern acupuncture science. “Dry needling”, however, is limited to trigger point theory. As for the positions, acupuncture is applied mainly at acupoints, involving in skin, muscles, tendons, vessels and nerves; while “dry needling” is used mostly at muscles. The needles of acupuncture are in various lengths and diameters and its manipulations are abundant, including the traditional skills and the achievements of modern science and technology research, such as electroacupuncture. It is different from the “dry needling” with the single tool and manipulation. Thus, acupuncture is suitable for a large range of syndromes, but “dry needling” is mainly for fascia muscularis pain and other related disorders. The acupuncturists need to embrace Chinese and western medicine, which is more rigorous than the training for“dry needling” practitioners. Based on the above reasons, we consider “dry needling” as part of acupuncture science, and it is a method during the modern development of traditional acupuncture.
Article
Full-text available
We think that all the methods of puncturing into the skin to prevent and treat diseases are belong to acupuncture science. In spite of its basic theory of meridian and acupoint, anatomy and physiology have been important parts of modern acupuncture science. “Dry needling”, however, is limited to trigger point theory. As for the positions, acupuncture is applied mainly at acupoints, involving in skin, muscles, tendons, vessels and nerves; while “dry needling” is used mostly at muscles. The needles of acupuncture are in various lengths and diameters and its manipulations are abundant, including the traditional skills and the achievements of modern science and technology research, such as electroacupuncture. It is different from the “dry needling” with the single tool and manipulation. Thus, acupuncture is suitable for a large range of syndromes, but “dry needling” is mainly for fascia muscularis pain and other related disorders. The acupuncturists need to embrace Chinese and western medicine, which is more rigorous than the training for“dry needling” practitioners. Based on the above reasons, we consider “dry needling” as part of acupuncture science, and it is a method during the modern development of traditional acupuncture.
Article
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Recently, the educators of Dry Needling (DN) in the West often proclaime that DN is not acupuncture, and thus DN practitioners do not need to have the same training as acupuncturists. Their primary reason is that DN does not use the meridian theory of traditional Chinese medicine (TCM). In this paper, the authors refuted this claim. Through a systemic review on the global “Acupuncture Fever”, there are several different manifestations of “De-Meridian” phenomena (meridian theory is not required for acupuncture and other related modalities). Although De-Meridian has played a positive role in the development of acupuncture, it does not mean “De-Acupuncture” (modalities derived from but different from acupuncture). Given the clear definition of acupuncture by WHO, even though DN has certain attributes of De-Meridian that is similar to other forms of novel needling therapies, all of them belong to acupuncture. DN is a style of contemporary acupuncture, also called Trigger points (TrPs) acupuncture. This is because not only these myofascial TrPs stimulated by DN have always been acupoints, the needles and techniques used in DN are no different than acupuncture. Moreover, the mechanisms of DN and acupuncture are one in the same. The development of modern DN theory and its application are closely associated with the clinical trials and research of acupuncture. On the other hand, researches and clinical applications on myofascial TrP have highlighted the importance of stimulating reflex points in the clinic. However, as it refuses to inherit the theory and experience from thousands of years of acupuncture practice, it has shown obvious shortcomings in clinical applications.
Article
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Although Western medical acupuncture (WMA) is commonly practised in the UK, a particular approach called dry needling (DN) is becoming increasingly popular in other countries. The legitimacy of the use of DN by conventional non-physician healthcare professionals is questioned by acupuncturists. This article describes the ongoing debate over the practice of DN between physical therapists and acupuncturists, with a particular emphasis on the USA. DN and acupuncture share many similarities but may differ in certain aspects. Currently, little information is available from the literature regarding the relationship between the two needling techniques. Through reviewing their origins, theory, and practice, we found that DN and acupuncture overlap in terms of needling technique with solid filiform needles as well as some fundamental theories. Both WMA and DN are based on modern biomedical understandings of the human body, although DN arguably represents only one subcategory of WMA. The increasing volume of research into needling therapy explains its growing popularity in the musculoskeletal field including sports medicine. To resolve the debate over DN practice, we call for the establishment of a regulatory body to accredit DN courses and a formal, comprehensive educational component and training for healthcare professionals who are not physicians or acupuncturists. Because of the close relationship between DN and acupuncture, collaboration rather than dispute between acupuncturists and other healthcare professionals should be encouraged with respect to education, research, and practice for the benefit of patients with musculoskeletal conditions who require needling therapy.
Article
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Trigger point dry needling is a treatment technique used by physical therapists around the world. In the United States, trigger point dry needling has been approved as within the scope of physical therapy practice in a growing number of states. There are several dry needling techniques, based on different models, including the radiculopathy model and the trigger point model, which are discussed here in detail. Special attention is paid to the clinical evidence for trigger point dry needling and the underlying mechanisms. Comparisons with injection therapy and acupuncture are reviewed. Trigger point dry needling is a relatively new technique used in combination with other physical therapy interventions.
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Background: Wet needling uses hollow-bore needles to deliver corticosteroids, anesthetics, sclerosants, botulinum toxins, or other agents. In contrast, dry needling requires the insertion of thin monofilament needles, as used in the practice of acupuncture, without the use of injectate into muscles, ligaments, tendons, subcutaneous fascia, and scar tissue. Dry needles may also be inserted in the vicinity of peripheral nerves and/or neurovascular bundles in order to manage a variety of neuromusculoskeletal pain syndromes. Nevertheless, some position statements by several US State Boards of Physical Therapy have narrowly defined dry needling as an ‘intramuscular’ procedure involving the isolated treatment of ‘myofascial trigger points’ (MTrPs). Objectives: To operationalize an appropriate definition for dry needling based on the existing literature and to further investigate the optimal frequency, duration, and intensity of dry needling for both spinal and extremity neuromusculoskeletal conditions. Major findings: According to recent findings in the literature, the needle tip touches, taps, or pricks tiny nerve endings or neural tissue (i.e. ‘sensitive loci’ or ‘nociceptors’) when it is inserted into a MTrP. To date, there is a paucity of high-quality evidence to underpin the use of direct dry needling into MTrPs for the purpose of short and long-term pain and disability reduction in patients with musculoskeletal pain syndromes. Furthermore, there is a lack of robust evidence validating the clinical diagnostic criteria for trigger point identification or diagnosis. High-quality studies have also demonstrated that manual examination for the identification and localization of a trigger point is neither valid nor reliable between-examiners. Conclusions: Several studies have demonstrated immediate or short-term improvements in pain and/or disability by targeting trigger points (TrPs) using in-and-out techniques such as ‘pistoning’ or ‘sparrow pecking’; however, to date, no high-quality, long-term trials supporting in-and-out needling techniques at exclusively muscular TrPs exist, and the practice should therefore be questioned. The insertion of dry needles into asymptomatic body areas proximal and/or distal to the primary source of pain is supported by the myofascial pain syndrome literature. Physical therapists should not ignore the findings of the Western or biomedical ‘acupuncture’ literature that have used the very same ‘dry needles’ to treat patients with a variety of neuromusculoskeletal conditions in numerous, large scale randomized controlled trials. Although the optimal frequency, duration, and intensity of dry needling has yet to be determined for many neuromusculoskeletal conditions, the vast majority of dry needling randomized controlled trials have manually stimulated the needles and left them in situ for between 10 and 30 minute durations. Position statements and clinical practice guidelines for dry needling should be based on the best available literature, not a single paradigm or school of thought; therefore, physical therapy associations and state boards of physical therapy should consider broadening the definition of dry needling to encompass the stimulation of neural, muscular, and connective tissues, not just ‘TrPs’.
Article
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STUDY DESIGN: Systematic review and meta-analysis. BACKGROUND: Myofascial pain syndrome (MPS) is associated with hyperalgesic zones in muscle called myofascial trigger points (MTrPs). When palpated, active MTrPs cause local or referred symptoms including pain. Dry needling involves inserting an acupuncture-like needle into a MTrP with the goal of reducing pain and restoring range of motion. OBJECTIVE: To explore the evidence regarding the effectiveness of DN in reducing pain for patients with MPS of the upper quarter. METHODS: An electronic literature search was performed using the keyword "dry needling." Articles identified with the search were screened for the following inclusion criteria: human subjects, randomized controlled trials (RCTs), dry needling intervention group, and MPS involving the upper quarter. The RCTs that met our criteria were assessed and scored for internal validity with the MacDermid Quality Checklist. Four separate meta-analyses were performed: (1) dry needling compared to sham or control, immediate effects; (2) dry needling compared to sham or control, 4 weeks; (3) dry needling compared to other treatments, immediate effects; (4) dry needling compared to other treatments, 4 weeks. RESULTS: The initial search yielded 246 articles. Twelve RCTs were ultimately selected. The methodological quality scores ranged from 23 to 40 points, with a mean of 34 points (scale range 0-48, best possible score-48). Findings of 3 studies that compared dry needling to sham or placebo treatment provide evidence that dry needling can immediately decrease pain in patients with upper quarter MPS, with an overall effect favoring dry needling. Findings of 2 studies that compared dry needling to sham or placebo treatment provide evidence that dry needling can decrease pain after 4 weeks in patients with upper quarter MPS, although a wide confidence interval for the overall effect limits the impact of the effect. Findings of studies that compared dry needling to other treatments were highly heterogeneous, most likely due to variance in the comparison treatments. There is evidence from 2 studies that lidocaine injection may be more effective in reducing pain than dry needling at 4 weeks. CONCLUSIONS: Based on the best current available evidence, we recommend (Grade A) dry needling, compared to sham or placebo, for decreasing pain (immediately after treatment and at 4 weeks) in patients with upper quarter MPS. Due to the small number of high quality RCTs published to date, additional well-designed studies are needed to inform future evolution of this recommendation. LEVEL OF EVIDENCE: Therapy, level 1a-.J Orthop Sports Phys Ther, Epub 11 June 2013. doi:10.2519/jospt.2013.4668.
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Trigger point theory as the soul of western acupuncture is very similar to acupoint theory of traditional acupuncture and moxibustion science. After comparison, it is found that over 92% of trigger points (235/255) is corresponding to acupoints in anatomy, and the local pain treated by 79.5% acupoints are similar to corresponding myofascial trigger point. Both of them can induce similar linear propagation of needling response, with complete uniform or basically complete uniform of 76%, and a part uniform of 14%; next, both of them can treat symptoms of internal organs such as diarrhea, constipation, dysmenorrhea, etc. Therefore, they are very similar in anatomic location, clinical indications, and the linear propagation of needling response induced by acupuncture, etc.
Article
Western medical acupuncture is a therapeutic modality involving the insertion of fine needles; it is an adaptation of Chinese acupuncture using current knowledge of anatomy, physiology and pathology, and the principles of evidence based medicine. While Western medical acupuncture has evolved from Chinese acupuncture, its practitioners no longer adhere to concepts such as Yin/Yang and circulation of qi, and regard acupuncture as part of conventional medicine rather than a complete "alternative medical system". It acts mainly by stimulating the nervous system, and its known modes of action include local antidromic axon reflexes, segmental and extrasegmental neuromodulation, and other central nervous system effects. Western medical acupuncture is principally used by conventional healthcare practitioners, most commonly in primary care. It is mainly used to treat musculoskeletal pain, including myofascial trigger point pain. It is also effective for postoperative pain and nausea. Practitioners of Western medical acupuncture tend to pay less attention than classical acupuncturists to choosing one point over another, though they generally choose classical points as the best places to stimulate the nervous system. The design and interpretation of clinical studies is constrained by lack of knowledge of the appropriate dosage of acupuncture, and the likelihood that any form of needling used as a usual control procedure in "placebo controlled" studies may be active. Western medical acupuncture justifies an unbiased evaluation of its role in a modern health service.
Article
Objective: To compare the differences in the efficacy on distant version of naked eye in the patients of juvenile myopia between rotating manipulation and lifting-thrusting manipulation of acupuncture. Methods: One hundred and twenty cases (240 eyes) were randomized into a rotating manipulation group and a lifting-thrusting manipulation group, 60 cases (120 eyes) in each group. Additionally, a corrective lenses group, 60 cases (120 eyes), was set up as the control. In both manipulation groups, Cuanzhu (BL 2),Yuyao (EX-HN 4), Sizhukong (TE 23), Taiyang (EX-HN 5), Fengchi (GB 20), Zusanli (ST 36), Guangming (GB 37) and Sanyinjiao (SP 6) were punctured, but stimulated with rotating manipulation and lifting-thrusting manipulation respectively three times per week, 10 times as a treatment session and totally one session was required. In the corrective lenses group, the glasses were applied at daytime. The clinical efficacy and the changes in distant vision of naked eye before and after treatment were compared among the three groups. Results: The total effective rate was 87.5% (105/120) in the rotating manipulation group, which was better than 69.2% (83/120) in the lifting-thrusting manipulation group (P < 0.05). The distant vision of naked eye was improved apparently in the rotating manipulation group and the lifting-thrusting manipulation group after treatment (both P < 0.05). But it was not improved in the corrective lenses group (P > 0.05). The distant vision of naked eye was improved more apparently after treatment in the rotating manipulation group as compared with that in the lifting-thrusting manipulation group (0.75 +/- 0.23 vs 0.68 +/- 0.24, P < 0.05). For 96 cases (192 eyes) with acupuncture treatment, in 3-month follow-up, 87.0% (167/192) of the cases maintained the stable vision as the original level and 13.0% (25/192) of them were reduced in the vision In the acupuncture groups, it was found that the improvement of distant vision of naked eye was more obvious after treatment with younger age, better basic vision and shorter duration of sickness (all P < 0.05). Conclusion: Acupuncture achieves the positive and sustainable clinical effect on juvenile myopia, and the results of rotating manipulation are superior to that of lifting-thrusting manipulation. Age, basic vision and duration of sickness impact the clinical efficacy.
Article
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.
Article
Background: Although acupuncture is widely used for chronic pain, there remains considerable controversy as to its value. We aimed to determine the effect size of acupuncture for 4 chronic pain conditions: back and neck pain, osteoarthritis, chronic headache, and shoulder pain. Methods: We conducted a systematic review to identify randomized controlled trials (RCTs) of acupuncture for chronic pain in which allocation concealment was determined unambiguously to be adequate. Individual patient data meta-analyses were conducted using data from 29 of 31 eligible RCTs, with a total of 17 922 patients analyzed. Results: In the primary analysis, including all eligible RCTs, acupuncture was superior to both sham and no-acupuncture control for each pain condition (P < .001 for all comparisons). After exclusion of an outlying set of RCTs that strongly favored acupuncture, the effect sizes were similar across pain conditions. Patients receiving acupuncture had less pain, with scores that were 0.23 (95% CI, 0.13-0.33), 0.16 (95% CI, 0.07-0.25), and 0.15 (95% CI, 0.07-0.24) SDs lower than sham controls for back and neck pain, osteoarthritis, and chronic headache, respectively; the effect sizes in comparison to no-acupuncture controls were 0.55 (95% CI, 0.51-0.58), 0.57 (95% CI, 0.50-0.64), and 0.42 (95% CI, 0.37-0.46) SDs. These results were robust to a variety of sensitivity analyses, including those related to publication bias. Conclusions: Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.