Pain

Management
by
Acupuncture
Continue Education Course of
@Advanced Acupuncture, Inc.
2007

Acupuncture Pain Management

Part I: Theory
Overview of scientific bases of
acupuncture
Mechanisms of pain management
Current researches and clinical trials
Pain Scores and evaluation methods
Scientific Bases of Acupuncture

The role of electric field in growth control and

morphogenesis
Organizing centers have high electric
conductance
Acupuncture points originate from organizing
centers

Nerve Reflex Theory

(Ishikawa and Fujita et al, Japan, 1950s)
Autonomic nervous system extending thru the
internal organs
Viscera-mutinous reflex
Cutanous Viscera reflex
Acupuncture utilize these reflexes for restoring
the homeostasis of the body and acceralate the
healing process.
Endorphin Theory
(Dr. Pomeranz, Canada, 1996)

Neurohumoral
Morphogenetic
Nerve Reflex Theory
The gate control theory of pain
Endorphin
Neurohumoral Approach
Acupoint-brain-organ
Acupuncture stimulates to brain cortex and
nerve system, then control the chemical or
hormone release to the disordered organs.
Morphogenetic Theory (Shang C. China, 1989)
Acupuncture points are singular points in
surface bioelectric field

Natural Morphine

Acupuncture trigger the release of endorphin

into the central nervous system
Only deal with pain
Corticoids and Substance P also released along
with endorphin

Therapeutic Mechanisms of Acupuncture

Meridian-Cortex-Viscera Correlation Hypothesis

1. The meridian system is and connected the nervous
system to the cerebral cortex.
2. It acts through neurohumoral mechanisms
3. Acu-point-Brain-organ model: stimulates the brain
cortex/nervous system, then controlling the chemical
or hormone release to the disordered organs for
treatment.
Acupuncture Mechanisms of Action

Conduction of electromagnetic signals

Activation of opioids systems
Changes in brain chemistry-release of
neurotransmitters and neurohormones.

Acupuncture Pathways

Morphogenetic Singularity Theory

Acupuncture points are singular points in

surface bioelectric field
Converging points of surface current for change
in electric
current flow.
Abrupt transition from one state to another.
Eg: BaiHui (Du 20)

Physical characteristics of the acupuncture points-WHO

Points are corresponds to the high electrical

conductance points on the body surface

High density of gap junctions at the epithelia of

the acupuncture points.
Gap junctions are hexagonal proteins that
facilitate intercellular communication and
increase electric conductivity.

Research on Auricular points

Effects of acupuncture on the Brain-auditory cortex

WHO found 43 points have proven therapeutic

value
Therapeutic effect can be achieved by needling,
temperature variation, laser, ultrasound, and
pressure.

Effects of Acupuncture on the Brain

UCI-Use functional MRI to investigate the

mechanisms of acupuncture analgesia
Stimulates Li 4 revealed activation of visual
cortex.
Needling Tin Hui revealed auditory cortex
activation

Why acupuncture has fewer side effects?

May indirect adjust the process and restore

normal function by activating the network of
organizing centers in the organism
The activation of the self-organizing activity is
less likely to cause the side effects resulted from
directly antagonizing a pathological process
which often overlap with other normal and
beneficial physiological processes.

The role of electric field in growth control and

morphogenesis

Enhanced cell growth toward cathode and

reduced cell growth toward anode in electric
fields of physiological strength
Fast growing cells tend to have relative
negativity polarity.
The polarity is due to the increased negative
membrane potential generated by mitochondria
at high rate of energy metabolism

Efficacy, effective, safety and costs of acupuncture for

chronic pain

Evaluated 304,674 patients over 10,000

physicians and received 10+ acupuncture for
pain
Results: acupuncture was an effective and safe
treatment
The effects attributed to specific or nonspecific
mechanisms and depend on the diagnosisresults a large research initiative.

1. Inserting a needle provokes an acute defensive

inflammatory response
2. Afferent nociceptive (pain) neurons distribute to
the dorsal horn of the spinal cord
3. Trigger the gamma loop efferent in the ventral
horn and activate neurons that cross over the
spinal cord to the brain
4. Activate somatic motor nerves
5. To muscles, and autonomic motor nerves to
peripheral blood vessels and to the internal
organs
Acupuncture Pain Management
Part II: Clinical applications
Differential diagnosis and treatment for
Headache & migraines, Trigeminal neuralgia,
Carpal Tunnel Syndromes, Arthritis, Neck
pain, Fibromyalgia, lumbago and sciatic
neuralgia.
Etiology of Headache

Mechanisms of acupuncture for Pain relief

Polymodal receptors
(PMRs) in the acupuncture points are sensitized for
the immediate action.
Action mediated by endogenous opioids
Potent stimulus for activating the analgesic
systems
Therapeutic Mechanisms of Acupuncture
-Dr.D. Kendall, 1980

Blood Vessels that become dilated enlarged or

constricted
Muscles in the neck and head become tight or
tense
Muscles around the eyes the become strained
due to overwork
Sinuses became swollen due to allergies or
infections
Nerves that transmit abnormal pain signals
Joints in the jaw and neck are overused or
damaged.

Types of Headache
(Western Medicine)
I.
II.
III.
IV.
V.

Vascular headache (Migraines)

Muscle contraction headache
Combined vascular & muscle contraction
headache
Headache of nasal vasomotor reactions
Headache of delusional conversion or
hypochondriacal states

Migraine Headache

Classic Migraine
Common migraine
Cluster headache
Hemiplegic and ophthalmoplegic migraine
Lower half headache

Headache
Principle acupuncture points
G 20
Taiyang
Li 4
GV 20
Liv 3
G8
T3
TCM Classification of headache
1. Headache due to invasion of pathogenic wind
into the channels and collateral:
Headache occurs often, especially on exposure
to wind.
The pain may extend to the nape of the neck
and back region.

Tongue white coating, pulse floating

2. Headache due to upsurge of liver-yang:

Headache distension of the head, irritability, hot
temper, dizziness, blurred vision,
Tongue red with thin and yellow coating
Pulse thin wiry and rapid.
3. Headache due to deficiency of qi and blood:
Lingering headache, dizziness, blurred vision,
lassitude, pale complexion
Tongue pale with thin white coating
Pulse thin and thread
Trigeminal Neuralgia (TN)

Causation:-blood vessels compressing the

Trigeminal nerve root as it enters the brain stem
Peripheral pathology-neurovas compression
Central pathology- hyperactivity of the
trigeminal nerve nucleus

Classifications of TN

We
ste
rn
Me
dic
ine
:

TN-Pathogenic Wind & Cold

1.
2.

Typic
al
1.
Atypi

Ea
st
er
n
Me
dic
in
e
Path
oge

 Clinical manifestation:
1. Acute onset
2. Usually affects V1 sensory
3. Aversion of wind & cold or aggravated by
4. Pain like cutting, boring and electric shock but
transient ( few minutes)s
5. Wind cold or wind heat symptoms
TMJ-Tempro mandibular joint
Dysfunction syndrome

Symptoms:
Grinding teeth,
Joint pain,
Headache
Ringing in the ears
Unable to open his or her month wide or hear a
pop upon opening

cal
3.
PreTN
4.
MSTN-acupuncture
treatment
relat 2.
ed
TN
5.
Seco
ndar
y or
tumo
r
relat
Li 3 or Li 4 plus
ed
Temporal branch:
Taiyang, G 3TN
& G 14
3.
6.
Maxillary branch:
G1, St2, SI18,
and ST3
neur
Mandibular branch:
opat
St6, St 5, and
G2
hy
TMJ (TMD)
7.
Post
trau
mati
c TN
4.

nic
wind
and
cold
Asce
ndin
g of
Live
r
and
sto
mac
h
fire
Defi
cien
cy
heat
due
to
liver
yin
depl
ete
Dam
p/he

TMJ-Etiology
1. Muscle spasm- pain
Masseter & temporalis
2. Meniscus-cartilage, buffer between the jaw and
skull. Caused pop
TMJ-Acupuncture points

ST 7
SI 19
T 17
Li 4

Osteoarthritis

dam
p
cold
Causing deformity of the joints
accu
Damage to the joints can occur early in the
disease and be progressive
mul
atio
Rheumatoid Arthritis
n
Auto-immune disease

Chronic inflammation of the tissue around

joints , organ and body
Body tissues attacked by own antibodies in the
blood level which causes inflammation.
Women to men: 3:1

Osteoarthritis

90% of arthritis
Destruction of the cartilage, bone and ligaments
causing deformity of the joints
Damage to the joints can be progressive

Principle Acupuncture Points

for Arthritis

Arthritis due to destruction of the cartilage,

bone and ligaments

Causation of
Carpal Tunnel Syndrome

Painful neuropathies of the hand and wrist are

from nerve compression, most often
compression of the median nerve in the carpal
tunnel.

Temporomandibular
ST7, SI 19, T
17, Li 4

Shoulde
r joints:
LI 15,
T14, SI
11, T3,G
34

Elbow
joints:
Li 11,
T10, Li
4

Wrist &
joints:
T5, Li 10., LI.
4

Lumbar
spinal
joints:
Huatuoparasp
inal
acupoints,
UB37 and UB
40

Lumbos
acra
Joints:
GV3, B30,
B 25, B40
B 60

Sacroil
iac
Joints:
B 27,
B28

Hip joints:
G 30, G 29,
G34, G39

Hip joints:
G30, G 29,
G34, G39

Knee
joints:
St 34,St
36, Sp 9,
G 34

Ankle
joints:
ST 41,
T 40,
K3,
B50, G
35 K8

Metatarsop
hala-ngeal
joints:
Sp 4, B 65, G
38, Sp 5

Etiology of CTS

Diagnosis of CTS

Numbing pain in the distribution of the median

nerve but not limited to it.
Phalens sign positive
Tinels sign positive
Light touch/vibratory touch positive
Muscle weakness and atrophy
EMG: slowed conduction velocity across the CT.

Median nerve compression by tendonitis

Usually due to repetitive motion of the wrist and
hands.

Carpal Tunnel Syndrome

Principle acupuncture points

P
P
T
T

6
5
4
5

Cervical Spondylosis
Principle acupuncture points

SI 3
G 39
B 64
B 11
G 21
GV 16
T 10

B 10

Rotator Cuff Syndrome

Principle acupuncture points

Li15
Si 11
T14
Li 16
Li12
Li4
L7
L9
T9
T4
Achilles Tendonitis

DX of Lateral Epicondylitis
(Tennis elbow)

Runners injury

History of tennis elbow use

Pain just distal to the prominence of the lateral
epicondyle
Radiological study negative
Knee Tendonitis

Lower back pain-Etiology

Herniated Disk (bulging)

Facet joint syndrome

Sacroilliac joint syndrome
Myofascial syndrome

Referred and Interactive

Low Back Pain

Make realistic prognosis based on the stage,

severity, stability and irritability of the
dysfunction

Referred and interactiveLow Back Pain

Low back pain

Principle acupuncture points
Referred and Interactive
Low Back Pain
The frequent referral of somatic pain into the
limbs
Cause of the cause: Identify the source of
symptoms.

B 40 & K2 (basic)
L5, B 40, G34, B 65, B 60, B 34, K7, L 5, Li 11, Li
4, Sp6, Liv. 2, Li 10.

Sciatic Neuralgia
Principle acupuncture points

B 23
B 30
G 30
B 36
B 37
B 40
G 34

Traumatic Injury-Brain-TBI
Clinical manifestations:
1. Altered mental status
2. Communication disorders
3. Emotional and psychitric disorders
4. Related paralysis or paresthesia
Dx: Refer to physician for further investigation.

Diagnosis of Fibromyalgia
1. Widespread aching > 3 months
2. Skin roll tenderness & hyperemia
3. Disturbed sleep with morning fatigue and
stiffness
4. Absence of lab. Evidence of inflammation or
muscle damage
5. Bilateral tender points in at least 6 areas.