Pain Management by Acupuncture - Borjis Holistic Health Clinic

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Pain Management by Acupuncture
Borjis Holistic Health Clinic
Dr. Ansari
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
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Neurohumoral
Morphogenetic
Nerve Reflex Theory
The gate control theory
of pain
 Endorphin
Neuro-humoral Approach
 Peripheral nervous
system to be crucial in
mediating the
acupuncture analgesia
 Meridian-CortexViscera correlation
hypothesis
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
 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.
The Gate Control Theory
Drs Melzack and Wall, 1965
 Model for acupuncture
pain relief
 Specific nerve fibers that
transmit pain to the spinal
cord (substantia gelatinous)
 Balance between
Stimulation & inhibitory
fibers
 Short term block pain by
acupuncture ( did not
explain the prolong effect)
Endorphin Theory
Dr. Pomeranz, Canada, 1996
 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
Acupuncture Mechanisms of
Action
 Conduction of
electromagnetic signals
 Activation of opioids
systems
 Changes in brain
chemistry-release of
neurotransmitters and
neurohormones.
Acupuncture Pathways
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.
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
 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
Effects of acupuncture on the
Brain-auditory cortex
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 selforganizing 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 diagnosis-results a
large research initiative.
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
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
 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. Vascular headache (Migraines)
II. Muscle contraction headache
III. Combined vascular & muscle contraction
headache
IV. Headache of nasal vasomotor reactions
V. Headache of delusional conversion or
hypochondriacal states
Migraine Headache
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Classic Migraine
Common migraine
Cluster headache
Hemiplegic and
ophthalmoplegic
migraine
 Lower half headache
Headache
Principle acupuncture points
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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


TCM Classification of
headache
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.
TCM Classification of
headache
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 pathologyneurovas compression
 Central pathologyhyperactivity of the
trigeminal nerve nucleus
Classifications of TN
 Western Medicine:
 Eastern Medicine
1.
2.
3.
4.
5.
6.
7.
1.
2.
Typical
Atypical
Pre-TN
MS-related TN
Secondary or tumor related
TN neuropathy
Post traumatic TN
3.
4.
Pathogenic wind and cold
Ascending of Liver and
stomach fire
Deficiency heat due to liver
yin deplete
Damp/heat or damp cold
accumulation
TN-Pathogenic Wind & Cold
 Clinical manifestation:
1.
2.
3.
4.
5.
Acute onset
Usually affects V1 sensory
Aversion of wind & cold or
aggravated by
Pain like cutting, boring and
electric shock but transient (
few minutes)s
Wind cold or wind heat
symptoms
Tx-TN Pathogenic wind & cold
 Acupuncture:
Yang bai, (GB14)
Taiyang, (extra)
Zan Zhu (Bl 2)
Wai guan (SJ5)
He Gu (Li 4)
 Herbal formula:
Jin Fang Bai du San plus
Ginger
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
TN-acupuncture treatment
Li 3 or Li 4 plus
 Temporal branch:
Taiyang, G 3 & G 14
 Maxillary branch:
G1, St2, SI18, and ST3
 Mandibular branch:
St6, St 5, and G2
TMJ (TMD)
TMJ-Etiology
1. Muscle spasm- pain
Masseter & temporalis
2. Meniscus-cartilage,
buffer between the jaw
and skull. Caused
“pop”
TMJ-Acupuncture points
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ST 7
SI 19
T 17
Li 4
Osteoarthritis
 Arthritis due to destruction
of the cartilage, bone and
ligaments
 Causing deformity of the
joints
 Damage to the joints can
occur early in the disease
and be progressive
Rheumatoid Arthritis
 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
Differential Dx of RA/OA
Principle Acupuncture Points
for Arthritis
Temporomandibular
Shoulder joints: Elbow joints:
LI 15, T14, SI
Li 11, T10, Li 4
11, T3,G 34
Wrist & joints:
T5, Li 10., LI. 4
Lumbar spinal
joints:
Huatuoparaspinal
acupoints, UB37
and UB 40
Lumbosacra
Joints:
GV3, B30, B 25,
B40 B 60
Hip joints:
G 30, G 29, G34,
G39
Hip joints:
Knee joints:
Ankle joints:
St 34,St 36, Sp 9, ST 41, T 40, K3,
B50, G 35 K8
G 34
ST7, SI 19, T 17, Li 4
G30, G 29, G34,
G39
Sacroiliac
Joints:
B 27, B28
Metatarsophalangeal joints:
Sp 4, B 65, G 38,
Sp 5
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.
Anatomy of CTS
Diagnosis of CTS
 Numbing pain in the
distribution of the median
nerve but not limited to it.
 Phalen’s sign positive
 Tinel’s sign positive
 Light touch/vibratory touch
positive
 Muscle weakness and
atrophy
 EMG: slowed conduction
velocity across the CT.
Etiology of CTS
 Median nerve
compression by
tendonitis
 Usually due to
repetitive motion of the
wrist and hands.
Carpal Tunnel Release
Surgery:
Carpal Tunnel Syndrome
Principle acupuncture points
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P6
P5
T4
T5
Cervical Spondylosis
Principle acupuncture points
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SI 3
G 39
B 64
B 11
G 21
GV 16
T 10
B 10
Rotator Cuff Syndrome
Principle acupuncture points
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Li15
Si 11
T14
Li 16
Li12
Li4
L7
L9
T9
T4
DX of Lateral Epicondylitis
(Tennis elbow)
 History of tennis elbow
use
 Pain just distal to the
prominence of the
lateral epicondyle
 Radiological study
negative
Knee Tendonitis
 Patellar Tendonitis
Achilles Tendonitis
 Runner’s injury
Lower back pain-Etiology
 Herniated Disk
(bulging)
 Facet joint syndrome
 Sacroilliac joint
syndrome
 Myofascial syndrome
Low Back Pain-diagnosis
 Clinical history
 Physical examination
 Pain sensitive
structures
 Pain generators
 Radiological studies
Low Back Pain-X-ray
Low Back Pain-MRI
 Imaging study to
evaluate the entire
lumbar bones, discs,
soft tissues and nerves.
 CT, myelography, and
discography use to
complement MRI
Referred and Interactive
Low Back Pain
Referred and Interactive
Low Back Pain
 The frequent referral of “ somatic pain into
the limbs
 Cause of the cause: Identify the source of
symptoms.
 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
 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
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B 23
B 30
G 30
B 36
B 37
B 40
G 34
Traumatic Injury-Brain-TBI
Clinical manifestations:
1.
2.
3.
4.
Altered mental status
Communication disorders
Emotional and psychitric
disorders
Related paralysis or paresthesia
Dx: Refer to physician for
further investigation.
Cause of Neck Pain
Radiological Findings of
Neck Pain
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.
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