Acupuncture treatment involves the insertion of very fine needles into tender points around the body. It is commonly used for back and neck pain, and muscle pain. There are two major schools of acupuncture:-
- Traditional Chinese Medicine (TCM) acupuncturists insert the needles according to a series of points joined by lines called meridians on the surface of the body. These lines do not represent any known structure within the body.
- The Five Seasons
- Heart, Circulation, Lung, Conception Meridians
- Small and Large Intestine Meridians
- Liver, Spleen, Kidney and Stomach Meridians
- Gall Bladder and Bladder Meridians
- Western Medicine Acupuncture uses a combination of these meridian points, combined with segmental and muscle trigger point acupuncture.
There is a 72% similarity between traditional Chinese acupuncture points and western muscle (myofascial) trigger points. Whichever system is used the aim is to reduce pain, reduce muscle spasm, and to improve general well being. The effects of acupuncture can be summarised as follows:-
- Local - in the vicinity of the needle - sensory nerve stimulation, blood vessel dilatation.
- Segmental - modulation of the pain processing mechanisms in the dorsal horn of the spinal cord, modulation of the autonomic nervous system (blood flow, visceral function)
- Distant - enhancement of descending inhibition of the dorsal horn of the spinal cord, general pain relief by the release of endorphins, release of other hormones like ACTH and oxytocin.
- Western Medical Acupuncture techniques involve searching for and treating the most prominent trigger points within the muscles of the area concerned. Points on the same meridians as the problem are also sometimes used.
- Initially no more than 5 needles are inserted, but more can be used when the patient has become used to the technique.
- In the acute phase twice weekly treatments can be performed, but most practitioners treat at weekly intervals, so as to let any local soreness settle between times.
- When the needle is inserted into the skin there is a small "pricking" sensation. Most practitioners press firmly on the skin with the plastic tube that the needle comes in, to cause pressure analgesia in the skin before inserting the needle. Once the needle is through the skin, it is inserted about 1-2 cm further (depending on the site) into the painful muscle. Different sensations are perceived once the needle enters the painful muscle, and have been described as gripping, spreading, warm, tingling and many more. The aim is to reproduce the type of pain, it's character and it's usual radiation.
- Once the correct needle position has been achieved, the strength of the stimulus can be increased by:-
- Gently moving the needle in and out (lift and thrust technique),
- Gently rotating the needle (Twizzelling),
- Gently scratching the surface of the underlying bone (periosteal pecking),
- Heating the needles (Moxibustion),
- Using Electro-acupuncture to electrically stimulate the muscles (typically alternating between frequencies of 2Hz and 80 Hz, and 0 - 2.0mA).
- For sensitive patients (strong responders) it is usually better to leave the needles in situ undisturbed for a few minutes, without any form of extra stimulation.
Acupuncture is safe when used by trained personnel. Acupuncturists can be medical or non-medical (traditional Chinese medicine practitioners, physiotherapists, pain clinic nurses, osteopaths, and chiropractors), and they all should have been on specially designed courses for their own profession.
Common Minor Problems
- Pain during and after treatment - usually settles in a short time with over the counter simple analgesics (pain killers / relievers).
- Local Bleeding - usually stops with firm pressure after a few minutes
- Fainting - usually in the nervous - the first treatment is usually performed sitting or lying on a couch
- Sweating - local or generalised - can be a normal response in some patients due to effects on the autonomic nervous system
- Sedation - can occur due to the release of endorphins in the central nervous system - patients should not drive afterwards if this is pronounced
- Bruising - most noticeable cosmetically after facial acupuncture - firm pressure after needling may reduce this - not serious, and more of an irritation
- Stuck needle - difficulty in removing a needle occurs mostly during acupuncture of the large spinal muscles when they are in severe spasm - relaxation techniques and patience usually allows the needle to be removed
Rare Minor Problems
- Local Infection - mostly in relation to indwelling needles used in the ear for addiction and smoking
- Broken needles - occurs more commonly in those who are liable to move suddenly during treatment e.g. children, or during sudden powerful muscle contractions
- Burns - may occur during electro-acupuncture or "hot needle" acupuncture (cauterising Moxibustion)
- Contact dermatitis - can occur in those allergic to nickel, chromium or zinc, usually when cheap needles are used
- Neuropathy - short lived nerve symptoms can occur rarely in relation to needling close to a peripheral nerve - not usually permanent
Rare Major Problems
- Cardiac Tamponade - some patients have a small defect in the front part of the sternal bone, allowing a needle to pass through it into the outer lining of the heart (pericardium). If sufficient bleeding occurs into this space, then the heart can stop. Prompt surgical removal of the clot is the treatment of choice.
- Pneumothorax - needling over the ribs can sometimes cause a small hole in the outer lining of the lungs (pleura). Leakage of air can cause severe difficulty breathing, and can occasionally be fatal. Prompt treatment with the insertion of a chest drain to relieve the excess air is the treatment of choice.
- Infection - Bacterial endocarditis has been reported in unwell patients with indwelling needles in the ear. Hepatitis and HIV is a possibility with re-useable needles. Modern practice with single-use needles should prevent this. Out of courtesy please tell your therapist if you believe that you are Hepatitis A or B or C positive, or if are HIV positive or have AIDS.
- Pacemakers - electro-acupuncture may cause pacemakers to mal-function. This technique should not be used over the heart or front of the neck. Ordinary acupuncture is safe in these sites.
- Pregnancy - there is little evidence that acupuncture can cause harm to the mother and un born baby. There must be a risk/benefit assessment prior to considering treatment. There is a risk of miscarriage during the first three months, and a risk of premature labour during the last three months. The middle three months is therefore the safest period for treatment to occur. It is generally accepted that there is virtually no risk from needling point PC6 at the wrist for the treatment of morning sickness.