WHAT IS CLINICAL ACUPUNCTURE … How Does it Work?
Clinical Acupuncture is an effective and simple treatment approach based on current concepts of neurophysiology, neuroanatomy, and pathophysiology. Insertion of solid needles and use of electrical stimulation are the foundation of this approach. The benefits of acupuncture treatments include muscle relaxation, pain modulation, changes in autonomic activity (vasomotor tone, cardiac rhythm, peristalsis), diverse neuroendocrine and immune responses, general relaxation, and a feeling of psychophysical well being. Clinical Acupuncture is generally performed by MDs, physiotherapists and chiropractors who use it as a tool to complement their regular treatment protocols, dealing mainly with pain related disorders.
The close correlation between local acupuncture points for pain and trigger points as noted by R. Melzack, co-author of the gate theory of pain, represents a major convergence of Western and Eastern knowledge. The traditional Chinese “Ah Shi” (translates to ‘Oh yes’) points are frequently equivalent to trigger points at which the application of pressure reproduces the pain syndrome. The near-and-far acupuncture technique, where needles are placed at the Ah Shi / Trigger points as well as distal points is the most commonly used technique in modern China today.
Relaxation of “stuck” myofibrils, increased local blood supply, the release of spinal dynorphin and encephalin (endogenous opioid compounds) have all been put forward to explain the rehabilitative effects of trigger point needling. The distal points usually below the elbow or knee which are used to modulate the sympathetic nervous system and the various ‘pain gates’ represent another meeting point between modern neurophysiology and ancient traditional Chinese acupuncture. Trigger points or ahshi points can be analysed clinically by using a tissue sensitivity gauge. How trigger points are involved in the pathogenesis and maintenance of commonly encountered pain states and their involvement with the Autonomic Nervous System remains unknown and is an important area of research that may well resolve many of the questions involving common pain states. Melzack, in a recent article on the role of compensation in chronic pain states, appears to support the importance of these concepts. “Patients who failed to respond to conventional forms of therapy were sometimes cured if the physician recognised that abnormal autonomic nervous system activity may persist indefinitely after a brief injury or that trigger spots may develop at the site of even relatively minor injury. Major procedures such as cordotomies may fail, but simple ones such as trigger point injections, may produce sudden remarkable recovery and subsequent return to work.”
Many GPs have responded to their patients’ needs by adding pain management tools to their practices. These tools frequently include pain assessment techniques, Acupuncture, Manipulation, Relaxation Training and Re-education of job task and posture. Clinical acupuncture in particular is one of general practice’s growth areas.
From the early 1970s when only a few medical practitioners used acupuncture, there is now widespread use and integration of alternate stimulation techniques developed from Traditional Chinese Acupuncture. (Stimulation techniques developed from Traditional Chinese Acupuncture include Dry needling, Electro-acupuncture and TENS, Trigger point injection and dorsal column stimulation.)
The results of controlled studies which have been extensively reviewed show good evidence for the short term effectiveness of acupuncture in many pain states. The long term studies, particularly where the well trained acupuncturist has been given the freedom of (traditional) normal practice profiles, have been encouraging, with success rates far higher than those associated with the placebo response.