Further Applications For Medical Acupuncture During Pregnancy

I have already discussed how Acupuncture may be of benefit for those women suffering from low back and pelvic pain, as well as discussing aspects relating to safety in a previous post. In quick summary, its safe, its effective, we should be using it more to help those suffering in this way.

But what of the other applications?

It would seem, according to three trials summarized by Lee & Ernst (2004) that Acupuncture may be useful in reducing labour pain. Furthermore, those who receive this treatment during labour have been found to be less likely to require epidural analgesia (Nesheim & Kinge, 2006). Of course the delivery of Acupuncture during labour may be challenging and would probably be dependant on a midwifery team who have not only been trained to deliver this form of treatment but who have the time, inclination and support to do so. Given the strain on resources in public healthcare environments this could be a barrier.

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De qi or not De Qi?

The de qi, or needling sensation as we refer to it in medical Acupuncture is not a single, but rather a combined sensory response which occurs when a variety of sensory receptors are stimulated.

These would include small fibre innervated nociceptors and myelinated fibre innervated mechanoreceptors (Leung et al, 2006).

Zhang et al (2012) hypothesise that the numbness, heaviness and distension felt as part of the needle sensation may be due to the stimulation of sites rich in muscle spindles and tendon organs (proprioceptors) and the soreness and aching in the deep tissues is likely to be due to the activation of intramuscular nociceptors (type II/III).

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No Pain equals More Gain!

In my private practice clients generally expect to be treated gently and specifically. Clients come to our clinic to be made comfortable not made to feel more pain. 

Current evidence supports treatment below the pain threshold (Nijs et al, 2009).

But why should treatment be below pain threshold?

A quick explanation…

Pain causes more pain; the nervous system will reconfigure in response to a persistent pain input and create more pain! (Nijs et al, 2009).

This process has been referred to as ‘wind up’  and occurs as the response of some spinal cord transmission cells becomes more vigorous (Woolf, 1996).

Further nociceptive input (on top of that arising due to injury) converging at dorsal horn may also cause increased activation of second glutamate receptors, the NMDA receptors. These previously ‘dormant’ receptors may become activated semi-permanently and contribute to the central sensitization process. Activation of NMDA receptors results in a much greater pain response to stimulation then the basic ‘AMPA’ receptor which is the first one which responds to the release of glutamate from the primary afferent nociceptive nerve (White et al, 2008).

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Acupuncture More Effective Than Local Injections for Low Back Pain

Inoue et al (2009) have shown in a randomised controlled clinical trial that repeated Acupuncture stimulation is more effective when compared to repeated local anaesthetic injection targeting ‘the most painful points’ once weekly over 4 weeks.

Two to five points were chosen, the depth was similar at 10-20 mm however the gauge of the injection needle was larger as would be expected at 0.5 mm vs 0.18mm for the Acupuncture needles.

The outcome measure was the VAS applied immediately before and after the first treatment, before each subsequent treatment and and 2 and 4 weeks following treatment with each measure showing improvements for both types of treatment but a significant difference in favour of the Acupuncture group.

The authors suggest this may be due to different mechanisms of pain suppression, however given the common use of the needle in both cases there could well be some overlap. This could be further evidence to support the notion that its not what you inject but the physiological effects of the needle itself. The advantage of ‘dry’ needling perhaps being a better ability to control dose thereby reducing the risk of over-stimulating more sensitive patients?

Acupuncture changes our Sympathetic Drive

An interesting study by Paulson & Shay (2013) confirms that Acupuncture activates the sympathetic nervous system during and after treatment. 

Their single blinded randomised descriptive study showed that those who received acupuncture to the forearm muscles (on one side) after a bout of fatiguing wrist extension exercises measured a bilateral decrease in skin resistance and distal skin temperature. There was a significant difference in outcome measures when compared to sham acupuncture or no treatment. The fact that the changes were measured bilaterally suggests central control changes, probably at the level of the hypothalamus.

The acupuncture group also measured an increase in perfusion (blood flow) but on the side of treatment only, which the authors suggest is likely to be due to a local circulatory versus central/systemic control change.

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