1. Pain Management by Acupuncture
Patient Education Course of
@Advanced Acupuncture, Inc.
2012

2. 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

3. Scientific Bases of
Acupuncture
 Neurohumoral
 Morphogenetic
 Nerve Reflex Theory
 The gate control theory
of pain
 Endorphin

4. Neuro-humoral Approach
 Peripheral nervous
system to be crucial in
mediating the
acupuncture analgesia
 Meridian-Cortex-
Viscera correlation
hypothesis

5. Neurohumoral Approach
 Acupoint-brain-organ
 Acupuncture stimulates
to brain cortex and
nerve system, then
control the chemical or
hormone release to the
disordered organs.

6. 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

7. 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.

8. 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)

9. 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

10. Therapeutic Mechanisms of
Acupuncture

11. Acupuncture Mechanisms of
Action
 Conduction of
electromagnetic signals
 Activation of opioids
systems
 Changes in brain
chemistry-release of
neurotransmitters and
neurohormones.

12. Acupuncture Pathways

13. 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.

14. 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)

15. 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.

16. 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.

17. 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

18. Effects of acupuncture on the
Brain-auditory cortex

19. 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.

20. 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

21. 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.

22. 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

23. 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

24. 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.

25. 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.

26. 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

27. Migraine Headache
 Classic Migraine
 Common migraine
 Cluster headache
 Hemiplegic and
ophthalmoplegic
migraine
 Lower half headache

28. Headache
Principle acupuncture points
 G 20
 Taiyang
 Li 4
 GV 20
 Liv 3
 G 8
 T 3

29. 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

30. 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.

31. 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

32. 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

33. Classifications of TN
 Western Medicine:
1. Typical
2. Atypical
3. Pre-TN
4. MS-related TN
5. Secondary or tumor related
6. TN neuropathy
7. Post traumatic TN
 Eastern Medicine
1. Pathogenic wind and cold
2. Ascending of Liver and
stomach fire
3. Deficiency heat due to liver
yin deplete
4. Damp/heat or damp cold
accumulation

34. TN-Pathogenic Wind & Cold
 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

35. 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

36. 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

37. 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

38. TMJ (TMD)

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

40. TMJ-Acupuncture points
 ST 7
 SI 19
 T 17
 Li 4

41. 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

42. 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

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

44. Differential Dx of RA/OA

45. Principle Acupuncture Points
for Arthritis
Temporo-mandibular
ST7, SI 19, T 17, Li 4
Shoulder 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:
Huatuoparaspinal
acupoints, UB37
and UB 40
Lumbosacra
Joints:
GV3, B30, B 25,
B40 B 60
Sacroiliac
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
Metatarsophala
-ngeal joints:
Sp 4, B 65, G 38,
Sp 5

47. 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.

48. Anatomy of CTS

50. 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.

51. Etiology of CTS
 Median nerve
compression by
tendonitis
 Usually due to
repetitive motion of the
wrist and hands.

52. Carpal Tunnel Release
Surgery:

53. Carpal Tunnel Syndrome
Principle acupuncture points
 P 6
 P 5
 T 4
 T 5

54. Cervical Spondylosis
Principle acupuncture points
 SI 3
 G 39
 B 64
 B 11
 G 21
 GV 16
 T 10
 B 10

55. Rotator Cuff Syndrome
Principle acupuncture points
 Li15
 Si 11
 T14
 Li 16
 Li12
 Li4
 L 7
 L 9
 T 9
 T 4

56. DX of Lateral Epicondylitis
(Tennis elbow)
 History of tennis elbow
use
 Pain just distal to the
prominence of the
lateral epicondyle
 Radiological study
negative

57. Knee Tendonitis
 Patellar Tendonitis

58. Achilles Tendonitis
 Runner’s injury

59. Lower back pain-Etiology
 Herniated Disk
(bulging)
 Facet joint syndrome
 Sacroilliac joint
syndrome
 Myofascial syndrome

60. Low Back Pain-diagnosis
 Clinical history
 Physical examination
 Pain sensitive
structures
 Pain generators
 Radiological studies

61. Low Back Pain-X-ray

62. 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

63. Referred and Interactive
Low Back Pain

64. 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

65. Referred and interactive-
Low Back Pain

66. 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.

67. Sciatic Neuralgia
Principle acupuncture points
 B 23
 B 30
 G 30
 B 36
 B 37
 B 40
 G 34

68. 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.

69. Cause of Neck Pain

70. Radiological Findings of
Neck Pain

72. 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.