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Acupuncture,Trigger Points and Pain

Acupuncture,Trigger Points and Pain. Adrian Lyster MA MBAcC Clinical Acupuncturist Pain Clinic Cheltenham General Hospital. Acupuncture, Trigger Points and Pain. Myofascial Pain Incidence of Pain and Trigger Points Definition of Trigger Points TP associated symptoms TP treatments

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Acupuncture,Trigger Points and Pain

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  1. Acupuncture,Trigger Points and Pain Adrian Lyster MA MBAcC Clinical Acupuncturist Pain Clinic Cheltenham General Hospital

  2. Acupuncture, Trigger Points and Pain • Myofascial Pain • Incidence of Pain and Trigger Points • Definition of Trigger Points • TP associated symptoms • TP treatments • TPs and Chronic Pain • TPs and Acupuncture research

  3. Incidence of Pain • 15% of all GP consultations for pain • HMSO 1991-2 Morbidity in General Practice • Thomas 2001 • 80% acupuncture consultations for pain • Skootsky 1989 • 30% General Pain referrals had TPs • Gerwin 2001 • Chronic Tension Headache, 98% had TPs associated with Headache

  4. Definition of Trigger Point • Produces Myofascial Pain • Palpable taut band within muscle, skin, fascia • Palpation reproduces pain pattern • Pain pattern crosses dermatomes • Palpation produces a flinch response or a local twitch along muscle fibre • Weakens muscle • Shortens muscle • Restricts ROM • Associated with endplate noise/SEA in EMG

  5. TPassociated pain symptoms Travell and Simons1999 • Musculoskeletal pain • Scar pain Gerwin ( in Gerwin & Whyte Ferguson 2005) • Migraine and headache Maloney Newman & Maloney (in Gerwin ibid) • Viscero-somatic pain – dysmenorrhoea, IBS

  6. TPs and Chronic Pain • Chronic pain > 3 months • Original TPs recruit associated TPs in associated muscle units • Central sensitisation develops • Cognitive and Behavioural effects and changes

  7. TP treatment • Dry needling/Acupuncture • Vapocoolant spray and stretch • Superficial dry needling and stretch • Injection local anaesthetic • Injection BoTox • Muscle energy techniques

  8. Clinical Implications • Needling variations • Baldry - Superficial Needling, non retention • Gunn - Deep needling, retained • Fischer – injection at TP and spinal segment level • Travell – Injection and stretch • Gerwin – deep needling non retained and stretch • Et al

  9. TPs and Acupuncture Points • Melzack, Stillwell & Fox 1977 • 71% correspondence between local AcPs and TPs • Birch 2003 • TPs and AcPs revisited • Suggests lower correspondence

  10. Ah Shi points and TPs • Needham ; Celestial Lancets. Ref. • Sun Ssu-Mo.C7AD.Ah Shih Hsueh • Tender to palpation, non channel points

  11. AnalgesicMechanisms • Gate Control Theory = pre synaptic inhibition of pain = post synaptic descending inhibition • DNIC • Neuromatrix models = complex interactive multidimensional experience of pain as represented in fMRI

  12. Summary • TPs are a sign of myofascial pain • TPs respond to acu needling • TPs may correspond to AcPs and Tp referred pain may correspond to channels • TPs are outside channels and have different referred pain patterns • TPs have some shared qualities with Ah Shi Points • TPs have unique qualities • Acupuncture practice TPs are a useful adjunctive model for

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