Acupuncture,Trigger Points and Pain

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Acupuncture,Trigger Points and Pain

• Adrian Lyster MA MBAcC
• Clinical Acupuncturist
• Pain Clinic Cheltenham General Hospital

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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

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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

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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

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TP associated pain symptoms

• Travell and Simons 1999
• Musculoskeletal pain
• Scar pain
• Gerwin ( in Gerwin Whyte Ferguson 2005)
• Migraine and headache
• Maloney Newman Maloney (in Gerwin ibid)
• Viscero-somatic pain dysmenorrhoea, IBS

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TPs and Chronic Pain

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

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TP treatment

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

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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

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TPs and Acupuncture Points

• Melzack, Stillwell Fox 1977
• 71 correspondence between local AcPs and TPs
• Birch 2003
• TPs and AcPs revisited
• Suggests lower correspondence

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Ah Shi points and TPs

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

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Analgesic Mechanisms

• 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

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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