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Chronic Pain
Depending on the degree of complication of each individual patient, we will use one or several of the following approaches, to reach the optimized recovery and good long term health.
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Regular acupuncture modalities
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Advanced acupuncture technique of motion technique
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Advanced acupuncture technique of manipulation/Qi jumping/electrical stimulation.
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Classical Chinese herbs pills or formulas.
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Up-to-date clinical research evidence of acupuncture and Chinese herbs from literature search, both in English and Chinese
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Individualized therapy: combining knowledge of anatomy, physiology, pathology, pathophysiology, pharmacology, psychiatry, psychology and clinical medicines, with Chinese herb medicine, to guide our practice.
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Discussion with state, national and international peers and specialists, for a complicated case.
Clinical Evidence and Scientific Mechanisms
Clinical evidence:
A recent meta-analysis conducted by investigators at Memorial Sloan Kettering Cancer Center, New York, NY, whose data received for a total of 20,827 patients from 39 trials. The report showed that acupuncture was superior to both sham and no acupuncture control for each pain condition (all p<0.001) with differences between groups close to 0.5 standard deviations (SD) for comparison with no acupuncture control and close to 0.2 SDs in comparison with sham. They also found clear evidence that the effects of acupuncture persist over time with only a small decrease, approximately 15%, in treatment effect at one year.
Scientific Mechanisms:
The mechanisms of acupuncture on chronic pain are mainly associated with three aspects: dissecting fascia adhesion, anti-inflammation and analgesia effects.
Dissecting fascia adhesion:
Fascia is a thin casing of connective tissue that surrounds and holds every organ, blood vessel, bone, nerve fiber and muscle in place. The tissue does more than provide internal structure; fascia has nerves that make it almost as sensitive as skin. When stressed, it tightens up.
Although fascia looks like one sheet of tissue, it’s actually made up of multiple layers with liquid in between called hyaluronan. It’s designed to stretch as you move. But there are certain things that cause fascia to thicken and become sticky. When it dries up and tightens around muscles, it can limit mobility and cause pain to develop.
By inserting acupuncture needles into layers of fascia, and using some special technique such as motion technique, which has been proved to dissect fascia adhesion, acupuncture can relive associated pain with fascia adhesion.
Anti-inflammation:
After antidromic stimulation of the nociceptor, calcitonin gene-elated peptide (CGRP), substance P and β-endorphin are all released. Initially, substance P will activate mast cells and in a later phase also macrophages to secrete inflammatory mediators. As a consequence, the mast cell will not only secrete serotonin and histamine, but also cytokines such as tumor necrosis factor (TNF)-a. In turn, TNF-a could prime sensory nerve endings. The activation of mast cells and mast cell-mediated inflammation is regulated by nitric oxide (NO). Macrophages will produce a number of cytokines and eicosanoids.
High levels of CGRP have been shown to be pro-inflammatory but, on the contrary, CGRP in low concentrations exerts potent anti-inflammatory actions. The main attributive effect of substance P could be the feedback regulation of CGRP release from nerve endings. The effects of neuropeptides may vary from one organ or tissue to another. The presence and time dependent contribution of mast cells, macrophages and other inflammatory cells to produce mediators that activate or counteract the inflammatory process may be of crucial importance). Therefore, a well-performed and frequently applied ‘low-dose’ treatment of acupuncture could provoke a sustained release of CGRP with anti-inflammatory activity, without stimulation of pro-inflammatory cells. That could be the explanation why acupuncture only seems to be beneficial in the treatment of some inflammatory conditions.
Analgesia effects:
This is related to pain inhibitory systems in the central nervous system. Endogenous opioids and their receptors such as β-endorphin, enkephalin, cholecystin cytokinase (CCK) and dynorphin are released selectively by acupuncture needle insertion and electrical stimulation. Common pain inhibitory systems including the arcuate nucleus in the hypothalamus, periaqueductal
rey (PAG), parabrachial nucleus (PBN), rostral ventromedial medulla (RVM), and descending inhibitory systems originating from the nucleus raphe magnus (NRM) and locus coeruleus (LC) as key substrates in the central nervous system (CNS) are also activated in the process of acupuncture. Meanwhile, both thin (A d and C fibres) and thick (A β fibre) afferents activate the pain inhibitory systems, which inhibits pain via the gate theory.
References:
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Vickers AJ et al. Acupuncture for chronic pain: update of an individual patient data meta-analysis. J Pain. 2018; 19(5): 455–474. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5927830/
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Kawakita, K et al. Mechanisms of action of acupuncture for chronic pain relief – polymodal receptors are the key candidates. Acupuncture in medicine. 2006;24(Suppl):S58-66. https://www.researchgate.net/publication/246211362_Mechanisms_of_action_of_acupuncture_for_chronic_pain_relief_-_Polymodal_receptors_are_the_key_candidates
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Zijlstra FJ, et al. Anti-inflammatory actions of acupuncture. Mediators of Inflammation. 2003;12(2), 59-69.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1781596/pdf/12775355.pdf -
Scar tissue release using Myofascial techniques.
https://www.firstphysio.com/scar-tissue-release-using-myofascial-techniques/
Our Special techniques
Besides classical acupuncture techniques, we also use some special techniques such as: Qi jumping, Set Mountain on fire, penetrate heaven coolness, motion technique
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Qi jumping: insert needles in induce one aspect of “De-qi sensation”, the response is like a finish taking the bait, and then add with/without electrical stimulation. This response usually shorten the duration of recover for 2-4 times.
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Set Mountain on fire: this technique can increase the temperature of local tissue by 0.5-4 Celsius degree. It is good for long time disorders, especially those feeling weak and cold from time to time.
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Penetrate heaven coolness: this technique can decrease the temperature of local tissue by 0.5-2 Celsius degree. It is usually good for sharp pain.
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Motion technique: After needles are inserted to certain acupuncture points, people are asked to do some movement with needles inside the body. This technique is good for pain caused by soft tissue.
FAQ:
What is chronic pain?
Chronic pain is pain that is ongoing and usually lasts longer than six months. It has seven categories:
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Chronic primary pain: defined by 3 months of persistent pain in one or more regions of the body that is unexplainable by another pain condition.
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Chronic cancer pain: defined as cancer or treatment related visceral (within the internal organs), musculoskeletal, or bony pain.
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Chronic post-traumatic pain: pain lasting 3 months after an injury or surgery, excluding infectious or pre-existing conditions.
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Chronic neuropathic pain: pain caused by damage to the somatosensory nervous system.
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Chronic headache and orofacial pain: pain that originates in the head or face, and occurs for 50% or more days over a 3 months period.
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Chronic visceral pain: pain originating in an internal organ.
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Chronic musculoskeletal pain: pain originating in the bones, muscles, joints or connective tissue.
What benefits are noticed from treatment?
According our experience, with our acupuncture techniques, more than 85% of people can feel improvement right after the initial treatment.
How many treatments are required?
This varies from people to people. Some only need 1-2 visits and some need longer. If the stress causing the pain still exists, we recommend a tune up treatment once every 1-2 month, to maintain normal function and prevent pain recurrence after the first whole course of treatment, even it is pain free.
Case report
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Chief complaint: Dec. 3rd, 2020. 60yr male presents with right meniscus tear for more than one month.
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History of present illness: When he was playing hockey, he felt down with the right knee on the still position. The twist caused him pain immediately, He then went to see a medical doctor, did MRI, which showed a 4mmx7mm tear, in the right meniscus. The doctor prescribed him cortisone injection at the lateral side of right knee, which had no major improvement. He is also taking ibuprofen which was not significantly helpful as well.
Examination: Antalgic gait, local swelling and tenderness, with limited range of motion. -
Medical diagnosis: Right meniscus tear.
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Treatment details: At the initial visit, Qi jumping and electrical stimulation cross the knee was conducted. At the second visit, Qi jumping and motion techniques were performed.
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Clinical outcome: After two visits, his right knee pain is 75% better.
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Note:
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Response of treatment varies from person to person. Pre-existing surgery caused some damage in the anatomy and physiology function of normal joints and soft tissues, left some scare tissue and tissue adhesion, thus, it usually takes longer time to reach the same improvement as a non-surgery person.
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The Qi jumping technique usually comes with a “Deqi” sensation, which is good for accelerating recovery of pain disorders by 2-4 times than a regular acupuncture technique. After receiving this technique, some people will feel some sequelae discomfort such as soreness, heaviness, or other feelings. If you don’t like the sequelae, please let us know. We can make the “Deqi” sensation from zero, mild, moderate to strong level.
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