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 TPs and Chronic Pain TPs and Acupuncture research

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

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

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

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

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

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

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

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

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

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