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 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. 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

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. 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

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