– Tips of spinous processes
– Interspinous ligament
– Paraspinal muscles
– Pain in chest wall (also local needling)
Pain in the thoracic spine is sometimes harder to help than pain in other parts of the back. Some patients have Type B pain localized to the spines of the thoracic vertebrae and in such cases periosteal needling of these works well. Remote needling of the dorsum of the hand or the ulnar border of the palm (SI 3) can also help thoracic spinal pain.
Pain in the chest wall generally does well; local needling over the painful area itself is effective.
What disorders are suitable for treatment?
Most acupuncture treatment is concerned with musculoskeletal disorders. Acupuncture can also be used to treat a number of disorders that are not – or not obviously – related to the musculoskeletal system.
It is possible to grade disorders according to the likelihood that they will respond to acupuncture.
- Group A: Those that generally do well (50 to 70 per cent).
- Group B: Those that do moderately well (10 to 50 per cent).
- Group C: Those that seldom or never respond (less than 10 per cent).
Musculoskeletal disorders are generally Group A. Being a strong reactor moves a patient up by at least one category.
Note that in many cases it is either not possible to assign a formal diagnostic label to a patient’s symptoms or else the label applied (e.g. ‘osteoarthritis’) is fairly unhelpful. This does not mean that reaching a pathological diagnosis is irrelevant, but rather that acupuncture can be used in cases where no formal diagnosis has been found in spite of ample investigations.
Recording the treatment
This is essential, both for medicolegal reasons and for future reference. In practice, I tend to use a mixture of traditional and modern terminology to describe my treatment. If there is a traditional acupuncture point at the site I have used I note that; otherwise I use a description based on Western anatomical terminology. I also record the side (L or R), together with any other relevant information, such as the duration of needling (if unusual) and the effects, if any. Thus an initial treatment might be recorded as follows:
Lr 3 L,R (brief stim.): general reaction ++ (euphoria -? strong reactor)
TP in L gluteus medius: painful ++; sensation down to ankle.
Another way of recording one’s treatment is to mark it on a drawing.
On a subsequent attendance one should also record the outcome, possibly with a VAS.
The BMAS record sheet as supplied to candidates for the Certificate of Basic Competence provides a template for these details.