Acupuncture for Thoracic Spine Pain

Needling sites:

– 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)

or:

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.

Acupuncture and Back Pain

Research carried out in 2002 indicated that almost 80% of the world’s population would suffer from some kind of back pain with lower back pain being the most common type. In addition to the high rate of incidence, back pain is also known to have a high rate of recurrence in patients. With patients trying everything from over the counter painkillers to physiotherapy to gain relief from back pain, Acupuncture comes as a welcome change.

Acupuncture is a natural method of treatment that involves no chemicals or surgery. Thin stainless steel needles are inserted into the body at various acupuncture points to stimulate the free flow of Chi or life force through the body. Free flowing Chi results in a healthy and pain free body. Large bodies of research have been able to establish a connection between acupuncture and relief from back pain-especially sciatica.

Sciatica refers to a type of back pain in which the pain radiates from the buttocks down the legs. Sometimes, sciatica pain can also be a consequence of a muscle spasm impinging on the sciatica nerve. Acupuncture can be effectively used to alleviate muscle spasms. The results are almost immediate and can provide relief within minutes.

Back pain is generally caused because muscles that are not frequently exercised and stretched are suddenly put to excessive use. Muscle spasms are common in such cases and result in the individual feeling sore, stiff and a dull ache in the back. Patients suffering from sciatica may even feel a tingling sensation or numbness. This is generally due to the narrowing of the disc space or a disc protrusion in the lumbar region.

Acupuncture is used to improve blood circulation to the entire lumbar region and spinal cord. It relaxes paraspinal muscles and provides relief from muscle spasms. The increased blood flow provides greater nourishment to the discs and increases the elasticity and strengthens the spinal cord. Thus, acupuncture can be extremely effective in reducing back pain symptoms. It is important to remember that different patients respond differently to acupuncture sessions and it can take anywhere between 4-12 sessions to really feel the difference.

Acupuncture, Muscle Numbness and Sciatic Pain – A Case Study

Attorney Holmes was born in Boston to a relatively poor family. He took odd jobs shoveling snow and paving streets as a teenager before joining the army for three years, which helped pay for his college tuition. He started drinking alcohol when he was serving the army. In his early forties, he decided to quit drinking alcohol because he finally realized that drinking made him feel horrible afterwards and because he believed the alcohol could cause damage to his brain cells. Since he was trained to be a disciplined person in the US Army, once he decided to quit drinking, he was able to quit completely. But years of drinking had caused hormone imbalances. For example, abnormal estrogen levels stimulated his prostate and when he was in his seventies, he developed prostate cancer. He had radiation treatment and developed impotence for a while after surgery due to nerve and blood vessel damage. However, because he did not eat junk food or drink alcohol any more, he was physically very healthy and was able to put his impotence behind him after about a year.

He came to my clinic four years ago due to hand numbness and weakness as well as muscular atrophy. At the age of 82, he still went to the court a couple of times a week as a defense lawyer. He walked a mile with his dog every day, did not take any medication, and amazingly, could still sleep through the night for 7 to 8 hours. But he drank too much coffee – between 4 to 5 cups a day – before he started acupuncture treatment.

When he first came to see me, I noticed that his thumb muscles were slightly atrophied. His grip was not firm, and sometimes, things dropped out of his hands. First, he went to see a hand specialist, who recommended surgery, but said that although surgery may fix the problem, it may also cause chronic pain, swelling, and even nerve damage. He decided to try alternative medicine.

First of all, I recommended that he cut down his coffee intake to one to two cups a day. Because acupuncture helps his body produce endorphins, serotonin, and dopamine, it became easier for him to cut down his coffee while he was in treatment. Although coffee did not interrupt his sleep, it caused blood vessel constriction in his hands and feet, stimulated his heart rate, and made his upper shoulder muscle very tight. I told him that if he could cut down to one cup each day, he could still stimulate his brain cells without sacrificing his heart and hand health. He gradually cut down his coffee.

I also found out that he loved to sleep on his stomach with his head turned to one side. This may have caused his muscle tightness and pinched his cervical nerves. If the compression of the nerves lasts for too long, his hand muscles could get weaker and weaker. I chose acupuncture points on his neck and foot to deeply relax his neck muscles and then used electrical acupuncture to facilitate the regeneration of the nerves in his hand, which also strengthened his hand muscles. Once the blood circulation in his neck and hand were improved, his hand muscles quickly become stronger. After 24 treatments, his hand function recovered completely and he stopped needing acupuncture.

Two years later, he came back with severe hip, leg, and ankle pain. The pain was so bad that he had to take Aleve in the morning just to be able to walk around. I treated him once with electrical stimulation, combining points on his lower back and leg. He felt instant relief in one day. Then, he had such strong pain in the morning two days later that he had to double his painkiller dosage. He was so afraid that he could not walk that he decided to increase his acupuncture treatments to two or three times a week.

I noticed that his pain was distributed along the L3, L4, and L5 area. In the morning, his pain was the worst and moving around help relieve the pain. Considering his sleeping posture, which may have caused tightness in his periform muscle and irritated his sciatic nerves, I recommended that he sleep on his back. Initially, he had to periodically turn onto his stomach because that had been his preferred sleeping position for the past 84 years. In this way, he could not stay in one position for very long. He might sleep on his back for 3 hours and then sleep on his stomach for another 4 hours. Combining the positional changes and acupuncture treatments twice a week, we successfully got rid of this new pain within three weeks.