Acupuncture for Pain Relief
During the past twenty years, a multidisciplinary approach to the management of cranio-cervical and temporomandibular disorders has been advocated by many pain practitioners including physicians, dentists, physical therapists, chiropractors, and acupuncturists.1,2,3
One technique often overlooked in the treatment of cranio-cervical and temporomandibular disorders and the resultant painful symptoms is acupuncture. Acupuncture and acupressure have long been utilized by the Chinese and Japanese for the relief of pain in the temporomandibular and cranio-cervical regions.4,5
In the USA, non-physician acupuncturists are licensed, registered, or certified, in 34 states; physicians are allowed to practice acupuncture in all states.6
Although acupuncture initially was used for disease management, its use has evolved as a pain control modality.7
Late in 1997, the National Institute of Health (NIH) released a consensus statement supporting the use of acupuncture as part of a comprehensive treatment plan for some conditions. According to the statement, there is some evidence of efficacy in relieving the pain of fibromyalgia, post-operative pain, osteoarthritis, and myofascial pain. Some researchers specifically recommend acupuncture for the facial pain of trigeminal neuralgia (tic doloreux) and of TemporoMandibular Joint (TMJ) dysfunction. This modality is most successful when the cause of the pain is neuromuscular rather than due to joint damage. The NIH panel pointed out that acupuncture is associated with a lower risk of adverse events than those associated with drugs or other medical intervention.8
The stimulation of specific sites on the body surface exerts a marked inhibitory influence on pain. The acupoints have been known to the Chinese for many years. Their validity in pain control has been verified by numerous researchers.9
One experimentally well-documented mechanism for pain relief by acupuncture is the modulation of endorphin levels. Myofascial pain is relieved primarily by inactivating the source of pain. Acupuncture apparently alleviates the awareness of pain.10,11
Multiple studies of acupuncture verses splint therapy have been reported in the literature.12,13,14,15,16,17 These studies show the comparative effectiveness of acupuncture in the treatment of temporomandibular disorders. No statistically significant differences are found in most studies.
In the study by Johansson, et al,15 forty-five individuals with long-standing facial pain or headache of muscular origin were randomly allocated into three groups. The first group was treated with acupuncture, the second group received an occlusal splint, and the third group served as controls. Both acupuncture and occlusal splint therapy significantly reduced subjective symptoms and clinical signs from the stomatognathic system. No differences between these two groups were found with regard to treatment effects. It was concluded that acupuncture is an alternative method for individuals with craniomandibular disorders of muscular origin.
In the study by Raustia and Pohjola,14 acupuncture seemed to be a useful early form of therapy in patients with TMJ disorders. Acupuncture could well be complimentary to stomatognathic treatment — either preceding or following — to achieve full neuromuscular rehabilitation, to ease the treatment, or to eliminate other possible contributing factors.
Rosted wrote an article to review the scientific validity of published papers on the efficacy of acupuncture in dentistry based on pre-defined methodological criteria.18 Acupuncture, in 11 out of 15 studies, proved effective in the treatment of TemporoMandibular Dysfunction (TMD) and as analgesia. Rosted concluded that the use of acupuncture in treating TMD and facial pain seems real and that acupuncture could be a valuable alternative to orthodox treatment.
Several theses have been presented in the field of acupuncture during the last few years. One dissertation, studying facial pain, compared the pain-relieving effect of acupuncture and a bite-splint. Acupuncture was found to be as good as a bite-splint with respect to the relief of pain and muscle tension after one year.19
During the many years of utilizing acupuncture in the daily treatment of patients with cranio-cervical and temporomandibular disorders, the author found the tabulated acupuncture points to be most effective in the treatment of these painful head, face, and neck pain syndromes (see Table 1).
This is the major anesthetic point. It is commonly used for headache and tooth-ache, and in conjunction bilaterally with:
Table 1. Acupuncture points found most effective for head, face, and neck pain syndromes
These points are normally stimulated for 10-20 minutes after needle insertion using a combination of LI-4 and multiple other points, bilaterally, based on the location of the pain, severity, and diagnosis.
Evidence of acupuncture’s effects on pain in humans consists of direct observation of change in pain threshold, and indirect evidence from neurotransmitter activity.
A good working knowledge of human anatomy is essential in the utilization of acupuncture. There are some areas which pose a greater risk to needling. The following areas should be avoided at all times.
- The scalp area of infants prior to the closure of the fontanelles.
- Nipples and breast tissue.
- External genitalia.
The National Institute of Health released a consensus statement in 1997 supporting the use of acupuncture as part of a comprehensive treatment plan for some conditions including pain of fibromyalgia, post-operative pain, osteoarthritis, and myofascial pain.
Contra-indications for acupuncture in certain patient populations are presented in Table 2.