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5 Articles in Volume 2, Issue #3
Acupuncture for Pain Relief
Intractable Pain
Menstrually-Related Migraine Treatments
Post-trauma Pain Management: A “Back to Basics” Approach
Spinal Cord Stimulation

Acupuncture for Pain Relief

Indications and contra-indications for the use of acupuncture in the treatment of cranio-cervical and temporomandibular dysfunctions.

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

Possible Mechanisms

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.

Efficacy

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).

Large Intestine 4 (LI-4, Hegu)

This is the major anesthetic point. It is commonly used for headache and tooth-ache, and in conjunction bilaterally with:

 

  1. Liver 3 (L-3)
  2. Triple Energizer 5 (TE-5, Waiguan)
  3. Bladder 10 (B-10, Tianzhu)
  4. Gall Bladder 14 (GB-14, Yangbai)
  5. Gall Bladder 20 (GB-20, Fengchi)
  6. Stomach 7 (ST-7, Xiaguan)
  7. Stomach 8 (ST-8, Touwgi)
  8. Stomach 44 (ST-44, Neiting)

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.

  1. The scalp area of infants prior to the closure of the fontanelles.
  2. Nipples and breast tissue.
  3. 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

Contra-indications for acupuncture in certain patient populations are presented in Table 2.

Contra-indications
  1. Patients on anti-coagulation medication
  2. Electro-acupuncture should be avoided in patients with pacemakers
  3. There is a danger of miscarriage when treating patients in the first trimester, and pre-mature labor in the last two months if improper points are needled. As a general rule, avoid the following points during pregnancy. LI-4 (Hegu), SP-6 (Sanyinjiao), B-60 (Kunlun), B-67 (Zhyin), KI-3 (Taixi), and GB-21 (jianjing).

Table 2. Contra-indications for acupuncture

Guidelines and Precautions

The following are common-sense guidelines and precautions for acupuncture treatment.

  1. If pain from needle insertion persists, it should be removed.
  2. Patients who are unable to remain still for any length of time are not suitable for acupuncture treatment.
  3. Acupuncture should not be utilized if there is any indication of possible infection at the site being considered for needling.

Care is necessary when needling diabetic patients due to the danger of poor periferal circulation and the effect of some points on blood sugar levels

There are also some acupuncture points which are located in potentially hazardous areas to needle. The practitioner must be aware of the hazard, and needle with appropriate care. Pneumothorax can be caused by improper needling of supra-clavicular points ST-11, and ST-12; Infra-clavicular points L-2, ST-13, and KI-27. Parasternal points, KI-22, 23, 24, 25, 26, 27 and ST-12 to 18 in the mid-clavicular line need particular caution. Cardiac Tamponade has been caused by improper needling of CV-17.20,21,22,23,24

General precautions, which are always necessary, should be adhered to strictly by acupuncturists. Those precautions include the use of sterile, disposable needles, the use of aseptic techniques with needle insertion, observing patients for bleeding, counting needles before and after treatment, using supine position during treatment, and advising the patients to avoid driving after treatment.25,26,27

Summary

The rise in the usage of complementary medicine in general, and acupuncture specifically, brings with it the potential for beneficial outcomes especially when used as part of a comprehensive treatment plan. Like all complementary medicine, acupuncture is often popularly perceived as more holistic and natural, and therefore intrinsically safe. Yet even acupuncture techniques that appear relatively simple must only be utilized after proper training and with a degree of caution to avoid serious complications.

Acupuncture can be an effective adjunct in the treatment of cranio-cervical and temporomandibular disorders. In addition to the pain relief itself, acupuncture has several positive attractions for patients, namely: time with the therapist, touch and personal dedication, and tangible sensations.

Last updated on: September 25, 2012
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