_survey of acupuncture treating neuropathic 针刺治疗神经性概述课件

Brief Survey of Acupuncture NEUROPATHIC PAIN Dover Publications Inc.,New York, 1965. Schematic view of Chinese cardiovascular system organization and vessel branching 經脈，絡脈，孫脈 Deke Kenall: Energy - Meridian Misconceptions of Chinese Medicine. 2008. 痛 - Pain CM: - “Qi obstruction” (Blocked Flow) - Huang Di NeiJing: 3 ch. on pain (1 on low back pain) - 2 ch. on 痹 Bi syndrome Attributed to 风，寒，湿 (wind, cold, damp) 不通則痛， 通則不痛 Bu tong ze tong, tong ze bu tong “If there is obstruction there is pain, if there is “communication” there is no pain” WM: - Is a warning signal - Is a subjective experience - Pain experience can not be reproduced - Can become a disease / chronic - Need be addressed using the “Biopsychosocial Model” 痹： Bi - translated as Impediment according to Nigel Wiseman Pain in the Clinic 1.Nocioceptive - Tissue Injury (Acute) 2.Neuropathic - Nerve Injury (Chronic) In Chronic Pain: Treatment Focus = Functional Improvement! a.ROM - Range of Motion b.Strength c.Endurance Treatment Approaches Biomedical model Biopsychosocial model Most appropriate for acute pain conditions More useful for those with chronic pain conditions Emphasizes peripheral nociceptionRecognizes the role that central mechanisms play in modulating peripheral nociception or generating the experience of pain in the absence of nociception Focus on physical disease mechanisms Recognizes the importance of illness behavior including cognitive and emotional responses to pain Reductionistic approach to understanding and treating pain Multidimensional systems approach to understanding and treating pain Reliance on medical management approaches Utilization of self-management approaches Chronic Pain Therapy Protocol 1. Set Goals/Make Plan with Patient = Explaining Procedure 2. Multi-discipline Approach is Best = Involving a Team 3. Focus on Functional Restoration = Improving ADL (Activities of Daily Living) 針 Needling Therapy 1.Neural Mechanism (Nerve Gate Theory) -Endogenous Opiates: enkephalins, beta-endorphins, dynorphins 2.Neuroimmune Basis of Anti-Inflammatory Actions -inhibition of macrophage activation, production of: TNF, IL-1B, IL-6, IL- 18+proinflammatory cytokines Neuroimmune Basis of Anti-Inflammatory Actions The neural modulation of the innate immune system involves proinflammatory (left) and anti-inflammatory (right) actions. Some of the major pathways are illustrated here. HMGB = high mobility group box; NF-B = nuclear factor-B; NK-1R = neurokinin-1 receptor. Image source: Matthay MA, Ware LB. Neuroimmune Basis of Anti-Inflammatory Actions Efferent activity in the vagus nerve leads to acetylcholine (ACh) release in organs of the monocyte-macrophage system, where ACh binds to the 7 nicotinic receptors on tissue macrophages and inhibits the release of proinflammatory cytokines.TNF = tumor necrosis factor; IL-1 = interleukin 1; HMGB = high mobility group box. Source: Tracey KJ (2002) Effective Needling Therapy Strategy SUMMARY OF EFFECTIVE PARAMETERS Site of Needle Insertion A combination of local needles in segmental receptive fields and distal needles in myotomes or sclerotomes both segmental and extrasegmental to the origin of pain is optimal. Intensity of Stimulation Pain decreased with either superficial needle insertion or deep mode acupuncture with de Qi (arrival of qi), but more patients responded to deep mode. Duration of Treatment Thirty-minute treatment was effective. Longer treatment relieved similar numbers of patients, but greater numbers had increased pain. Timing of Intervention Preemptive acupuncture for dental extraction pain increased postoperative pain and analgesic consumption. By contrast, treatment of chronic episodic dysmenorrhea with acupuncture one week prior to menses reduced pain and analgesic consumption. Mode of Stimulation Chronic nociceptive musculoskeletal pain is reduced by low-frequency electrical stimulation. Periosteal stimulation has the greatest effect upon nociceptive visceral pain of dysmenorrhea, although other modes of acupuncture and low-frequency TENS also reduced pain. Lundeberg T, et al. Pain Clinic 1988; 2(1):1531. Importance of Movement Therapy viscerosomatic relationship 1./spiltmilk/2009/04/yoga_baby.html 2./keys_recip.html