Medical Acupuncture

Pain management is a great burden on society; therefore, cost-effective and nonaddictive treatments for pain are urgently required. Needling of painful spots has been applied in acupuncture along with dry needling <DN) to treat pain without opioids at minimal costs. However, no attempt has been made to examine DN, trigger point(TrP) physiology, and acupuncture to identify potential areas for pain-management research. This review compares the modalities of acupuncture and DN based on the current research on TrP physiology and diagnostics to advance both modalities.

A narrative review of the literature on TrP physiology, its associated diagnostics, and the techniques of DN and acupuncture was performed.

Diagnostic imagery may benefit the study and treatment of TrPs using needling. Acupuncture and DN techniques are similar in their applications. However, the warm needling technique is established in acupuncture but not in dry needling. Additionally, translational difficulties have inhibited crossdiscipline learning.

Historical evidence suggests a need to examine the use of heat in needling further. Additional research should be conducted on TrP categories to determine if a relationship with the needling technique can be established. Furthermore, interdisciplinary communication would benefit both modalities.

Pain following total knee arthroplasty (TKA) is common. Various modalities of treating orthopedic postoperative pain (POP) exist; however, the optimal management of POP remains unclear. The purpose of this study was to examine acupuncture's effect on postoperative analgesic consumption and cortisol levels in patients undergoing TKA.

In this randomized controlled trial, 80 patients scheduled for elective TKA surgery were recruited and randomly assigned to 2 groups: (1) an intervention group, receiving acupuncture treatment on days 1 and 2 in addition to standard POP management (n = 40) and a control group, who received standard POP management only (n = 40).

There was no statistical difference between the groups in analgesic consumption on days 1 and 3 postoperatively. On day 5 postoperatively, lower analgesic consumption was seen in the intervention group, compared to the control group. However, this difference was not statistically significant (1.4 versus 2.3, respectively; P = 0.215). There was no statistical difference between the groups in cortisol levels on day 1 postoperatively. In contrast, on day 2 postoperatively, cortisol level was significantly lower in the intervention group, compared to the control group (296 nmol/L versus 400 nmol/L, respectively; P < 0.05).

The findings suggest that acupuncture may have some effect on patients' analgesic consumption short-term after TKA. Further studies with larger samples are required for establishing these results.

This trial was registered at ClinicalTrials.gov (Registration #: NCT03415204).

This research was conducted to evaluate the effect of adding dry needling (DN) treatment to conventional rehabilitation for pain, range of motion (ROM), and functionality in patients with hemiplegic shoulder pain (HSP).

Patients with HSP (n = 38) were divided into 2 groups. A multimodal rehabilitation protocol, including physical therapy and exercise treatments, was given to both groups (5 sessions per week for 15 sessions). In addition to this rehabilitation, 3 sessions of DN therapy were given to one of the 2 groups. Measurements were a visual analogue scale; ROM; and 2 other scales (Quick Disability of the Arm, Shoulder, Hand; and the Fugl–Meyer Assessment Upper Extremity). Evaluations were made before, after, and at the third month after treatment.

While a statistically significant improvement was seen in both groups in all parameters after their treatments, a statistical superiority was found in the conventional treatment+DN group (P < 0.05). However, the differences were not greater than the minimal clinically important difference values (MCID). At the 3rd month follow-up, there was no difference in pain and functionality parameters between the groups, while flexion and abduction measurements were higher in the conventional treatment+DN group (P < 0.05).

Adding DN treatment to conventional rehabilitation did not show any difference except in some joint ROM measurements in the subacute time. Although the changes found were statistically significant, they were not clinically significant as they did not reach MCID values.

This study was registered prospectively at ClinicalTrials.gov (ref. no: NCT04790071).

In sports, recovery after exercise is a very important process for athletes. Several studies have shown that the rate of an athletes recovery can be increased by several modalities, one of which is acupuncture. This study was conducted to learn how press-tack needle acupuncture reduces blood lactic-acid levels after sports students exercise.

This was a randomized controlled trial. Twenty-four sports students were divided into 2 groups: (1) an acupuncture group (n = 12) and (2) a control group (n = 12). In each acupuncture group member press-tack needles were attached on PC-6 Neiguan and ST-36 Zusanli 30 minutes before doing high-intensity exercise. Measurement of lactic-acid levels was performed at 5 minutes and at 30 minutes after exercise.

The mean levels of lactic acid at 5 minutes after exercise in the acupuncture group were higher (p = 0.028), compared to the control group. The mean levels of lactic acid at 30 minutes after exercise in the acupuncture group was lower (p = 0.572) than in the control group. The mean reduction of lactic acid levels in the acupuncture group from 5 minutes after exercise to 30 minutes after exercise was statistically higher (p = 0.007) than in the control group.

Press-tack needle acupuncture affects reduction of lactic-acid levels after high-intensity physical exercise. Further studies are needed to investigate the more-detailed biochemical mechanisms.

This trial was registered at ClinicalTrials.gov (ID: NCT04892784).

Rotator cuff (RTC) tendinopathy is a common painful condition of the shoulder that impairs function and quality of life. Nonoperative treatments when physical therapy and oral medications have not resolved the issue often consist of different strategies to improve blood flow and promote growth factors, thereby creating regeneration and healing of injured tissue in the RTC tendons. Acupuncture could serve in a similar role when needles are strategically targeted into injured tissue utilizing ultrasound visualization.

A 58-year-old male presented with over 1 year of symptomatic RTC tendinopathy involving the supraspinatus and infraspinatus tendons. He had not gotten sustained pain relief with physical therapy or a corticosteroid injection to the subacromial bursa and was not a surgical candidate for RTC repair due to only having small partial tearing of the tendons. He wanted to consider alternative treatment options and it was decided that he could pursue ultrasound-guided electroacupuncture.

Treatment was successful and completed within 4 weekly sessions. He reported 85% improvement in symptoms two months after starting treatment and is now over 1 year out from treatment, with what the patient states as “minimal” residual discomfort with one stretching movement.

Ultrasound guidance of acupuncture needles into areas of RTC tendon injury simulates many of the current nonoperative treatment modalities sports medicine has to offer for RTC tendinopathy. This short- and long-term successful case report provides a steppingstone for future research into this area.

Musculoskeletal injuries can be debilitatingly painful, with long recovery times and activity-limiting prognoses. While numerous studies and case reports illustrating the benefits of acupuncture in treating various musculoskeletal conditions are available, more studies specific to acute injury are needed.

A 45-year-old male presents ∼48 hours post a severe injury to his R hamstring while walking in his neighborhood. He has a history of musculoskeletal disorders, which may be due to an undiagnosed hypothyroid condition. A combination of acupuncture, myofascial release techniques, and kinesiology taping (KT) was administered in 7 treatments over 28 days postinjury.

This patient was back to normal functionality, strength, and ROM within 4 weeks of this injury, more than 5 weeks ahead of his orthopedic physician's estimated recovery time. At 28 days postinjury, after 7 treatments, visual analog scale had decreased from 9/10 to 0/10, Tenderness To Palpation Scale decreased from grade IV to I, and Lower Extremity Functional Scale increased from 0/80 to 74/80.

Using a combination of acupuncture, myofascial release techniques, and KT may greatly reduce the healing and recovery time in patients with acute musculoskeletal injuries.