Acupuncture

1
Examples of Current Modulations used by TENS
units to delay accommodation Name them
2
Evidence for the Efficacy of TENS
3
Efficacy vs Effectiveness

• Efficacy Mixed results in research have
  occurred due to several factors, such as waveform
  type, frequency, pulse rate, intensity, electrode
  placement, and treatment time
• Effectiveness Lack of comprehensive updated
  education of health care professionals is the
  main stumbling block to effective practice of
  electrotherapy for pain control. 

4
Acupuncture

• One branch of traditional Chinese Medicine
• Dates back to at least 2000 BC
• Most in the US think . . . very unusual concepts,
  language, practices
• Labeled by Western medicine as
• - unconventional
• - unscientific
• - mystical

5
Historical Development

• Noticed assoc. between pain in some areas causing
  relief in other areas.
• Began trial/error process of locating
  describing meridians surface points and their
  association with organs tissues.
• Groups of points are categorized as Meridians.
  The primary meridians . . .
• - 12 paired, 14 total
• - Names P, H, T, Lu, Si, Li, B, Gb, St, Sp,
  L(v), K, GV, VC

6
Philosophy

• Good health is balance btwn man the natural
  world balance btwn Yin Yang everything has a
  YY component
• Yin - assoc w/ earth, coldness, dampness
• Yang - assoc w/ heaven, sky, warmth, dryness
• Balance is regulated by the flow of chi (qi) the
  life energy flowing along meridians. Imbalance
  disrupts flow of chi - resulting in pain or
  illness - stimulation of points restores balance.

7
Neurophysiological Aspects

• Most points are highly conductive
• High concentrations of free nerve endings and
  sensory receptors have been are commonly found at
  points.
• Electroacupuncture causes increased levels of
  beta-endorphin in the CSF
• Some parasympathetic effects have been documented
  - lowered BP stress even fainting/hypnotic
  state
• Moderately strong relationship between trigger
  points, motor points acupuncture points
  (location)
• Possible placebo effect
• Unknown traditional Chinese philosophy
  (mysticism)

8
Types of Stimulation

• Classic Acupuncture
• - Needling
• - Needling w/ manual stimulation of needle
• - Needling w/ electrical stimulation thru needle
• Physical Therapy on acupuncture pts.
• - Manual pressure (acupressure)
• - TENS on the points
• - Laser on the points
• - Ultrasound on the points

9
Point Selection

• The Prescription method certain points are for
  particular clinical presentations symptoms. A
  Western adaptation
• Stimulate point in the same area as the pain /
  stimulate known MTPs in the area / stimulate Ah
  Shi points
• Classical method Holistic assessment w/
  detailed understanding on body, mind, lifestyle,
  environment, etc.. (ie. Yin Yang)

10
Practical Aspects

• What was once a scope of practice issue is now
  a fairly accepted part of practice (except for
  most 3rd party payers) more common in Europe
• movements continue to develop toward giving
  ownership of the skill licensure and
  legislation
• Primary use in PT - pain control
• Pain from chronic conditions or substantial
  pathology is likely to not respond as well
  Acupuncture in PT still largely relegated to last
  resort status b/c of unavailability, skepticism
  expense.