Osteoporosis, this is a condition of decreased bone density as the result of failure of the body to rebuild itself and occurs naturally because of the aging process. Bone naturally destroys itself and rebuilds the cells responsible for this process are called osteoclasts. These drill microscopic holes in the bone allowing new bone cells called osteoblasts to refill them. What’s interesting is calcium supplements have no part to play in the prevention of Osteoporosis and the condition is found to be enhanced in people with more sedately lives, smokers, alcoholics, extreme low body weight or have undergone repeated corticosteroid injections. Women are more prone to this condition than men and occurs often after menopause. Vitamin D is often prescribed, and hormone replacement therapy is given to menopausal women. Osteoporosis has no symptoms and will usually be diagnosed as a subsidiary as the result of another condition. Conventional treatment has little protocols for the condition it is just manage by dealing with the fractures as and when they arise.
Osteoarthritis is a condition where the degeneration of a joint and Its articulate cartilage is occurring with additional abnormal bone growths. This condition leads to a restricted range of motion with pain on movement, occurring due to either loss of cartilage and bone now rubbing together, or in the irregularities of the two cartilages attempting to move as it once did. Most common joints this condition affects are the weight bearing ones such as the knees, hips and spinal joints. Anti inflammatories topical NSAID cream such as Capsaicin are typically prescribed.
Tennis/ Golfers elbow is not just specific to sports people but is also common in anyone that does a repetitive job involving gripping and twisting of the hands and tensing the forearms. The condition to do with an inflammatory effect of the tendons known as tendinitis, (words with itis refer to inflammation) affecting both medial and lateral epicondyles of the humerus. Symptoms include local pain to the elbow joints but pain can often travel from the elbow up and down the arm as well as specific to the elbow itself.
Treatment protocols typically involve corticosteroid injections and non-steroid anti inflammatory.
Bursitis
Is a condition when the synovial membrane lined pouch around a joint becomes inflamed. The local area becomes swollen hot and tender to palpate with a restricted range of motion. This is commonly referred to as house maids’ knee or students elbow from repeated compression of the joint causing irritation.
Typical treatment protocol involves local corticosteroid injection.
Nerve impingements
This occurs when a nerve is being pinched by a joint, bone spur or muscle compression often resulting in pins and needles or a burning sensation. Weakness, numbness or total loss of movement is often reported, typical impingements occur in the neck affecting the arms and hands or in the lower back and pelvis affecting the legs and feet.
Treatment protocols include anti-inflammatory, neurological nerve blockers, corticosteroids or surgery.
Inflammatory conditions or more accurately conditions where inflammation is the prominent feature are referred to as Auto immune disease and Rheumatic diseases fit into this category. Conditions occur when the bodies own tissue attacks itself, the actual mechanism for this is currently unknown but there is a hypothesised link to it being related to T cell regulation and dysfunction. T cells are the killer cells of the body that fight infections, so it is suggested that any dysfunction of them leads to loss of control and development of autoimmune diseases.
Rheumatoid Arthritis, an extremely common disease-causing deformation and destruction to the joints, its symptoms are mainly that of joint pain which are often hot to touch, stiff, red with swellings and obvious joint deformation is very common. The main joints affected are that of the small joints of the fingers and toes, but due to its systemic nature can affect any part of the body. As the inflammation progresses weakness, numbness and tingling may be reported as the result of nerve impingements.
Treatment protocol is by a combination of Pain killers and anti-inflammatory such as Methotrexate, Sulfasalazine, Azathioprine, Ciclosporin, Chloroquine/ Hydroxy chloroquine. The condition has no conventional cure.
Polymyalgia rheumatica is an inflammatory disease affecting the muscles, occurring typically in the elderly and affects more women than men. Classical symptoms include sudden onset pain and stiffness, worse in the morning on first movement to neck hips and lower back. Additional symptoms may include fatigue, malaise and mild fever are often common factors.
Treatment is by means of corticosteroids to reduce any inflammation.
Ankylosing Spondylitis is an inflammatory condition that affects the spine. The whole vertebral common is usually affected, even the sacral iliac joint and as is very common effecting men more than women. Typical symptoms are rigidity to the spine, normal curvature becomes affected with exaggerated kyphosis.
Typical treatment protocols may include corticosteroids, non-steroid anti inflammatories and physiotherapy.
Gout, this is an inflammatory arthritic condition from a result of increased Uric acid in the blood and the resulting formation of crystals that are formed in joints. Increased Uric acid levels occur from several reasons, dietary factors can play a major part especially with food with high protein levels such as meat, alcohol also raise Uric acid levels. Some diuretic drugs such as frusemide and thiazide can also cause this to occur. Although commonly associated with pains in the feat the condition may occur in other joints and is extremely painful in nature to touch or bare weight on.
Common prescribed medication is Colchicine and Allopurinol.
Other aspects of pain within the body from a Chinese medicine perspective are known as Bi syndromes and are the result of external pathogenic factors or EPF’s entering the body due to a deficient Wei qi . If the pathogens do invade the meridian and collaterals the natural flow of qi and blood becomes obstructed causing stagnation and pain results or numbness and heaviness.
Bi syndrome can me mild in nature with pains to limbs and joints and in severe cases the pain is much more severe and recurring, often accompanied with local swellings, limited range of movement and even joint deformity.
Bi syndromes or obstruction syndrome is classified into four categories depending on the etiology and presenting condition.
1. Wandering Bi = Pain that moves around the body from one location to another, one-minute presenting in one location then another. This would be enough to diagnose the EPF to be a wind invasion.
2. Painful Bi = Severe stabbing pain in a fixed location, no local heat or redness present to an area with an underlying origin of cold.
3. Fixed Bi = Numbness and heavy sensation to limbs, soreness and fixed pain as a result of external damp invasion.
4. Hot Bi = Pain associated with heat signs, local redness, swelling severe pain limited range of movement with sudden rapid onset.
Bi syndrome may also be classified further to the specific locality of the condition that of
Skin bi this manifest as numbness of the skin with cold sensation.
Muscle bi is the pain and soreness of muscles
Tendon bi is soreness and stiffness to tendon.
Vessel bi pain from obstruction of vein or arteries
Bone bi is heaviness, stiffness and pain of joints during extension and flexion and pain the bear weight.
If conditions are acute or trauma related it must be noted that the tongue and pulse may not be affected but if the condition is chronic, stagnation, cold and heat can all be seen on the tongue and pulse.
Fortunately for us as acupuncturist we have several options in treatment methodology and all are valid but for different reason. As practitioners it is our job to now convert what the patient is telling us and transpose this into Chinese medicine, so we may attempt to treat the condition. Always ask the patient after they have told you what is wrong with them usually from the diagnosis of their GP to list what symptoms are currently occurring and how the condition arose and its duration.
If the area is too tender to palpate such as Gout for example distal needling will be the preferred method, for any other condition you may either choose to locally needle or distally needle and then review which protocol gives the best results. To remove inflammation and heat from a joint direct needling can have good effect and erythema will be clearly visible from around the point of needle insertion. Electro acupuncture on knee joints are another great way to move inflammation in the local joint, by passing an electrical current through the knee and under the patella it forcibly moves any inflammation encouraging new blood flow into the area.
As we have already stated pain for whatever reason is due to the obstruction of Qi and blood and as acupuncturists it is our job to free this obstruction and encourage the flow of Qi to the affected area. The most basic of all treatment forms using Acupuncture is simply to place a needle exactly where the pain is or on palpation of a local area finding ashi points. Other additional modalities of Chinese medicine may include cupping and Moxibustion to assist the imbalance.
Unfortunately for the majority of acupuncturist trained today there is a strong evidence to suggest that what is currently taught is not what was being taught and practiced hundreds or thousands of years ago. Due to severe turmoil in the history of China many books manuscripts and eminent physicians were destroyed or killed, and it is suggested that modern acupuncture is a construct based more on herbalism and internal medicine than that of channel theory. As a result, many practitioners fail to fully be competent in pain management and feel more comfortable treating internal conditions instead.
Regarding the treatment of pain, I will suggest that distal acupuncture using correct imagery techniques is the original method used not the current one and is currently becoming made famous as more practitioners are being trained in systems such as Tan or Tung.