20 Acupuncture in Treatment of Aging Spine–Related Pain Conditions

Acupuncture is an important component of Traditional Chinese Medicine (TCM), which has been used in China and other regions for over 5000 years. A Chinese classic, Huang Di Nei Jing (黄帝内经), Yellow Emperor’s Inner Canon in English translation, has been regarded as the earliest source on acupuncture in writing. Compiled in circa 100 bc, this treasured classic contains eighty-one treatises organized into two parts: Su Wen (素问) and Lin Shu (灵枢). The latter is considered the bible for the application of acupuncture. The principles stated in the treatises still guide the practitioners in modern times.

Acupuncture was introduced to Europe in the eighteenth century by returning missionaries and was mentioned in a history of surgery published in 1774 in France. In North America, widespread public and professional awareness of acupuncture commenced in 1971 when James Reston reported his observations in Beijing, as a sports journalist on a ping-pong tournament trip, in The New York Times.¹ There has been a substantial increase in the use of complementary and alternative medicine in the United States since then.² Acupuncture is the most frequently used modality in complementary and alternative medicine for the treatment of symptoms of osteoarthritis,³ and especially in the treatment of back and neck pain, or other related pain conditions, including radiculopathy resulting from disc herniations or spinal stenosis. Despite the vast application of acupuncture, evidence-based clinical research in English publications, in which most authors used the approaches of “Western style of acupuncture,” has show an inconsistent conclusion on the effectiveness of acupuncture. The Western approach of acupuncture was defined as conventional diagnosis followed by individualized acupuncture treatment using a combination of prescriptive tender, local, and distal points. This is in contrast to the approach in TCM, which would formulate an individualized diagnosis based on TCM theories of meridians and energy (or qi).⁴

Acupuncture is the procedure of inserting and manipulating filiform needles into various points (called acupuncture points) to relieve pain or for other therapeutic purposes. According to TCM, acupuncture points are the sites through which the vital energy, or “qi” and “blood,” are transported throughout the body surface. In the basic framework of TCM, there is a channel system with meridians connecting most of the acupuncture points regulating the functions of the internal organs and musculoskeletal system in a human body. The meridian system is believed to transport energy to every part of the body to keep the physiological function in balance. Health is regarded as a state of balanced homeostasis of the yin and the yang. Any creature, including human beings, is presumed to suffer from diseases when the energy is not flowing smoothly because it is blocked or stagnant along the meridians, which in turn would result in disharmony in the body as a whole. The etiology of disharmony is usually categorized as internal pathological excess, such as sadness, anger, or fear; and external assaults, such as cold, heat, or dampness. Acupuncture is reports to restore the flow of vital energy and to bring the human body to a new balanced state (homeostasis). Despite the long history in the application of acupuncture in many clinical conditions, the mechanism behind it has not been fully understood and explained within the framework of the Western medical system.

Description of the Needle

An acupuncture needle is divided into five parts (Figure 20-1): tip, body, root, handle, and tail. The tip and body of a needle are the parts being inserted into the body of a subject on the acupuncture points. The handle and tail of a needle are the parts used by a practitioner to manipulate the needle. The root connects the body and handle of a needle. Commonly used acupuncture needles are made of stainless steel, with sizes from 26 to 40 gauge and lengths from 0.5 inch to 2.5 inches. Because of the small size, quite often people describe an acupuncture needle as a “painless needle.” The tip of an acupuncture needle is blunt, even though it is very tiny. Compared with the tip of a regular needle in the same gauge number, the tip of an acupuncture needle has less chance of cutting the tissue.

FIGURE 20-1 Acupuncture needle.

Operative Techniques

Depending on the location of acupuncture points, a patient can be placed in supine, prone, recumbent, or sitting positions. Lying position is usually preferred due to the possibility of fainting in some patients from needling (Figure 20-2 ).

FIGURE 20-2 A needle is inserted in a patient in the lying position.

Needle Insertion Techniques

There are four common ways to insert a needle: finger pressing insertion, pinching needle insertion, pinching skin insertion, and tight skin insertion. The skin at the insertion site is cleaned with an alcohol pad. The needle insertion angle can be perpendicular, oblique, or horizontal to the skin surface with various depths, depending on the location of the acupuncture points, the medical conditions being treated, and the patient’s general health.

Finger pressing insertion. This technique is used when a short needle is used. Before inserting, the practitioner uses one fingertip (guiding finger) of the assisting hand to gently press the acupuncture point. The needle is then inserted into the skin of the acupuncture point along the edge of the guiding finger.

Pinching needle insertion. This technique is used when an acupuncture point is deep and a long needle is used. Once the acupuncture point is identified, the thumb and index finger of the assisting hand hold the distal part of the needle with sterile gauze or sterile cotton ball, and the dominant hand holds the handle of the needle. The needle is then inserted with both hands.

Pinching skin insertion. This technique is used when the skin and muscles of the insertion site are thin or if the insertion point is close to important organs, such as lungs or eyeballs. Once the acupuncture point is identified, the skin and muscles are pinched or picked up with the thumb and index fingers of the assisting hand. The needle is then inserted through pinched skin with the dominant hand.

Tight skin insertion. This technique is used when the skin over the acupuncture point is loose. Once the acupuncture point is identified, the skin over the acupuncture point is stretched and tightened with the thumb and index fingers. The needle is inserted with the dominant hand.⁵

Needle Manipulation

In TCM, the outcomes of acupuncture treatment are believed to rely heavily on the means of stimulations to the needles after insertion. There are two basic methods of stimulating the needles: manual manipulation and electrical stimulation.

There are various techniques in manipulating the needles manually to achieve the desired effects, which have been developed by generations of acupuncturists over thousands of years. The techniques are grouped by the needle effects, which are categorized as tonification (to treat deficiency), sedation (to treat excess), or neutral. For example, in tonification, the needle is inserted so that the angle of the needle is in the direction of energy flow on a specific meridian, and then advance the needle slowly, turning it with slow yet firm clockwise rotations as the needle is being advanced, and not penetrating too deeply. The needle can be continuously manipulated or left alone. When withdrawn, the needle should be removed quickly and the skin at the insertion point should be covered by a finger and massaged in a clockwise fashion. Sedation is the opposite of tonification. The needle is angled against the direction of energy flow on the meridian and is inserted quickly and deeply with rapid counterclockwise rotations. The needle should be withdrawn slowly and the surface should not be touched after removal of the needle. The duration of the treatment is usually 20 to 40 minutes.¹

Electric stimulation became available in modern times. The electrodes are connected to the needles. The negative lead is attached to the needle(s) where the electron flow is started, whereas the positive lead is attached to the needle(s) where the flow is directed to. The low-frequency impulse, between 2 and 8 Hz, is considered to have the tonification effect. Higher frequency impulse, between 70 and 150 Hz, is used on the points surrounding the painful area, especially in musculoskeletal pain conditions.¹

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