Acupuncture: needle insertion

Introduction

• The insertion and manipulation of needles at particular loci on the body:
  • Causes local release of vasoactive amines which induces capillary vasodilation.
  • Stimulate A´ nerves (mechanoreceptors)    →   descending inhibition effect on pain signals.
  • Up-regulates opioids release in the CNS.
  • Elicits somatovisceral reflexes: tendency to normalize underlying abnormal autonomic activity, including visceral tone and motility, vasomotor regulation, reduce sympathetic tone in stressed states.
  • Acupoint stimulation on the ventrum and in the ear elicits vagal reflexes; new studies show an anti-inflammatory effect from vagal stimulation.
  • Deactivates the limbic (emotional) centre of the brain (anxiolytic effect); this integrates with the reduction in stress effects on the autonomics.
  • Promotes normal neuro-endocrine interactions and thereby helps correct dysfunctioning endocrine activities.
  • Neurohumoral interactions enhance immune functions.
  • Improve or resolve bioelectrical disturbances in local tissue, eg deep scars.
  • Patient interaction appears to be an important factor in outcome.
  • May take up to 5 treatments to induce long-term benefits.
• The needling sensation (de-Qi) is described by human patients as a soreness, heaviness or pulling sensation at the point of insertion. The sensation may travel along part of the channel     in man but we have no ability to assess de-Qi or propogated needle sensation in animals.
• The nearest phenomena is the pilomotor response in some horses during acupuncture        . The acupuncturist will often feel and see a local muscle twitch with a needle grabbing sensation. The horse may show resentment to this, but most appear unperterbed. The resistance to further needle manipulation can last for up to 20+ minutes and very occasionally persist as a "stuck needle". One normally waits for the needle gripping to release before removal, and the stuck needle may be helped out by an additional adjacent needle.
• The therapeutic analgesic results of acupuncture were believed from early research to be related to eliciting de-Qi, however, there is increasing evidence that superficial needling may achieve a similar result, especially in sensitive animals. A stoic individual may need the deeper and stronger needle stimulation.

Uses

Advantages

• Provide analgesia and enhanced recovery from injury in competition horses without use of prohibited drugs.
• Offers clients a further option to treat many of the chronic conditions which may be responding poorly to conventional therapies.

Disadvantages

• Do not place needles in areas where there is an active infection.
• Do not place needles in known cancerous tissue.
• Avoid use of certain points in pregnancy - an historical guideline that has very little evidence to support any claimed abortagenic risks. Most evidence is that no such risk exists. The risk of coincidental abortion or pregnancy complication may make for allegations of malpractice.
• Avoid placing needles through contaminated/dirty hair or skin.

Requirements

Materials required

Minimum equipment

• Any number of needles can be used but more than 12 is not recommended for most cases.
• Acupuncture needles, typical Chinese type, made from surgical stainless steel with 'cone' shaped point offering painless insertion.
• Use disposable (single-use) needles.
• Often have copper coiled handle with loop, offering good grip and conductivity.
• Often supplied with clear plastic guide tube to aid insertion, protecting the needle from bending excessively.
• Recommended to have a range of sizes:
  • Needle diameter of 0.25-0.35 mm.
  • Needle lengths from 10-150 mm.
• Choice of needle determined by location of acupuncture point and operator preference.
• Other types of needle are available, some with silicon coating making for less friction on insertion.
• In the UK, costs range from £2.50-£10.00 for a box of 100 needles.

Minimum consumables

• None required.

Preparation

• Assuming a primary diagnosis already exists:
  • 5-10 min palpation of acupoints and associated tissues; identification of tender or myofascial trigger points.

Sequelae

Complications

• Needle fracture (extremely rare since the advent of single use needles).
• Needles bent in situ difficult to remove.
• Minor bleeding at insertion point can be controlled by brief digital compression.
• Infection at point of needle insertion (rare).
• Increase in intensity of symptoms (usually transient   →   improvement).

If horse is treated on a competition day, treatment can cause such a calming effect as to render the horse non-competitive; not recommended! Better to treat 3-4 days prior to competing.

• Occasional vasovagal syncope has been reported in humans, but not in horses.
• Adverse events such as cardiac tamponade, pneumothorax and severe infections have been reported very rarely in human acupuncture patients. According to the evidence from 12 prospective studies which surveyed more than a million treatments, the risk of a serious adverse event with acupuncture is estimated to be 0.05 per 10,000 treatments. There is no data on serious adverse reactions to acupuncture in horses, but it is suspected to be even less. No equine cardiac tamponade or pneumothorax has ever been reported from acupuncture.

Prognosis

• The majority of horses treated for any of the chronic complaints respond favorably, and most equine acupuncturists report an 80% or more positive resonse.
• However, if the underlying condition is chronic and with pathology that is beyond repair, then symptom relief will always be limited, even if many such cases may do well for months after a course of 4-6 treatments.
• The prognosis improves the earlier acupuncture is employed as it fosters the innate healing as well as coping mechanisms. In this way, acupucnture should be viewed as a part of "integrative medicine" and not as "alternative".

Reasons for treatment failure

• Excessive anxiety/stress increases cholecystokinin (CCK) which blocks endorphins.
• Patient too painful with very chronic disease.
• Unsuitable placement of needles.
• Too few or too many needles for the individual. 
• Owner non-compliance with follow up sessions.
• Non-responder/poor responder; 10% in a study of a large number of rats.

Sources

Publications

• Recent references from PubMed.
• Habacher G, Pittler M H & Ernst E (2006) Effectiveness of acupuncture in veterinary medicine: systematic review. J Vet Intern Med 20 (3), 480-488 PubMed.
• Xie H & Ortiz-Umpierre C (2006) What acupuncture can and cannot treat. JAAHA 42 (4), 244-248 PubMed.
• White A (2004) A cumulative review of the range and incidence of significant adverse events associated with acupuncture. Acupunct Med 22 (3), 122-133 PubMed.
• Scott S (2001) Developments in veterinary acupuncture. Acupunct Med 19 (1), 27-31 PubMed.
• White A, Hayhoe S, Hart A & Ernst E (2001) Adverse events following acupuncture: prospective survey of 32,000 consultations with doctors and physiotherapists. BMJ  323 (7311), 485-486 PubMed.
• Ridgway K (1999) Acupuncture as a treatment modality for back problems. Vet Clin North Am Equine Pract 15 (1), 211-221.
• Bossut D F (1996) Veterinary clinical applications of acupuncture. J Altern Complement Med 2 (1), 65-69 PubMed.
• Yu C, Zhang K, Lu G, Xu J, Xie H, Lui Z, Wang Y & Zhu J (1994) Characteristics of acupuncture meridians and acupoints in animals. Rev Sci Tech 13 (3), 927-933 PubMed.
• Panzer R B & Chrisman C L (1994) An auricular acupuncture treatment for idiopathic canine epilepsy - a preliminary report. Am J Chin Med 22 (1), 11-17 PubMed.
• Janssens L A (1993) The role of acupuncture in analgesia. Tijdschr Diergeneeskd 118 (Suppl 1).
• Altman S (1992) Techniques and instrumentation. Probl Vet Med 4 (1), 66-87. 
• Altman S (1992) The incorporation of acupuncture into a small animal practice. Probl Vet Med 4 (1), 223-233. 
• Dill S G (1992) Acupuncture for gastrointestinal disorders. Probl Vet Med 4 (1), 144-154. 
• Durkes T E (1992) Gold bead implants. Probl Vet Med 4 (1), 207-211.
• Hwang Y C (1992) Acupuncture atlas. Probl Vet Med 4 (1), 16-33. 
• Hwang Y C (1992) Anatomy and classification of acupoints. Probl Vet Med 4 (1), 12-15. 
• Jaggar D (1992) History and basic introduction to veterinary acupuncture. Probl Vet Med 4 (1), 1-11. 
• Janssens L A (1992) Acupuncture for the treatment of thoracolumbar and cervical disk disease in the dog. Probl Vet Med 4 (1), 107-116. 
• Janssens L A (1992) Trigger point therapy. Probl Vet Med 4 (1), 117-124. 
• Klide A M (1992) Acupuncture Analgesia. Vet Clin North Am Small Anim Pract 22 (2), 374-379. 
• Limehouse J B (1992) Oriental concepts of acupuncture. Probl Vet Med 4 (1), 53-65. 
• Lin J H & Panzer R (1992) Acupuncture for reproductive disorders. Probl Vet Med 4 (1), 155-161. 
• Rogers P A, Schoen A M & Limehouse J (1992) Acupuncture for immune-mediated disorders. Literature review and clinical applications. Probl Vet Med 4 (1), 162-193. 
• Schoen A M (1992) Acupuncture for musculoskeletal disorders. Probl Vet Med 4 (1), 88-97. 
• Schwartz C (1992) Chronic respiratory conditions and acupuncture therapy. Probl Vet Med 4 (1) 136-143. 
• Smith F W jr (1992) Acupuncture for cardiovascular disorders. Probl Vet Med 4 (1), 125-131. 
• Smith F W jr (1992) Neurophysiologic basis of acupuncture. Probl Vet Med 4 (1), 34-52.
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• Janssens L A & Rogers P A (1989) Acupuncture versus surgery in canine thoracolumbar disk disease. Vet Rec 124 (11), 283.
• van Niekerk J & Eckersley N (1988) The use of acupuncture in canine epilepsy. J S Afr Vet Assoc 59 (1), 5.
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• Schoen A M, Janssens L & Rogers P A (1986) Veterinary acupuncture. Semin Vet Med Surg (Small Anim) 1 (3), 224-229.
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• Altman S (1981) Clinical use of veterinary acupuncture. Vet Med Small Anim Clin 76 (9), 1307-1312.
• Wright M & McGrath C J (1981) Physiologic and analgesic effects of acupuncture in the dog. JAVMA 178 (5), 502-507.
• Janssens L, Altman S & Rogers P A (1979) Respiratory and cardiac arrest under general anaesthesia - treatment by acupuncture of the nasal philtrum. Vet Rec 105 (12), 273-276.
• Rogers P A (1978) Veterinary acupuncture. Vet Rec 102 (17), 387.
• Altman S (1977) Acupuncture - taking a closer look. Mod Vet Pract 58 (12), 1003-1006.
• Freeman A (1974) Veterinary acupuncture. J Am Vet Med Assoc 164 (5), 446-448.