Page 108 - BSAVA Guide to Pain Management in Small Animal Practice

6 | Physical methods used to alleviate pain: complementary therapies

VetBooks.ir must be considered as such because physical Acupuncture points
interactions occur during examination and
treatment of the patient. owever, despite the
potential for non speci c e ects, there are Terms such as T and refer to speci c
point or ‘meridians’. The meridian name
plenty of experimental animal and clinical is given rst, followed y a num er. n
human studies to demonstrate speci c estern acupuncture, these notations are
e cacy of the needle insertion i.e. over and simply shorthand for a reasona ly speci c
above placebo and non speci c e ects ilshie anatomical area in which needles are
et al., 16 . commonly placed. or e ample T is a
or the purposes of this chapter, point in the cranial tibial muscle just lateral
acupuncture is de ned as the insertion of a to the tibial crest in the most prominent part
solid needle into the body for the purpose of of the muscle, oriented from the cranial to
therapy and pain relief . the caudal aspect of the limb.
Summary of the mechanisms
he high threshold stimulus of needle
Acupuncture stimulates a erent nerves, insertion stimulates a erent nerves. hese
competes with other inputs at the dorsal horn of nerves, despite their name, release most of
the spinal cord, and triggers e ects on the brain, their neurotransmitters at their prodromal
which include, but are not limited to peripheral end. hese include substance P
deactivation of the limbic system; facilitation of SP , calcitonin gene related peptide C RP ,
descending inhibitory pain pathways; stimulation vasoactive intestinal peptide VIP , and nerve
of the hypothalamus; and release of beta growth factor N , amongst others. hese are
endorphins from the peria ueductal gray PA . healing factors, released normally in response
to damage and trauma. Adenosine is also
released and achieves analgesia locally.
An acupuncture needle is a solid, non
traumatic needle that is inserted through the
skin. here it goes thereafter depends on he a erent nerves stimulated are alpha delta
what the acupuncturist is trying to achieve. bres in skin and type II III bres in muscle .
rom a estern perspective, the therapist is hese nerves signal so called fast pain , which
not necessarily aiming for a very speci c indicates actual or potential tissue damage and
anatomical location with a speci c name i.e. limits such damage by its rapid transmission to
an acupuncture point such as LI 4 , although the central nervous system, resulting in the
these are used, but they will have a speci c withdrawal of the a ected part of the body from
structure in mind. Such structures include the threat. he transmission of fast pain is
myofascial trigger points rPs tiny mediated in the dorsal horn by the activation of
ischaemic areas within the end plate ones of enkephalinergic interneurons in the substantia
muscles, which give rise to potentially intense gelatinosa of the dorsal horn. hese interneurons
pain, referral of pain, muscle weakness and release enkephalins and block the onward
muscle shortening igure 6.14 rPs are transmission of so called slow pain from the C
not in ammatory and are not e uivalent to bres type IV bres in muscle this is the
muscle spasm , tendon insertions, oint competition aspect of an acupuncture stimulus.
margins, the most prominent part or the he fast pain signal is then transmitted
raphae of muscles, ligaments, tender areas of to the brain where it stimulates the release of
fascia, and periosteum. beta endorphins from the PA , which circulate
hen treating pain, the aim of the humerally, and hydroxytryptamine
acupuncturist is to place the needle as close and noradrenaline from the locus coeruleus,
as possible to the source of pain without making which facilitate the descending inhibitory
it worse. pain pathways.

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