Page 956 - Adams and Stashak's Lameness in Horses, 7th Edition

922 Chapter 8

(less than 20 Hz), high‐amplitude stimulation causes judged to be caused by muscle hypertonicity. Acupuncture
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visible muscle contractions and produces generalized may be used in cases that have an incomplete or lack of
VetBooks.ir that are mediated by endorphins. High‐frequency or compensatory lameness associated with primary joint
response to traditional medical and surgical approaches
analgesia with slow, prolonged, and cumulative effects
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or limb pain. The use of acupuncture or the combination
(80–100 Hz), low‐amplitude stimulation activates low‐
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threshold skin and muscle receptors and produces non- of acupuncture with conventional care is believed to
opiate‐derived analgesia that has a rapid onset and produce beneficial and lasting effects and provides an
decline, is localized segmentally, and is not cumulative. opportunity to expand a veterinarian’s diagnostic and
In a randomized control trial, four different electroa- therapeutic armamentarium. Acupuncture combined
cupuncture protocols were evaluated for antinociceptive with diagnostic joint blocks and intra‐articular therapy
effects on thermal stimulation of the pastern region. is thought to provide a more comprehensive diagnostic
25
Local acupuncture points and high‐frequency (80–120 Hz) and treatment approach to chronic lameness. 9,10
stimulation were more effective in blocking limb pain than Contraindications for acupuncture include acute
the use of distant acupuncture points and low‐frequency injuries, fractures, severe cardiac disease, extremely
(20 Hz) stimulation. nervous or exhausted patients, acute infections, and
Aquapuncture uses a 20‐ to 25‐gauge, hypodermic neoplasia. Patients with organic disease or overt muscu-
needle to mechanically stimulate acupuncture points, loskeletal pathology need a complete diagnostic workup
followed by injection of various solutions in an effort and consideration of appropriate Western treatments
to produce longer‐lasting or combined pharmacological with documented efficacy and safety for the condition
effects. Some of the more commonly injected substances of interest.
include saline, vitamin B , and 2% iodine in peanut
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oil. Other substances include corticosteroids, Sarapin,
Traumeel (a homeopathic remedy), vitamin B , 25% LAMENESS
1
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magnesium sulfate, 2% procaine, and 15% dextrose.
Injected volumes at each site vary from 0.5 to 5 mL (and Acupuncture is reportedly useful for treating myofas-
up to 30 mL)/site, depending on the injected substance cial pain, osteoarthritis, stifle or hock pain, tendinitis,
and desired response. Some practitioners believe that laminitis, and navicular disease, but there is a lack of
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treatment effects last longer with injected substances, controlled studies to validate efficacy. Most evidence is
compared with dry needling. Other practitioners prefer in the form of clinical experience, case reports, and case
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dry needling with solid acupuncture needles due to the series. Numerous equine acupuncture case series on
increased risk of breaking off hypodermic needles under lameness are reported in the Chinese literature; however,
the skin due to skin or fascial movement. poor scientific quality and lack of controls make the evi-
Additional forms of acupuncture stimulation include dence difficult to interpret. A review of several case
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acupressure (i.e. digital pressure), implantation of gold series on nonspecific shoulder lameness, fetlock injuries,
beads or surgical staples for long‐term stimulation, and and laminitis report overall success rates ranging from
laser stimulation, which uses low‐level laser generation 87% to 94% after 1–5 treatments, applied every 1–4
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to stimulate superficial acupuncture points. Laser acu- weeks. However, the lack of details about case selec-
puncture provides the benefit of having no physical tion, diagnostic findings, objective outcome parameters,
puncturing of the skin, but the initial cost of equipment and nonuniform point selection and type of stimulation
is expensive. Anecdotal evidence experienced by the reduces the strength of the studies. A large number of
author suggests that low‐level laser stimulation is effec- horses across several disciplines were used to investigate
tive for producing a temporary reduction in acute or the reported usefulness of acupuncture in the diagnosis
severe back pain when affected horses do not tolerate of stifle disease in athletic horses. 12
acupuncture needle placement or forms of manual ther- Only a few randomized, controlled trials have evalu-
apy. Dry needling, laser stimulation, and injection of ated the effectiveness of acupuncture for limb pain or
saline into acupuncture points appear to be equally lameness. Cutaneous nociceptive thresholds to mechani-
effective for treating horses with chronic back pain. 8 cal and heat stimuli during control and electroacupunc-
ture trials in 23 horses showed significant cutaneous
analgesia within 5 areas of the trunk, but not in the head
1
GENERAL INDICATIONS FOR TREATMENT or limbs. Electroacupuncture has demonstrated varia-
ble effectiveness for reducing pain associated with either
Acupuncture case selection is often based on thorough experimentally induced or naturally occurring lame-
physical examination and elimination of conditions that ness. 20,25 In a randomized controlled trial, electroacu-
are judged to respond more effectively to conventional puncture was used to treat horses with chronic laminitis
20
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therapies. Because of the lack of proven effective medi- (n = 10) and navicular disease (n = 10). The degree of
cal or surgical approaches for the treatment of chronic lameness was assessed by changes in subjective lameness
back pain in horses, acupuncture is often considered as a scores, stride lengths, and ground reaction forces.
first treatment of choice. If clinical signs of back pain Although 7 out of 10 horses with chronic laminitis
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persist after a few acupuncture treatments, then addi- improved clinically during the trial, there were no statis-
tional diagnostics and re‐examination are indicated in an tically significant differences between treatment and
attempt to better localize and identify the source of pain control groups. Six out of 10 horses with navicular dis-
and to prescribe a targeted treatment or a combination ease improved, but there were no significant differences
of therapies. Acupuncture is generally not sufficient by between treatment and control groups. Reasons for fail-
itself to manage overt lameness, unless the lameness is ing to demonstrate efficacy of acupuncture treatment