Page 957 - Adams and Stashak's Lameness in Horses, 7th Edition

Principles of Therapy for Lameness 923

include small sample size and inappropriate point selection,
frequency, or intensity of stimulation. An additional
VetBooks.ir troacupuncture to treat palmar heel pain reported no
randomized, blinded study using dry needle and elec-
significant differences between treatment and control
groups with regard to lameness grade or hoof compres-
sion thresholds. The authors reported limitations of a
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small sample size and the need for MR imaging to
improve diagnostics for inclusion criteria. A case series
of 12 horses with chronic laminitis showed positive
results to two acupuncture treatments 1 week apart,
based on inertial sensor‐based lameness evaluation and
subjective lameness scores. Another prospective, sin-
3
gle‐blinded, crossover study to evaluate the effects of
acupuncture treatment on gait parameters demonstrated
that objectively assessed pelvic limb parameters could
detect changes in gait that might be difficult to appreciate
2
by visual assessment. Overall, treated horses moved in
a more symmetrical manner, which suggested a lesser
degree of discomfort.
Electroacupuncture has also been evaluated in an Figure 8.12. Horse with bilateral chronic laminitis treated with
experimentally induced lameness model using an instru- acupuncture needles placed around the coronary band at Ting
mented shoe to apply transient localized sole pressure. acupuncture points. Source: Courtesy of Dr. Tim Holt.
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Electroacupuncture was able to partially reduce lame-
ness scores, compared with bupivacaine or saline con-
trols. Inconsistent changes in stride kinematics were
noted, but there was no change in overall stride lengths.
In another study using instrumented shoes to induce
lameness in 6 horses, there was inconsistent evidence to
suggest that pain, as measured by increased heart rates,
was reduced after needle puncture to induce bleeding
(hemoacupuncture) around the coronary band and dry
needle placement between the heel bulbs. For empirical
4
treatment of laminitis, acupuncture points around the
coronary band (Ting points) reportedly reduce local
pain, and proximal thoracic limb points are used to
address the sustained laminitic posture and subsequent
muscle hypertonicity and pain associated with chronic
laminitis (Figure 8.12).

Figure 8.13. Horse presenting with pain localized to the saddle
CHRONIC BACK PAIN region treated with acupuncture needles placed along the dorsal
The majority of the equine acupuncture literature midline adjacent to the spinous processes and within the epaxial
addressing musculoskeletal issues is focused on treat- musculature. Source: Courtesy of Dr. Tim Holt.
ment of chronic back pain (Figure 8.13). In one review
of acupuncture treatment for back pain, 11 different presenting with a chief compliant of poor performance,
types of acupuncture stimulation have been described; presumably due to primary back pain, were treated with
however, some methods are quite unconventional and different forms of acupuncture stimulation, and pain
not used in Western acupuncture. In acupuncture case alleviation varied from 53% to 87%. Out of the 350
8
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series for treating back pain, success rates range from horses, 75% were able to perform at an acceptable level
66% to 100%; however, many studies have small sam- after acupuncture treatment. Unfortunately, there were
ple sizes, and all studies lack objective outcome param- no control groups in these studies, so the natural course
eters. 22,23 In a case series of 200 horses treated with of back pain resolution or true effectiveness of acupunc-
acupuncture, 73% had primary back problems or back ture treatment could not be determined. 8
problems combined with pelvic limb lameness. Of the In a randomized controlled study, both dry needle
11
horses that received treatment for primary back pain, acupuncture and electroacupuncture of the trunk signifi-
58% (84 of 146) received acupuncture treatment alone. cantly increased cutaneous analgesia measured by ther-
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Another case series of 25 horses with back pain and mal stimulation, compared with sham needle placement.
poor performance reported that all horses returned to Another randomized, controlled study reported that
their previous level of competition following a combina- electroacupuncture produced significant decreases in
tion of acupuncture treatment, changing saddle pads, thoracolumbar pain scores after three treatments, which
and addressing poor saddle fit. In a large case series remained reduced 14 days after the last treatment, com-
5
(n = 350) reported over several successive studies, horses pared with oral phenylbutazone and control (i.e. oral