Pain TRIGGER POINTS AND ACUPUNCTURE POINTS FOR PAIN

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normal saline 33 34 or transcutaneous electrical stimulation 24 may. also iminish or abolish these pains for days weeks and sometimes perma. nently These effects of intense stimulation which have been labeled as. hyp rstimulation a algesia 22 resemble the effects of acupunture in. whi h brief intense pain is produced by rota ing the needles manually or. pas ing electri d i z e n t s through t h e m on a hritic neuralgic and other. form0 of chronic pain 5 12 20 Well contro c d stu dies 3 10 12 24 show. that these procedures produce significantly gr ater pain relief than placebo. contributions It is apparenL therefore that ntense stimulation of either. trigger points or acupuncture points can produce prolonged relief of pain. Indeed Fox and Melzack 9 have found that acupuna ure and transcutane. ous electrical stimulation are equally effective n relieving chronic low back. There is yet another simila Aty between trigger points and acupuncture. points for pain they often lie within the areas of refel red pain but many are. located at a distance from them Furthermore some rigger points appear to. coincide spatially with acupuncture points and both kinds may be asso. ciated with the same pain patterns 1he purpose of this study therefore was. to determine the correlation between trigger points described by Travell and. Rinzler 35 Kennard and Haugen 13 Sola and Kuitert 33 Sola and. Williams 34 mad acupuncture points for pain 11 18 19. DISTRIBUTION OF T R I G G E R POINTS, Trigger points have long been used inWestern medical practice for the. diagnosis and treatment of pathological pain 15 35 Application of pres. sure at a trigger point evokes pain at the point as well as referred pain in. myofascial or visceral structl res Travell and Rinzler 35 in a classic study. of myofascial pain describtd a large number of spatial patterns of pain. associated with trigger point Figs 1 4 Other points have been found by. Sola and Kuitert 33 ann ola and Williams 34 Fig 5A who examined. myofascial pain associated i h the sho ider arm and neck Additional. points have been descr ibed by Bonica 5 Livingston 16 Kraus 15 and. Trigger points are dso associated with visceral structures McBumey s. point is a well known site of tenderness in acute appendicitis and gentle. pressure at the point triggers local pain as well as distant diffuse abdominal. in 1 Similarly patients with cardiac disease frequently develop referred. pain in tha shoulder chest and arm 13 35 Examination of cardiac pa. tients by Kennard and Haugen 13 revealed a common pattern of rigger. points Fig 5B in the shoulder and chest Fressure on the trigger points. generally produces intense pain which sometimes persists for several hours It. is important to note tha subjects who do not have heart disease have an. Imost identical distribution of trigger points 13 The application of. pressure at the trigger points in these subjects okes pain which lasts for. several minutes and may even increase in in Lens ty for a few seconds after. removal of he pressure,DISTRIBUTION OF ACUPUNCTURE POINTS. Perhaps the most baffling feature of acupuncture maps on first encounter. is the profusion of points Some degre e of clarification is achiew d if a par. ticular book on acupuncture is examined only for points relevant to pain. We have done this for Kao and Kao s 11 book Acupuncture Therapeutics. When the acupuncture points are organized on the basis of pain syndromes. or discrete spatial locations of pain the number of relevant acupuncture. points is relatively small An examination of Figs 6 and 7 derived from Kao. and Kao s 11 book reveals that each major pain syndrome or painful. region is associated with a acupuncture points that are at or near the a c t u a l. site of pain as well as b more distant points that are seemingly unrelated. A similar analysis has been carried out with the maps and book prepared. by Mann 18 19 Although a multitude of points are designated specifically. for the relief of particular pain syndromes only a relatively small number. of points is generally used in the actual day to day practice of acupuncture. for the relief of pain Figs 8 and 9 As in Figs 6 and 7 it is evident that. there are points which lie within or near the painful area Fig 8 and others. that lie at a distance from it Fig 9, C O R R E S P O N D E N C E B E T W E E N A C U P U N C T U R E POINTS A N D T R I G G E R POINTS. In order to determine the degree of correspondence between trigger points. and acupuncture points each trigger point on thc maps of Travell and Rinz. ler 35 Sola and Kuitert 33 Sola and Williams 34 and Kennard and. Haugen 13 Figs 1 5 was numbered and acupuncture m ps were ex. amined to see whether there was a nearby acupuncture point Because Kao. and Kao 11 used only selected points for their exposition of acupuncture. the more complete maps prepared by Mann 18 were used D e to obvious. differences in drawings or even anatomical variation from person to person. the proximity of the points to particular muscle groups or other anatomical. landmarks was sought A difference of 3 cm between the two sites seemed to. be a reasonable allowance for variation based on drawings or a tual anatomi. cal variability If the points showed good correspondence wil hin the 3 cm. criterion the site was labeled plus Acupuncture points outside the. 3 cm criterion were labeled m i n u s The next step was to find the clini. cal syndromes listed in Mann s 19 and Kao and Kao s l l J books asso. ciated with the acupuncture points If the clinical syndrome corresponded. reasonably to that associated with the trigger point a plu was re. corded Lack of correspondence was labeled minus, The results of this analysis Table I using Travell and Rinzler s points. indicate that every trigger point has a corresponding acupuncture point. Furthermore there is a close correspGndence 64 betweer the pain syn. dromes associated with the two kinds of points A similar procedure was. carried out using the trigger points described by Sola and his olleagues and. by Kennard and Haugen Table II The degree of correspondence in terms. HEAD A N D NECK,STERNOMASTOID SPLENIUS CAPITIS,TEMPORALIS MASSETER.
TRAPEZIUS RAPEZIUS,LEVATOR CAPU POSTERIOR CERVICAL. P N PATTERN l TPIGGIER AREA X, Fig 1 Trigger point associated with myofascial pain syndromes of the head and neck. Reprinted torn Travell and Ri zler 35 Each trigger point is numbered and the major. nerve inner cation is described i Table I,SHOULDER AND ARM. I NFRASPINATUS SUPRASPINATUS,SCALENm DELTO D,MIDDLE EXTENSOR. FINGER CARPI,EXTENSOR RADIALIS SUPINATORS,13 14 15 16.
FIRST INTEROSSEO JS ADDUGTOF POLLICUS,PAIN PATTERN E TRIGGER AREA X. Fig 2 Trigger points t ssociated with myofascial pair syndromes vf the shoulder and ar. Reprinted from Travell and Rinzler 35 Each trigger point is Immbered and the major. nerve innervation is described in Table I,CHEST A N D BACK. PECTOR PECTORALIS MAJOR,i i i i i i iI,SERRATUS ANTERIOR. ILIOCOSTALIS GLUTEUS IL IOCOSTALIS,LONGiSSIMU MULTiFIDUS. PAiN PATTERN i J TRIGGER AREA X, Fit 3 Trigger points associated v i t h myofascial pain syndromes of the chest and back.
eprinted from Travell and Rinz er 35 Each trigger point is numbered and the major. nerve innervation is described in 2 able I,LowER EXTREMITY. GLUTEUS MINIMUS ADDUCTOR LONGUS,30 31 32 3,VASTUS MEDIALIS BICEPS FEMOIRIS. SOLEIIS GASTROCNEMIUS ABDUCTOR HALLUCIS,I l SHORT PE R NIEUS. ANTICUS EXTENSORS EXTENSORS LONGUS,PAtN PI TTERN TRIGGER AREA X. Fig 4 Trigger points e sociated with myofasciaI pain syndro nes of the lower extremi Ly. Reprinted r0m Travel and Rinzter 35 Each trigger point h numbered and L emaio. nerve innervation is described in Table I,Trigger Zones for.
Shoulder Pain Shoulder and Neck Pain,Trigger Zones in Cardiac Patients. Fig 5 Trigger points associated with A myofascial pain syndromes and B cardiac pain. syndromes The oints in A are de ived from Sola and Kuitert 33 and Sola and Williams. 34 The points a B are reprintefl from Kennard and Haugen 13 Each trigger point is. numbered and the major nerve and muscle innervation is described in Table II. Left the number of the trigger points described by Travell and Rinzler in Fig 1 the. nerve innervation of the points and the associated clinical syndrome s Right the acu. puncture point that coincides wittl the trigger point and the associated clinical pain syn. drome s designated for the acupuncture point by Mann 19 a n d K a o andKao 11 The. plus signs indicating correspondence are shown under the Clinical Syndrome column. at the right Tke first plus sign indicates coincident or adjacent trigger and acupuncture. points the second indicates correspondence of clinical syndromes A minus sign. denotes lack of correspondence Abbreviations of the acupuncture points see Fig 6. Point Trigger points Acupuncture points, Nerve innervation Clinical syndrome Nearest Clinical syndrome. of trigger point acup pnt, 1 Accessory N XI L 3 1i myalgia Li 18 Orbital neuralgia. of neck muscles hip pain,head and facial pains, 2 Dorsal Brs C2 8 Cervical disc disease T 6 Headache eye pain. degenerative arthritis shoulder back and,of cervical spine arm pain stiff neck.
kaeadaches,TABLE I continued,Point Trigger points A upuncture points. Nerve innervation Clinical syndrome Nearest Clinical syndrome. of trigger point acup t, 3 Trigeminal N Migraine myalgia X H3 Headache trigem. V Br 3 ina neuralgia tooth,ache eye pain, 4 Trigeminal N Facial myalgia S7 Facial neuralgia or. V Br 3 toothache headache spasm headache,temporo mandibular orbital neuralgia. joint pain eye pain, Accessory N XI Shoulder arm and G21 Stiff neck shoulder.
and branches of neck pain headache and back pain,C3 4 stiff neck rheumatism arm. Accessory N XI Shoulder arm and neck B37 Acute pain of. and branches of pain headache intra shoulders,C3 4 scapular pain. 7 C3 5 Myalgia in shoulder lil4 Muscular pain,region neuralgia and spasm. of shoulder and arm,spasm of neck,CI TI Degenerative 310 Brachial neuralg a. diseases of cervical neck spasm torti,spine collis writer s.
Suprascapular N Musculoskeletal diseases i i13 Neuralgia and. of the shoulder numbv ess of the,shoulder and arm, 10 Suprascapular N Musculoskeletal diseases r15 Pain of shoulder. of shoulder back arm elbGw,neck clavicie,stiff neck. 11 C4 8 via cervical Pain in neck and shoul Lil7 Throat pain. plexus der, 12 C 5 6 v i a brachial Shoulder pain L2 Neuralgia ot sheal. plexus Axillary N der chest paiP, 13 Subseapular N Musculoskeletal diseases H1 Pain ia che t and. C5 6 via brachial of shoulder ribs cardiac pain, 14 Radial N Extensor tendonitis of T9 Pain ill forearm.
forearm tennis elbow a td elbow joint,pain tc othache. 15 Radial N Extensor tendonitis of T9 in in forearm. forearm tennis elbow aud elbow joint,pain toothache. 16 Radial N Extensor tendonitis of Li11 Brachial or inter. forearm tennis elbow costal neuralgia,pain torticol is elbow. pains pain in front,TABLE I continued,Point Trigger points Acupuncture points. Nerve innervation Clinical syndrome Nearest Clinical syndrome. of trigger point acup pnt, 17 Ulnar N C8 vi Tendinous strain in Li4 Headache migraine.
brachial plexus hand neuralgia of scapula,back and renal. areas toothache,sore throat, 18 Ulnar N C8 via Sprain of thumb Li4 Headache migraine. brachial plexus neuralgia of scapula,back and renal. areas toothache,sore throat, 19 Anterior thoracic N Sternoclavicular 15 Chest ribs and. C5 T1 via brachial arthritis limbs heavy,plexus intercostal neuralgia.
20 Anterior thoracic N Strain of pectoralis Sp19 Chest ribs and. C5 6 via brachial major limbs heavy,plexus difficulty in lying. down or turning, 21 Long thoracic N Costal vertebral Spl7 Chest ribs and. C5 7 via brachial sprain scapular limbs heavy,plexus fractures diaphragmatic. 22 C3 4 Chest pain shoulder C 19 Chest and breast,and arm pain pain cardiac pain. 23 L1 Low back pain B44 Rheumatism inter,myalgia of the long costal neuralgia.
extensors of the back abdominal discom, 24 Superior gluteal N Lumbosacral strain B48 Pain and stiffness. L Sl in back and renal,area pain in lower,2r L1 Low back pain B47 Pain and stiffness. myalgia of long exten of back,sors of back, 26 T8 T9 dorsal brs Low back yain B19 Pain in lower ribs. myalgia of long exten eye pain,sors of back, 27 TS T9 dorsal brs Dorso lumbar pain B18 Intercostal neuralgia. 8 C3 5 dorsal krs Myalgia of long e ten B25 I umbar muscle. sors of back paraumbil spasm pain around,icai pain umbilicus intestinal.
29 C3 5 dorsal hrs Myalgia of long ex B22 Stiff vertebral. tensors c f back para column tightening,umbilical pain in back and shoulder. pain in loins,TABLE I continued,Point Trigger points Ac apuncture points. Nerve innervation Clinical syndrome Nearest Clinical syndrome. of trigger point acvp pnt, 30 Superior gluteal N Diseases of the hip B49 Lumbar and sacral. L4 S1 via lumbo joint degenerative pain sciatica,sacral plexus conditions of lumbar. 31 Superior gluteal N Diseases of the hip G3O Pain in buttocks. L4 S1 via lumbo joint degenerative sciatica pain in. sacral plexus conditions of lumbar loins spine and. spine thighs rheumatism,pain in knee pain,in hip joint.
trigger points or acupuncture points can produce prolonged relief of pain Indeed Fox and Melzack 9 have found that acupuna ure and transcutane ous electrical stimulation are equally effective n relieving chronic low back pain There is yet another simila Aty between trigger points and acupuncture points for pain they often lie within the areas of refel red pain but many are located at

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