This fibromyalgia case report presents a new acupuncture approach for treating fibromyalgia syndrome (FMS). The patient featured in this report had poor responses to previous treatments. The unique acupuncture technique was similar to Hong’s myofascial trigger point injections.
However, the practitioners used simultaneous needle rotation of tiny acupuncture needles instead of injections. After five sessions, the patient’s pain decreased by 80 percent. A follow-up confirmed that she was no longer suffering any severe discomfort. This case demonstrates that a patient with FMS may show remarkable pain relief after receiving acupuncture.
Introduction – Fibromyalgia
Acupuncture therapy is well known for treating chronic pain. Previous reports indicate that acupuncture therapy helps control pain. In this case report, we present a modified technique of acupuncture to treat a patient with fibromyalgia syndrome [FMS]. This new technique is similar to myofascial trigger point injection and has had excellent results.
In addition to the acupuncture points in the painful local regions, the practitioner also needled several acupoints distal to the painful site to manage the proximal pain.
Medical History
This fibromyalgia case report featured a 58-year-old woman. For more than 20 years, she experienced the gradual onset of chronic pain in her neck, upper back, and upper limbs, with episodic flares. Initially, the pain intensity ranged from 3/10 to 5/10. She also had generalized fatigue and difficulty sleeping. Under the impression that she was suffering from FMS, physicians treated her with oral nonsteroidal anti-inflammatory drugs and antidepressants.
Unfortunately, the medication only brought temporary relief. A few years after the initial onset, the patient’s neck pain increased, especially on the right side. An x-ray of the cervical spine showed evidence of osteoarthritis. She received physical therapy treatments, including thermotherapy, electrotherapy, and manual therapy. However, as with the pain medications, relief was only temporary. Furthermore, her pain levels kept increasing.
In the last several years, she received steroid injections to the cervical vertebrae with good results. However, the pain never disappeared entirely, and she still experienced episodic flares. Then, at age 45, she injured her right shoulder doing yard work, causing 9/10 level pain. An MRI revealed a rotator cuff tear. She underwent physical therapy intermittently for several years, which provided temporary relief but never resolved the pain. She also received traditional acupuncture therapy without much benefit and with post-needling discomfort.
Physical Examination of Fibromyalgia Patient
At the time of her first visit to the acupuncture clinic, the patient in this fibromyalgia case report had 9/10 pain in the right side of the neck, upper back, shoulder, arm, and elbow. In addition, she experienced 5/10 pain in the left neck, upper back, and shoulder. Her neck, shoulder, and upper limb muscles had multiple active trigger points. Furthermore, she had numerous tender spots in her lower back and extremities.
Examination of her cervical spine revealed a limited range of motion in all directions, especially right rotation and left side bending. In addition, there was evidence of reduced normal lordotic curvature due to paraspinal muscle spasm. Examination of her right shoulder revealed a re- reduced range of motion in flexion, abduction, and internal rotation, with pain in the terminal range.
INITIAL FIBROMYALGIA TREATMENT – OCTOBER 12, 2006
During her first visit, practitioners applied the following bilateral acupoints: GB-21, SI-11, TW-14, LI-11, TW-5, and GB-34. The modified acupuncture technique is similar to the trigger point injection technique described by Hong ( Am J Phys Med Rehabil 73(4): 256–263, 1994.)
Initially, the practitioner inserts an acupuncture needle into the subcutaneous layer. Then the needle is moved into the muscle layer at a speed of approximately 10 mm per second for a distance of about 5 to 15 mm and pulled out to the subcutaneous layer at the same rate. During the needle movement, the practitioner simultaneously rotates the needle to facilitate the moving of the needle and to avoid grasping the muscle fibers.
This needle insertion is repeated in different directions, eliciting multiple muscle twitches. This multiple-fast insertion technique is slightly different than that described by Hong. Remarkably, the pain decreased by at least 50 percent immediately following treatment. In addition, there was an increased range of motion in the cervical spine and right shoulder.
SECOND FIBROMYALGIA TREATMENT – OCTOBER 17, 2006
After the first treatment, the patient’s pain in all sites except for the right shoulder was significantly reduced, with less intensity than before. Practitioners applied the following bilateral acupoints: GB-21, SI-11, TW-14, LI-11, TW-5, GB-34, and SP-6.
THIRD FIBROMYALGIA TREATMENT – OCTOBER 19, 2006
Following the second session, the patient’s neck and upper back pain decreased even further. At this point, the major sites that still had significant pain included the base of her head, right scapula, and shoulder. During the third visit, she received the following points: GB-21, SI-11, BL-43, GB-20, LI-11, TW-5, GB-34, SP-6, and ST-40.
FOURTH FIBROMYALGIA TREATMENT – OCTOBER 23, 2006
After the third treatment in this fibromyalgia pain report, her pain intensity decreased to 4-5/10 [tolerable level] in the right shoulder area and 2-3/10 in the other sites. Therefore, during the fourth visit, the practitioners selected the following bilateral acupoints: GB-21, SI-11, BL-43, PC-6, HT-7, and BL-40.
FIFTH FIBROMYALGIA TREATMENT – OCTOBER 30, 2006
Following the fourth session, the pain intensity remained at 2 to 3/10 in all sites. During the fifth visit, she received the following points: GB-21, SI-11, TW-14, LI-15, SI-10, LI-11, TW-5, GB-34, and SP-6. Following the fifth treatment session, therapy was interrupted because she planned to leave the country.
The practitioners originally planned ten acupuncture sessions. However, despite the limited treatments, she showed remarkable pain relief. This experience was quite different from her previous trigger point injections, after which she experienced severe pain for a few days before achieving pain relief.
FOLLOW-UP PHONE CALL – JANUARY 11, 2007
A follow-up phone call revealed that, after the last treatment, she no longer suffered severe discomfort at any site. However, the pain in her left neck and shoulder worsened occasionally with short-lasting flares of pain intensity up to 5 to 6/10. Overall, the patient in this fibromyalgia pain report experienced an 80 percent improvement.
She felt that the duration of needling to the left side was much shorter than that of the right, which is why she experienced ongoing issues on the left side. However, she also thought that she could have achieved total pain relief if she had completed the entire course of therapy.
Fibromyalgia Case Report Discussion
Fibromyalgia syndrome is a complex and disabling medical condition. The American College of Rheumatology’s criteria for diagnosing FMS includes a history of widespread musculoskeletal pain for at least three months and pain in 11 or more of 18 specific tender point sites.
Patients with FMS usually experience pain on both sides. However, if the pain persists over a soft tissue injury on one side, the intensity of the involved side can be much higher than that of the uninjured side. For example, because the patient in this fibromyalgia case report had a history of right shoulder injuries, she experienced higher pain in the right shoulder than in the left.
Old Trauma, New Fibromyalgia Pain
Suppose a patient has old trauma that has healed completely. In that case, the residual scar tissue may impair circulation and make the area more vulnerable to reinjury from even minor trauma. The practitioner found that FMS patients with asymmetric pain usually reported old trauma to the more painful side. Previous surveys indicated that 66 to 99 percent of patients with FMS used at least one complementary therapy, such as acupuncture or massage, because pain medications failed to provide sufficient relief of symptoms. In addition, they were not curative.
Interestingly, research suggests that FMS patients respond to trigger point injections quite differently from non-FMS patients. FMS patients experience more post-injection pain with less pain relief than non-FMS patients. However, using a small needle (such as an acupuncture needle) can prevent post-needling pain, as demonstrated in this fibromyalgia case report.
Several studies have demonstrated the significant benefit of acupuncture in treating FMS patients. Improvement of local circulation is a mechanism for pain relief. However, the practitioners believe that the occurrence of local twitch responses (LTRs) was the most crucial factor in obtaining a good result. The patient had been previously treated with “traditional acupuncture” but had poor results.
Local Twitch Reponses Benefit Fibromyalgia Patients
The literature documents the similarity between acupuncture and trigger point injection. In the last 15 years, trigger points have become better understood based on human and animal studies. Hong has hypothesized multiple sensitive locations in a trigger point region. Based on histological studies, the sensitive areas are probably nociceptors [free nerve endings]. Stimulation of a sensitive area can elicit pain and, sometimes, referred pain.
Intense stimulation can also produce an LTR via a spinal cord reflex. Therefore, the effectiveness of trigger point injection depends on the occurrence of LTRs during the injection. In traditional acupuncture, patients can relieve pain immediately if they experience a “De-Qi” reaction during treatment. De-Qi feels heaviness, soreness, numbness, tingling, and sometimes muscle twitching. The muscle twitching of De-Qi is similar to the LTRs during TrP injection.
Hong suggested using a multiple insertion technique to elicit as many LTRs as possible during trigger point injection to achieve optimal results. The mechanism for LTR elicitation is still unknown. However, intense pressure stimulation to the trigger point most likely generates powerful neural impulses to the dorsal horn cells in the spinal cord. These impulses subsequently break the vicious cycle of the neural circuit responsible for myofascial trigger point-like hyperstimulation analgesia.
Unique Needle Technique for Fibromyalgia Patients
In this fibromyalgia case report, the practitioner applied a technique similar to trigger point injection, performing multiple needle insertions to elicit LTRs. However, the diameter of the acupuncture needle is much smaller than a trigger point injection needle. Therefore, during numerous insertions, the acupuncture needle is too flexible to be moved rapidly, which is essential in providing high-pressure stimulation to elicit LTRs.
Therefore, he developed a new technique of simultaneous needle rotation during insertion. This way, he could move the flexible acupuncture needle more easily and quickly into the muscle tissue. This technique is similar to but somewhat different from what has been recommended by Hong.
Selection of Acupuncture Points
The practitioner selected the acupoints in this fibromyalgia case report based on his knowledge of acupuncture and clinical experience. Needle stimulation of a specific point can likely produce an expanding effect at a remote site via the central connections in the spinal cord, similar to the mechanism of referred pain.
Using this new technique, the practitioner combined the benefits of trigger point injection and acupuncture. An acupuncture needle causes less pain and tissue damage, reducing post-needling soreness. However, tiny needles are too flexible to be inserted into the muscle tissue easily and without bending. Incorporating a rotation of the needle makes it much easier to move the needle into the muscle.
Fibromyalgia patients typically have a low tolerance to needle stimulation and can experience post-needling discomfort. This new technique can elicit multiple LTRs with only a small-diameter needle and minor discomfort. This fibromyalgia case report shows remarkable improvement immediately after the needling. Although her treatment course was incomplete, the patient experienced an overall improvement.
Conclusions
The clinicians have demonstrated the long-term effectiveness of a new acupuncture technique on a patient with fibromyalgia. The post-needling discomfort was mild as compared with the previous trigger point injections.
Next Steps
At Raleigh Acupuncture, we successfully treat patients with fibromyalgia using a similar needle technique to this fibromyalgia case report. The key is to elicit a limited number of trigger point releases using a small gauge needle. In addition, we incorporate organ-strengthening points to improve metabolism and boost energy. Finally, our treatment reduces the frequency and intensity of future flares.
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Reference
Chou, Li-Wei, Hong, Judith Y. and Hong, Chang-Zern (2008) ‘A New Technique for Acupuncture Therapy and Its Effectiveness in Treating Fibromyalgia Syndrome: A Case Report,’ Journal Of Musculoskeletal Pain, 16:3, 193 — 198
Focus Keyphrase: Fibromyalgia Case Report
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I am a long term patient of Raleigh Acupuncture. Prior to being under their care, I was disabled with terrible fatigue and pain all over my body. I was unable to drive, could only walk less than a block, and had numerous symptoms that mystified doctors. After countless lab work, x-rays, and MRI’s, several doctors including my primary physician told me that there was nothing that could be done. According to them, it was either an illness that was undiagnosable or it was all in my head. When I came to Raleigh Acupuncture, it was a breath of fresh air. They took me very seriously and were not mystified by my condition. They assured me that my condition was treatable and manageable. They treat me with respect, dignity and care; something that I didn’t receive at my primary care doctor. Thanks to their treatments I am now living a normal life. They have restored my health and taught me how to manage my condition. My family and friends can’t believe how much improvement I have made. My son is grateful to have his mommy back! And I am eternally grateful to Raleigh Acupuncture! They truly have the gift of healing!
I would like to thank Raleigh Acupuncture for the wonderful and very helpful treatments. I had been seeing them for my insomnia, which was making excellent progress at the time and has since been cured. On a previous Monday I was involved in a minor traffic accident. Due to the stress of the accident on Tuesday I awoke in a severe flare-up of my fibromyalgia. The pain was so bad I took pain killers and stayed in bed for the day. The following day I had an appointment with Dr. Mark which I wanted to cancel. My husband suggested I keep the appointment and tell Dr. Mark about the pain. After our discussion, he modified the treatment he had planned for me and treated the pain. I came home, took another pain pill and went back to bed. The following morning I woke pain free and have been since, which is about 2 to 3 months. Thanks again Raleigh Acupuncture!
I still am forever in your debt for helping me through the Lymes recovery. My body pain and fatigue were overwhelming before getting acupuncture. I still tell everyone today that I am 100% positive that my recovery was a direct result of your expert care. Truly. I have very little residual effects from the disease that I can easily live with. So again,thank you not only for your amazing skills, but for the compassion and kindness that you showed me during that time.
All of my joints were hurting. I’ve got fibromyalgia and it effects me by making my joints hurt. The pain would move around from place to place, first the hip, the next day the shoulder, then the knee, etc. The practitioner at Raleigh Acupuncture explained that the best way to treat my kind of moving joint pain was to treat me holistically. Instead of treating the hip one day, the shoulder the next, they treated the root of the pain. They said this type of treatment would also improve my mood and my sleep. Right on all counts. I started feeling better after the second treatment. It’s like all of the joints just settled down and stopped giving me trouble. I had less flares and the intensity of the pain went way down. My sleep is better, not just because I have less pain. I’m more relaxed and less stressed. I’ve made this treatment a regular part of my life. I’m very grateful.
I’ve been going to Raleigh Acupuncture for 4+ years. I first went to them because I was having problems with my monthly period lasting two weeks or more, hot flashes that were extreme, and all over pain from fibromyalgia, which is a chronic pain condition. I was in a state of depression and despair, unable to work, or do things I love to do, like working in my yard. On a good day, I could perform simple household chores, perhaps a little yoga, and that was all. My first few visits brought relief from hot flashes, terrible neck pain, and wrap-around pain in my ribs that restricted my ability to breathe comfortably. I felt this was a miracle as I had suffered for many years, and had no idea it was so easily remedied. This miraculous ride continued as I took Chinese herbs for aiding my menopausal symptoms, sinus problems, anxiety, and general pain. As time went on I began to depend on Raleigh Acupuncture for psychological strengthening as well. Nowhere else have I found anyone that really listens to what I have to say without thinking I was crazy. Today, as I sit and reflect, I am about to graduate from an intense two year program for Landscape Architecture Technology. I took a huge leap when I signed up for full-time classes when I was 50 years old. I have enjoyed great success, making one B in 64 credit hours, the rest were A’s! In February of 2011, I was in a car accident where I was sandwiched between a van and a school bus. I was able to continue school and finish the semester, I believe because of my acupuncture treatments. I contribute most of my academic success, emotional well-being, and diminished pain to Raleigh Acupuncture.