An Introduction to Veterinary Acupuncture

1. An Introduction to Veterinary Acupuncture Nina Malik, DVM October 15, 2008 Atlantic Coast Veterinary Specialists

2. Outline History of Acupuncture Eastern Framework Western Framework- Mechanism of Action Acupuncture Modalities Indications for Acupuncture Case Studies

3. What We Learn Curriculum in Veterinary Medicine Graduation Requirements • First YearCr. Fall 5 Principles of Morphology I—B M S 330 6 Biomedical Sciences I—B M S 333 3 Physiological Chemistry—BBMB 420 1 Clinical Foundations—B M S/V C S 339 1 Clinical Imaging I—V C S 391 1 Case Study I—B M S 345 R Veterinarian in Society I—V C S 311 17 Cr. Spring 4 Principles of Morphology II—B M S 331 6 Biomedical Sciences II—B M S 334 3 Neurobiology—B M S 337 2 Veterinary Immunology—V MPM 380 2 General Pathology—V Pth 342 1 Case Study II—B M S 346 1 Veterinarian in Society II—V C S 312 19 • Second YearCr. Fall 4 Veterinary Parasitology—V Pth 376 3 Systemic Pathology—V Pth 372 5 Veterinary Microbiology I—V MPM 386 2 Case Study III—V Pth 377 1 Veterinarian in Society III—V C S 313 15 Cr. Spring 3 General Pharmacology—B M S 354 1 Anesthesiology—VCS 398 3 Veterinary Microbiology II—V MPM 387 3 Public Health—V MPM 388 6 Principles of Surgery—V C S 397 2 Case Study IV—V MPM 378 18 • Third YearCr. Fall 3 Clinical Path—V Pth 425 2 Infert. Diseases—V MPM 436 5 Clinical Medicine I—V C S 444 3 Surgery Laboratory—V C S 449 4 Disturbances of Reproduction—V C S 450/VDPAM 450 3 Pharmacology and Therapeutics—B M S 443 1 Veterinarian in Society IV—V C S 314 R Introduction to Clinics—V C S 440/VDPAM 440 R Seminar—V C S 385 21 Cr. Spring 4 Special Pathology—V Pth 422 3 Infectious Diseases and Preventive Medicine—V MPM 437 5 Clinical Medicine II—V C S 445/VDPAM 445 3 Veterinary Toxicology—VDPAM 426 2 Radiology—V C S 448 1 Ophthalmology—V C S 399 1 Veterinarian in Society—V C S 315 R Seminar—V C S 385 18 • Fourth Year The fourth year of the veterinary medical curriculum is designed to be flexible and to provide for species emphasis. Students must complete 38 credits during their fourth year. They must take a required block and at least one option block. The remainder of the fourth year credits are acquired by selecting additional option blocks, Veterinary Teaching Hospital clinical electives, off-campus clinical electives, or other electives. Additional off-campus clinical elective credits can be earned at approved government agencies, research laboratories, veterinary practices, and other university hospitals. Indications Applications Mechanisms of action

4. Journal of the American Veterinary Medical Association September 15, 2007, Vol. 231, No. 6, Pages 913-918 Abstract Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disk disease in dogs Ayne Murata Hayashi, DVM, MSc, Julia Maria Matera, DVM, PhD, Ana Carolina Brandão de Campos Fonseca Pinto, DVM, PhD Department of Surgery, School of Veterinary Medicine, University of São Paulo, São Paulo-SP, Brazil 05508-900. (Hayashi, Matera, de Campos Fonseca Pinto) Conclusions and Clinical Relevance—Electroacupuncture combined with standard Western medical treatment was effective and resulted in shorter time to recover ambulation and deep pain perception than did use of Western treatment alone in dogs with signs of thoracolumbar intervertebral disk disease.

5. What do these athletes have in common?

6. Ancient Healing Art • Theories of circulation and pulse character postulated in China 4,000 years before Western medicine • Various nations claimed to be founders • Founders of acupuncture- Northern India or Tibet (Ayurvedic Medicine?)

7. Huang-de-nei-jing • First written record of acupuncture over 2,200 years ago in China • Two books- Suwen is the most famous • Conversation with Yellow Emperor (3rd millennium B.C.) • Physiology, pathology, diagnosis, and prevention of disease • Authorship- Yellow Emperor?

8. History of Veterinary Acupuncture

10. First Veterinary Acupuncture Textbook Sun-Yang, 650 B.C. Lyon, France, 1761

11. CBS 11:00 p.m. News- 9/24/08 http://wcbstv.com/seenat11

12. The Eastern Framework Yin + Yang • Dark • Descends • Cool, moist • Anabolism, rest • Substance- tissues • Ventral and Inner aspects of body • Light • Expands outwards • and upwards • Hot • Metabolism, movement • Head, Back, Outer

13. Qi • Energy force running through body • Flow of Qi influences health of animal

14. Insufficient • Unbalanced • Obstructed

15. Meridians • Qi travels in meridians/channels • Acupuncture points- locations where meridians come to surface/accessible • Needling points= manipulate Qi and restore balance • Allows body to heal itself

16. Veterinary Acupuncture Points • Based on transpositional system (human) • Points located via anatomical landmarks and body measurements (cun)

17. GB 34 and BL 54

18. Pattern Differentiation • TCM diagnosis is based on pattern differentiation, not on diagnosis of a particular disease as in Western medicine • One disease entity in Western medicine may have multiple underlying possible TCM patterns. • TCM Patterns are based on a number of different factors: History Diagnostic Tests (Radiographs, Bloodwork) Physical Examination Tongue and Pulse diagnosis Lifestyle, external factors (damp weather), and personality/behavior

19. The Forest through the Trees

20. The Western Framework Anatomy of acupuncture points Mechanisms of Action Effects on the CNS Endogenous Pain Inhibition Segmental Analgesia Local Tissue Effects Autonomic Nervous System Trigger Point Therapy

21. Anatomy of Acupuncture Points • Not random points on the body • Areas of lower electrical skin resistance compared with the surrounding skin. Normal skin: 200,000-2 million ohms vs. 50,000 ohms • High electrical skin conductance • Many found in palpable depressions on the body

22. Anatomy of Acupuncture Points

23. Trigger Points • Hyperirritable locus within a taut band of skeletal muscle or its associated fascia • Approximately 70% of acupuncture points correspond to trigger points

24. Mechanisms of Action • Endogenous pain inhibitory system • Segmental analgesia • Local inflammatory effects • Autonomic nervous system to affect viscera • Relief from trigger points

25. Review of Nociceptors A-beta receptors • Large diameter, rapid conduction, myelinated A-delta receptors • Medium diameter, medium conduction, myelinated • Mechanoreceptors; mediate touch/pressure • Skin/fascia • Rapid pain response (“first pain”) C-polymodal receptors • Small diameter, slow conducting, non-myelinated • Activated by thermal, mechanical, chemical stimuli • Mediate slow pain

26. Effects of Acupuncture on the CNS • 3 Regions of CNS Activated • Spinal Cord • Brainstem • Hypothalamus-pituitary Release of NT (endogenous opiates) Block Pain Messages

27. Endogenous Pain Inhibition • A delta fibers carry pain impulse to lamina I of dorsal horn • Activate neurons of the neospinothalamic tract • Neurons have long axons that cross to opp spinal cord and ascend to the hypothalamus/pituitary by way of the brainstem

28. Hypothalamus and Pituitary • Arcuate nucleus + pituitary contain all the beta-endorphin cells in the brain • Beta-endorphin release into blood and CSF

29. Endogenous Pain Inhibition • Third CNS region activated is the brainstem • Input via the A-delta fibers to the dorsal horn of the spinal cord • Via the anterolateral fasciculus of the spinal cord to the brainstem

30. Activation of the Brainstem • Stimulates descending • norepinephrine inhibitory • and serotonergic inhibitory • fibers • Travel in dorsolateral • tract of the spinal cord • Synapse on dorsal horn • interneurons

31. Combined result: beta-endorphin, NE/5-HT3 inhibitory fibers • Release of enkephalin and dynorphins from segmental interneurons of spinal cord • Bind opiate receptors on pain afferents • Pre-synaptic inhibition of A-delta and C fibers (temp, crude touch, aching, burning, chronic pain)

32. Naloxone reversal • Naloxone reverses acupuncture analgesia • Evidence that pain inhibition is mediated through endogenous opioid neural loop

33. Suppression of substance P from afferent pain axon to inhibit pain impulse transmission to the brain for conscious perception

34. The Western Framework Anatomy of acupuncture points Mechanisms of Action • Effects on the CNS • Endogenous Pain Inhibition • Segmental Analgesia • Local Tissue Effects • Autonomic Nervous System • Trigger Point Therapy

35. Segmental Analgesia • High frequency (100 Hz), low intensity stimulation • Electroacupuncture (EAP) • Localized analgesia, rapid onset, ceases after stimulation has stopped • Brainstem activated

36. Stimulates NE and 5HT inhibitory fibers in brain stem • Dorsal horn of spinal cord • Mediation by GABA in the spinal cord

37. Activates the dynorphin synapses in the spinal cord • Relieves chronic pain possibly by selectively inhibiting input from C fibers

38. The Western Framework Mechanisms of Action Effects on the CNS Endogenous Pain Inhibition Segmental Analgesia Local Tissue Effects Autonomic Nervous System Trigger Point Therapy

39. Local Tissue Effects

40. Local Tissue Effects Microtrauma

41. Histology of Acupuncture Point

42. Vasoactive Effects PHASES 2 minutes-2 weeks 3. 10 seconds-2 minutes 2. 15-30 seconds 1.

43. Time-dependent Phases Vasodilation Inactivation Nociceptive of Reaction potentiation Tissue Repair Chemotaxis Solubility

44. Sum Total of Local Tissue Effects • Improved local tissue perfusion • Increased local immune responsiveness • Muscle and tissue relaxation • Pain relief: increased perfusion and cessation of muscle spasms

45. Western Framework Mechanisms of Action Effects on the CNS Endogenous Pain Inhibition Segmental Analgesia Local Tissue Effects Autonomic Nervous System Trigger Point Therapy

46. Viscerocutaneous Reflex • General mechanism by which diseased organs are able to refer pain, sensitivity, or muscle contraction to areas of skin often correlating to acupuncture or trigger pt • The pain can be referred to areas that are far away or directly over the painful organ

47. Referred Pain • McBurney’s point- right lower abdominal quadrant painful in appendicitis • Heart attack- Left arm, back, neck (not at chest) • “Brain freeze”- ice cream • Diaphragm refers to right shoulder

48. Cutaneovisceral Reflex • Reverse loop proposed • GV 26- hemorrhagic shock in dogs: increases cardiac output- blood pressure increases • PC-6 in cats: EAP inhibits frequency of transient lower esophageal sphincter relaxation • ST-36 accelerates colonic motility rats

49. Cutaneovisceral Reflex Needle in paravertebral muscle at myotome segmental level associated with muscular pain Somatic nerve ending of a muscle stimulated Afferent impulse to dorsal horn Stimulation of contralateral anterior hypothalamus Activation of somato-autonomic reflex Cholinergic vasodilator nerves activated to spastic muscles

50. Western Framework Mechanisms of Action Effects on the CNS Endogenous Pain Inhibition Segmental Analgesia Local Tissue Effects Autonomic Nervous System Trigger Point Therapy