Acupuncture As A Treatment For TMJ & Other Oralfacial Pain Jun Xu, MD American Board Certified in Physical Medicine and Rehabilitation American Board Certified in Acupuncture American Board Certified in Chinese Herbology 1171 E Putnam Avenue, Building 1 Riverside, CT Yin-Yang Theory The Application of Yin-Yang Theory The organic structure of the human body. The physiological functions of the human body. The pathological changes in the human body. Yin-Yang as a guide to clinical diagnosis and treatment. The Five Elements Theory The Meridians Theory 1. Transporting Qi Energy and Blood, regulating Yin and Yang. 2. Resisting pathogens and reflecting symptoms and signs. 3. Transmitting needling sensation and regulating deficiency and excess conditions. Qi ( Energy ) Qi: a fundamental substance constituting the universe, and all phenomena were produced by the changes and movement of Qi. How does Acupuncture work? Human body contains 14 major meridians. Energy (Qi) goes through the meridians. If the energy is not in balance, diseases occur. Needles being inserted into body will smooth the energy and make the energy balance. The Twelve Regular Meridians The Large Intestine Meridian The Lung Meridian The Twelve Regular Meridians The Stomach Meridian The Spleen Meridian The Twelve Regular Meridians The Heart Meridian The Small Intestine The Twelve Regular Meridians The Bladder Meridian The Kidney Meridian The Twelve Regular Meridians The Pericardium M. The Sanjiao M. The Twelve Regular Meridians The Liver Meridian The Gallbladder M. How does Acupuncture work? Gate-Control Theory of Pain In 1962, Ronald Melzack and P. D. Wall proposed the gate-control theory. pain perception is not simply a direct response to the stimulation of pain fibers, but is also mediated by the cooperation of excitation and inhibition in pain pathways. Gate-Control Theory of Pain Because the pain is controlled by the inhibitory action on the pain pathway, the perception of pain can be altered. In other words, the pain can be gated on or off through various methodsmechanically, pharmacologically, physically, physiologically, and psychologically. Gate-Control Theory of Pain In 1976, Melzack used the gate-control theory to explain the mechanisms of acupuncture. He believed that acupuncture acts on the reticular formation in the brain stem to alter the pain pathway. Many studies shows that pain is blockaded at the brain (i.e. central to the brain rather than at the spinal cord or periphery) via the release of endogenous opioids (natural painkillers in the brain), and neurohormones, such as endorphins and enkephalins (naturally occurring morphines). A combined [11C]diprenorphine PET study and fMRI study of acupuncture analgesia Needle manipulation on either hand produced prominent decreases of fMRI signals in the nucleus accumbens, amygdala, hippocampus, parahippocampus, hypothalamus, ventral tegmental area, anterior cingulate gyrus (BA 24), caudate, putamen, temporal pole, and insula in 11 subjects who experienced acupuncture sensation (Figure 2b). endogenous opioids are central to the experience of pain and acupuncture analgesia. Behavioural Brain Research, Volume 193, Issue 1, 3 November 2008, Pages Behavioural Brain Research, Volume 193, Issue 1, 3 November 2008, Pages Research at Harvard's Gollub Neuroimaging Lab Acupoint Stimulation and Its Effect on the Brain Imaging the functional connectivity of the Periaqueductal Gray during genuine and sham electroacupuncture treatment 1, Karin Jensen1, Ginger Polich1, Rita E Loiotile1, Alexandra Cheetham1, Peter S LaViolette1, Peichi Tu2, Ted J Kaptchuk3, Randy L Gollub1, 2, Jian Kong 1Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA 2MGH/Massachusetts Institute of Technology/Harvard Medical School (HMS) Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA 3Osher Research Center, Harvard Medical School, MA, USA Compared with sham acupuncture, EA can significantly reduce Periaqueductal Gray (PAG) activity when subsequently evoked by experimental pain. Case Discussion James is 45 years old female, who complains of both jaw pain for 2 months, he feels difficulty opening her jaws and biting food, he is under a great stress and he reports headache, worsening while she opens and closes his jaw; ear pain with multiple antibiotics treatment without any improvement; grinding, crunching, or popping sounds while chewing, fullness at ear and other sinus, sometimes accompanied tinnitus and dizziness Differential 1: TMJ Disorder 2. Local Points: SI 19, SJ 21 and GB 2 1. General Points: LI 4, LI 11 and SJ 5 Clin J Pain Jul-Aug;26(6): Acupuncture in the treatment of pain in temporomandibular disorders: a systematic review and meta-analysis of randomized controlled trials. La Touche R, Goddard G, De-la-Hoz JL, Wang K, Paris-Alemany A, Angulo-Daz-Parreo S, Mesa J, Hernndez M. Faculty of Health Science, Department of Physical Therapy, Universidad Europea de Madrid, Villaviciosa de Odn, Madrid, Spain. La Touche RGoddard GDe-la-Hoz JLWang KParis-Alemany AAngulo-Daz-Parreo SMesa J Hernndez M A total of 8 RCTs(randomized controlled trials) were selected, and the quality of only 4 was considered acceptable. These 4 studies showed positive results such as reducing pain, improving masticatory function, and increasing maximum interincisal opening. By combining the studies (n=96) and analyzing the results, it was concluded that acupuncture is more effective than placebo in reducing pain intensity in TMD (standardized mean difference 0.83; 95% confidence interval, ; P= ). Differential 2: Sinus Headaches Three major sinus: 1. Frontal, 2. Ethnoid and 3. Maxillary sinuses, which are easily infected or irritated with allergens leading to headaches Sinus Headaches Acupuncture Tx The most important Points; LI 20, UB 1, UB 2 and GB 14 Am J Chin Med. 1982;10(1-4):55-8. The effects of treatment with antibiotics, laser and acupuncture upon chronic maxillary sinusitis in children. Pothman R, Yeh HL. Pothman RYeh HL 45 patients, 3-40 years old, were treated, 19 with antibiotics, 18 with acupuncture and 8 with Laser- acupuncture. There was no statistical difference of results between Laser-therapy and antibiotics (Chi- Square-Test). Compared to previous treatments with antibiotics, results and duration of improvement was significantly better after acupuncture. Conclusion: acute sinusitis, especially of frontal sinus and in younger children, will better be treated by antibiotics because of the danger of osteomyelitis and meningitis. Acupuncture should be tried in chronic and recurrent stages after exclusion of large adenoids in children or bone inhibition of sinus clearance, especially before an invasive operation like removal of sinus mucosa is carried out. Differential 3: Tension, Cluster, Migraine Headaches 1. Tension Headache the most common type of chronic and frequent headache. The symptoms include steady pain on both side of the head and or back of the scalp with the feeling of pressure and tightness around head and as if a band was put tightly around it. The pain usually increased over period of hours when the pain gets worse, and might develop pulsating quality. The pain radiates from neck, back, eyes or other body parts. Differential 3: Tension, Cluster, Migraine Headaches 2. Cluster headache: often described as a sharp, penetrating or burning sensation on the one eye. The patients feel as if somebody punched the eye and this pain is of sudden onset without warning; within a few minutes excruciating pain develops and people with cluster headaches appear restless The pain is so severe, some patients report it is even worse than childbirth. The cluster headache usually lasts about 2 to 12 weeks, though some chronic cluster headaches may continue for more than a year. These sometimes go with seasonal change. Differential 3: Tension, Cluster, Migraine Headaches 3. Migraine Headache: a throbbing or pulsating headache that is often one side and associated with nausea and vomiting, and sensitive to light, sound, and smell with sleep disruption and depression. These attacks are very often recurrent and do not change with age, sometimes develop a chronic migraine headache. Differential 3: Tension, Cluster, Migraine Headaches Tx Headache Apr;46(4): Acupuncture for chronic headaches--an epidemiological study. Melchart D, Weidenhammer W, Streng A, Hoppe A, Pfaffenrath V, Linde K. Department of Internal Medicine II, Centre for Complementary Medicine Research, Technische Universitt Mnchen, Kaiserstr. 9, Munich, Germany. Melchart DWeidenhammer WStreng AHoppe APfaffenrath VLinde K A total of 2,022 patients (732 with migraine, 351 with episodic and 440 with chronic TTHs, and 499 with other diagnoses) treated by 1,418 physicians were included in the main analysis. Statistically highly significant and clinically relevant improvements were seen for all clinical outcome measures in all diagnostic groups. In 52.6% of patients headache frequency decreased by at least 50% compared to baseline. The comparison of headache frequency, pain intensity, and generic outcome measures showed that some of these outcomes correlate only weakly. CONCLUSIONS: In this epidemiological study, headache patients reported clinically relevant improvements after receiving acupuncture. Randomized trials performed in parallel to this study confirm the relevant overall effect, however, the effect may largely be due to potent unspecific needling and placebo effects. Differential 4: Trigeminal Neuralgia A sudden, severe, electric-shock- like, or stabbing sensation is most often felt only on one side of the face, jaw, or cheek, but it can affect both sides of the face in rare pain typically last only seconds to minutes; It can be brought on by such triggers as talking, brushing the teeth, touching the face, chewing, drinking, swallowing, kissing, or even a gentle breeze. The attacks may come and go throughout the day and can last for days or months at a time, and then disappear for months or years. Differential 4: Trigeminal Neuralgia 1. Ophthalmic nerve branch. This is the top branch of the trigeminal nerve. Acupuncture points include the EX-HN4 Yu Yao, GB 1 Tong Zi Liao, SJ 23 Si Zu Kong, EX-HN5 Tai Yang and UB1 Jing Ming. 2. Maxillary nerve branch. Use the St 2 Si Bai and St 1 Chen Qi points and the manipulation described above. 3. Mandibular nerve branch. Use the St 7 Xia Guan, Ren24 Cheng Jiang and St 4 Di Chang points and the manipulation described above. Ann Ital Chir May-Jun;66(3): [Treatment of trigeminal neuralgia with electroacupuncture. Experience with 104 cases] Costantini D, Tomasello C, Buonopane CE, Sances D, Marandola M, Delogu G. Istituto di Anestesiologia e Rianimazione, Universit degli Studi di Roma La Sapienza. Costantini DTomasello CBuonopane CESances DMarandola MDelogu G The essential or secondary trigeminal neuralgia is a very frequent and invalidant disease. In this forms, the medical or surgical conventional therapies are often inadequate. In this study we evaluated the effects of the acupunctural therapy on 104 patients (mean age /- 13 years) with idiopathic or secondary trigeminal neuralgia. Utilizing cycles of twelve sessions, the acupunctural treatment was performed with an electrostimulator on local points and a distance or on aching points, in the secondary forms. The results was evaluated on the basis of three parameters (reappearance of the symptomatology, absence of pain in months and preceding treatments) and was defined using this scale: very well, well, fair and null. In conclusion we can say that acupuncture is an elective treatment in all kinds of secondary tregeminal neuralgia, while, in the idiopathic form, its validity is conditioned by preceding medical treatments and by beginning of the disease. Braz Dent J. 2007;18(2): Electro-acupuncture efficacy on pain control after mandibular third molar surgery. Tavares MG, Machado AP, Motta BG, Borsatto MC, Rosa AL, Xavier SP. Department of Oral Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeiro Preto, University of Sao Paulo, Ribeiro Preto, SP, Brazil. Tavares MGMachado APMotta BGBorsatto MCRosa ALXavier SP The aim of this study was to evaluate the efficacy of electro-acupuncture (EAC) on postoperative pain control after mandibular third molar surgery. Twenty four young patients (12 male and 12 female) with symmetrically impacted mandibular third molars were selected. Each patient was submitted to two separate surgical procedures under local anesthesia. At one side, extraction was carried out employing both prior (24h) and immediately postoperative application of EAC, while on the contralateral side surgery was carried out without any treatment. EAC was applied on 6 bilateral systemic and 2 auricular points with a WQ10Dl appliance using Hz frequency for 20 min and individually adjusted intensity. Postoperative pain intensity was rated on a 100 mm visual analog scale (VAS) between 2 and 72 h and recording the amount of analgesics intake after surgery. Statistical analysis was performed using theWilcoxon test. Postoperative pain VAS scores were significantly lower for the EAC group (p