ISDN therapy is a drugless and nonspecific inoculation into the body that causes minute lesions, which in turn initiate the mechanisms of self-healing, including autonomic homeostasis, tissue healing, and pain relief. At the needling site, a cutaneous microcurrent circuit is created to produce a current of injury (about 10 mA), which stimulates tissue growth. Mechanical stimulation from the needle, especially from needle manipulation, deforms the connective collagen and elastic fibers; this causes transduction of signals for tissue healing and gene transcription.
The needling and its lesion also induce a local inflammatory reaction against the intrusion. Endogenous (nonvoluntary) muscle contracture, which creates an energy crisis in the shortened muscle, can be relaxed by needling the corresponding acu-reflex points, to restore normal muscle physiology. This occurs through segmental and nonsegmental neural mechanisms. Needling signals from local (segmental) points are processed at both the spinal cord and supraspinal cord centers (midbrain, thalamus, pituitary gland, and cortex), whereas signals from distant (nonsegmental) points may be directly relayed to supraspinal cord centers. These mechanisms enhance one another to activate descending control systems, which include the secretion of chemicals and hormones into the blood and cerebrospinal fluid to restore homeostasis and facilitate the neural modulation of pain relief.
Responses to needling treatments vary because of physiologic differences among patients. In an average clinic population, about 28% of patients respond strongly, 64% respond adequately, and 8% respond weakly.2
Differentiation of patients and predictive prognosis are an important part of treatment procedure in ISDN therapy. An understanding of the needling mechanisms enables the development of a practical protocol for all pain symptoms. The neuromuscu-lar acu-reflex point system introduced in this book simplifies the process of point selection and ensures more predictable and effective pain management.
In this chapter, the peripheral effects of needling stimulation have been discussed, and both peripheral and central mechanisms are summarized as follows.
It is clear that needling stimulation, with both peripheral and central effects, activates the physiologic processes of complex, innate survival mechanisms in order to restore and maintain homeostasis. The peripheral effects involve creation of needle-induced lesions, cutaneous microcurrents, mechanical signal transduction through connective tissues, local relief of muscle shortening and contracture, and other local reactions.
The central effects are a form of CNS response as a result of peripheral sensory stimulation. This response includes the neural-immune interaction, the humoral and autonomic nervous system pathways, and the efferent nerves present in other hypo-thalamic neural circuits. The peripheral and central effects of needling stimulation are physiologically inseparable.
Newly available molecular imaging tools such as high-resolution and high-sensitivity positron emission tomography (PET) and high-field fMRI enable clinicians to investigate in vivo the mechanisms of the human brain, especially higher brain (cortex)
mechanisms, such as neurochemical and hemo-dynamic responses to needling stimulation.17 The information gained from these tools will help clinicians better understand the mechanisms of needling and select more effective clinical procedures, although the interpretation of these data needs more development.
The central effects of neelding stimulation activate the four determinants of homeostasis: (1) nervous system, (2) immune system, (3) endocrine system, and (4) cardiovascular system. They also depend on interactions between these systems and those controlled by neural pathways such as the autonomic nervous system.
Each acu-reflex point produces both a local and central systemic effect. Findings of fMRI corroborate clinical data in demonstrating that stimulation of any sensory nerve endings produces analgesic effects in the spinal cord and brain. Clinicians distinguish between the stimuli at different acu-reflex points according to whether more local effect or systemic effect is needed. If local effect is the priority (as in cases of localized inflammatory soft tissue pain), the treatment may focus on the local symptoms. If a systemic effect is desirable (as in cases of fibromyalgia or headache), the treatment should include both local and systemic treatment.
For example, elbow and paravertebral acu-reflex points between C4 and T1 are selected for treating elbow pain, whereas knee and paravertebral acu-reflex points between L2 and L5 are selected for treating knee pain. These combinations of symptomatic acu-reflex points (as in the elbow or the knee) with paravertebral acu-reflex points are based simply on the segmental innervation of the spinal nerves. However, the neck and shoulder should be treated together in some patients with knee pain because the knee pain may change the entire posture and cause imbalance of the spine.
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