CHAPTER 16 Using the Integrative Neuromuscular Acupoint System for Acupoint Injection Therapy
INTRODUCTION
The purpose of this chapter is to present the Integrative Neuromuscular Acupoint System (INMAS) to healthcare professionals who have already used injection therapy for pain management.
In the late 1960s, traditional Chinese medicine (TCM) was experiencing an extraordinary period of development, and the leading direction of research in the field, sponsored by the Chinese government, was the integration of TCM with modern medicine. Many new methods were explored to improve the effectiveness of traditional needling and were referred to as “innovative needling-method therapy” (xin zhen liao fa). These new techniques included electrical acupuncture, scalp acupuncture, acupoint implant therapy (surgically implanting foreign material at the acupoints), acupoint tissue extraction therapy (surgically removing fatty tissue from the acupoints), and acupoint injection therapy. In addition, practitioners of Chinese folk medicine were using more than 80 types of needling methods such as eye, nose, wrist-and-ankle needling, and so on.
For injection therapy the Chinese doctors injected about 1cc of a vitamin solution (but not vitamin C, which creates a very painful reaction), and various Chinese herbal extracts at the location of acupoints, and they claimed very good therapeutic results. Like acupuncture anesthesia, this was developed as a move toward the integration of traditional Chinese and modern medicine.
In the United States, Dr. Janet Travell, without previous knowledge of Chinese acupuncture, discovered and published the patterns of pain trigger points in 32 skeletal muscles in 1952.1 The locations of these trigger points basically matched most acupoint locations in the ancient Chinese system. Dr. Travell injected anesthetics (0.5% procaine in physiologic saline) into these trigger points to treat myofascial pain symptoms such as lower back pain. Today the solutions used for injection may include isotonic saline, procaine, lidocaine, Botulinum toxin A (BTA), corticosteroids, and other longer-acting local anesthetics. Some of these injected solutions have some myotoxic effects.
THE BENEFITS OF INMAS FOR ACUPOINT INJECTION THERAPY
The Chinese acupoint injection system is based on the traditional concept of yin-yang balance and “channel (meridian) theory,” whereas Dr. Travell’s system focuses on intramuscular trigger points whose locations are based on modern pathology, anatomy, and physiology. INMAS combines the benefits of both because the majority of the 24 HA points are at the same time major channel (meridian) points and trigger points.
Of the 24 HAs that are specified in INMAS all but three are suitable for injection therapy, the exceptions being the facial HAs (H2 great auricular, H19 infraorbital, and H23 supraorbital), with H3 spinal accessory being a unique case requiring special caution on account of the lungs beneath. Note also that:
INMAS AND CHRONIC MYOFASCIAL PAIN
The area to be injected should contain no damaged tissue, swelling, bruises, or scar tissue. Chronic myofascial pain usually develops around one or more HAs, and the location of these is a guide to the location of the other secondary tender points. Some of the HAs may also be related to referred pain.
For example, in patients with lower back pain, all the 7 HAs associated with the lumbosacral plexus may be tender: H14 superior cluneal, H15 posterior cutaneous of L2, H16 inferior gluteal, H22 posterior cutaneous of L5, H18 iliotibial, H11 lateral popliteal, and H10 sural. In addition to these major points, secondary tender points can develop around:
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