MEDICAL ACUPUNCTURE Volume 22, Number 1, 2010 # Mary Ann Liebert, Inc. DOI: 10.1089 =acu.2009.0699
Treatment of Neck Pain Using Yamamoto New Scalp Acupuncture (YNSA) Ali Shaladi, MD, Francesco Crestani, MD, Stefano Tartari, MD, and Teresa Trombella, RN
ABSTRACT Background: Cervical pain can be defined as a painful condition of the upper region of the spinal column affecting the neck and shoulders. The conservative treatment for uncomplicated neck pain includes physical and pharmacological measures, together with the provision of advice and manual treatment such as mobilization and manipulation. Objective: To evaluate the effectiveness of scalp acupuncture in the treatment of neck pain. Design and Setting: We studied patients with neck pain between June 2007 and January 2008 at Pain Service, San Luca Hospital, Trecenta (Rovigo), Italy. A prospective questionnaire using a visual analog scale (VAS) and the Present Pain Index (PPI) was administered. Patients: We treated 46 patients (29 women and 17 men) with neck pain. Among them were 25 patients with osteoarthritis diagnosed by radiological examination and 21 patients with myofascial pain syndrome. Intervention: Patients were treated with only 1 session of Yamamoto New Scalp Acupuncture (YNSA) in the Basic Points A 1–7. Main Outcome Measures: Level of pain at 30 minutes after the session, evaluated with the VAS and PPI. Results: The degree of reduction of pain was 71% when evaluated with the VAS and 80% with PPI. Conclusions: YNSA acupuncture was effective in the reduction of neck pain for this group of patients, with only 1 needle in a single session. Key Words: Acupuncture, Neck Pain, Yamamoto New Scalp Acupuncture (YNSA)
INTRODUCTION
N
frequent problems in clinical practice and is a common cause of disability. It is a painful condition of the higher part of the spinal column, between the occipital condilum and the spinous process of the VII cervical vertebra, and involves the neck, shoulders, and upper arms.1 Neck pain is second only to low back pain as the most common common musculoskel musculoskeletal etal disorder disorder in population population surveys surveys and primary care. 2 From an epidemiological point of view, little is known about the exact incidence of neck pain in the ec eck k pain pain is one one of the more more
San Luca Hospital, Trecenta, Rovigo, Italy.
41
population. It is estimated that almost everyone has experienced, at one time or another, a form of neck pain that often spontaneously resolves and that may or may not be associated with pain in the arms. About 15% of women and 10% of men older than 40 years complain of chronic neck pain related to working activity. 3 Many have tried to classify the origin of pain. The best method of classification and the more widely accepted is a diagnostic triad in which patients are categorized to 1 of the following following groups: groups: spinal pathology pathology,, neurologica neurologicall involveinvolvement, ment, and idiopath idiopathic ic neck neck pain. pain. In a smalle smallerr number number of cases, neck pain is caused by tumors, systemic arthropathies
42
SHALADI ET AL.
(i.e., (i.e., rheumatoid rheumatoid arthritis, arthritis, ankylosing ankylosing spondylitis) spondylitis),, infecinfectious illness, thyroid disorders, obstructive esophagitis, or gastroesophageal reflux disease.4 In about 95% of patients, neck pain is caused by trauma, myofascial pain syndrome, postural pain, and=or degenerative osteoarthritis. 5,6 The clinical picture shows cervical stiffness in the more frequent form, followed by headache, pain, and segmental paresthesia in the neck, shoulder, arm, forearm, hand, and fingers.7,8 Trea Treatm tmen entt of neck neck pain pain cons consis ists ts of vari variou ouss methods with the aim of relieving the pain and improving quality of life.
METHODS Patients We used used Yamamo Yamamoto to New New Scalp Scalp Acupun Acupunctu cture re (YNSA) (YNSA) in 1 treatment session and then evaluated pain relief. Our study took took place place betwe between en June June 2007 2007 and January January 2008 2008 at Pain Pain Service, San Luca Hospital, Trecenta (Rovigo), Italy. The authors, authors, who complete completed d 4 years years of postgrad postgraduate uate training training in acupun acupunct ctur ure, e, were were the acupun acupunct cturi urists sts in the study. study. The aim and methods of the study were explained to the patients; voluntary participation was requested and informed consent was obtained, according to the local and international guidelines. The study was reviewed and approved by the institutional review board of our local health care authority. Forty-six patients with cervical pain lasting for at least 6 weeks were recruited for the study: 29 women (63%) with a mean age of 51 years (range 28–73), and 17 men (37%) with a mean age of 57 years (range 35–84). Twenty-five patients (54%) had osteoarthritis diagnosed by radiological examinati examination, on, and 21 patients patients (46%) (46%) had myofascial myofascial pain 9 syndrome.
Outcomes Pain Pain was evalua evaluated ted with a visual visual analog scale (VAS) (VAS) measuring measuring 0–100 mm on a horizonta horizontall line, where 0 means no pain pain and and 100 100 the the wors worstt pain pain..10 To be eligib eligible, le, the patien patient’s t’s mean pain score score had to be greater greater than 40 mm on the scale. We also used the Present Pain Index (PPI) to quantify the pain on the basis of the effects on functional capacity; PPI is a numeric rating scale that includes a list of adjectives, rankordered by the level of pain. In this case, the evaluation of pain was determined by the physician.11
the thumb and the second finger. When the Liver Point is stiff, the chosen treatment is in Yin and when the muscle is soft, the treatment is in Yang. We treated 36 patients with the Yin method and 3 patients with the Yang method. We researched the acupoints to treat by palpating the scalp with the tip of the second finger until we found a hard, painful point. point. Then we used used a stimul stimulato atorr to refine refine the location location (Figure 1). The The Basi Basicc Poin Points ts A 1–7 1–7 are are situ situat ated ed on a line line abou aboutt 1.5 cun long representing representing the cervical cervical spine from C1 to C7 with all its elements (Figure 2). The Yin points are situated in the insertion insertion line of the hair, 0.5 cun (the fingertip fingertip of the index finger), at the side of the median frontal line. The third cervical vertebra is represented on the hairline. The Yang treatment was performed on the occipital lambdoid suture, 0.5 cun at the side of the central point of the the occipital bone. We used 0.2525 mm Hwato sterile, single-use single-use acupuncture needles (Suzhou Medical Appliance Factory, Suzhou, China). China). The needles needles were inserted inserted to a depth of 10 mm with an angle of 70 ; each session lasted 30 minutes. The scalp side to treat was ipsilateral to the referred cervical pain. The statistical analysis was calculated using the t test for paired data. 8
RESULTS The reductio reduction n of pain was evaluate evaluated d by the VAS and PPI before the session and 30 minutes after the session. The mean baseline VAS was 7 (range, 5–8) and after treatment was was 2 (ran (range ge,, 0–5) 0–5).. The The obta obtain ined ed redu reduct ctio ion n was was 71% 71% (P < .001). At baseline, the mean PPI was 2.5 (range, 2–4) and after treatment was 0.5 (range, 0–2), with a reduction of 80% (P < .001). None of the patients reported adverse effects.
DISCUSSION The majority of studies report that the treatment of neck pain with acupuncture is performed with a mean of 2 sessions a week for 6–8 weeks; the reduction of the pain ranges
Technique The patients were evaluated with VAS and PPI before and after the treatment. They were evaluated with YNSA Basic Neck Diagnosis Test to choose the kind of treatment, Yin or Yang. The test is carried out by palpating the Liver Point in the middle part of the sternocleidomastoid muscle with
FIG. 1.
Stimulator used to locate points.
TREATMENT OF NECK PAIN USING YNSA
43
CONCLUSIONS It is possible to conclude from this pilot study that treatment with YNSA was effective for this group of patients; it seems to be a useful method to reduce pain and quickly impr improv ovee the the move moveme ment nt of the the neck neck,, in only only 1 sessi session on.. However, the pain reduction was evaluated only 30 minutes after the acupuncture session, so that it is difficult from our data to establish the long-term duration of the symptom relief. Nevertheless, YNSA is a simple technique and easily performed without adverse effects. Further studies are needed to validate these conclusions and to explain the physiologic mechanism underlying the acupuncture-induced analgesia in neck pain. FIG. 2. Basic Points Points A 1–7 are situate situated d on a line about 1.5 1.5 cun long representing the cervical spine from C1 to C7.
DISCLOSURE STATEMENT from 20% to 50%. 12 In our study, we obtained a rapid reduction of the symptoms, evaluated with a single session of 30 minutes and a single needle, using the YNSA method. The pain relief reduction was reported as 71% on VAS and 80% on PPI. It is difficult to predict how long the relief will last. The study was carried out to evaluate the immediate response to a single acupuncture session; our future intentions are a long-t long-term erm follow follow-up -up of the patien patients, ts, althou although gh our cliniclinical impressi impression on is that that a series series of sessio sessions ns is needed needed for lasting lasting improveme improvement, nt, just as with classical classical acupunctur acupuncture. e. However, a rapid relief of the pain satisfies and motivates the patient. YNSA is a method developed around 1970 by Toshikatsu Yamamoto13 and officially presented for the first time during the 25th Congress Congress of Riodoraku Riodoraku Japanese Japanese Society Society in 14 Osaka. The word ‘‘new’’ was added to distinguish it from the Chinese craniopuncture. The YNSA method is classified as ‘‘somatic microsystem’’ as well as other known microsystems (for example, ear, nose, pulse acupuncture). 15 The somatotope of the Scalp Basic Points situated bilaterally in the frontal area is called Yin, while Yang points line up bilate bilateral rally ly in the occipi occipital tal area area along along the lambdo lambdoid id suture. These points represent specific parts of the body and it is possible to locate them by palpating with a rotating motion on the scalp using the tip of the second finger, or a pen or special stimulator (Figure 1). The patient can confirm a sensation of pain or discomfort while the point is palpated. These sensory points are treated ipsilaterally to the affected side, and the needle is inserted at an angle of 70 .16 While Yamamoto Yamamoto currently currently labels the A line with numbers numbers from 1 to 8, we still used the older numeration, from 1 to 7 (considering a careful detection of a hard and painful point of the scalp more important important then a numerical numerical classification classification of it). 8
No competing financial interests exist.
REFERENCES 1. Ferrar Ferrarii R, Russell Russell AS. Region Regional al muscul musculoske oskelet letal al condicondiPract Res Clin Rheumatol. Rheumatol. 2003;17: tions: tions: neck pain . Best Pract 57–70. 2. Nachemson A, Wadidell G, et al. Epidemiology of Neck Pain: The Scientific Evidence of Causes, Diagnosis and Treatment. Nachemson A, Jonsson E, eds. Philadelphia, PA: Lippincott Williams & Wilkins; 2000:165–187. 3. Bovim G, Schrad Schrader er H, Sand Sand T. Neck pain in the general general population. Spine. 1994;19:1307–1309. 4. Crob D. Surgical aspects aspects of the cervical cervical spine in rheumatoid rheumatoid arthritis. Orthopade. 2003;33:1201–1212. 5. Chiu TT, Lam TH, et al. A randomized randomized controlle controlled d trial on the efficacy of exercise for patients with chronic neck pain. Spine. 2005;30:E1–E7. 6. Hoving Hoving JC, Devet HC, et al. Prognostic Prognostic factors for neck pain in general practice. Pain. 2004;110:639–645. 7. Bogduk Bogduk N. Cervic Cervical al causes causes of headac headache he and dizzin dizziness ess.. In: Modern Manual Manual Therap Therapy y of the Verteb Vertebral ral Grieve Grieve G, Ed. Modern Column. Edinburgh, UK: Churchill-Livingstone; 1986:289– 302. 8. Bogduk N. Innervation and pain pain patterns in the cervical cervical spine. Clin Phys Ther . 1988;17:1–13. 9. Simons Simons DG. Muscular pain syndromes. syndromes. In: Fricton JR, Awad E, eds. Advances in Pain Research and Therapy. Vol 17. New York, NY: Raven Press; 1990:1–41. 10. Jensen MP, Karoly Karoly P, et al. The measurement measurement of clinical clinical pain intensity: a comparison of six methods. Pain. 1986;27:117– 126. 11. Scott J, Huskinsson EC. Graphic representation representation of pain. Pain. 1976;2:175–184. 12. White White P, Lewith Lewith G, et al. Acupuncture Acupuncture versus versus placebo for the treatment treatment of chronic chronic mechanica mechanicall neck pain: a randomized randomized controlled trial. Ann Intern Med . 2004;141(12):126.
44 13. Yamamoto T, Yamamoto Yamamoto H. New scalp acupuncture. acupuncture. Medical Tribune, Tribune, Japan. 2003. 14. Yamamot Yamamoto o T. The effect effective ivenes nesss of Yamamo Yamamoto to new scalp scalp acupunture (YANSA) on Mibyou condition. Geriatr Gerontol Int. 2004;4:S223–S225. 15. Nissel H. Pain treatment treatment by means of acupuncture. acupuncture. Acupuct Electrother Res 1993;18(1):1–8. 16. Feely Feely RA. Yamamoto New Scalp Acupuncture: Principles and Practice. Thieme Medical Publishers; 2006.
SHALADI ET AL.
Address correspondence to: Francesco Crestani, MD Pain Service, Local Health Care, Authority 18 San Luca Hospital Trecenta, Rovigo Italy E-mail:
[email protected]
