Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. 10S2017027
Pet has had on and off again neck pain for the past 3 years. Pet has been on pain, anti-inflammatory, and muscle relaxant medications as needed when he has a flare-up. The medications were not effective for his most recent flare-up. Pet recently received a total of four acupuncture sessions daily with significant improvement in his neck pain.
History and Presentation:
Bandit is a 12 year and 10 month old male, neutered Welsh Corgi Mix, 30 lbs. Pet initially presented for neck pain on 12/4/17. Pet has had on and off again neck pain for the past 3 years. Pet is also a diabetic and currently controlled on Humulin N 12 units SQ every 12 hours. Radiographs of the cervical spine were taken on 11/4/16 and were unremarkable. Pet was not on any pain medication at the time of presentation on 12/4/17. Pet was placed on gabapentin 100 mg bid, methocarbamol 250 mg, and galliprant 30 mg sid. Pet was still painful on this regimen so the doses and frequencies were initially increased to 100 mg gabapentin po tid and methocarbamol 500 mg tid. Galliprant dose was kept the same. Dose adjustments did not result in significant improvement in pet’s pain and pet came in for 1 session of acupuncture, dry needling, on 12/6/17. Pet did a little better, but then pain started again on 12/09/17, more severe than on 12/4/17. Pet went to the ER on 12/10/17 and received a methadone injection IM. Pet was still acting painful so came in on 12/11/17 for his first of four daily acupuncture sessions (dry needling and electroacupuncture). Pet received a total of four sessions daily from 12/11/17 to 12/14/17. Pet’s methocarbamol dose was decreased to 250 mg bid and then discontinued after 2 weeks. Pet’s gabapentin dose was decreased to 100 mg bid and then discontinued after 1 month. Pet stayed on 30 mg galliprant sid for another month as well and then discontinued. Pet has been doing well since then.
Physical Examination and Clinical Assessments:
On 12/11/17 – Pet was very painful on the left side of his neck on myofascial palpation along the semispinalis capitus muscle, both the biventer cervicis and complexus muscle. Left shoulder was very tense on myofascial palpation along the deltoideus, lateral head of the triceps, and long head of the triceps, these muscles could be seen actively twitching. Pet would yelp when trying to get down from a low set cage and could not follow a treat to the left side. At home, pet was hesitant to walk and would just sit in the same position when called. Pet’s vital signs and neurologic exam were normal.
Medical Decision Making:
I started with cervical spinal nerve points to stimulate the cervical spinal nerves to address cervical interveterbral disk disease and neck pain. I then proceeded with BL 10 bilaterally to stimulate the cranial cervical spinal nerves to address cervical pain and tension. I then moved on to SI 11 and SI 12, bilaterally, to stimulate the suprascapular nerve to address myofascial dysfunction and to hit trigger points in the left triceps. I also placed a point in SI 9, left side, to stimulate the axillary nerve and radial nerve to address shoulder pain. I lastly placed needles in the tight muscle bands going over the scapulohumeral joint – lateral head of the triceps, deltoideus, and cleidobrachialis.
Soft tissue trauma
Intervertebral disc disease/disc herniation (extrusion vs protrusion)
Nerve Root Impingement
Meningitis/Meningomyelitis (infectious vs autoimmune – steroid responsive meningitis arteritis vs granulomatous meningoencephylitis)
Discospondylitis (bacterial vs fungal)
Cervical Spondylomyelopathy –(congenital vertebral canal malformation, ligamentous hypertrophy, acquired osseous stenosis, vertebral instability/subluxation, joint capsule proliferation/synovial cyst formation)
Definitive (or Putative) Diagnosis (or Diagnoses):
Given the pet’s history and previous response to treatment, pet most likely suffers from a compressive lesion or impingement on a nerve root and has secondary muscular spasms along left side of neck and left shoulder because of it. Cervical radiographs ruled out a fracture, spondylosis, and an obvious subluxation. Further diagnostics declined due to financial constraints from pet parent so cannot diagnose the type of compressive lesion present.
45 minute session once a day consecutively for 4 days:
Cervical spinal nerves bilateral – electroacupuncture (Pantheon) performed using 3 Hwato 0.20 x 0.25 mm needles, continuous, at 4 Hz frequency, amplitude just under 2, 20 minutes
BL 10 bilateral – dry needling using Serin 0.20 x 30 mm needles
SI 9, SI 12, and SI 11 left – electroacupuncture (Pantheon) performed using 2 Hwato 0.25 x 0.25 mm, continuous, at 4 Hz frequency, amplitude just under 2, 20 minutes
SI 12 and SI 11 right – dry needling with Serin 0.20 x 30 mm needles
Tight muscle bands palpated on left shoulder, combination of dry needling and electroacupuncture (Pantheon) -5 Serin 0.20 x 30mm needles placed in tight bands (deltoideus, lateral head of the triceps, and cleidobrachialis) with 2 Hwato needles 0.20 x 0.25 mm, continuous, at 4Hz frequency, amplitude just under 2, 20 minutes
Outcomes, Discussions, and References:
Pet received a total of four acupuncture sessions daily from 12/11/17 to 12/14/17. After the second session, pet parent noticed a dramatic improvement in pet’s neck pain and mobility and after the fourth session, pet was pretty much back to his normal self. After the fourth session, he was able to follow a treat to the left and get up and down a low set cage without hesitation or yelping. The twitching on left shoulder was now mild. This progress was not seen after pet had been on medical management for 1 week with only 1 dry needling acupuncture session performed. Pet will definitely receive acupuncture as a standard treatment going forward when needed.
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3. Evans and deLahunta. Guide to the Dissection of the Dog. 2004
4. Fu LM, et al. Randomized controlled trials of acupuncture for neck pain: systematic review and meta-analysis. J Altern Complement Med. 2009;15(2):133-145
5. Jeffery ND, et al. Intervertebral Disk Degeneration in Dogs: Consequences, Diagnosis, Treatment, and Future Directions. J Vet Intern Med 2013 Sept 6
Robinson, NG. Medical Acupuncture for Veterinarians Canine Point Mini-Manual. 2017