Written by a Medical Acupuncture for Veterinarians Course Graduate. Author’s name available upon request. Signed release obtained from client/author/4932.
Hef presented for evaluation of chronic cervical pain. Client reports a long history of discomfort with cervical manipulation. Client has experimented with various pain control treatments in the past without substantial long-term success due to Hef’s resistance to taking oral medications. Medical acupuncture was offered and performed to alleviate Hef’s discomfort during routine activities secondary to suspected cervical osteoarthritis. The results observed include less noticeable discomfort without the stress of oral medication administration.
Hef is a six-year-old male neutered Yorkshire Terrier canine. Client reports observing a significant pain response during cervical manipulation over the past few years. Activities that cause Hef to yelp out in pain include harness application, any forced neck manipulation, and jumping on/off furniture. Hef has always been a happy, healthy dog with a great energy level. Client believes that his repetitive jumping behavior has likely led to the early onset of osteoarthritis within his neck. No other known or suspected traumatic events exist in Hef’s history. Cervical radiographs and CT performed January 2016 were inconclusive (no significant changes noted). Other medical history includes a recent castration and scrotal ablation performed April 2016. No other medical concerns were present at the time of presentation. Hef does not receive any regular medications except for Glucosamine-chondroitin supplements once daily. Client has extreme difficulty with oral medication administration, which has led her to pursue acupuncture for Hef. Client’s goals include pain relief and increased comfort during normal activities and daily routines. Hef has not received acupuncture prior to presentation.
Physical Exam and Clinical Assessment
Hef’s physical exam was largely unremarkable. No lameness or other abnormalities found on orthopedic exam. Neurological evaluation revealed a normal mentation and a lack of neurological deficits. Myofascial palpation found severe cranial and caudal cervical discomfort, tense triceps brachii muscles bilaterally, and bilateral shoulder discomfort. Hef displayed muscle fasciculations during palpation along his cervical vertebrae – especially the caudal cervical vertebrae – and shoulders. In these regions, multiple areas of trigger point pathology were palpated as well. Hef yelped out in pain during the initial portion of the exam when being picked up out of his kennel.
Medical Decision Making
I decided to choose an acupuncture plan based on the location and degree of Hef’s discomfort. A schedule of one to two sessions per week was arranged based on client’s schedule. Acupuncture points directly related to cervical pain were planned in addition to consideration of local trigger points. Distant acupuncture points were mapped as well to provide anti-inflammatory and anti-anxiety effects. Neuromodulation through cervicothoracic spinal nerves, cervical spinal nerves, spinal accessory nerves, radial nerves, and ulnar nerves was applied to Hef’s treatment plan. Local trigger points were incorporated into each acupuncture session based on myofascial palpations. The connective tissues extending over the skull, along the cervical region, over the shoulders, and down the dorsum were influenced. The triceps brachii muscles were treated during most of the sessions given the tension bilaterally due to compensatory weight-shifting. In addition to acupuncture, Hef was massaged for about five minutes at the end of each session mainly in the regions of trigger point pathology. As Hef was found to be more relaxed, the regions of massage extended along all of the previously mentioned fascial planes.
Each acupuncture session consisted of dry needling acupuncture followed by about five minutes of manual massage. Acupuncture was performed one-two times per week (four-seven days in between sessions) for a total of five sessions. Along the Lung channel, LU-7 was chosen for neuromodulation of the superficial radial nerve and the nervi vasorum to aid in cervical pain. Along the Large Intestine channel, LI-4, LI-10, and LI-11 were chosen for neuromodulation of the radial nerve and the nervi vasorum to reduce discomfort along this channel. ST-36 was used to provide anti-inflammatory effects. Along the Small Intestine channel, SI-3 was chosen for neuromodulation of the ulnar nerve and to aid in cervicothoracic pain. Along the Bladder channel, BL-10 was chosen for neuromodulation of the cranial cervical spinal nerves and to reduce cervical tension and discomfort. Along the Gallbladder channel, GB-20 and GB-21 were chosen for neuromodulation of the cranial cervical spinal nerves and spinal accessory nerve, respectively. These points were used to reduce regional muscle tension, thoracic limb dysfunction, and local neck pain. Along the Governor Vessel channel, GV-14 was chosen for neuromodulation of the cervicothoracic spinal nerves and reduction of neck and back discomfort. GV-20 was used as well for cranial cervical spinal nerves neuromodulation and for anti-anxiety effects. Local trigger points along the cervical vertebrae and triceps brachii muscle bellies were addressed during each session with dry needling and massage.
Outcomes, Discussion, and References
After the first session, client reported a decrease in the frequency in which cervical pain was observed. Hef only yelped out in pain once in between the first and second session (five days in between). After subsequent sessions, a similar response was noted – Hef seemed much more comfortable in the days immediately following acupuncture therapy but displayed discomfort if more than four days extended between sessions. Client expressed how relaxed Hef was during his acupuncture treatments and how much he enjoyed them. No other therapy was instituted during this time.
During Hef’s acupuncture sessions, I learned how to adapt to the patient’s needs and adjust my plans accordingly. I learned the local and distant points for cervical pain and became more comfortable with identification of trigger point pathology. I gained experience in performing acupuncture and leading sessions on my own. I also gained insight into a common client perspective – sometimes traditional medicine is not practical or appropriate and medical acupuncture can be beneficial for those pets. In Hef’s case, the implications mostly lie in the inability to distinctly measure the patient’s response and the outcome of treatment. Hef is a companion animal with a sedentary lifestyle making functional improvement difficult to assess. No implications with clinical practice were encountered as client and I considered medical acupuncture successful for Hef.