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Written by a Medical Acupuncture for Veterinarians Course Graduate. Author’s name available upon request. Signed release obtained from client/author/4927.

small dog experiencing pain on palpation

Abstract

A case study on back pain and suspected tail neuropathy in a 12-year-old spayed female Jack Russell Terrier.

Acupuncture has given her relief from pain based on palpation and observation of movement. She will need ongoing treatment to continue to provide relief from suspected spinal osteoarthritis (OA).

History

Kahli had a habit of standing with her paws on the windowsill with her back arched. She also had developed a tendency to chase her tail and bite at it sometimes violently. She was exhibiting kyphosis at the start of this case study. She is also a somewhat anxious dog.

Dog experiencing Pain on Palpation

Exam

Kahli was found to exhibit back pain along the inner and outer bladder lines from T-5 through L-1. She also had trigger points in her L triceps m, area of BL-10 on the right side, her R sartorius m, and just cranial to her L scapula. She also exhibited muscle tension in her R pelvic limb.  Based on palpation I think there may be and old injury present in her tail that is causing some neuropathy.

No lab work or imaging was done at this time. She did have a normal CBC and chemistry panel prior to a dental procedure in January 2016.

Medical Decision Making

I arrived at my approach based on myofascial palpation and clinical signs. I wanted to address her trigger points and see if I could provide some relief from back pain that I believe to be the result of OA based on her age and habits. I also was curious to see if I could decrease the tail biting. I believed that decreasing the tail biting, and therefore the spinning, would help with the pelvic limb tension. The sequence of treatments was somewhat based on my schedule but I also wanted treatments to be at least 2X/week. I wanted to determine if that was an adequate frequency of treatments. Since I suspect OA and a chronic course of treatment, starting with 2X/ week seemed reasonable with a long-term approach that may be weekly to monthly based on palpation and clinical signs.

Acupuncture Treatment

4/28/16

I treated GV-14 and Bai Hui for general relaxation. I used HT-7 as one of my peripheral points for balance and her anxiety. I treated GV-2 for tail biting. I treated inner BL points between T-10 and L-1 for back pain. I treated ST-36 for pelvic limb tension. She was anxious about ST-36, so I stopped there since this was her very first treatment.

5/3/16

Treatment: GV-14, Bai Hui, HT-7, BL-10 for trigger point, GB-21 for trigger point, also trigger points in L triceps m and R sartorius m. GV-2 for her tail. BL-60 for pelvic limb tension. Inner BL points between T-5 through L-1 for back pain. I used EA on the BL line points at 2hz for 5min and 100hz for 5 min at an amplitude of 2 on the ITO ES-130.

5/5/16

Treatment:  GV-14, Bai Hui, HT-7. BL-60, ST-34 and BL-40 for pelvic limb tension. (Trying different pelvic limb points based on her tolerance and muscle tension relief). Bladder line between T-5 through L-1 some EA on those points but she was fussy about pelvic limb points and kept dislodging the needles being used for EA.

5/9/16

Treatment: by this day her kyphosis was not present. (see pictures) I found a trigger point in her R quadriceps and treated it. Also, GV-14, Bai Hui, HT-7, GV-2. Treated outer bladder line points between T-5 through L-1 based on palpation. The bladder line received EA at 2hz for 5 min. Used BL-60 and ST-36 for pelvic limb. She still fusses about pelvic limb points which makes me suspect that is where she really needs more treatment.

5/12/16

Treatment: GV-20 extra point for relaxation since I wanted to get more aggressive on her pelvic limb treatment. GV-14, Bai Hui, GV-2, HT-7. Outer bladder line points. For the pelvic limb I treated BL-54, ST-36 and BL-60 and performed EA between BL-54 and BL-60 at 2hz for five min. She was fussy at first but the EA on the pelvic limb did seem to give her some relief.

Outcomes, Discussions and References

There has been release of her trigger points based on palpation.(1) She still has some reaction to palpation of her back especially T-12 through L-1, I believe from ongoing OA in her back. However her kyphosis has been relieved.(2) Some spinning and tail biting has become habit, but the tail biting has decreased overall, especially the violent tail biting. She had no adverse events from treatment. There were no other simultaneous treatments so I believe the results to be from her acupuncture and EA treatments. This would suggest that acupuncture is a worthwhile approach to treating trigger points, back pain and muscle tension. My plan is to continue acupuncture treatments weekly and see how she progresses. At this time, I have also added Dasaquin to her treatment plan to help with the OA. As far as medical research goes, in general it seems that the difficulties with sham acupuncture vs. verum need to be worked out. It would also be nice to see a study that had a longer duration of follow up. Especially for chronic pain states. I think my palpation and treatment skills have already improved as I have worked through this case. It was a challenge to find a treatment for the pelvic limb that she was more tolerant to and comfortable with. Overall, I think she has relief based on my palpation, observation of movement, decrease in tail biting and resolution of the kyphosis. Also, a decrease in tail biting and lack of kyphosis was noticed.

 

References:

1. http://www.ncbi.nlm.nih.gov/pubmed/27143259

2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4364128/