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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. A2017056

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Many of our veterinary patients suffer from debilitating osteoarthritis, and their owners seek alternative therapies to either reduce or eliminate traditional pharmaceutical therapy. Acupuncture offers a means of providing analgesia to these patients. It has been shown that the insertion of acupuncture needles results in the release of adenosine, a neuromodulator with anti-nociceptive properties1. Medical acupuncture is based on the “activation of mechanoreceptors in the skin, muscle and connective tissue in tendons and muscles.” The insertion of acupuncture needles sends signals from the peripheral nervous system to the brain, where regulation of pituitary hormone modulates both endocrine and metabolic function and responses2. The addition of acupuncture to a pain management regime is complementary and may be superior to traditional pharmaceutical intervention in chronic and maladaptive pain cases.

History and Presentation
A 12-year old, female spayed Domestic Shorthair cat with a history of bilateral moderate elbow osteoarthritis, severe osteoarthritis in her left coxofemoral joint, and is approximately 9 months post total hip replacement on the right. Her owner reports she has reached a plateau in her recovery.

Physical Examination and Clinical Assessment
Her first exam was approximately 3 months post-op. She was ambulatory on all four limbs, with marked atrophy of both hind legs, with the right being most affected. She had reduced range of motion in both elbows on flexion and extension, and severely restricted range of motion in her left hip. She was very painful with hip examination. A myofascial exam revealed secondary strain patterns in the front end from weight shifting forward. She had trigger points and tension in her neck muscles, pectorals, and triceps. She also had severe muscle tightening of her quadriceps and sartorius muscles that was particularly painful, even with gentle palpation, and tight gastrocnemius muscles bilaterally.

Medical Decision Making
The treatment plan was made based on her exam findings and took into consideration her degree of pain, the secondary strain patterns and trigger points, as well as her tolerance for handling the most sensitive areas. She was still relatively recent post-op at her first visit, and care was taken to be particularly delicate in her right hip region.

Differential Diagnoses
Post-op atrophy, muscle strain, trigger points, severe osteoarthritis

Definitive (or Putative) Diagnosis (or Diagnoses)
Post-op atrophy, muscle strain, trigger points, severe osteoarthritis

Acupuncture Treatments
For the first session, it was considered that she had not had acupuncture previously, and that she was extremely guarded around her hips/hindlimbs. Therapeutic laser (K-Laser® Cube 4, set to feline/light coat/musculoskeletal chronic disease) and gentle massage was used instead of needling for her caudal sites of pain during the first several sessions. By the fourth session, she allowed needle placement in her hip points. Most treatments last 5-10 minutes, at which time she shakes her head and stands up.
Seirin acupuncture needles were used (0.14 x 15mm) and were placed at the following sites:
Elbows: LI-4, LI-10, LI-11, LU-5, HT-3 and local trigger points in neck and triceps
Hip/Hind end: GB-29, GB-30, BL-54, local trigger points, as well as (if permitted by Julep) LR-3, SP-6, ST-36.
Acupuncture sessions were originally scheduled every three days for two weeks, then reduced to once weekly. She continues to do best at about every 7-10 days. Each session uses laser and massage prior to needle placement. Treatments are focused on trigger point release as well as points for her elbows and hips.

Outcomes, Discussions, and References
The patient has responded well to her treatment over the course of the last 6 months. Her owner has noticed an improvement in her overall demeanor, mobility, noting that she can even jump up on the sofa unassisted. The use of acupuncture has been shown to affect areas of the brainstem as well as structures of the limbic, endocrine and autonomic systems. The result being a more widespread effect, including generalized pain relief, improvement of sleep quality or mood.
It is not uncommon for patients with polyarthritis to develop secondary strain patterns and trigger points due to abnormal weight shifting. Trigger points are defined as “hyper-irritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers.” It is also important to note that there are different types of pain (nociceptive or inflammatory vs. maladaptive pain, for example), and that response to acupuncture may vary depending on the type being treated3. In many patients with maladaptive pain, acupuncture may offer some relief where other therapies fail.
1 Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nature neuroscience. 13. 883-8. 10.1038/nn.2562Goldman, Nanna & Chen, Michael & Fujita, Takumi & Xu, Qiwu & Peng, Weiguo & Liu, Wei & K Jensen, Tina & Pei, Yong & Wang, Fushun & Han, Xiaoning & Chen, Jiang-Fan & Schnermann, Jurgen & Takano, Takahiro & Bekar, Lane & Tieu, Kim & Nedergaard, Maiken. (2010).
2. Mechanisms of acupuncture Irene Lunda, Thomas Lundebergb a Department of Physiology and Pharmacology, Karolinska Institute, Sweden b Rehabilitationmedicine University clinic, Danderyds Hospital, Sweden. (2016).
3. Western Medical Acupuncture in Neurological Conditions. ClinicalGate, Admin post, (2015).
4 Myofascial Pain and Dysfunction: The Trigger Point Manual (2 vol. set, 2nd Ed.).Travell, Janet; Simons David; Simons Lois. USA: Lippincott Williams & Williams. (1999).