Written by a Medical Acupuncture for Veterinarians course graduate. Author’s name available upon request. Signed release obtained from client/author. 10D2017034
Abstract: Loki, a 9-year-old female spayed cockapoo, was treated in 3 separate dry-needling acupuncture sessions over the course of several months for intervertebral disk disease. At the beginning of the treatment she had been conservatively medically managed for approximately a month with some improvement but continued pain. She was treated primarily along the bladder line, with minimal additional distal points. After the first session, she showed marked improvement the next day according to the family and did not return to her previous level of sensitivity. The remaining sessions did not elicit a similarly drastic level of improvement however the family reported that they felt she appeared more comfortable.
History and Presentation: Loki is a 9-year and 10-month-old, female spayed cockapoo. She has a history of a TPLO surgery to one of her pelvic limbs (family not sure which) approximately 5 years prior. About 1 year ago, she started slowing down on her walks. The family attributed this to her being out of shape. Then approximately 6 months ago she started suddenly yelping when you bumped into her at all, would yelp when jumping, or when overall being active. She is normally a very anxious, hyperactive dog at home. They went to their family veterinarian and radiographs were performed. She was diagnosed with degenerative disk disease – acutely in her cervical region and more chronically in her thoracolumbar region. She was prescribed (presumably at different times) with prednisone and ranitidine, although family describes it as her receiving both at the same time for several weeks and then just one of them. They did notice some improvements with her medications relatively quickly as well as with more modified exercise. However, she was still yelping intermittently and off of her medications at the time of our first session (approximately 2 months after initial event). She had no history of trauma, and no other previous medical history aside from the TPLO surgery and a spay procedure when she was very young, as well as dental procedures. There are two young children in the house (one 15 months old and one 4-year-old).
Physical Examination: T: not taken P: 140 R: 40
GEN: bright, alert, responsive; appropriate hydration, pain 1-2/4; mucous membranes are pink, capillary refill time is 1-2 seconds; body condition score of 5/9
EENT: clear eyes, no ocular, nasal, or otic discharge
CV/ Resp: normal rate/rhythm, no murmur, clear bronchovesicular sounds bilaterally, no crackles/wheezes
Abd: tense on palpation, no appreciable masses or organomegaly
M/S and myofascial exam: no luxation of patellas; some crepitus bilaterally of the knees and hip joints; significant reaction and pain noted along the longissimus and iliocostalis, most pronounced in the lumbosacral area but extending caudally towards the sacrum. Additionally, there is discomfort cranially in the area of the splenius capitis. She licks her lips and turns towards you/tries to get away when palpating softly in any of these regions. No appreciable pain in the distal limbs. There is good muscle tone throughout.
Neuro: Appropriate mentation, all cranial nerves are intact; there is no conscious proprioceptive deficits in any of the limbs; she has superficial pain and appropriate reflexes in the distal limbs
Skin: No obvious lesions
LN: peripheral lymph nodes small, soft, symmetric
GU: spayed female, no discharge
Clinical Assessments: Radiographs were performed at the family veterinarian and were not available for review. This visit was solely for integrative pain therapy with dry needling acupuncture and performed as an independent contractor. No other laboratory findings are available.
Medical decision making: My particular acupuncture approach was for dry needling given availability of my supplies. I elected to start with calming points. I then elected to focus on both cervical and thoracolumbar regions, starting with less tender regions and moving on to the more tender trigger points. In general, I was trying to influence inflammatory modulation at these areas and recruitment of lymphocytes, macrophages, metalloproteinase, interleukins, and other mediators at the spinal cord (1). I eventually did try some distal points, in trying to influence neuromodulation from the periphery.
Differential diagnoses: intervertebral disk disease (IVDD), soft tissue injury, fracture/luxation, discospondylitis, neoplasia, other. While my highest suspicion was for intervertebral disk disease given her age and localization of pain, other causes of back pain can include sources of trauma, infectious processes, and neoplasia.
Putative Diagnosis: Given that radiographs had been performed at the family veterinarian, and there was no obvious sign of fracture, luxation, or neoplasia, my highest level of suspicion was for IVDD. One may be able to see some disk narrowing on radiographs, however it is not the best imaging modality of choice for IVDD, which is myelogram or MRI. Given that there was additionally improvement with anti-inflammatories, I felt infectious disease to be less likely. Certainly, soft tissue injury could still be an important rule out and likely more advanced imaging would be necessary to make a definitive diagnosis.
Acupuncture treatments: I started with calming points including Bai Hui and GV20. I also treated many points along the bladder line, starting with less painful regions given I felt there would be some analgesia from myofascial continuity that would help once I treated more painful trigger points. I chose BL 10 for her chronic neck pain, which I was unsure of whether this due to chronic wind up and sensitization or due to IVDD itself. I was hoping to induce neuromodulation and decrease muscle tone in this area. I then treated many bladder points including BL 11 and 12 (for cranial thoracic pain), BL 18, as well as BL 20, 21, 22, 23 (for thoracolumbar pain). In my final treatment with her, I tried adding in distal points. As a distal point for the cervicothoracic region, I chose SI3 because it originates from C8, T1, and T2 and is a point that can help treat cervicothoracic pain or spinal cord injury. I additionally tried ST36, in order to stimulate afferent nerves that ascent to the CNS and the higher spinal cord segments for neuromodulation (2). She did not respond as favorably to these locations however perhaps with more time she may become more amenable to these. Other modalities that would be favorable for her include massage, electroacupuncture, and laser therapy.
Outcomes and Discussions: After the first acupuncture treatment Loki stopped yelping in the house and the family reported increased mobility at home (less reluctance to play). When I saw her for the second treatment, the myofascial examination had improved significantly with much less pain elicited on palpation of the muscles of the back. However, she would still lick her lips and show discomfort, which I felt meant ongoing chronic pain issues. She showed similar reactions on my most recent visit. Her family does feel that she shows improvement each time after the acupuncture treatments, although they aren’t as drastic as the first session. I suspect that given there was no pharmaceutical therapies being offered at the time, the improvements can be attributed to my treatments. No adverse effects were noted.
1. Hayashi AM, Matera JM, Pinto ACB. 2007. Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disk disease in dogs. JAVMA 231 (6): 913-918.
2. Joaquim JGF, Luna SPL, et.al. 2010. Comparison of decompressive surgery, electroacupuncture, and decompressive surgery followed by electroacupuncture for the treatment of dogs with intervertebral disk disease with long-standing severe neurologic deficits. JAVMA 236 (11): 1225-1229.
3. Roynard P, Frank L, Xie H, Fowler M. 2018. Acupuncture for Small Animal Neurologic Disorders. Vet Clin Small Anim 48: 201-219.