lundi 3 octobre 2016

WET NEEDLING. N°1. The BMN, hypodermic & acupuncture needle.

WET NEEDLING. N°1. The BMN, hypodermic & acupuncture needle.

In the book published in 1981, 'Myofascial Pain and Dysfunction, the Trigger Point manual', describing the fundamental work of Drs. Travell and Simons, can be found in the chapter "Methods to deactivate a Trigger Point_ TP, the original description of the Dry Needling and Wet Needling.
'Dry' as opposed to 'Wet' is defined as the treatment in human pathology, by insertion of the needle (Needling) into the soft tissues without injection of a liquid drug or Dry, to the contrary of the WET Needling defined by inserting needle with drug injection.  
We can also find in this book, among other methods to deactivate a Trigger Point comments about the injection of various drugs, with a hypodermic needle.

The goal of treatment of chronic musculoskeletal pain is
·         First of all, to identify accurately, for treatment, the cause and location of pain by pointed palpation of the contracted muscular band (Taut band) and Trigger Point. Trigger Point, palpation often generating a local contractile response (Local Twitch response) and a referred pain, easily confirmed when a needle is inserted into this Trigger Point. 
It is necessary, in the second place, to identify for treatment, all the etiological factors perpetuating the pain. 
There are non-invasive methods that can relieve chronic musculoskeletal pain, including physiotherapy and  Pharmacology (anti-inflammatory drugs/opiates...), but the usual and non-specific general treatments fail to eliminate the underlying causal factors at the origin of pain and symptoms associated, objectives of the treatment protocol.
In summary, it is necessary, to reduce or eliminate the Trigger Point pain to be able to stretch the muscular band le tape and to produce a whole muscle flexion: According to some authors, the Trigger Points injections are more effective than acupuncture or Dry Needling for certain types of muscle pain and myofascial pain.
It is in total agreement with our philosophy with regard to Mesopuncture.

THE WET NEEDLING, as sole treatment.
The Wet Needling proposed by Travell and Simons is of an immediate intervention technique in pain medicine.
All drugs injected with the hypodermic needle, have a positive effect, including simple saline solution: They allow for the relief of pain, stretching the contracted muscle band, the 'Taut Band', which blocks movement.
If at the beginning it seemed obvious to use the therapeutic properties of a Pharmacopoeia drug, appreciated by many professionals to deactivate the Trigger Point, such deactivation was also simply obtained, by mechanical effect of the single hypodermic needle insertion.
It is useful to note that the injected drug has other properties:
·         The pharmacological analgesic drug effect or proper effect of the drug as well as the mechanical distension driven by the injected volume are two positive factors additional to the action of the needle itself.
  The Wet Needling when injecting an anesthetic allows shortening the insertion pain of the needle in the Trigger Point. Trigger Point already painful, more even when this insertion must be repeated several times.
 The authors, Travell SIMONS, after performing the Wet Needling with an anesthetic, write: ' Lidocaine has controlled the pain of the patient, but the injected volume has made a mechanical breakage of the Trigger Point, clear and simple and in comparative studies, the Dry Needling has proven to be as effective as, the injection of an anesthetic solution which is procaine or lidocaine for the immediate inactivation of Trigger Point.
. It is useful to take into account the similarity of the Wet Needling with Mesopuncture. In both cases, it is the local injection of small doses of a liquid drug endowed with, on the one hand, known pharmacological properties and on the other hand, mechanical properties due to the injected volume. 
The Wet Needling is an evolving treatment, the debate continues about the various aspects of its use.

THE WET NEEDLING in a protocol
The Trigger Point deactivated eliminates the skeletal muscle pain without treating the underlying factors that cause or perpetuate the pain and require further treatment, e.g. Elimination of the Trigger Point facilitates completion of another therapy, physical therapy, to regain the muscle length and range of motion.
It is for this reason that several authors propose a multidisciplinary approach, a protocol containing, methods of treatment of the Trigger Points as well as possible methods of treatment of the factors contributing to chronic skeletal muscle pain by the inclusion in this Protocol: The Dry Needling and Wet Needling, Acupuncture and   Mesopuncture, Western Pharmacopoeia (opioid analgesics or anti-inflammatory steroids,...), physical therapy to improve the strength and flexibility of the skeletal muscle groups, psychosocial support...

 Among the several treatment options we retain a therapeutic set for Trigger Points given the confusion of the acupuncture point location and tailored to each patient's needs, including in a same and unique technical Act: Acupuncture and/or Dry Needling. Mesopuncture and/or Wet Needling performed with BMN, hollow acupuncture needle topped by a mini reservoir in deformable polymer.

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