Thursday, May 26, 2016

Dry Needling

War, huh, yeah

What is it good for

Absolutely nothing

Uh-huh huh

War, huh, yeah

What is it good for

Absolutely nothing

Say it again, y’all

War, huh,

What is it good for

Absolutely nothing

Listen to me

Ohhh, war, I despise

Cause it means destruction

Of innocent lives

War means tears

To thousands of mothers eyes

When their sons go to fight

And lose their lives

Ooh, war, huh

Good God, y’all

What is it good for

Absolutely nothing

Say it again

War, whoa,

What is it good for

Absolutely nothing

Listen to me

War, it ain’t nothing

But a heartbreaker

Friends only to the undertaker

Ooooh, war

It’s an enemy to all mankind

The point of war blows my mind

War has caused unrest

Within the younger generation

Induction then destruction

Who wants to die

Aaaaah, war-huh

Good God y’all

What is it good for

Absolutely nothing

Say it again

War, huh

What is it good for

Absolutely nothing

Listen to me

War, huh, yeah

What is it good for

Absolutely nothing

Come on, let me hear ya

War, it ain’t nothing but a heartbreaker

It’s got one friend

That’s the undertaker

War has shattered

Many a young mans dreams

Made him disabled, bitter and mean

Life is much to short and precious

To spend fighting wars these days

War can’t give life

It can only take it away

Ooooh, war, huh

Ooh yeah

What is it good for

Absolutely nothing

Say it again, y’all

War, whoa,

What is it good for

Absolutely nothing

Come on, sing it

War, whoa,

Come on and shout it, y’all

What is it good for

Absolutely nothing

Come on, come on now

It ain’t nothing but a heartbreaker

Friends only to the undertaker

Peace, love and understanding

Is there no place for them today

They say we must fight to keep our freedom

But Lord knows there’s got to be a better way

Ooooooh, war, huh

Good God y’all

What is it good for

absolutely nothing

Say it again, y’all

War, huh

What is it good for

Absolutely nothing

Say it again, y’all

What is it good for

Absolutely nothing

Edwin Starr

I’m convinced. War is bad. But I have a solution. To the 54 current armed conflicts in the world: forget about it. Then no shots will be fired and no one will be injured or killed. It’s that easy. Problem identified, problem sol-ved. Go Science and Big ’S’ Skepticism. Any complaints of my solution aren’t worth responding to.

Now that the problem of war is settled lets more on to dry needling.

What is dry needling?

Well there is its ying, wet needling, which is the use of hollow bore needles to inject, well, wet things: steroids, anesthetics, etc.

Contrast to the yang that is dry needling, which in its original manifestation used small hypodermic needles placed directly into trigger points, but which now often uses thin monofilament/filiform needles (not acupuncture needles, oh no. It’s a filiform needle) placed into various soft tissues primarily to treat chronic pain such as myofascial pain syndromes and ISN’T ACUPUNCTURE NO IT ISN’T. IT MAY LOOK LIKE ACUPUNCTURE BUT REALLY IT IS NOT.

Sorry I shouted.  You will see why later.

Dry needling has nothing to do with chi and meridians and acupoints and the rest of the fantastical underpinnings of traditional Chinese pseudo-medicine with its tongue and pulse diagnosis. Nor is dry needling used for every human aliment. Nope. Because it’s not acupuncture. No siree Bob. It’s dry needling.

Although that presupposes that there is a single form of acupuncture which dry needling is not, but has been noted in the past there as likely as many forms of acupuncture as there are acupuncturists, so dry needling is not like the multitudinous forms of acupunctures.

Since dry needling isn’t acupunctures, oh no, it isn’t, how does it work?

Well, in correctly done dry needling a needle is placed into a myofascial trigger point, causing a local twitch response (LTR), aka muscle contracture which activates endogenous opioids, which is not how acupuncture is supposed to relieve pain. Totally different mechanism.

Other mechanisms by which dry needling is alleged to work include

…mechanical disruption of the integrity of dysfunctional endplates, alterations in the length and tension of muscle fibers and stimulation of mechanoreceptors, increased muscle blood flow and oxygenation, and endogenous opioid release affecting peripheral and central sensitization, among others.

Proposed mechanisms mind you.  They really don’t know the mechansim of action. Not at all like the foundations of acupuncture where

modern research into acupuncture, the potential therapeutic mechanisms of acupuncture have been explored and include Pavlovian conditioned reflexes, nerve segment theory, gate theory, somato-autonomic nerve reflexes and others.

Dry needling is ‘amoung others’ where acupcunctures is ‘and others’.  Big difference. Presuming an efficacy, dry needlers keep looking for anatomical and physiologic correlates to back up their clinical practice and they do find a variety of structures and associations, although

the lack of anatomical information about these structures constitutes a major obstacle to obtaining a complete understanding of the pathophysiology and widespread clinical treatment of MTrP.

I sense they are finding what they want to find. Not at all like acupunctures.

Does dry needling work? As always, it depends on who you ask and for what.

One meta-analysis suggested that

DN was less effective on decreasing pain comparing to the placebo group. Other treatments were more effective than DN on reducing pain after 3–4 weeks.

I think that is a first for a meta-analysis of a pseudo-medicine. It was actually worse than placebo.

Another suggests

dry needling is effective in reducing pain associated with lower quarter trigger points in the short-term. However, the findings suggest that dry needling does not have a positive effect on function, quality of life, depression, range of motion, or strength.

but it is not as effective as wet needling aka lidocaine.

Dry needling can be recommended for relieving MTrP pain in neck and shoulders in the short and medium term, but wet needling is found to be more effective than dry needling in relieving MTrP pain in neck and shoulders in the medium term.

others are more optimistic

strong evidence for dry needling to have a positive effect on pain intensity.

Reading through the literature is not at all like the acupunctures literature: a hodgepodge of studies with a variety of methodologies with variable results.

Dry needlers are adamant that dry needling is  not acupuncture, although acupuncturists as just as adamant that it is and keep trying to draw dry needlers into the fold; acting the goody two shoes of looking out for patient welfare.

But really. Given the innumerable forms of acupuncture, it is safe to say that for all practical purposes dry needling is yet another form of acupunctures and likely just as ineffective. Dry needlers have simply abandoned 2000 years of nonsensical baggage that accompanies acupunctures and have added a ducks breath of Science and modernity to their placebo.

I suspect that dry needling is at somewhat of a disadvantage when compared to acupuncture: acupuncturists have the whole mystique of eastern medicine on their side to help with their theatrical placebo, although I can’t find any head to head comparisons.

Dry needlers just have trigger points, a concept that upon review comes across as only just a little more believable than chi and meridians. Although as best I can tell my wife sure as hell has trigger points as defined in her trapezius and she has never used the term.

But the real reason that dry needling is not acupunctures is turf wars. Since dry needling is the

number-one threat to the existence of the acupuncture profession

It is quite amusing to see how upset acupuncturists are,  getting their medians twisted into a knot over physical therapists taking their business and how acupuncturists want

“to protect the public’s health safety, welfare and to stop all insufficiently trained and unlicensed practitioners from unsafe acupuncture.”

when from my perspective there are no sufficiently trained acupuncturists who practice safely.  Extended training in nonsense doesn’t make for better nonsense.

It is our (acupuncturists) professional duty to change the message that a weekend seminar is comparable to the more than 700 hours of clinically supervised training obtained by the LAc.

I agree. Two days of education on pseudo-medicine is not the same as 3 months of education on pseudo-medicine. In this, the principles of homeopathy are probably valid; less is better.

If you are practicing the pseudo-medicine of acupunctures, then you have to have gone through the education and training of an acupuncturist, which is 99.9% nonsense and are subject to state licensing and oversight.

If dry needling is not acupuncture, then a PT or a DC or an ND or whoever is free of those onerous requirements and can needle without the worry of acupuncture boards and regulations.

There have been lawsuits in a variety of states to try and prevent physical therapists from offering dry needling saying dry needling is acupuncture and beyond their scope of practice. Physical therapists beg to differ.

Me? I would take a PT over an acupuncturist any day. They are not trained in the nonsense of chi and meridians,  with the somewhat more plausible trigger point.  PT’s have a grounding in reality based medicine and I want my pseudo-medicines with a modern patina. PT are not going to needle for fertility, blindness, schizophrenia and more. Or so I would hope.  And I suspect we will never see the equivalent of A case of perforating injury of eyeball and traumatic cataract caused by acupuncture  from a dry needler.  Or so I would hope.

But more importantly, as often as not practitioners of dry needling use gloves during their needling, which is NEVER seen in the practice of acupuncture. Give me good infection control with my pseudo-medical practice any day.



from Science-Based Medicine http://ift.tt/20J2y2W

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