According to the FDA, the BMN, we manufacture is hollow hypodermic needle, and also, acupuncture needle. The BMN is hypodermic needle, o.3mm external diameter like acupuncture needles, surmounted by a resilient polymer micro-reservoir for storing and releasing a small volume of liquid drug by pressing/releasing  the reservoir walls and aspiration/restoration through its hollow hypodermic needle.

This micro-reservoir allowing the Therapist to handle the needle during the acupuncture session confers to this BMN, the acupuncture needle status according to the FDA.

                           In the treatment of Trigger Points_ TPs,

 cause of most musculoskeletal pain: The fundamental treatment proposed to use hypodermic needles without liquid drug injection or Dry Needling and/or with injection or Wet Needling.

The pain of insertion and manipulation of the needle in the TP have made to prefer using acupuncture needles, less aggressive because thinner, triggering the ire of professional acupuncturists, fearing a depreciation of Acupuncture, practiced par practitioner without qualification.  Their main argument is to use the hypodermic needles proposed in the fundamentals for the treatment of Trigger Points by Drs. TRAVELL and SIMMONS.

 Dry Needling and Wet Needling have their detractors and defenders, it seems that the treatment of TPs is complete if it includes, in combination wet and dry needling, which implies the qualification for therapists to use liquid drugs. Most of Western countries reserve this use to the medical profession.

Some TPs being deeply located, two versions of treatment are available:

  • The ‘Direct Dry Needling’ and 'Direct Wet Needling'
    The needle reaches the AP and the injection is done into the AP.
  • The ‘Indirect Dry needling' and   ‘Indirect Wet Needling’
     The needle, 13mm length,  is remote from the AP and the injection is done away from the AP.

The BMN is used in these indications, Dry and Wet Needling with a single needle inserted.

This needle is inserted

  • Either in the version ‘Direct Dry and wet needling’ directly into the same superficial TP,
  • Or in  the version ‘Indirect Dry and Wet needling’ remotely from the TP if the TP is out of reach of the needle.

The BMN needle both hypodermic and acupuncture, has 13mm length, allowing:

  • Either direct access to the superficial TP, it is the Direct Wet & Dry Needling
  • Or indirect access to the TP, deeper located into the skin, it is the 'Indirect Wet & Dry Needling'.

The controversy between the use of acupuncture needles, by professionals not acupuncturists, to treat trigger points which are the cause of most musculoskeletal pain, instead of hypodermic needles, as advocated by the founding doctors, is thus appeased. 
Professionals non-Acupuncturists cannot be criticized for exceeding their qualification by using a specific acupuncture needle dedicated to the treatment by qualified Acupuncturists, according to them.

                           Mesopuncture Acupuncture Mesotherapy_ MAM.

The Acupuncture Point location is systematized and easily recognized on the skin surface by various anatomical landmarks, described for millennia. The Acupuncture Point _AP is described as a well open at the surface of the skin and leading, into the skin, to a mass connective tissue folds where collagen and elastin fibers are aligned: It is the AP.

To be active and produce the Acupuncture Effect, described for millennia, the AP must be stimulated:

*-* For centuries, the stimulation was made by metal needle, compact or hollow, inserted and manipulated into the AP, it is the classical acupuncture producing the Acupuncture effect described in Chinese medicine.

-* Since the end of last century, traditional Chinese medicine has proposed injecting a liquid drug in the PA or Mesopuncture.

 By its physicochemical structure or volume, it stimulates the AP, producing the Acupuncture Effect which depends solely of the stimulated AP and not of the stimulus.

The liquid drug into the PA keeps its pharmacological properties,  producing the Pharmacological Effect.

  • In Mesopuncture, the liquid drug injected has two effects: The Acupuncture and Pharmacological Effect.                   

-* Since, also, the last century end was born Mesotherapy.

It is a drug administration mode by creation, into the dermis or superficial hypodermis, of micro reservoirs with some drops of a liquid drug injected,  in any part of the skin body, the closest possible to the altered zone: The Mesotherapy Points_ MPs.

It is difficult, without accurate knowledge of the location of APs, to assert that the drug injection made by the Therapist during the treatment, is not made into APs and that it is Mesotherapy and not Mesopuncture.

It is of major importance for the therapist to know what the active treatment was: Acupuncture Mesopuncture or Mesotherapy?

It is possible with a succinct training through Internet for example, for a given condition, to learn and know the location of the local action APs in the skin area chosen for Mesotherapy

  • In this skin area chosen for treatment, the MPs that will be created around the APs will be so close to the APs, that they are adjacent, often. The same needle can reach them.

In practice: The MAM or Mesopuncture Acupuncture Mesotherapy.
The needle of the BMN is inserted into the AP to create Acupuncture and Mesopuncture. Then, the needle of the BMN, from its insertion point into the AP, allows, through the thickness of the dermis, creating MPs, all around the AP, according to a star shape.

The BMN:  From a single insertion into the PA has allowed realizing Acupuncture-Mesopuncture and around the PA, creating PMs, without additional pain to the first insertion.

What is Mesopuncture? details

#Mesopuncture is the deposit of few drops of a neutral or active liquid drug, either by injection or passive deposit into the Acupuncture Point _ AP. It is a version of treatment, proposed by Chinese medicine, accompanying in general the classical Acupuncture.

Its revival in the West, after a period of oblivion, was initiated by #Bleumedical, Fr, facilitated by the concept of BMN, and published in a website: mesopuncture.com

This Internet publication was followed by a multitude of sites, under various titles.

If initially, the liquid drug was injected, only by needle, into the AP, the use of iontophoresis has allowed later to describe a version without needles.

 At what point of the acupuncture consultation, is performed Mesopuncture?
The Mesopuncture is fully integrated into the acupuncture consultation before, during or after insertion of the conventional acupuncture needles which remain in situ for about twenty minutes.

 What is the diameter of the acupuncture needle and injection hypodermic needle?

• Usually, the Acupuncture needle diameter is 0.3 mm. The injection needle diameter is 0.45 mm.

 Is diameter the only criterion for the needle to be qualified as acupuncture needle?
Normally, the acupuncture needle diameter is 0.30mm there are, but rarely indeed, acupuncture needles with a finer diameter.

It is not the exclusive criteria to define the acupuncture needle. This is the need for the needle to have a handle allowing the Therapist to perform acupuncture.

 How is the liquid drug chosen?
It is selected in the pharmacopoeia according to the health or aesthetics disorder, presented by the Patient.
It is a liquid drug, already used in daily practice, preferentially intravenously or intramuscularly more rarely. The liquid drug is then divided into micro-doses, injected or deposited, by needle or iontophoresis, into the AP for Mesopuncture and into the dermis around the AP, to create, in this case, Mesotherapy Points_ MPs.

Both actions can be realized during the same session with the same injection vector, the BMN.

 What is the advantage of combining Acupuncture and Mesopuncture?

  • First these two actions can be carried out during the same consultation with the same injection vector, the BMN.
  • The medication acts by both 'Pharmacological effect' and ' Acupuncture Effect ', two effects due to physicochemical structure of the drug. These two actions are added to conventional stimulation with an acupuncture needle.

It seems moreover, that the most tangible benefit of using the medicine in Acupuncture is the possibility to act on the length of the ‘Acupuncture Effect’ like the titanium implants in Auriculotherapy or the catgut burial into the APs.

 The use of Hyaluronic Acid -HA allows prioritizing duration of the Acupuncture Effect when injected into a PA while taking into account the positive Pharmacological Effect in aesthetics, but of not immediate but of secondary interest for the Therapist.

Hyaluronic acid _HA is known in aesthetic medicine, as having a so-called comfort action but of  long duration, several months, without major adverse effects described on health.

 Into the PA, the HA produces an Acupuncture Effect, of same duration as the Pharmacologic Effect, but in this case, the possible improvement of  aesthetic problems, would not be an obstacle for using the HA to get an Acupuncture Effect extended over several months.

It is a virtual separation between the 'Acupuncture Effect’ and "Pharmacological Effect', both  effects are subtended by the physicochemical structure of the drug.

It is thus possible to use a liquid drug, not for its ‘Pharmacological effect’ duration, but for its PA stimulus duration or ‘Acupuncture effect’.

 Are all drugs eligible?

  • All liquid drugs, including drugs without significant therapeutic or Pharmacological effect, such as distilled water or saline, can be used. For these liquid drugs, the Acupuncture Effect by stimulation of the AP is privileged.
  • Some drugs allow obtaining a prolonged stimulation of the AP giving a therapeutic effect by Acupuncture or ‘Acupuncture effect’, also extended.

 In effect,  the drug acts on the AP, by its physicochemical structure that controls both the duration of the drug effect in the body, its ‘Pharmacological effect’ and duration of stimulation of the AP that is to say its ‘Acupuncture effect’.

 Is it possible to separate the two effects of the liquid drug, of same duration the ‘Pharmacological effect’ and ‘Acupuncture effect’: Both effects depending on the physicochemical structure of the drug.

 Both effects are of equal duration but only ‘Acupuncture effect’ is privileged at the expense of the ‘Pharmacological effect’ of same duration but ignored because of low impact on the health patient, in effect, the liquid drug used is classified in, Drugs of comfort.

 How to optimize the double needle insertion pain, knowing that if it is acceptable for a single AP, it becomes uncomfortable when several APs are targeted?

 In effect, in each AP it is necessary to insert a compact acupuncture needle.
After about twenty minutes, required to obtain the ‘Acupuncture Effect’, this compact needle is replaced by the hollow needle of a syringe. It allows to inject few drops of the liquid drug contained in the syringe, first in the AP to achieve Mesopuncture and secondly in the dermis around the AP to create Mesotherapy points.

To avoid inserting several needles into the same AP and privileging insertion of a single needle into the same AP or no needle at all, two solutions are possible:

Either the Therapist chooses the non-invasive version: Mesopuncture performed by iontophoresis and Acupuncture by massaging, waves, heat…

Or he chooses to use the BMN, in the version by needle: It is the best solution, comfortable and practical, and why?

The BMN is a simple device, a hollow needle of 0.3 in diameter, surmounted by a deformable polymer reservoir, all functioning as a dropper.

The originally empty reservoir, used for gripping and using the needle, is filled by two fingers pressure.

Furthermore the BMN does not prevent the dorsal or ventral decubitus.

 Why the BMN is an acupuncture needle notwithstanding?
Because, according to the FDA, to be an acupuncture needle, the needle must have a handle for grasping it when performing Acupuncture: The reservoir is the handle necessary to properly perform acupuncture with the BMN.

 The needle is inserted into the PA to stay twenty minutes at the end of which are injected few drops of the drug filling the reservoir, not only in the AP, but also in the dermis around the AP to create the Mesotherapy Points_ MPs.

The BMN with a single insertion of the same needle has enabled the realization of two versions of Chinese medicine, Acupuncture and Mesopuncture and a new western method of drug delivery by local injection or Mesotherapy.

 How is held the Acupuncture-Mesopuncture consultation?
The BMN is inserted into the AP, the consultation continues, the dorsal or prone positions are possible. At the end of the allotted time (about 20 minutes), some drops of the reservoir contents are injected into the AP, this is Mesopuncture. According to a star shape, into the dermis, all around the AP, some drops of liquid drug from the same origin are injected to create the MPs.

It could thus be achieved the set Mesotherapy Acupuncture Mesopuncture or MAM with a single insertion pain of a single needle in the skin.    The BMN thus allows optimizing the pain due to the insertion of multiple needles.

 Analogies between #Mesopuncture or fluid stimulus of the #AcupuncturePoint (Acupuncture Point _AP) and #WetNeedling (Wet Needling_WN) or injection of #triggerpoint(Trigger Points_ TPs) therapy. Two administration modes of liquid drug.

Generalities
Trigger Points_ TPs
They are the most common cause, about 75%, of chronic musculoskeletal pain. TRAVELL and SIMONS, two doctors who described the TPs, define a TP as a tender nodule, a muscle knot in a palpable taut band of skeletal muscle.

  • The data for identifying the TPs are now considered to be:
    Reproduction or aggravation of the pain usually experienced by the Patient.
    Location of a taut muscle band.
    Spot tenderness.

The TP is an irritable spot either spontaneously (active TP) or on digital compression (latent TP) able to generate either local or referred pain to other musculature, motor dysfunction and even autonomic phenomenon such as sweating, swelling, and ‘goose bumps’.

 Note. It is difficult to find ASHI Points with such properties.

These TPs may become activated by a variety of factors such as, poor posture, overuse or muscle imbalance.
TPs exhibit a local twitch response (muscle fasciculation) or a more global response, jump sign (flexion response) in reaction to digital pressure or Dry Needling (DN) or Wet Needling (WN).

Wet Needling_ WN
WN is the original method, proposed by two physicians, Drs. TRAVELL and SIMONS, to deactivate the TP by injection of a liquid drug into.

Acupuncture Point
It is described as a path starting in the epidermis and ending in the connective tissue.

Mesopuncture
Fluid stimulus of the Acupuncture Point_ AP or Mesopuncture is another stimulus mode of the AP proposed by the Chinese medicine, in addition to the metal needle stimulus or classical acupuncture

The fundamentals

In the book, ‘Précis d’ acupuncture Chinoise’ edited in 1977 by the Academy of traditional Chinese medicine from Beijing and intended for French-language students, one can read on page 292,Therapy by injection into acupuncture points,  a detailed description  of the treatment technique  by a liquid drug stimulus of the APs or Mesopuncture. 

In the books published in 1983 and 1999,Myofascial Pain and Dysfunction, the Trigger Point Manual, describing the fundamentals of TRAVELL and SIMONS work, can be found, in the chapter 'Methods to deactivate a trigger point’, among other methods to deactivate a TP, the original description of the WN.

The description of Wet needling treatment on Trigger Points_ TPs is identical to description of Mesopuncture or fluid stimulus on Acupuncture Points_ APs.

Whether it be to stimulate the AP in Mesopuncture or deactivate the TP in WN, we use liquid drugs and a vector of administration.

Liquid drugs used in Mesopuncture and WN.

  •        The liquid drug used depends on the medical expertise of the Therapist, his qualification in injecting liquid drugs and perfect knowledge of the pharmacology of each liquid drug used.

A variety of fluids have been injected into the TPs, including distilled water, normal saline, local anesthetics (procaine, lidocaine, bupivacaine), vitamin B solutions, long-acting corticosteroids, acetylsalicylate, and botulinum toxin.

It is possible to distinguish, liquid drugs

  • Without therapeutic effect, such as distilled water, saline…
  • With therapeutic effect of very long duration before reaching an efficient level: Trace elements, homeopathic remedies.
  • Whose physicochemical structure makes it possible to extend the duration of effectiveness as with some anti-inflammatory of the Western Pharmacopoeia used in the treatment of chronic TPs, for example or with hyaluronic acid
  •      The administration mode of liquid drug in Mesopuncture and WN

 

It should be noted that in Mesopuncture like in WN these are micro doses of liquid drug that are injected locally either directly in the AP or TP or indirectly around the AP or TP.

 From the injection point in the skin, the liquid drug has the becoming of local injections:

  • At first, the liquid drug injected into a skin point, near the body area being treated, headed directly to this altered zone.
  • In a second step, the liquid drug passes into the blood, reaches the liver where it is conjugated.It returns into the blood to reach the injured area a second time.

Conclusion

The injured area receives twice the liquid drug, as well if the liquid is injected directly in the point or in the immediate vicinity of the point: what might explain equal efficienc, it seems, between indirect and direct liquid drug injections.

  •        Action Mode of the liquid drug in Mesopuncture and WN

The liquid drug has a dual action dependent on its physicochemical structure:

  • A physical or mechanical action due to the injected volume allows:
    - facilitating the treatment of the trigger point in WN.
    - obtaining the Acupuncture effect by stimulation of the AP.
  • A therapeutic action, due to the pharmacological properties of the liquid drug injected and described in the pharmacopeia. 

The injection vectors

Once the liquid drug selected it must be injected either in an AP or in a TP, by a hypodermic needle: It allows the selected liquid drug to cross the skin and reach either the TP to deactivate it or the AP to stimulate it. The main problem is the pain associated with the hypodermic needle use.

Compared to the acupuncture needle, the hypodermic needle is supposed to produce a ‘searing pain’, by numerous Patients.

  • It is necessary to ease the inserting pain of the conventional hypodermic needle in a TP already painful, pain accentuated by the various manipulations performed in the TP to deactivate it:

It is necessary, for this, to reduce the diameter of the hypodermic needle to be similar to the diameter of the acupuncture needle whose insertion is much less painful.

  • It is uncomfortable to insert the hypodermic needle into in an AP where a compact acupuncture needle comes to be inserted.

It is judicious, in this case, to use the hypodermic needle inserted into the AP for injecting the liquid drug for the Wet Needling treatment, as an acupuncture needle for the Dry Needling.

**-* The BMN fulfills this dual function.
The BMN is both a hypodermic needle and according to the FDA, an acupuncture needle: Its diameter of 0.30 mm is identical to the classical acupuncture needle. This hollow needle is surmounted by a resilient polymer reservoir with no silicone, no glue and no syringe body.
This deformable reservoir of the liquid drug selected is also used as a handle, essential for gripping the BMN during the acupuncture session, essential feature for the FDA, to qualify the BMN as acupuncture needle. 
Using the BMN needle both hypodermic and acupuncture, optimizes the insertion pain, during the Acupuncture or TP treatment.
In this first version, the useful needle length is 13 mm allowing, thanks to the resilience of the polymer reservoir, to any medication, whatever its viscosity, to be sucked through the needle for filling the reservoir, by pressing the reservoir with two fingers.

The reservoir may be filled, by the Therapist, with any one of the drugs mentioned above.

 The BMN device and Wet needling

Wet needling realized with the BMN, allows performing, according to the depth of the TP into the skin, in the same TP, a mechanical deactivation, by the BMN needle itself, supplemented by a liquid deactivation with the same device, by the volume of liquid drug from the reservoir, injected into the TP, adding by this way, the anesthetic or therapeutic properties of this liquid drug to the double mechanic deactivation, from the needle and the volume injected.

Two Wet Needling versions

Both versions of liquid drug injection are described according to the depth at which the liquid drug is injected.

-       The Wet Needling Trigger point injection, or direct wet needling, involves fluid injection directly into the TP located in the taut muscle band.

-       The indirect wet needling in which fluid is injected into the skin or subcutaneous tissue over the TP.

.It is the most commonly used option for the treatment of TPs by WN performed with the BMN, especially if the TP is deep because,  in the current version, the needle of the BMN is of 13mm long.

 The BMN allows performing Wet Needling according to two ways:
If the TP is superficial, the BMN will complement the treatment by performing Dry Needling also.
If the TP is deep, the Wet Needling, performed with an anesthetic by the BMN, will be followed by a mechanical treatment by the Therapist.

The BMN device and Mesopuncture
Mesopuncture is an acupuncture treatment version in which the AP is stimulated by a liquid drug chosen by the Therapist.
Mesopuncture or stimulation by a liquid drug of the AP completes the historical AP stimulation by metallic needle.

       Usually Mesopuncture accompanies the metal stimulation or classical Acupuncture, preceding or following it,                  becoming perfectly integrated in the conduct of the consultation without downtime and without preventing the            decubitus, as with the BMN: 

       A specific disposable device, avoiding the double needle insertion, traditional stimulus by metal needle and fluid            stimulus by a hypodermic needle, particularly uncomfortable when this double insertion is repeated with two                  needles inserted, although with a single BMN inserted into the AP, the Therapist can perform Acupuncture and            Mesopuncture.

 The fluid stimulus of the Acupuncture Point AP or Mesopuncture is another stimulus mode of the AP, in addition to the metal needle stimulus, proposed by the Chinese Medicine.

       Inserted into the AP, the BMN needle performs a metal stimulus or classical acupuncture: The needle handling is          soft and suave; it does not seek to deactivate a muscle knot but to stimulate, carefully, an AP: it is the metal               Acupuncture effect.

      A few drops of liquid drug from the reservoir are deposited into the AP, they stimulate the AP mechanically by             their volume or physicochemical structure or both,  it is the fluid acupuncture effect or MESOPUNCTURE.

      The pharmacological activity of the selected liquid drug is preserved: It is the pharmacological effect.

Conduct of the Mesopuncture
The BMN needle or an acupuncture needle is inserted into the AP to perform acupuncture. 
A few drops of liquid drug from the BMN reservoir or few drops of a liquid drug contained in a syringe are injected into the AP: The liquid drug acts both by the volume injected and its pharmacological properties.

It will have been realized with the Mesopuncture performed by a metallic needle:

A metal stimulus due to the inserted metallic needle.
A fluid stimulus due to the volume injected.
A pharmacological effect by preservation of the therapeutic properties of the liquid drug injected.

  • We find the same classification as in WN

Direct Mesopuncture
The liquid drug is injected directly into the PA localized in the connective tissue by the BMN needle.

Indirect Mesopuncture
The liquid drug is deposited on the skin to reach the PA by iontophoresis: indeed the PA starts at the epidermis and ends in the connective tissue…

It can be emphasized the role of massage in the AP stimulation and TP relaxation.

Conclusion

This article highlights the deep analogies in the treatment of trigger points and acupuncture points, between Wet Needling and Mesopuncture.

Mesotherapy Acupuncture Mesopuncture or MAM, needleless, is a non-invasive set of three treatments proposed for various disturbances of health or aesthetics

Acupressure is a non-invasive version of Acupuncture treatment without needle insertion. It is associated with, in our training, Mesopuncture, Mesotherapy also performed without needles.

Acupuncture: To obtain the Acupuncture effect, in the treatment of a particular condition, the selected AP is stimulated by various external stimuli, without needles: Moxas, laser, waves, magnets, massage and more…   it is necessary to add in our training, Mesopuncture and Mesotherapy also performed, without needles by another external stimulus, a liquid drug.

Mesopuncture or Fluid stimulus of the same Acupuncture point_  AP, was initiated, thirty years ago by the Chinese medicine, to complete by a fluid stimulus of the AP the conventional metallic needle stimulus or classical Acupuncture.

       To obtain the Mesopuncture effect, the APs must be stimulated by a liquid drug. There are two categories of liquid drugs that can be used for the fluid stimulus, liquid drug with or without pharmacological activity.   

       Apart from the classical Mesopuncture, using needles to inject few drops of a liquid drug into the AP, there is a needleless version, performed, by an external way or Virtual Mesopuncture. 

The virtual Mesopuncture is founded on the fact that the AP is described, in histology, as a path, of systematized location starting in the epidermis, at the skin surface and ending in the subcutaneous tissue in the connective tissue.

Few drops of drug applied on the skin surface, at the level of the AP, cross the skin and reach the AP, by iontophoresis provided by the electric apparatus for Virtual Mesotherapy.  
There is a complex interplay between on one part the APs, already localized at the skin surface, activated by a liquid drug on which is applied the virtual Mesotherapy apparatus, and on the other part, the Mesotherapy Points_ MPs that can be created in the dermis, of the whole area separating two neighboring APs and using the same apparatus.

Mesotherapy. In effect, if the AP is of systematized localization in the thickness of the skin, the MP is created by few drops of a fluid drug, deposited, in any part of the skin on which will be applied the electrical apparatus for virtual Mesotherapy.
The liquid drug can thus cross the skin and create in the dermis or superficial hypodermis small reservoirs of liquid drug which are the Mesotherapy Points_ MPs.

The Mesotherapy Point_ MP does not exist until it is created by the deposit, with or without needle in the dermis or superficial hypodermis, of micro-reservoirs of some drops each one of a liquid drug, active on the pathology, in treatment.

Mesotherapy Acupuncture Mesopuncture.
The most logical way, exploiting the proximity of the AP and MP and the ease to involve them in the initial and local treatment was to group them together, in a set, Mesotherapy Acupuncture Mesopuncture or MAM, of significant efficacy for the patient, associating two versions of the Chinese medicine and an occidental mode of drug administration or Mesotherapy, whose value depends on the effectiveness of the drug chosen and employed by the Therapist.

The MAM is a non-invasive set of three treatments proposed for various disturbances of health, aesthetics or body shape - Pain, cellulite, overweight… instead of specific and isolated treatment. This is an easy opportunity to link the benefits of each therapeutic mode.

This version of MAM, performed without needles, is aimed at all Professionals wishing to integrate the MAM in their daily practice replacing, eventually, the virtual Mesotherapy apparatus by the BMN: The MAM is performed with a single needle inserted.

OUR COURSES

Our purpose, in Bleu Medical, is to inform the Professional who uses the skin as a vector for his treatment, how easy it is,

  • On the one hand

To recognize the APs on the skin,
To opt for a non-invasive treatment,
To associate current liquid drugs, allopathic or not, deposited without injections into the AP (Mesopuncture) or into the dermis (Mesotherapy).

  • On the other hand,

To integrate Acupuncture and Mesopuncture in a set, Mesotherapy Acupuncture Mesotherapy or MAM.

       In the courses

*** In the courses

          AESTHETIC: Face, neck, scalp, hands.

          PAIN, RHEUMATIC & SPORTS

We indicate only the APs in front of the painful or specific area.

*** In the other courses

          AESTHETIC body:

1- Overweight and diet

  • 2- Cellulite.
  •           OBESITY and ACUPUNCTURE
  •           DAILY NERVOUS DISORDERS 

          Dependence: alcohol, tobacco, other drugs

We mention, more often, the action of the point either on the symptom or on the imbalance of Energy, cause and/or the consequence of disease.

 

       The philosophy of our teaching, always the same, is to learn to:

 

Recognize the active APs in the skin for Acupressure, on various health conditions. In all the courses you will find a listing of active APs on the health disorder described in the course. In each course, we display diagrams and a detailed anatomical description which allows recognizing the location of a set of selected APs acting on the disease described in the course.  Sometimes, there is mention of activity of the selected APs, on the yin-yang energy, disease from the acupuncture angle.

Define the skin surface between two neighboring APs where

Mesotherapy points will be created by the Therapist.

Treatment
Once the AP recognized, the treatment applied will depend on the qualification of the Professionals to use needles or injectable.

We have to highlight that Mesotherapy and Acupuncture Mesopuncture have the same goal which is to treat medically, the same alteration of the health or aesthetics.

Performing Mesotherapy Acupuncture Mesopuncture or MAM

The MAM is performed, in its version not invasive by an external stimulus of the AP (Massage, laser, pulsed light etc.) coupled with the iontophoresis on the AP for the Mesopuncture and around it, for Mesotherapy.

       These APs are stimulated by a deep massage or various external stimulations commonly used: Moxas, laser, microwaves, cupping magnets electro-acupuncture, LPG, VACUUM, Ultra sounds, and more…   

As the AP is a path starting in the epidermis/dermis and ending in the connective tissue, the liquid drug can be deposited at the skin surface (Virtual Mesopuncture).

  • In the skin area from and around this AP to the neighboring APs, are spread some drops of the same liquid drug, with therapeutic effects, chosen by the Therapist. The virtual Mesotherapy apparatus, acting by iontophoresis, is applied on these drops; They  cross the skin and create in the dermis, without needle, multiple micro-reservoirs of few drops, each one, which are the Mesotherapy Points_ MPs.

The effectiveness of Mesotherapy depends on the pharmacology of the drug selected by the Therapist, in contrast to the Mesopuncture where the drug by its physicochemical structure not only keeps its pharmacological properties but is a stimulus of the AP, which could differentiate the Mesotherapy from Mesopuncture.
Note.

Each session of Mesopuncture uses the volume of a standard vial of liquid drug. A period of 8-12 days or more separates two successive sessions, decreasing, thus, the risk of addiction to the painkillers.

                        Therapeutic by injection into acupuncture points

 

Injection of liquid drug into the Acupuncture Points _ APs or Mesopuncture is part of the acupuncture session objective which is the research and treatment of cause and symptoms, apparent or not, of the health deterioration.

 

Questioning, inspection etc., application of eight rules (BA GANG) pulse taking, examination of the tongue etc., allow retaining three kinds of APs: General, regional and local points. Injection of liquid drug, into APs, essentially concerns local points including, in addition to the ASHI points, points of positive reaction as one can read it in the article below, translated in extenso from french, published in 1977 by Academy of traditional Chinese medicine in 'Précis d’Acupuncture Chinoise’, Edition in foreign languages (French), page 292, Beijing :

Therapeutic by injection into acupuncture points is a method of treatment developed on the basis of acupuncture, combining traditional Chinese medicine and Western medicine. It involves injecting drugs into the points or areas of positive reaction. By injecting a solute of drugs into the acupuncture point it will produce sensations due to the physical and chemical stimulation caused by acupuncture and drugs which allows to regulate the body's resistance and thereby achieve the healing of ailments.                 

                         (1) Palpation of the Points

Palpation points aims to detect abnormal change of meridians points, i.e. their expressions of positive feedback, using the touch sense of fingers, which is the basis for the diagnosis and treatment.

To practice palpation, we first leave the patient take a comfortable and natural position according to the regions to be palpate and asked him to relax the muscles. And then we palpate carefully and with patience the regions selected using the thumb and forefinger.
We can leave the finger slide on the skin, massaging it, pressing it point-by-point, or depressing it to determine if there are abnormalities (manifestations of positive reaction) in the connective tissue of the dermis and subcutaneous and deep tissue.

For example there are perhaps at the level of the meridians points, cords and nodules, large or small, soft or firm of different shapes (round, spindle-shaped or flattened). Hypersensitive or painful points by pressure can be found and the same for impastos, musculo-cutaneous depressions and modification of muscle tone, the change of the skin color can be also observed.

The scope of palpation includes, paravertebral points (Huatuojiaji), Shu points of the back located on the dorsal lumbar region, Mu points in the thoraco-abdominal region, points of the four members meeting the condition to be treated as well as Ashi points (painful points by digital pressure)

                                  (2) Treatment technique

1- Choice of points.

a. By palpation of the fingers, are chosen the points having the most remarkable reaction as key points for treatment. We should know to avoid choosing too many points in a single session. It is important to accurately locate the selected points. It is important to accurately locate the selected points… If the positive reaction is not very clear, we can choose the corresponding meridian points.

b. We choose the points as is done in regular acupuncture. But the points of the hand and foot as well as areas where there are not many soft parts are less-used.

2- Operative technique.

Prior to treatment should be explained to the patient characteristics of the therapeutic process and reactions that may occur when processing such as feelings of swelling, heaviness or weariness. Some patients may feel a sensation of heat.

After usual disinfection of the determined point, we take a charged syringe and inserted its needle into the acupuncture point to a desired depth or until the appearance of a certain acupuncture sensation. Then, if by pulling slightly the piston, no trace of blood appears in the syringe, then we will be able to inject the drug into the AP.

Manipulations vary according conditions to be treated. In most cases the injection is made at an average speed. For debilitated patients with chronic disease injection should be slow and  more diluted medicinal solution, while that for  patients of strong constitution, injection should be fast with more concentrated solution.

3- Choice of medication

The drugs used must be easily absorbable and without side effects. In addition to pharmacological effects, they must still present some irritant properties to extend the effect of acupuncture.

The usual drugs are:

a. Placental extract: it is stated in common diseases. Often prescribed in the treatment of chronic hepatitis, nephritis, gastric ulcer, allergy reactions, neurosis and certain gynecological disorders reactions.

b. The solutes of Vit.B1, Vit.B12 and Vit. C are indicated in chronic diseases and elderly and debilitated people. The sensation produced by the Vit.B12 is less pronounced than that determined by the Vit. B1. The Vit.C is indicated in hembleeding tendency and cardiovascular diseases...

c. Drugs responding to disorders such as penicillin, Streptomycin and sulphate of magnesia.

d. Some medicines of traditional Chinese medicine such as injectable aqueous extracts of Radix angelicae and Flos Carthami can also be used.

e. the intradermal injection of distilled water alone is painful and can provide a physical stimulation without side effects. It is suitable in certain diseases. Injection should be fast because the duration of produced acupuncture sensation is fleeting.

                                                   (3)  Remarks

a. Account must be taken of incompatibilities, of allergic reactions and side effects of drugs used. Skin Allergy tests should be performed prior to use drugs of antigenic properties. The injection will be made only when the test is recognized negative.

b. Carefully follow the dosage and concentration of injectable solutions. They vary depending on the disease state and regions to treat. In general for the region cephalo-facial (rarely chosen region), we would use medicated fluids at low concentration, less irritating, the dosage should be reduced with a slow injection. For regions of the trunk, drug solute must be more concentrated, stimulation may be stronger, the highest dose and rapid injection.

For Points of the four members we should not use drug solutes very concentrated or very irritating. But it is permissible to combine drug injection to acupuncture treatment..

c. In principle we retain to introduce solutes into articular cavities or blood vessels.

d. A large aseptic care will be taken to prevent any infections. For elderly and debilitated patients, are taken fewer points and for the first meeting, a smaller dose of solute will be injected.

e. Avoid the puncture of the viscera during injection into back points and more, precautions will be taken to avoid the needles discomfort, needles breaking and other potential accidents.
f. A session a day or every two days. A cure includes 7-10 sessions. The interval time between two cures is 4-7 days.

                                    DRY NEEDLING

Abbreviations
TP, TPs: Trigger Point, Trigger Points.
DN: Trigger Point Dry Needling
WN: Wet Needling
AP, APs: Acupuncture Point, Acupuncture Points.
Ac: Acupuncture.

Trigger point Dry Needling_ DN or: Intramuscular Manual Therapy.  Trigger point needling. Functional dry needling. Intramuscular stimulation.


The Trigger point_ TP, TRAVELL and SIMONS, is defined as a tender nodule, a knot inserted in a palpable taut band of a skeletal muscle. 

DN involves palpating the taut band within the affected muscle, isolating the tender nodule, and inserting an acupuncture needle directly into the TP to cause a muscle twitch, a reflexive relaxation and lengthening of the muscle.

This set of manipulations, deactivates the TP responsible for the musculoskeletal pain and impaired movement caused by trauma or disease but ignores the root cause as it is not a holistic treatment but this approach is evolving …

TPs and Ashi Points
Many TPs are confused with APs.
Dorsher & al., determined that of the 255 TPs, listed by Travell and Simons, 234 (92 percent) had anatomic correspondence with classical, miscellaneous, or new APs listed in Deadman & al.

  • For Acupuncture
    Outside the listed APs there are APs commonly termed ‘Ashi point’ that do not necessarily correspond with traditional point locations.
    Ashi points are specific tender spots, palpated in a pain area and painful when pressed, without name, randomly located and only selected in accordance with the syndromes or diseases.

Ashi points are often not technically APs or on specific meridians but have a clinical effect nonetheless.

They are treated and needled in Acupuncture according to a classically and globally approach.

  • For Dry Needling
    In front of the same components, for the Therapist using TPs, this falls within his jurisdiction with exquisitely tender and hyperirritable spots, included in a taut band of a skeletal muscle, painful on deep palpation and originated of a referred pain and motor dysfunction in deep palpation. Inserting an acupuncture needle into the area, in concordance with the TPs treatment or DN, pain or sufferings are relieved after having reproduced the pain spontaneously felt.

‘ Either Acupuncture or DN, deepen palpation allows finding musculoskeletal tender points interpreted for millennia as Ashi points by the Acupuncturist and since 50 years as TPs by Professionals in DN’.
Both are treated by insertion of acupuncture needles either compact or hollow with the possibility for the latter (the BMN) to associate Acupuncture and DN respectively with Mesopuncture and Wet Needling _WN.

The Distal Trigger Points
Evolution of the DN treatment, as including distal TPs in DN, brings DN nearer to Acupuncture

Some authors recommend to research and treat the distal TPs, away from the primary TPs.  This recommendation involving, in the TPs treatment, the distal TPs is similar to the conventional diagnostic and therapeutic approach, performed in Acupuncture, since a lot of years, for research and treatment of local and remote APs.

  • The facts
    About 75% of pain is caused by TPs. Over 74% of common TPs are located remote to the area where the patient feels pain.
  • Therefore, in a Patient too sensitive to be needled in the area of the primary pain source, the treatment can be initiated with distal needling. A recent study demonstrated that distal points needling reduce proximal pain by means of the diffuse noxious inhibitory control.
  • Distal TPs are listed in Pain guides available on the internet. Then they will be adapted to the particularism of each patient.

In summary
Insertion of a needle into a TP, confused with an AP, could be likened to Acupuncture.
Injection of a liquid drug into a TP could be equated with Mesopuncture.
Research and involvement of remote TPs in the DN treatment is a classical approach in Ac.

Extension of the DN activity field

Dry needling can be appropriate and very helpful for Patients with chronic pain, of undetermined origin but clearly identified not to be of internal organ origin especially when other interventions have failed, although DN initiated being limited to the local area of pain only: Extending its field of activity in the treatment of any non-visceral chronic pain by TPs is also a classical approach to Acupuncture…

DN and needles

  • Hypodermic needle, 1981.

In 1981, having found that, the effectiveness of the alone needle insertion, was identical to the liquid drug injection, TRAVELL & SIMONS recommended the use of a single hypodermic needle, without injection. “In comparative studies, DN was found to be as effective as injecting an anesthetic solution such as procaine or lidocaine in terms of immediate inactivation of the TP”. 

DN focuses only, on treating the locally musculoskeletal pain and dysfunction by inserting hypodermic needles into the locally painful area. 

Dry needling technique uses sterile hollow hypodermic needles from empty syringes (“dry” needles instead of “wet”) inserted, through the skin and muscle, directly into the TP:
We note a local twitch response, indicating the proper placement of the needle in the TP.

  • It is an involuntary spinal cord reflex, in which the muscle fibers, in the taut band of muscle contract, due to a reflexive relaxation and lengthening of the muscle fibers, improving the global flexibility of the muscle and relieving impaired movement.
    Repeated movements of the needle into the skin thickness and TP, during about one minute help to inactivate one TP.

. These manipulations can be painful, a fortiori if, more than one TP in a muscle requires needling and more than one muscle with multiple TPs, is involved: Perhaps some drops of an anesthetic liquid drug would be appreciated, interesting possibility when using the BMN.

 

Mechanism of Action

The exact mechanisms of the therapeutic effects of the needle insertion into the TP are not
fully understood, although the principle behind DN is known as being the reflex arc.

Studies, Dr. Jay Shah and colleagues and other Authors, have shown that Dry Needling,

  • Disrupts mechanically the integrity of the dysfunctional endplates within the trigger area.
  • Causes, locally, favorable biochemical changes which aid in reducing the pain, partially.
  • Involves supra-spinal pain control via midbrain periaqueductal gray matter.

DN also affects the central nervous system about the perception and modulation of pain.

 

**- No mention is made of the role of connective tissue, its fundamental substance particularly, like the role ascribed thereto, in Acupuncture, in the management of the therapeutic effect due to the implantation of the acupuncture needle in the soft tissue, into the APs location in the connective tissue.

 

Another hypothesis about the healing mechanism

  Dry Needling injures and causes minor bleeding within the tissues. The minor trauma elicits a local inflammation, recognized by the body as an acute problem area, requiring an increased blood flow while usually this area has a poor blood circulation. By increasing bleeding and blood flow into the tampered area the body tries allowing the area to heal.

  • Acupuncture Needle, 1999.

In 1999, on the second edition of their book, Travell and Simons advocated, for disabling the TPs, to use an acupuncture needle, thin, compact and less painful than a hypodermic needle, wider in diameter.

This recommendation allowed the Professionals to mitigate the insertion and manipulation pain of the hypodermic needle into the TP, already spontaneously painful.
Moreover, hypodermic needle was described in unflattering terms, by the Therapists, as causing a searing pain and discomfort.
  
The use of an acupuncture needle and confusion of many TPs with APs has aroused among Acupuncturists, a deep and sustainable controversy, yet noticeable today but also including some signs of lull.

  • Acupuncture needle for DN

It was necessary for optimizing the needle insertion pain, to select a finer needle even compact.

Karl LEWIT, 1979, published in the medical journal ‘Pain’ an article emphasizing the role in DN, of a solid filament needle as is used in the Acupuncture practice.

**- How are described acupuncture needles

By the Therapists:  Acupuncture needles are thin as a filament, sterile and effective and do not cause the searing pain of a large hypodermic needle. (This is no longer true currently).
By the Regulations. FOOD AND DRUG ADMINISTRATION
An acupuncture needle is a device intended to pierce the skin in the practice of Acupuncture. The device consists of a solid, stainless steel needle. The device may have a handle attached to the needle to facilitate the delivery of Acupuncture treatment.

Indeed, acupuncture needles are effective for inactivating TPs.

Acupuncture Needle and the controversy

The choice of acupuncture needle as a cause of controversy is artificial now. This choice is only the triggering event of a dispute initiated by the Acupuncturists regarding several encroachments on their Profession by the Needling therapy: Common points, field of activity extended to remote points, treatment of all pain causes except of visceral origin, insertion or injection in a skin point and more.

  • In various countries, Acupuncturists, referring to the first texts of Travell and Simons describing the procedure of DN with hypodermic needle instead of Acupuncture needle now, argue that anytime a Therapist uses an acupuncture needle while performing a 'dry needling' session, he will be outside of his scope of practice and into the Acupuncture practice.
  • Other authors are more intransigent

Dry Needling, intramuscular stimulation or any other method by which a needle is inserted to effect therapeutic change, is, by definition, the practice of Acupuncture.

Controversy and protocol, Acupuncture and Acupuncture needles.  

The controversy has diminished because on one hand the classical approach of DN treatment has evolved, including it in a protocol treatment encouraging coupling DN and Acupuncture, especially if it is noted a probability of confusion between TPs and APs, of location either defined or randomized as Ashi points, on the other hand the use of a disposable device classified both as acupuncture and hypodermic needle, the BMN.

**-* DN Protocol

It is interesting to note some evolution in the DN treatment favoring the lull of the controversy while DN becomes a protocol treatment including Acupuncture.
DN cannot be regarded as a full-fledged medicine that is why, partially, some Authors recommend considering DN as a protocol with a prominent place for Acupuncture in its two versions: Acupuncture and Mesopuncture (and various other treatments), for maintaining homeostasis and preventing pain to become chronic.

DN works best when it is combined with other physical therapy interventions such as soft tissue massage, stretching, strengthening, posture training and home exercises.
DN works best, when it is combined, in front of recurrent TPs for example, with a diagnostic and therapeutic set, identical to that achieved in General Practice;

In many ways, the protocol recommended corresponds to the conduct and conclusions of the acupuncture session: Questioning and looking for personal and family history, inspection, palpation, differential diagnosis, additional tests, biological or radiological etc. 

**-* Acupuncture in DN Protocol

 

Acupuncture is an Eastern version of Medicine, trying to determine and treat the root cause of the diseases and their symptoms, in particular:

  • All diseases encountered in the daily medical practice.
  • Musculoskeletal pain as well as pain due to any cause.
  • Other medical conditions.

Acupuncture, in its two versions, Acupuncture and Mesopuncture, is an integral part of Chinese Medicine treating both the symptoms and the identified root cause of the health problem, according to a holistic approach.
Acupuncture is thus the treatment of choice to treat all pathology involving the TPs. 
It is a fully qualified medicine, which allows eliciting a long-term relief by searching, finding and treating the underlying factors, which perpetuate, in this case, the TPs in an activity state contributing to chronic pain.
Both Acupuncture as an eastern medicine and Dry Needling as a western medicine, use very fine, compact or hollow, needles inserted into the skin and muscle, into numerous common sites, APs/TPs,

Acupuncture needles are inserted into Acupuncture Points_ APs, located in local and distal areas connected by meridians described as cleavage planes of the connective tissue.
Acupuncture needles are inserted in Trigger points of often confused location with the APs.


Inserting acupuncture needles in carefully selected points, of recognized and logical efficacy, enables on one hand to easily deal with the TPs involved in the painful condition and secondly to act on the various factors initiating and perpetuating the state of active TPs.

  • Various Acupuncture Points_ APs could be selected: Tender points or “Ah-Shi” points, proximal or remote APs on the meridians and extra-meridians, affecting the area of pain or disharmony.
  • Various factors could be treated: Mechanical stresses, injuries, nutritional or sleep problems, emotional factors, acute or chronic infections, organ dysfunction and disease…

Controversy and BMN

BMN in DN treatment

It is possible to use the BMN both for Dry & Wet Needling as recommended.

 BMN being a hypodermic and Acupuncture needle, its use avoids the controversy on using an acupuncture needle and performing an acupuncture act without being an official Acupuncturist and not using a hypodermic needle as advocated by Travell and Simons in their first book. 

BMN is a disposable device used by Acupuncturists for Acupuncture and Mesopuncture and all Therapists practicing Dry or Wet needling as well as professionals in Mesotherapy.
It is a hollow acupuncture needle with a diameter identical to current acupuncture needle (0.30 mm) topped with an empty resilient polymer reservoir.

The resilient polymer reservoir located in the handle of the needle, (or rather, topping the hollow needle, the reservoir is used for gripping the needle) is filled by the Therapist with the liquid drug he has previously selected, based on the disease to be treated.

The BMN is of dual identity: It is a hypodermic needle because it is hollow, but it is also an acupuncture needle, as described by the FDA.

Its use is plural if we consider,
first, the multiplicity of TPs confused with APs with, for the latter the need to leave in situ the acupuncture needle while allowing the supine position, the treatment continuing.
The second feature is the ability to initiate or complete the effectiveness of the DN or Acupuncture treatment resulting from insertion of a metal needle, by injecting a liquid drug chosen for its own therapeutic virtues or its complementary biochemical or mechanical effect, thus performing a Wet Needling or a Mesopuncture session.  

It is thus possible, for the Therapist, to perform with the same BMN inserted in the TP, both Dry needling coupled or not, with Wet needling, facilitating the TPs deactivation and optimizing the therapeutic result of this deactivation.

If from moreover the TP is of common localization with the Acupuncture Point, it would be possible:

  • To keep the BMN inserted in the Point for about 20 minutes as recommended for an acupuncture treatment.
  • To Achieve with the same BMN insertion, both versions of Acupuncture: Metal needle therapy (Acupuncture) and treatment with the liquid drug reservoir, injected into the TP (Mesopuncture).
  • To continue the treatment while the patient is lying on his back, with various BMN inserted in the TPs or APS, located in the back.
  • To perform, possibly, with the same needle insertion some Mesotherapy points, in the dermis around the AP.


In fact, the BMN leaves, to the Therapist, the complete freedom to choose:

For TPs, the Wet and Dry needling,
For APs, Acupuncture and Mesopuncture, 
For Allopathic /Homeopathic medicine, the creation of Mesotherapy points by injecting micro doses of liquid drug into the dermis surrounding the APs.

 

BMN & DRY NEEDLING, WET NEEDLING, TRIGGER POINT.

 

                        TRIGGER POINTS

 

They are the most common cause of chronic musculoskeletal pain in the Myofascial Pain Syndrome_ MPS, a regional pain syndrome, originated from regional Trigger Points or TPs.

DEFINITION
TPs are the most common cause of chronic musculoskeletal pain. About 75% of pain is caused by TPs.

TRAVELL and SIMONS define a Trigger Point_ TP as a tender nodule, a muscle knot in a palpable taut band of skeletal muscle.
It is an irritable spot either spontaneously (active) or on digital compression (latent) able to generate either local or referred pain to other musculature, motor dysfunction and even autonomic phenomenon such as sweating, swelling, and "goose bumps."
These TPs may become activated by a variety of factors such as, poor posture, overuse, or muscle imbalance.
TPs exhibit a local twitch response (muscle fasciculation) or jump sign (flexion response) in response to digital pressure or Dry & Wet Needling.

CLASSIFICATION OF TRIGGER POINTS  
TPs can be Active or Latent, depending on their varied clinical characteristics (Han and Harrison, 1997; Travell and Simons, 1999); however, either of these may cause musculoskeletal pain (Travell and Simons, 1999; Wilks, 2002; Hou, 2002): Active and Latent TPs can cause significant motor dysfunction but more commonly occurring with Latent TPs than Active TPs (Travell and Simons, 1999).

Active Trigger Point ATP

It is a hypersensitive point; it may display continuous pain in the zone of reference with or without palpation.
Palpation of the muscle injured, reveals a

  • Muscular stiffness and weakness: Muscle is with increased muscular tension, reduced muscular stretch, restricted range of motion.
  • Taut band and local twitch response located in the muscle.
  • Spontaneous pain referral.  Localized and referred pain appeared on manual compression simulating by all aspects the current pain. [Travell and Simons (1999); Chaitow and DeLany (2002) Wilks (2002)].

Latent Trigger Point_ LTP

Is a TP more commonly occurring, hypersensitive with active nociceptors but not enough to generate spontaneous pain and it is not associated with spontaneous pain referral (Travell and Simons, 1999; Alvarez & Rockwell, 2002). We find also a taut band.
However, it exhibits all the muscular characteristics of an ATP: Stiffness and restricted range of motion due to increased muscle tension and shortening, muscular weakness.  
Manual compression causes localized pain, local twitch response with a ‘jump sign’ (muscular flexion}.

ATP and LTP can be subdivided into Primary TP and Satellite TP.

  • Primary TP
    A Primary TP is defined as a TP that has been activated directly by acute or chronic overload or repetitive overuse of the muscle in which it occurs and was not activated as a result of TP activity in another muscle (Travell and Simons, 1999)

A Primary TP contains nociceptors activity and is mainly responsible for the development of the Myofascial pain.
 Further aggravating factors can lead to the creation of an active trigger point, which may recover spontaneously or persist without further development.

  • Satellite TP
    A Satellite TP is induced mechanically by an Active Primary TP (Travell and Simons, 1999). A Satellite TP forms within the pain referral zone of another muscle containing a Primary TP. Satellite TP result from the stress and muscle spasm caused by neighboring TPs. As such an Active TP in one muscle can induce an Active Satellite TP in another muscle and vice versa, inactivation of the key TP will therefore lead to inactivation of its Satellite TP without actually treating the Satellite TP (Travell and Simons, 1999).

According to Davies and Davies ‘long term chronic pain is often a compound effect from a chain of Satellite TPs, cascading from muscle to muscle.

  • Secondary TP
    A Secondary TP develops in synergistic muscles of the affected muscle. An imbalance of tension in the primary muscle, due to shortening muscle fibers and, compensatory overload of the synergistic muscles, causes Secondary TPs to develop.
  • Of the trigger points actually found within the zone of pain, most of those are not very common trigger points, or they formed because they were satellite trigger points formed due to primary trigger points elsewhere.

ETIOLOGY

Contributing factors

Among the various direct causes or contributing factors, generating TPs in Patients, mention may be made, with many authors of:  

  • Occupational or athletic activities with postural deficiencies, muscle imbalances, overuse injuries, intervertebral discs diseases, trauma…
  • Psychosocial and emotional factors, fatigue…
  • Inflammatory diseases, fever, arthritis, viral infections,
  • Internal disease, scar formation after surgical incision etc…

Perpetuating or aggravating factors

 Further aggravating factors may lead to the creation of further TPs 

Chronic psychological problems,
Chronic infections,
Chronic muscle tension due to poor posture…

PATHOPHYSIOLOGY

The existence and understanding of the genesis of the TPs, was the subject of many debates involving EMG, elastography, Magnetic Resonance, ultrasound etc. to both confirm their existence and obtain a more extensive knowledge of the pathophysiology of these TPs, commonly overlooked cause of chronic musculoskeletal pain and dysfunction.The etiology and genesis of TPs have yet to be satisfactorily explained.

It is generally thought that abnormal muscle strain, in combination with emotional stress, in genetically predisposed individuals, can cause a LTP to develop in a taut muscle band and subsequent nerve sensitization. 
Taut muscle bands commonly occur in pain-free individuals.

Several diverse yet complementary models have been proposed to explain the development of TPs at the cellular level, but it is still not known what the role of each is in the pathogenesis of chronic musculoskeletal pain. Nonetheless, it is clear that the pathogenesis of TPs is a complex process that involves both the central and peripheral nervous systems.

Recent basic studies have confirmed that,  at the site of an active TP, there are elevated levels of inflammatory mediators, known to be associated with persistent pain states and myofascial tenderness and that this local milieu changes with the occurrence of local twitch response.

Appropriate treatment

Appropriate treatment to the locally musculoskeletal pain and dysfunction could be performed by needling therapies applied into the TP, a locally painful area, to produce a “twitch” response and deactivate the TP.

Needling therapies can be divided in two groups with or without liquid drug injected:

  • Two versions of Acupuncture: Acupuncture & Mesopuncture.
  • Two versions of DN: Wet & Dry needling, in association with other treatments, optionally. 

 

 

                WET NEEDLING.TRIGGER POINT INJECTION. BMN

 

In the book published in 1981, Myofascial Pain and Dysfunction, the Trigger Point Manual, describing the fundamentals of Travell and Simons work, can be found, in the chapter      'Methods to deactivate a trigger point’, the original description of the WN and DN:

 

“Dry, as opposed to Wet needling, is defined as needling the soft tissue without injection of any liquid substance to treat human pathology”.
We also find in this book, among other methods to deactivate a TP, comments on hypodermic needle injection of a variety of chemicals.

 

“In comparative studies, DN was found to be as effective as injecting an anesthetic solution such as procaine or lidocaine in terms of immediate inactivation of the TP. All substances injected had a positive effect, including simple saline solution”.
It should be noted the similarity with Mesopuncture. In both cases, it is the local injection of small doses of a liquid drug with, on one hand, known pharmacological and on the other hand mechanical properties, due to the volume injected.

 

Technique
The Therapist utilizes a hypodermic needle inserted into the skin, to allow the liquid drug to cross the skin and reach the TP to deactivate it with the goal of a long-term pain relief.  

 

The needle
The insertion pain of a hollow hypodermic needle in the Trigger Point, already painful, is accentuated by the various manipulations performed in the TP to disable it.

This pain is optimized by using the hollow needle BMN whose diameter is identical to the diameter of acupuncture needles and by the properties of the liquid drug injected.

 

The liquid drugs
Currently, it is easier using DN than Wet Needling (WN) but WN optimizes the effectiveness of Trigger-Points treatment:

 

Indeed, using a liquid drug depends on one hand of the medical expertise of the Therapist, entitled to use liquid drugs injected and knowing, perfectly, the complete pharmacology of the selected liquid drug,on the other hand, the liquid drug has a dual therapeutic action:  
A physical effect due to the injected volume and a therapeutic effect, as in Mesopuncture, due to the pharmacological properties of the liquid drug injected:

 

For example, injecting locally an anesthetic, into the TPs, allows stretching of the involved muscles painless.
Anesthetic, Botox, steroids... are commonly used.
Many other liquid drugs may be used, when the TP is, at the same time, an Acupuncture Point_ AP and a TP, WN and Mesopuncture are then combined.
It is also possible to use liquid drugs without therapeutic effect, such as distilled water, saline or whose action is integrated into the physiological mechanism of recovery of the initial state of health, such as trace elements, homeopathic remedies…

 

The needle, liquid drugs and BMN
Wet needling performed with the BMN, allows performing in the same TP, a mechanical deactivation, by the BMN needle, supplemented by a liquid deactivation with the same device, by the liquid drug from the reservoir, injected into the TP; adding the anesthetics or therapeutic properties (ant-inflammatory, vitamin, etc.) of this liquid drug to the double deactivation.

 

Results.

 

  • Injection of a chemical, popular among many practitioners, is not necessary; however, the analgesic or therapeutic effect of chemical provides an additional effect while keeping the therapeutic effect of the needle itself for example to avoid the needle insertion pain in the already painful TP, a fortiori when this insertion must be repeated many times.
  • It seems that Wet Needling is more practical and rapid, since it causes fewer disturbances than Dry Needling.

 

WN is more effective than Acupuncture or DN for certain types of musculoskeletal pain.
WN shortens the needle insertion pain, in the already painful TP, a fortiori when this insertion must be repeated many times.
WN appears to be the quickest treatment for new TPs formations, with chronic TPs sites requiring multiple and frequent, injections.  
WN could be selectively used in TPs recurrent or resistant to conventional treatment, caused perhaps by

 

  • Physical factors: Postural stress, repetitive movement, vitamin and mineral deficiencies… 
  • Psychological factors such as stress, tension and anxiety….

 

 

 

  •  

                 

 

 

 

 

ROLLER, Mesopuncture & BMN

It is used to reduce wrinkles, fine lines, scars, without damaging the skin barrier.

It is a device composed of compact needles attached to a drum, rolling on the facial skin, in general, by small and smooth and manual pushes. The needles penetrate the skin either vertically or asymmetrically to a depth, sometimes adjustable in some devices, between 0.5 and 2.5 mm, more specifically 1.5 mm to 0.5mm for the face and the eye.

  • Its use is to reach the connective tissue, collagen fibers and elastin.
    It creates thousands of micro wounds, well defined, perfectly controlled under the upper layers of the skin in just seconds, causing the creation of collagen fibers and elastin and a rush of blood to the injured spot.
  • Its use is to provide access to deeper tissues, for local topical fluids (applied to the skin surface), which is reminiscent of Mesopuncture.

The insertion of needles temporarily opens paths to all sub-epidermal tissue to local topical liquid drugs, to active drugs.

It is interesting to note the common features with

 **-* The seven star needle, the plum-blossom needle.

These are two devices used in Acupuncture.
These are 5-7 needles attached, permanently, on a same support, at end of a handle of a given length; they are used to a greater area than that assigned to one needle. They do not roll but the percussion of the skin by the device is repeated on a large area of the skin.

**-* The fundamentals of Acupuncture are intimately associated with the connective tissue as well at the anatomical level as at its mechanism of action or its therapeutic results. The Acupuncture effect, by a compact needle insertion either at the level of APs or at any point of the skin, is due to stimulus of the fundamental substance of the connective tissue. This effect may occur no matter where the needle is placed but may be enhanced when the needle is inserted into APs where the amount of connective tissue is important; this stimulus propagates along the connective tissue cleavage planes (LANGEVIN) to all over the skin.

**-* Mesopuncture 
It is an acupuncture version in which few drops of a liquid drug stimulate the Acupuncture Point_ AP. They are either deposited needleless by iontophoresis or injected by needle. In general, Mesopuncture is performed after stimulation of the APs by a compact metallic acupuncture needle (Acupuncture). Besides their recognized therapeutic effect they stimulate the connective tissue, irrespective of the skin injection site, but stimulation is more noticeable at the AP.

**-*The BMN device

It is a hollow acupuncture needle topped with a resilient polymer reservoir allowing to perform Acupuncture and Mesopuncture with the same skin insertion, by Therapists entitled to use liquid drugs. It also allows, around the APS to create in the dermis, reservoirs of few drops of a liquid drug or Mesotherapy Points.

It seems that the ROLLER allows a soft version of Acupuncture and Mesopuncture (and Mesotherapy?) for APs of local action.
It is interesting for the Therapists using the roller, to recognize the APs for better targeting the application of Roller.

Hyaluronic acid, Botox, Mesopuncture unexpected improvements

 Since few months, in social networks, about aesthetic or anti-ageing treatments or in medical spas, comments are published on the beneficial collateral effects of injections of Hyaluronic Acid_ HA or BOTOX: Improvement of depressive signs, migraine, headaches, knee pain, sinusitis etc.

It is likely that the observed improvement is due, PERHAPS and IN PART, to

• Injection of a liquid drug into a skin point, which, without being necessarily an Acupuncture point _ AP of local action, has the same therapeutic properties but of lesser intensity.

• 'Therapeutic effect acupuncture', hereafter called 'acupuncture effect', awarded by the Traditional Chinese Medicine _ TCM, when stimulating this skin point known / unknown as AP.

• The duration of the ‘acupuncture effect 'secondary to the fluid stimulus: The duration of stimulation of the AP is the same as the duration of elimination from the human body, of the liquid medicine injected into this AP.

  • About Acupuncture

**- For millennia are described in the thickness of the skin Acupuncture Points _ APs, interconnected by meridians. Recent research, Prof. LANGEVIN, involve the connective tissue in Acupuncture structure, organization and at the functioning level.

Acupuncture points are linked together in a network of “meridians” running longitudinally along the surface of the body. Acupuncture meridians are believed to form a network throughout the body, connecting peripheral tissues to each other and to central viscera.

According to LANGEVIN, there is an anatomical correspondence of APs and meridians to connective tissue planes. The network of APs and meridians may be viewed as a representation of the network formed by interstitial connective tissue.

LANGEVIN and Al. propose that the anatomical relationship of APs and meridians to connective tissue planes is relevant to acupuncture's mechanism of action.

**- APs stimulation

** The APs should be activated or stimulated:
By needle (classic Acupuncture).
By a liquid drug, with/without therapeutic activity (Mesopuncture).
Both by needle and liquid drug, potentiating the Acupuncture effect of each mode of stimulus.

Duration of the effect ‘Acupuncture’ following the conventional stimulus: Few days.

Note: The BMN, we manufacture, allows performing Acupuncture and Mesopuncture (as well as Mesotherapy), once its needle inserted into the skin.

** Two ways of stimulation are possible

External: Moxas laser, massage, magnets, iontophoresis … (Traditional Acupuncture), iontophoresis (Mesopuncture)...

Internal: Conventional Compact acupuncture needle (Traditional Acupuncture) and injecting a liquid drug or (Mesopuncture). 

** The stimulation causes cellular and extracellular matrix changes that propagate using connective tissue pathways.

‘These changes may occur no matter where the needle is placed but may be enhanced when the needle is placed at APs”, Pr. LANGEVIN.

This explains that, without precise knowledge of the location of the AP, the Therapist can achieve the effect Acupuncture.

**- The AP is selected either for its local acupuncture effect, symptomatic or for its regional or general acupuncture effect and resulting in these last two cases, from a line of reasoning requiring expertise in Acupuncture.

The AP of local action requires no special knowledge in Acupuncture but training in Human Anatomy. They are located in the immediate vicinity of the injured area, and are generally easily accessible.

  • About Mesopuncture

In Mesopuncture, the liquid drug is active by its physicochemical structure, at the origin of both the  effect therapeutic recognized by the western pharmacopeia and the effect Acupuncture recognized by the TCM, performed by stimulating the selected AP.

It is performed by the BMN, we manufacture, allowing to perform Acupuncture and Mesopuncture (as well as Mesotherapy), once the needle inserted into the skin.

  • It is possible in Mesopuncture, using the long duration of elimination of certain drug liquid to produce a long stimulus of an AP at the expense of its therapeutic effect, for example, for the so-called liquid drugs of comfort (Hyaluronic Acid_ HA, Botox).

In general the liquid drug is injected into an AP which stimulation causes an acupuncture effect synergistic of the own therapeutic effect of the liquid drug injected.

This therapeutic effect is undoubtedly beneficial in Mesopuncture.

It is ensured by

  • Liquid drugs with rapid elimination or rapid duration of stimulation of the AP identical to the duration of stimulation by the metal needle, i.e. a few days.

Stimulation of the AP by this liquid drug injection added its acupuncture effect to the acupuncture effect of the acupuncture needle already inserted and its own therapeutic effect synergistic to the Acupuncture effect.

The injection should be repeated after a few days.

These are the liquid drugs, commonly used in daily medicine.

** Stimulation of short duration by a liquid drug has the advantage of potentiating the metal stimulus by a liquid stimulus while preserving the therapeutic properties of the liquid drug but the downside is the repetition of acupuncture sessions according to the classical scheme.

  • The liquid drugs of slow release are less numerous.

 Their therapeutic effect, also used in practice, is remarkable in very specific areas: Pain, osteoarthritis, for example. They have a lifetime of 3 weeks.
They are currently the subject of warnings about side effects; their use, in Mesopuncture as a stimulant of the AP, for few weeks cannot be applied to areas other than those recommended by the western pharmacopoeia.

  • The liquid drugs so-called of comfort, HA and Botox are easier to handle. The elimination time is long, few months; Injected into an AP, they have a long duration of stimulation. Their specific therapeutic effect and potential side effects are known.

The long-lasting effect by few drops of these liquid drugs, stimulating the AP, depends on the properties recognized at this AP by the MTC.

  • Deposited in an AP dealing with facial aesthetics, the acupuncture effect will be synergistic of the therapeutic effect and of same duration.
    Filed in an AP dealing with sinusitis or pain, only its long-term effect in acupuncture will be privileged, the non-harmful therapeutic effect will not be a contraindication to its use in this pathology: Thus, it is possible to explain, by the MTC, the beneficial collateral effects of injection of this liquid drug of aesthetic use.
  • The possibility of obtaining a long-term stimulus of APs selected for their action on a given condition, permits to space acupuncture sessions and improve some drawbacks of a close repetition of acupuncture sessions: Financial weight, loss of time, fear of needles delaying consultation etc.

We believe that the unexpected improvement of reported illnesses is due, Perhaps and in part, to stimulation of very long duration of Acupuncture Points or points Acupuncture-like of local action.

The pharmacological property of a drug, dependent on its physico-chemical structure, is one of the main criteria for inclusion in the pharmacopoeia, particularly western pharmacopoeia. 

This is also the criterion for its use in Mesotherapy, which is inactive if the liquid drug used is not active; for example, distilled water is inactive in Mesotherapy.

Recall that Mesotherapy is a mode of drug administration in the form of micro-depots, of a liquid drug, active imperatively on the condition being treated, randomly created, in the dermis or superficial hypodermis facing the altered area where are located the APs_ Acupuncture Points, of local action, described for millennia as active on this condition.

In Mesopuncture, fluid stimulus of the AP, keeps its pharmacological properties but its physicochemical structure is the fluid stimulus of the AP acting either by its volume or chemical irritation...

Some liquid drugs are of rapid elimination or degradation requiring a daily injection, others are of slow release of 3 weeks for some anti-inflammatories or painkillers others have a slower degradation, 6-12 months if not more.

The duration of fluid stimulus by the liquid drug on the AP is function, of its elimination rate, its bioavailability.

In Mesopuncture, the liquid drug is injected with/without needle in the APs of local action, facing the altered zone, chosen to be active on the medical condition or aesthetics; Mesopuncture completes or potentiates the stimulus by the metal acupuncture needle: Acupuncture and Mesopuncture are often performed with the same device as our BMN.

This effect of fluid stimulus is regained with all the liquid drugs be they with/without pharmacological effect that is to say, neutral, such as distilled water, saline: Mesotherapy being inactive in the latter case.

The deposit or injection of a liquid drug with pharmacological effect divided into micro-deposits, in the thickness of the skin, face an altered body area has a known metabolic pathway:

There is an immediate and direct passage of liquid drug from the subcutaneous to the altered area of the body.

Then the liquid drug passes into the bloodstream to reach the liver where it will be modified to be used by the tissues. It passes again into the blood to reach a second time the weathered zone.

During the treatment with local deposit of liquid drug in the skin, the weathered zone receives twice the liquid drug.

It is difficult to find in the pharmacopoeia, liquid drugs of long or very long duration of action that is to say, long or very long-term elimination of the liquid drug and long or very long stimulus  of the AP, acting in synergy, when injected into an AP with the acupuncture effect obtained by this fluid stimulus.

It is, thus, difficult to have liquid drugs with duration of antalgic or anti-inflammatory action greater than 3 weeks. Injected / deposited in the PA, the stimulation obtained, will last three weeks, too.

Generally speaking, the pharmacological action and Acupuncture effect (resulting from the stimulation) contribute to treat the same condition: Thus, in osteoarthritis of the knee, a liquid drug chosen for its anti-inflammatory action is injected / deposited in the knee APs, active on the pathology of the knee.

There is a synergistic action between on one hand, the two properties of liquid drug, therapeutic pharmacological property and AP stimulus and secondly, the therapeutic benefit, in acupuncture, resulting from this stimulation.

Recall that, as any deposit of liquid drug into the thickness of the skin in front of the weathered zone, the liquid drug is first distributed to this altered zone and then after passage in the blood and liver it is again distributed to the altered zone.

Concerning the liquid drug: It is difficult, if not impossible to dispose of liquid drug with delayed therapeutic effect, long duration of stimulus action, for the various pathologies encountered.

Nowadays, the liquid drugs with notable delay effect are those used in cosmetic and particularly HA and its derivatives which duration of action exceeds the year.

In Mesopuncture, hyaluronic acid is injected into an AP; it stimulates the AP at a time depending on its rate of elimination which is usually of several months.

The HA, having no harmful impact, it is possible to privilege, in Mesopuncture, depending both on the rate of elimination of the liquid drug, its action of long duration stimulation of the AP at the expense of its pharmacological action, to be used in pathologies where are missing the liquid drugs, electively active during more or less time.

It is necessary to well analyze the liquid drug used for its long duration effect and well evaluate its pharmacological action and consequences and precautions for use.

For example, treatment of osteo arthritis of the knee

It is performed by injecting into the selected APs,  few drops of derivatives of hyaluronic acid, of very long duration of action and very long duration of AP stimulus,  without known pharmacological action on osteoarthritis of the knee.

We recall the implants of titanium or steel used in auriculotherapy and the catgut burial technique   used in Acupuncture, of very long stimulating action but without proven therapeutic action.