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.