PERCUTANEOUS NERVE STIMULATION
Percutaneous Nerve Stimulation is an acupuncture treatment that involves sequential or simulataneous electro-acupuncture using low-, mid- and high-frequencies for the treatment of chronic musculoskeletal pain. The reason for multiple frequencies is that the various groups of neurotransmitters involved in anti-nociceptive (reducing sensitivity to painful stimuli) activity are mobilized for central and peripheral release by different frequency ranges. For example, low-frequency electro-acupuncture (2 to 4 hertz) has been shown to stimulate the release of beta-endorphin in the hypothalamus and met-enkephalin in the midbrain. Mid-range frequency stimulation (10 to 30 hertz) causes the release of dynorphin B and metkephalin in the spinal cord. High-frequency stimulation (70 hertz and above) causes release of dynorphin A in the spinal cord. It appears a logical hypothesis that a unique frequency range will provoke the release of each neurotransmitter involved in pain modulation (for example, serotonin, norepinephrin, substance P, GABA, dopamine) and in return to homeostasis. It is probable that the waveform and depth of needle penetration also affect the specificity of neuromodulator release. The theoretical model for percutaneous nerve stimulation involves activating the dermatomal sensory, myotomal sensorimotor, sclerotomal sensory and synpathetic, and splanchnotomal autonomic innervations involved in a pain lesion. The pathology of chronic musculoskeletal pain can involve all four anatomic divisions. The clinician must identify the appropriate spinal levels to stimulate.
A favorable response to a percutaneous nerve stimulation treatment is an asymptomatic state of any duration at the conclusion of the treatment session or within twenty-four hours of the session.
Since chronic pain invariably occurs in or creates a body depleted of vitality, tonification of weakened systems/organs is an important preparatory treatment.
PERIOSTEAL ACUPUNCTURE STIMULATION
Periosteal electro-acupuncture which involves needling over bony prominences and penetrating deeply to be in proximity to or to touch the periosteum, can be highly effective to relieve the deep and chronic pain associated with traumatic or degenerative bone changes. This technique influences the sclerotomal innervation causing or perpetuating chronic pain. Its primary method of action seems to be the stimulation of sympathetic fibers in and around the periosteum, which in turn stimulates an increase in blood flow to the area. This does not alter the configuration of the osseous structures, BUT it can modify vascular sympathetic and segmental nerve responses and soft tissue inflammation, edema, and contraction that result from BONE DEGENERATION. It can change the course of even a very stubborn pain problem. Periosteal stimulation can also effectively ameliorate symptoms associated with peripheral vascular compromise and peripheral neuropathies.