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Dry needling (Myofascial Trigger Point Dry Needling〔http://www.ncbi.nlm.nih.gov/pubmed/23606888〕〔http://jmmtonline.com/past/vol14no4.php〕〔https://clinicaltrials.gov/ct2/show/NCT00804089〕〔http://www.archives-pmr.org/article/S0003-9993%2815%2900006-4/abstract?cc=y=〕) is the use of either solid filiform needles (also referred to as acupuncture needles) or hollow-core hypodermic needles for therapy of muscle pain, including pain related to myofascial pain syndrome. Dry needling is sometimes also known as intramuscular stimulation (IMS). Acupuncture and dry needling techniques are at times similiar but vary depending on the style of practice of the practitioner. Chinese style tendinomuscular acupuncture relies on careful palpation of what are called "Ah Shi" points, which often correspond to both trigger points and/or motor points in the myofascial tissue. Chinese style tendinomuscular acupuncture tends to use the lower gauge needles necessary for puncturing contraction knots with a high degree of precision. On the other hand, lighter styles of acupuncture, such as Japanese style, and many American styles, may tend towards very shallow insertions of higher gauge needles. Most acupuncture styles, especially those with lighter techniques, require a detailed knowledge, not only of western anatomy, but also of the channel networks and connections. Thus, while some forms of acupuncture are not at all the same as dry needling, the term dry needling can refer quite specifically to what is now called Myofascial Acupuncture, Tendinomuscular Acupuncture, or some version of Sports Acupuncture. The origin of the term “dry needling” is attributed to Janet G. Travell, M.D. In her book, 'Myofascial Pain and Dysfunction: Trigger Point Manual', Dr. Travell uses the term "dry needling" to differentiate between two hypodermic needle techniques when performing trigger point therapy. The two techniques she described are the injection of a local anesthetic and the mechanical use of a hypodermic needle without injecting a solution (Travell, Simons, & Simons, 1999, pp. 154–155). Dr. Travell preferred a 22-gauge, 1.5-in hypodermic needle for trigger point therapy and used this needle for both injection therapy and dry needling. Dr. Travell never used an acupuncture needle. Dr. Travell had access to acupuncture needles but reasoned that they were far too thin for trigger point therapy. She preferred hypodermic needles because of their strength and tactile feedback: “A 22-gauge, 3.8-cm (1.5-in) needle is usually suitable for most superficial muscles. In hyperalgesic patients a 25-gauge, 3.8-cm (1.5-in) needle may cause less discomfort, but will not provide the clear “feel” of the structures being penetrated by needle and is more likely to be deflected by the dense contraction knots that are the target… A 27-gauge needle, 3.8-cm (1.5-in) needle is even more flexible; the tip is more likely to be deflected by the contraction knots and it provides less tactile feedback for precision injection” (Travell, Simons, & Simons, 1999, p. 156). The use of a hypodermic needle for dry needling was described by Dr. Chang-Zern Hong in his research paper on "Lidocaine Injection Verses Dry Needling to Myofascial Trigger Point”. In his research, he describes the procedure for trigger point injection and dry needling by using a 27-gauge hypodermic needle 1 ¼-in long (Hong, 1994). Both Travell and Hong used hypodermic needles for dry needling. Dr. Hong, like Dr. Travell, did not use an acupuncture needle for dry needling. Although dry needling originally utilized only hypodermic needles due to the concern that solid needles had neither the strength or tactile feedback that hypodermic needles provided and that the needle could be deflected by "dense contraction knots", those concerns have proven unfounded and many healthcare practitioners who perform dry needling have found that the acupuncture needles not only provides better tactile feedback but also penetrate the "dense muscle knots" better and are easier to manage and caused less discomfort to patients. For that reason both the use of hypodermic needles and the use of acupuncture needles are now accepted in dry needling practice. Ofttimes practitioners who use hypodermic needles also provide trigger point injection treatment to patients and therefore find the use of hypodermic needles a better choice. As their use became more common, some dry needling practitioners without acupuncture in their scope of practice, started to refer to these needles by their technical design term as "solid filiform needles" as opposed to the FDA designation "acupuncture needle." The "solid filiform needle" used in dry needling is regulated by the FDA as a Class II medical device described in the code titled "Sec. 880.5580 Acupuncture needle" as "a device intended to pierce the skin in the practice of acupuncture." 〔(【引用サイトリンク】of Federal Regulations )">url=http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?fr=880.5580 )〕 Per the Food and Drug Act of 1906 and the subsequent Amendments to said act, the FDA definition applies to how the needles can be marketed and does not mean that acupuncture is the only medical procedure where these needles can be used.〔http://www.gpo.gov/fdsys/pkg/USCODE-2010-title21/pdf/USCODE-2010-title21-chap9-subchapV-partA-sec360j.pdf〕〔http://www.gpo.gov/fdsys/pkg/USCODE-2010-title21/pdf/USCODE-2010-title21-chap9-subchapV-partA-sec360c.pdf〕〔http://www.gpo.gov/fdsys/pkg/USCODE-2010-title21/pdf/USCODE-2010-title21-chap9-subchapV-partA-sec353.pdf〕〔http://www.gpo.gov/fdsys/pkg/USCODE-2010-title21/pdf/USCODE-2010-title21-chap9-subchapV-partE-sec360bbb.pdf〕〔http://www.gpo.gov/fdsys/pkg/USCODE-2010-title21/pdf/USCODE-2010-title21-chap9-subchapV-partE-sec360bbb-2.pdf〕 Also the FDA definition does not mean that the FDA or any US Regulatory agency defines Dry Needling as a form of Acupuncture or that the two terms are interchangeable. Dry needling using such a needle contrasts with the use of a hollow hypodermic needle to inject substances such as saline solution, botox or corticosteroids to the same point. Such use of a solid needle has been found to be as effective as injection of substances in such cases as relief of pain in muscles and connective tissue. Analgesia produced by needling a pain spot has been called the ''needle effect''. The Founder of Integrative Systemic Dry Needling (ISDN), Dr. Yun-Tao Ma PhD, L.Ac., has been spearheading the "dry needling" movement in the United States. Dr. Ma states, "Although ISDN originated in traditional Chinese methods, it has developed from the ancient empirical approach to become modern medical art rooted in evidence-based thinking and practice." 〔Ma, Yun-Tao. "Integrative Systemic Dry Needling/ A New Modality for Athletes." Biomedical Acupuncture for Sports and Trauma Rehabilitation: Dry Needling Techniques. St. Louis: Churchill Livingstone Elsevier, 2011. 4. Print.〕 Dr. Ma then contradicts himself stating, "Dry needling technique is a modern Western medical modality that is not related to Traditional Chinese acupuncture in any way. Dry needling has its own theoretical concepts, terminology, needling technique and clinical application." 〔Ma, Yun-Tao. "What Is Dry Needling?" (n.d.): 1. Web. 02 Aug. 2010.〕 Dr. Ma realizing both the self contradictions and the legal ramifications of dry needling being rooted in acupuncture and Chinese medicine has since taken down all information in his bios regarding his education in Chinese Medicine and being a Licensed Acupuncturist in the United States. 〔Ma, Yun-Tao. "Meet Your Teacher." Dry Needling Course RSS. Dr. Yun-Tao Ma, PhD, LAc, n.d. Web.〕 Dry needling for the treatment of myofascial (muscular) trigger points is based on theories similar, but not exclusive, to traditional acupuncture; both acupuncture and dry needling target the trigger points, which is a direct and palpable source of patient pain. However, dry needling theory is only beginning to describe the complex sensation referral patterns that have been documented as "channels" or “meridians” in Chinese Medicine. Dry needling, and its treatment techniques and desired effects, would be most directly comparable to the use of 'a-shi' points in acupuncture.〔Aung & Chen, 2007, p. (101 ).〕 What further distinguishes dry needling from traditional acupuncture is that it does not use the full range of traditional theories of Chinese Medicine which is used to treat not only pain, but other non muscular-skeletal issues which often are the cause of pain. The distinction between trigger points and acupuncture points for the relief of pain is blurred. As reported by Melzack, et al., there is a high degree of correspondence (71% based on their analysis) between published locations of trigger points and classical acupuncture points for the relief of pain. The debated distinction between dry needling and acupuncture has become a controversy because it relates to an issue of scope of practice of various professions. == Technique == In the treatment of trigger points for persons with myofascial pain syndrome, dry needling is an invasive procedure in which a filiform needle is inserted into the skin and muscle directly at a myofascial trigger point. A myofascial trigger point consists of multiple contraction knots, which are related to the production and maintenance of the pain cycle. Deep dry needling for treating trigger points was first introduced by Czech physician Karel Lewit in 1979. Lewit had noticed that the success of injections into trigger points in relieving pain was apparently unconnected to the analgesic used.〔 Proper dry needling of a myofascial trigger point will elicit a local twitch response (LTR), which is an involuntary spinal cord reflex in which the muscle fibers in the taut band of muscle contract. The LTR indicates the proper placement of the needle in a trigger point. Dry needling that elicits LTRs improves treatment outcomes,〔 and may work by activating endogenous opioids.〔 The activation of the endogenous opioids is for an analgesic effect using the Gate Control Theory of Pain. Inserting the needle can itself cause considerable pain,〔 although when done by well-trained practitioners that is not a common occurrence. No study to date has reported the reliability of trigger point diagnosis and physical diagnosis cannot be recommended as a reliable test for the diagnosis of trigger points. Chan Gunn introduced a type of dry needling called intramuscular stimulation in the 1980s that moved away from using trigger points. Gunn believed that the peripheral muscle spasm was not the origin of pain, but instead a tight multifidi was causing spinal nerve compression, radiculopathy, and nerve damage running peripherally. This spinal nerve damage eventually reached the associated muscle, causing spasm and transformation to a trigger point. Therefore, Gunn recommended a needle be placed in the paraspinal muscles in addition to the distally affected muscle. Peter Baldry developed a version called superficial dry needling in 2005, in which the needle is inserted about 5–10 mm into the tissue above the trigger point. Baldry practiced deep dry needling until he had a patient in the early 1980s with a trigger point in his anterior scalene muscle. Baldry decided to only penetrate the skin for fear of puncturing a lung. Baldry has such success with this technique that he applied it throughout the body by simply puncturing the skin superficially over a trigger point without actually reaching it.〔 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「dry needling」の詳細全文を読む スポンサード リンク
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