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Needles that bring relief from chronic pain
Extract from The Times - 17/2/2000
An elderly woman with neck pain sits with two lines of needles
stuck into her naked back; an amputee who has suffered 22 years
of constant pain lies groaning as his right buttock gets similar
treatment; and a middle aged woman with discomfort in several parts
of her body has a row of needles protruding from her spine.
This may sound uncomfortable, but the practice could herald a revolution
in chronic-pain relief. The work has begun quietly at Addenbrooke's
Hospital Cambridge, where a small team with limited resources is
pioneering a technique called intramuscular stimulation (IMS).
IMS, a needle technique that has been used in Canada and Sweden
for many years, is often described as a "sort of scientific
acupuncture". But instead of the "chi" energy and
meridian lines of traditional Chinese medicine, it is concerned
with the musculoskeletal system. The technique was developed from
the 1970's onwards by the Canadian professor Dr Chann Gunn. Now
two of his disciples, Dr Rajesh Munglani and Robin Shepherd have
combined forces to show that IMS can have a dramatic effect
in reducing chronic pain.
Whatever the nature of chhronic pain, muscle spasm is often an
integral part. IMS is based on a technique familiar to osteopaths,
who induce relaxation in a muscle by tightening it and then letting
go. The advantage with the needling is that it can go deep into
the body- sometimes several inches- to hit the right spot. A knotted
muscle will "grab" the needle and after a while "let
go"- and carry on relaxing after the needle has been removed.
An osteopath who saw the possibilities of IMS early on was Robin
Shepherd, who began using to great effect in his practice in Surrey.
When Munglani ran an IMS course at Addenbrooke's, Shepherd attended
and the two men felt they could work together: Munglani with his
anaesthetists background and obsession with getting closer to the
roots of pain; Shepherd with his osteopaths skill at palpating to
find to the exact points of problem muscle. Shepherd was so keen
to pursue this partnership that he moved to the Cambridge area,
where he divides his time between his work at Addenbrooke's and
private practice. The pain relief service operates five days a week,
dispensing advice to patients and also educating nurses and other
health workers. But, due to limited resources, the Munglani and
Shepherd double act only performs once a week.
On their clinic day, when Munglani concentrates on thermocoagulation
and PFR, while Shepherd taps in IMS needles, they see patients with
chronic pain, all of whom have been referred by a GP or consultant.
"I'm a needle phobic," says Victor Marsh, 40,"but
I tried this because I was in so much pain." He lost his right
arm in a motorcycle accident at the age of 18. He had lived with
pain for years before coming to see Shepherd.
His original reason for seeking help was phantom pains in his missing
limb, but by the time he got to Addenbrooke's he had developed severe
pain in his right leg and lower back. Two IMS treatments had given
him relief. Now he was back for a third session, with Shepherd inserting
three needles into his right buttock- one going in about four inches.
When another needle goes into his leg, just above the knee, he shudders
with pain and utters an agonised cry. "Yes, that's the spot,"
says Shepherd with a smile. "After treatment it's agony for
a day," says Marsh, from Fulbourn, near Cambridge," but
then it's better. The needling does seem to make the pain easier."
Katherine Kenny is in her late seventies. She came in with severe
neck pain that had plagued her for 10 years and found herself sitting
with her head face down on a pillow and 10 of Shepherd's needles
arranged in her upper back. "You've got wear and tear from
overuse," Shepherd tells her. "You have relied on your
shoulders for a long time. They have carried a lot of tension- while
you have been caring for others and perhaps neglecting yourself."
She nods in confirmation.
"Knowledge of anatomy is essential if you are going to practice
IMS ," says Shepherd. There are potential dangers. Areas around
the front and side of the lower part of the neck, and at the centre
of the base of the skull, are no-go zones. With the former there
is the danger of pneumothorax and with the latter of damage to the
brain stem.
The needles stay in for up to 15 minutes. Shepherd removes them
when he can feel that the muscle is ready to "let go".
A clinical trail of IMS is due to start shortly at Addenbrooke`s
with a comparative study of two groups of patients- one on IMS and
one receiving "dummy" therapy. "Its an important
therapy," says Shepherd. "But it needs some status
and credibility before it can take off."
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