Trigger points and sensitized acupoints: same book, different covers?
Mingsheng Sun, Mingxiao Yang, Jing Rong, Xingsha Ma, Hui Zheng, Dingjun Cai, Ling Zhao, Fanrong Liang
Trigger points and sensitized acupoints: same book, different covers?
Acupoints and trigger points in traditional Chinese medicine represent two different minimally invasive therapy systems-based, respectively, on traditional acupuncture and dry needles. Many studies argue that trigger points and traditional acupoints are conceptually similar because they generally have identical locations on the human body. However, whether trigger points contribute to the formation of the traditional acupuncture technique is controversial. Although many relevant studies have been conducted, this controversy continues to hinder the development of both disciplines. Recently, researchers of Chinese acupuncture have proposed the “acupoint sensitization” theory, which postulates that traditional acupoints may be sensitized by diseases, environments, and therapies. This turns them into a “sensitized state.” Recent studies suggest that trigger points and sensitized acupoints share similar biological properties. To clarify the above-mentioned confusion, we reviewed relevant studies on these two concepts and attempted to analyze their relationship. In this paper, we provide a general summary of acupoint sensitization theory and sensitized acupoints. We then compare trigger points with sensitized acupoints by categorizing their similarities and differences, including location and range, pathological morphology, pain perception, surface temperature effects, and bioelectrical properties. We believe that, because trigger points and sensitized acupoints have many shared properties, they might constitute “the same book with different covers.”
Acupoint sensitization / Biological characteristics / Trigger points
[[1]] |
Fan AY, Xu J, Li YM. Evidence and expert opinions: Dry needling versus acupuncture (I) : The American Alliance for Professional Acupuncture Safety (AAPAS) White Paper 2016. Chin J Integr Med 2017;23(1):3-9.
|
[[2]] |
Fan AY, Xu J, Li YM. Evidence and expert opinions: dry needling versus acupuncture (II). Chin J Integr Med 2017;23(2):83-90.
|
[[3]] |
Fan AY, Xu J, Li YM. Evidence and expert opinions: dry needling versus acupuncture (III) - The American Alliance for Professional Acupuncture Safety (AAPAS) White Paper 2016. Chin J Integr Med 2017;23(3):163-165.
|
[[4]] |
Liu L, Skinner MA, Mcdonough SM, et al. Traditional Chinese medicine acupuncture and myofascial trigger needling: the same stimulation points? Complement Ther Med 2016;26:28.
|
[[5]] |
Peng ZF. Comparison between Western trigger point of acupuncture and traditional acupoints. Zhongguo Zhen Jiu 2008;28(5):349.
|
[[6]] |
Dorsher PT. Can classical acupuncture points and trigger points be compared in the treatment of pain disorders? Birch's analysis revisited. J Altern Complement Med 2008;14(4):353-359.
|
[[7]] |
Dorsher PT. On the probability of trigger point-acupuncture point correspondences: an evidence-based rebuttal of Stephen Birch's commentary. J Altern Complement Med 2008;14(10):1184-1185.
|
[[8]] |
Birch S. On the impossibility of trigger point-acupoint equivalence: a commentary on Peter Dorsher's analysis. J Altern Complement Med 2008;14(4):343.
|
[[9]] |
Birch S. Trigger point--acupuncture point correlations revisited. J Altern Complement Med 2003;9(1):91-103.
|
[[10]] |
Gibson RG, Gibson SL. Neural therapy in the treatment of multiple sclerosis. J Altern Complement Med 1999;5(6):543-552.
|
[[11]] |
Zhu H, Most H. Dry needling is one type of acupuncture. Med Acupunct 2016;28(4):184-193.
|
[[12]] |
Dorsher PT, Fleckenstein J. Trigger points and classical acupuncture points: part 1: qualitative and quantitative anatomic correspondences. Dtsch Zeitschrift Akupunkt 2008;51(3):15-24.
|
[[13]] |
Dorsher PT, Fleckenstein J. Trigger points and classical acupuncture points: part 2: clinical correspondences in treating pain and somatovisceral disorders. Dtsch Zeitschrift Akupunkt 2008;51(4):6-11.
|
[[14]] |
Simons DG, Travell JG, Simons LS. Myofascial pain and dysfunction: the trigger point manual. Volume 1. Upper half of body. Lippincott Williams & Wilkins 1999;21:22.
|
[[15]] |
Zhu B. The plasticity of acupoint. Zhongguo Zhen Jiu 2015;35(11):1203.
|
[[16]] |
Stedman's medical dictionary for the health professions and nursing. 2005;Lippincott Williams & Wilkins, 2005.
|
[[17]] |
Gerwin RD. Myofascial and visceral pain syndromes: visceral-somatic pain representations. J Musculoskelet Pain 2002;10(1-2):165-175.
|
[[18]] |
Facco E, Ceccherelli F. Myofascial pain mimicking radicular syndromes. Acta Neurochir Suppl 2005;92:147.
|
[[19]] |
Liang F. Acupuncture-Moxibustion. 2006;Shanghai Science and Technology Publishing House,
|
[[20]] |
Qi X, Ji CF, Shi H, et al. Distribution of sensitized acupoints on patients with functional intestinal disorder. World Chin Med 2013;8(3):259-262.
|
[[21]] |
Zhu B. The sensitization phenomenon of acupoint and biological significances. Zhongguo Zhen Jiu 2019;39(2):115-121.
|
[[22]] |
Lin W, Liu X, Zhou Y, et al. Research on the surface temperature of related channel points in patients with knee osteoarthritis based on infrared imaging technology. Modern Tradit Chin Med Mater Med 2021;23(05):1484-1489.
|
[[23]] |
Dorsher PT. Myofascial meridians as anatomical evidence of acupuncture channels. Med Accupunct 2009;21(2):91-97.
|
[[24]] |
Melzack R, Stillwell DM, Fox EJ. Trigger points and acupuncture points for pain: correlations and implications. Pain 1977;3(1):3-23.
|
[[25]] |
Wang C, Ge HY, Ibarra JM, et al. Spatial pain propagation over time following painful glutamate activation of latent myofascial trigger points in humans. J Pain 2012;13(6):537-545.
|
[[26]] |
Defrin R, Ronat A, Ravid A, et al. Spatial summation of pressure pain: effect of body region. Pain 2003;106(3):471-480.
|
[[27]] |
Xu GX, Zhou YM, Sun MS, et al. Clinical observation on distribution characteristics and rules of pain sensitivity points on body surface in patients with knee osteoarthritis. Zhongguo Zhen Jiu 2020;40(11):1198-1201.
|
[[28]] |
Yu LL, Li L, Qin QG, et al. Colorectal nociceptive signal input facilitates impact of acupoint stimulation of “Zusanli” (ST 36) on electrical activities of wide dynamic range neurons in lumbar spinal cord in rats. Acupunct Res 2014;39:390-395.
|
[[29]] |
Rong P, Li X, Li L, et al. Mechanism of dorsal column nuclei in acupoint sensitization phenomena. World Chin Med 2013;(4):316-319.
|
[[30]] |
Gerwin R. Myofascial pain syndrome: here we are, where must we go? J Musculoskelet Pain 2010;18(4):329-347.
|
[[31]] |
Henderson JC. Myofascial pain and dysfunction: the trigger point manual. J Can Chiropr Assoc 1984;28(3):341.
|
[[32]] |
Zhou K, Ma Y, Brogan MS. Dry needling versus acupuncture: the ongoing debate. Acupunct Med 2015;33(6):485.
|
[[33]] |
Trigger T, Manual P. Myofascial pain and dysfunction, The trigger point manual, 2nd Edition. (2 Volumes). Anesth Analg 2001;13(1):69-70.
|
[[34]] |
Legge D. A history of dry needling. J Musculoskelet Pain 2014;22(3):301-307.
|
[[35]] |
Jing Y, Han Y, Qi-wei X, et al. Phenomenon and regularity of acupoints sensitization for knee osteoarthritis. China J Tradit Chin Med Pharm 2019;34(11):137-140.
|
[[36]] |
Hairong L, Jianbin Z, Xiaohui H. Clinical application of acupoints diagnostic method. Jilin J Tradit Chin Med 2014;(4):5.
|
[[37]] |
Takla MK, Razek NM, Kattabei O, et al. A comparison between different modes of real-time sonoelastography in visualizing myofascial trigger points in low back muscles. J Man Manip Ther 2016;24(5):253-263.
|
[[38]] |
Ballyns JJ, Turo D, Otto P, et al. Office-based elastographic technique for quantifying mechanical properties of skeletal muscle. J Ultrasound Med 2012;31(8):1209-1219.
|
[[39]] |
Sikdar S, Shah J, Gebreab T, et al. Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue. Arch Phys Med Rehabil 2009;90(11):1829-1838.
|
[[40]] |
Zhang WJ, Liu ZC, Gao Y, et al. Clinical efficacy on knee osteoarthritis treated with ashi points based on the evaluation of musculoskeletal ultrasound technology. World J Integr Tradit West Med 2014;9(8):834-836.
|
[[41]] |
Müller CE, Aranha MF, Gavião MB. Two-dimensional ultrasound and ultrasound elastography imaging of trigger points in women with myofascial pain syndrome treated by acupuncture and electroacupuncture: a double-blinded randomized controlled pilot study. Ultrason Imaging 2015;37(2):152-167.
|
[[42]] |
Hudspith MJ, Siddall PJ, Munglani R. Chapter 23 - Physiology of pain. Foundations of Anesthesia 2006;267-285.
|
[[43]] |
Li YQ, Rong PJ, Xu WD, et al. Conditioning stimulation induced change in receptive field of spinal neurons. Chin J Neurosci 1999;316-319.
|
[[44]] |
Cummings M, Baldry P. Regional myofascial pain: diagnosis and management. Best Pract Res Clin Rheumatol 2007;21(2):367.
|
[[45]] |
Delaney GA, Mckee AC. Inter- and intra-rater reliability of the pressure threshold meter in measurement of myofascial trigger point sensitivity. Am J Phys Med Rehabil 1993;72(3):136.
|
[[46]] |
Bendtsen L, Jensen R, Jensen NK, et al. Muscle palpation with controlled finger pressure: new equipment for the study of tender myofascial tissues. Pain 1994;59(2):235.
|
[[47]] |
Bendtsen L, Jensen R, Olesen J. Qualitatively altered nociception in chronic myofascial pain. Pain 1996;65(2-3):259-264.
|
[[48]] |
Zhang Y, Ge HY, Yue SW, et al. Attenuated skin blood flow response to nociceptive stimulation of latent myofascial trigger points. Arch Phys Med Rehabil 2009;90(2):325.
|
[[49]] |
Shultz SP, Driban JB, Swanik CB. The evaluation of electrodermal properties in the identification of myofascial trigger points. Arch Phys Med Rehabil 2007;88(6):780-784.
|
[[50]] |
Kruse RA Jr, Christiansen JA. Thermographic imaging of myofascial trigger points: a follow-up study. Arch Phys Med Rehabil 1992;73(9):819-823.
|
[[51]] |
Prushansky T, Handelzalts S, Pevzner E. Reproducibility of pressure pain threshold and visual analog scale findings in chronic whiplash patients. Clin J Pain 2007;23(4):339.
|
[[52]] |
Chae Y, Kim HY, Lee HJ, et al. The alteration of pain sensitivity at disease-specific acupuncture points in premenstrual syndrome. J Physiol Sci 2007;57(2):115-119.
|
[[53]] |
Qi XZ, Chen LZ, Zhang XN, et al. Distribution of algesia sensitized acupoints in the patients of intestinal cancer. Zhongguo Zhen Jiu 2017;37(9):963-966.
|
[[54]] |
Chen S, Miao Y, Nan Y, et al. The study of dynamic characteristic of acupoints based on the primary dysmenorrhea patients with the tenderness reflection on Diji (SP 8). Evid Based Complement Alternat Med 2015;2015:158012.
|
[[55]] |
He W, Wu M, Jing XH, et al. Entity of acupoint: kinetic changes of acupoints in histocytochemistry. Zhongguo Zhen Jiu 2015;35(11):1181.
|
[[56]] |
Farasyn A, Meeusen R. Effect of roptrotherapy on pressure-pain thresholds in patients with subacute nonspecific low back pain. J Musculoskelet Pain 2007;15(1):41-53.
|
[[57]] |
Moraska AF, Schmiege SJ, Mann JD, et al. Responsiveness of myofascial trigger points to single and multiple trigger point release massages: a randomized, placebo controlled trial. Am J Phys Med Rehabil 2017;96(9):639.
|
[[58]] |
Hong CZ, Simons DG. Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points. Arch Phys Med Rehabil 1998;79(7):863-872.
|
[[59]] |
Hong CZ. Pathophysiology of myofascial trigger point. J Formos Med Assoc 1996;95(2):93-104.
|
[[60]] |
Shah JP, Phillips TM, Danoff JV, et al. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol 2005;99(5):1977-1984.
|
[[61]] |
McLennan H. The theoretical foundations of Chinese medicine by Manfred Porkert. Pacific Affairs 1978;47(4):533.
|
[[62]] |
Shah JP, Gilliams EA. Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome. J Bodyw Mov Ther 2008;12(4):371-384.
|
[[63]] |
De SR, Selvi E, Villanova M, et al. Image analysis quantification of substance P immunoreactivity in the trapezius muscle of patients with fibromyalgia and myofascial pain syndrome. J Rheumatol 2000;27(12):2906-2910.
|
[[64]] |
Shah JP, Danoff JV, Desai MJ, et al. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch Phys Med Rehabil 2008;89(1):16.
|
[[65]] |
Müller W, Stratz T. Local treatment of tendinopathies and myofascial pain syndromes with the 5-HT3 receptor antagonist tropisetron. Scand J Rheumatol Suppl 2009;33(sup119):44-48.
|
[[66]] |
Baldry PE, FRCP MB, John W, et al. Acupuncture, Trigger Points and Musculoskeletal Pain (Third Edition). 2005;Churchill Livingstone, 384.
|
[[67]] |
Rossi C, Sehnem E, Rempel C. A termografia infravermelha na avaliação dos pontos-gatilho miofasciais em patologias do ombro. Conscientiae Saude 2013;12(2):208-212.
|
[[68]] |
Li CR, Xun L, Bai ZH, et al. Characteristic research of three yin meridians of hand distributed in upper arms of pulmonary tuberculosis using infrared thermal imaging. J Liaoning Univ Tradit Chin Med 2013;15(2):99-101.
|
[[69]] |
Ovechkin AM. Application of infrared thermography in diagnostics of acute viral infections of respiratory system. Med Thermogr 2002;1(2):70-76.
|
[[70]] |
Chen RX, Kang MF, Chen MR. Return of Qibo: on hypothesis of sensitization state of acupoints. Zhongguo Zhen Jiu 2011;31(2):134-138.
|
[[71]] |
Ovechkin A, Lee SM, Kim KS. Thermovisual evaluation of acupuncture points. Acupunct Electrother Res 2001;26(1-2):11.
|
[[72]] |
Ovechkin A, Kim KS, Lee JW, et al. Thermo-visual evaluation of the Yin-Tang acupuncture point for intracranial hypertension syndrome. Am J Chin Med 2003;31(3):455.
|
[[73]] |
Zhang YQ, Ding GH, Shen XY. Difference of the infrared spectra radiated from the acupoints between healthy volunteers and patients of coronary heart disease. Zhongguo Zhen Jiu 2004;(12):846-849.
|
[[74]] |
Shui YL, Institute QH, Pasadena
|
[[75]] |
Zhang D. A method of selecting acupoints for acupuncture treatment of peripheral facial paralysis by thermography. Am J Chin Med 2007;35(6):967.
|
[[76]] |
Agarwalkozlowski K, Lange AC, Beck H. Contact-free infrared thermography for assessing effects during acupuncture: a randomized, single-blinded, placebo-controlled crossover clinical trial. Anesthesiology 2009;111(3):632-639.
|
[[77]] |
Zheng X, Hua LU. Study of thermo metabolic features in infertility with Yang-deficiency. Liaoning J Tradit Chin Med 2014;41(07):1412-1413.
|
[[78]] |
Seixas A, Soares M, Vardasca R, et al. Using thermal imaging to monitor the treatment of latent myofascial trigger points. 3th Quantitative InfraRed Thermography 2016;10.21611/qirt.2016.118.
|
[[79]] |
Gu Z, Cheng W, Ping Y. Observation of temperature variations at acupoints before and after needling using infrared thermographic apparatus—a preliminary report. Acupunct Res 1989;138613528.
|
[[80]] |
Meng XW, Liu GW, Wang XY, et al. An infrared-thermal-image observation on the therapeutic effects of puncturing Si-Tian-acupoint in patients with cervicalspondylotic radiculopathy. Shanghai J Acupunct Moxibust 2003;(09):29-31.
|
[[81]] |
Bron C, Dommerholt JD. Etiology of myofascial trigger points. Curr Pain Headache Rep 2012;16(5):439-444.
|
[[82]] |
Moreira DVQ, Nohama P. Mapeamento térmico nos pontos de acupuntura. Rev Univ Vale Do Rio Verde 2016;14:1034-1043.
|
[[83]] |
Shultz S, Driban J, Swanik C. The evaluation of electrodermal properties in the identification of myofascial trigger points. Arch Phys Med Rehabil 2007;88(6):780-784.
|
[[84]] |
Chiou SY, Chao CK, Yang YW. Topography of low skin resistance points (LSRP) in rats. Am J Chin Med 1998;26(1):19.
|
[[85]] |
Becker RO, Reichmanis M, Marino AA, et al. Electrophysiological correlates of acupuncture points and meridians. Psychoenerg Syst 1976;(1):105-112.
|
[[86]] |
Zhu B, Chen G, Xu R. Electrical characteristics and specificities of auricular points. Zhongguo Zhen Jiu 2001;(12):27-30.
|
[[87]] |
Al-Kasasbeh R, Korenevskiy N, Ionescou F, et al. Prediction and prenosological diagnostics of heart diseases based on energy characteristics of acupuncture points and fuzzy logic. Comput Methods Biomech Biomed Eng 2012;15(7):681-689.
|
[[88]] |
Kim SB, Lee NR, Shin TM, et al. Development and evaluation of a multi-frequency bioelectrical impedance analysis analyzer for estimating acupoint composition. J Acupunct Meridian Stud 2014;7(1):33.
|
[[89]] |
Colbert AP, Larsen A, Chamberlin S, et al. A multichannel system for continuous measurements of skin resistance and capacitance at acupuncture points. J Acupunct Meridian Stud 2009;2(4):259.
|
[[90]] |
Liang Y, Ma SX, Chen JX. Effect of nitric oxide on noradrenergic function and skin electric resistance of acupoints and meridians. Acupunct Res 2008;33(3):213.
|
[[91]] |
Chen RX, Ming-Fei R, Chen MR. Return of Qibo: on hypothesis of sensitization state of acupoints. Zhongguo Zhen Jiu 2011;31(2):134-138.
|
[[92]] |
Liu S, Wang Z, Su Y, et al. A neuroanatomical basis for electroacupuncture to drive the vagal-adrenal axis. Nature 2021;598(7882):641-645.
|
[[93]] |
Li L, Rong P, Luo M, et al. The central mechanisms underlying the phenomenon of acupoint sensitization evoked by visceral nociceptive afferent. Zhongguo Zhen Jiu 2015;35(11):1187-1191.
|
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