In other news —

I participate in conversations on various listserves and I often touch on topics I would like to share here, but don’t have time to flesh into a full post or make a proper introduction. I’m going to go for content over polishing and am hoping you all can manage to pick it up on the fly (which is how it was written) —

This is from a thread that began in response to the SNL acupuncture skit.  Some colleagues were upset that it would scare people away from acupuncture, which led to posts about how practitioners already have to reassure potential clients that acupuncture doesn’t hurt, which led to posts pointing out that sometimes acupuncture does hurt, which led to this post (slightly edited, and with some formatting issues I can’t correct. Sorry.) —

This makes me think of the conversations I have with acupuncturists about TPDN.  Often one concern is that “dry needling” is acupuncture and we acupuncturists are the best trained people to be doing this technique.  Another concern is that people go to PT’s and have this treatment and it hurts and then they think that acupuncture hurts.  Among the things I usually ask when I’m in this dialogue —
1)  Did you learn this technique in acupuncture school and were you using it regularly?  (I was not taught it at TAI and from the conversations I’ve had NESA Tri-State is the only [US] school where most students were learning the technique prior to when LAcs felt threatened by the PT’s “stealing” it.)
2)  If you used this technique didn’t you notice that it is painful even when done by an LAc?  After all, you are sticking needles into a tender spot and lifting and thrusting until the muscle releases.
3)  Since when are we guaranteeing that our treatments will be pain free?  Is this something we want to start regulating — if it hurts you can’t do it?
4)  If this technique is uncomfortable and gives people the wrong impression about acupuncture, why are we insisting that the PT’s use that term?  If you want consumers to think of acupuncture as pleasant and painless, isn’t it better to call this technique dry needling?
That’s this afternoon’s contribution to “In other news.”  Just some things to think about.


Copyright —

© Elaine Wolf Komarow and The Acupuncture Observer, 2013-2033. Unauthorized use and/or duplication of this material without express written permission from Elaine Wolf Komarow is prohibited. Excerpts and links are encouraged, provided that full and clear credit is given with specific direction to the original content.

15 thoughts on “In other news —

  1. As to the SNL skit: HAHAHAHA! My patients who watched it thought it was hilarious. The people who watch Saturday Night Live are not likely to be scared off by a funny over-the-top skit.

    It’s always amazed me that we aren’t the subject of more jokes. The idea of acupuncture is funny. It’s bizarre-ness can’t help but be at the center of comedic repertoire. It’s practically begging to be made fun of – bring it on, I say!

    (Then again, you don’t see me posting the link to the SNL skit on my home page.)

  2. I agree that it shouldn’t take 300 hours to teach a professional body therapist (PT, chiropractor, acupuncturist, etc.) how to do trigger point needling.

    Maggie, in fact, we called it trigger point needling, and not TPDN, in the early days with Mark Seem. He also referred to the technique as Tight Tender Point needling for a while. He believed it to be a form of dry needle technique. I suspect TPDN arose from a need for a term that included what physical therapists were calling it. (Mark, you should jump in if you read this and I’m misquoting you!)

    As to frequency of use, I use this technique several times a day, and not always for physical pain conditions. I categorize it as one of many acupuncture techniques, rather than as a “tradition” or “style” of acupuncture. When I use it, it is in the context of a framework of theory, such as meridian energetic, or TCM, or, yes, five element, to name a few.

    I too, learned it after graduation, when we were calling it trigger point needling. It fit in with my meridian theory protocol, and I had actually been doing a less directed version of it when using this protocol without realizing what it was.

    The issue of whether other professional therapists and doctors may use TPDN is political. Practically speaking, many are capable with proper training. As Elaine pointed out, acupuncturists also need to have proper training to perform TPDN.

    As an acupuncturist, I am more worried about this technique being removed from my own scope of practice than I am about properly trained professionals doing it.

  3. I completely understand what you are saying and it is why I’m not completely up in arms about it. However, tribally, I’ve felt obligated to stick to the larger going mojo that we be territorial about certain practices.
    Really, I supposed if I had a PT who had taken an intensive course that constituted at least 300 hours of practice and didactic trigger point needling I probably would not be afraid to have one perform it on me. Let’s face it, TPN is very different than the rest of what we commonly do with needles and it wasn’t something my school taught. I learned it later.

    • Well, mainly what I’m saying is that tribal thinking creates a lot of destruction in our world, so perhaps we want to get beyond that. As for the 300 hours, I think it would be a good idea to have a thoughtful conversation about how many hours of training it actually takes to learn a needle manipulation and needle safety — especially for someone who already has an excellent understanding of anatomy (better than most LAcs, perhaps) and may already be able to do things (depending on the state) such as wound debridement or emg’s. I don’t think I could think of 300 hours of things to teach that person. When I learned TPDN I didn’t get more than 3 hours of practice, even though it was nothing like the acupuncture I had been taught.

      I absolutely understand the initial emotional reaction LAcs get when they think about TPDN. It is unwise to base our public and political response on our initial emotional reaction. I’m glad you aren’t up in arms, but thus far the response of the acupuncture community has been an armed response.

  4. OH! One more thing; about the SNL skit. Gotta keep a sense of humor! It was kind of yucky, but I thought it was funny. I wouldn’t worry about something like that being detrimental at all. EVERYONE in any kind of limelight and EVERY profession gets fun made of at sometime. It’s part of life.

    • Yah, we’re not known for our sense of humor. In my house, we all laughed, then I thought, ohhhh, folks are going to get upset about this.

  5. Even in a booklet I wrote explaining Acupuncture, I do NOT say it is painless. I qualify what type of needling may be necessary for certain ailments and how that may feel to some people.
    I do see your point in having the PT’s continue to call it Dry Needling rather than Acupuncture and am glad that here in Connecticut we managed to include the term Dry Needling in our standards of care. I’m not sure why it isn’t just called trigger point needling.
    When and if a client may need Trigger point needling, I make clear explanations about what it is, how it will feel, and that it is different than my traditional Acupuncture needling. If it does create what a client perceives as too much pain or discomfort I won’t continue or push it.
    No matter what, there are always people out there for whom any type of needling does hurt no matter what technique, but there is no getting around that Trigger point needling is not whimpy stuff and we need to be very clear with our clients about what we are offering and doing.
    I do believe that both Acupuncture and DN or TPN should belong to Acupuncturists, but I have to say, considering Dry needling is based more on anatomical locations than acupoints, although there are tons of correlations, PT’s use that as a leg to stand on and they do have the anatomical training. Chances are they aren’t going to pierce a blood vessel or lung because they aren’t an Acupuncturist.
    This is a hard one for me. I’m not not completely clear about how to address the issue.

    • Maggie — I expect if the acupuncture community had thought this through, gone to the PT Boards, and requested that they use the term Trigger Point Dry Needling to properly describe the procedure, distinguishing it from what we do, and helping to avoid the slippery slope of PT’s using distal points (as described by Mark Seem and as I hear is being done by PT’s) I expect it would have been given thoughtful consideration. Instead we went in there talking about how they were a danger to the public, which isn’t a great way to begin a dialogue.

      As for TPDN belonging to Acupuncturists, remember that, in some states, the MD’s felt that Acupuncture belonged to them. The psychiatrists thought counseling belonged to them. Does dietary advice belong to the nutritionists? Tui Na to the MST’s. I understand the feeling that we know best and we should control this procedure, but if we start thinking about what it would be like if that principle were applied across the board, it wouldn’t make for better healthcare and it wouldn’t be a climate we’d enjoy. Keep in mind, too, that there are a lot of folks in the US who live places where there are no LAcs accessible. Should they suffer?

      I’ve written about it before, but I believe there are ways we could have remained a positive influence on patient care and TPDN through open dialogue and mutual respect with other professions. But, for the most part, we’ve instead gone about casting aspersions on other professions and demanding what we would find intolerable if the tables were turned.

    • Maggie, I’d love to see your booklet – I didn’t know you had written one. I’ll check it out next time I’m over. Or maybe get the pdf from you.

  6. I think TPDN use is a question of protecting profession’s integrity and safety of our patients. It is also a question of reimbursement and inclusion of that techique in a scope of practice, of course 🙂
    I, personally, never advertise acupuncture as a painless procedure, because there are situations and points that will – and should be – sensitive.

    I learned that techinque in Eastern School (NJ) and used it for some of my patients and had it done on myself, many times. I do have to say, that if done properly, it doesn’t necessarily hurt – more like a very unpleasant twitching during the TPN. You do feel like you’ve been hit by the truck shortly after, wich goes away though 🙂

    IMHO, TPDN is an acupuncture, and it should be used and billed by properly trained professionals (L.Ac’s) only. I would hate to see the Ma Huang story to be repeated, when someone untrained hurts people and the whole branch is being shut off because of it.
    Do you?

    • Taya — There are a few different things going on in your post, so I’m going to try and separate them out. First of all, regarding Ma Huang, the problem arose not because other trained professionals were misusing a regulated herb. The problem arose because herbs are not regulated — the substances themselves are generally available to anyone, and many in our field scream bloody murder anytime there is any legislation introduced that would regulate herbs. So, if we say the FDA should not regulate herbs and supplements, which most of us do, then we pay the price when folks use them in ways they weren’t intended.

      One person’s unpleasant twitch is another person’s pain 🙂 Even when done properly, some folks are going to experience this technique as being painful, and we seem to agree that discomfort is not proof that the treatment is being done poorly.

      As for TPDN — we do have regulations which protect the safety of our patients. And, there is a regulatory board that protects the safety of PT patients too. That’s the PT board. The acupuncture board doesn’t get to regulate PT’s, we regulate acupuncturists. (We have acupuncturists who have IV therapy as part of their scope — how does that work?) As for billing, I’ve noticed that as more acupuncturists take insurance more and more seems to be added to folks acupuncture bills. All of a sudden we have billing for hot packs, for example.

      I’m curious, how often do you use this technique in your treatment room — on most of your pain patients at some point?

      Mainly, I dislike hypocrisy. Do we feel we should be able to regulate our own profession? Would we defer to the Massage boards if they thought we shouldn’t add tui na to our scopes? I just want to be sure we aren’t asking for something (veto over another profession’s practices) if we wouldn’t accept the same level of interference.

  7. Actually it was Tri-State College of Acupuncture (or Tri-State Institute of Traditinal Chinese Acupuncture at that time) in NYC, not NESA, that pioneered this technique as part of acupuncture, pre-PT scare.

      • Gosh, I can only estimate and someone will doubtless correct me. I studied there in the late 1980s when the focus was French Vietnamese meridian theory. I served on faculty there from 1990-2005, and would guess this TP technique gradually became the focus in late 1990s, or maybe early aughts. Mark Seem brought it to acupuncture attention, and developed the acupuncture version we know today.

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