Event 5: Margaret Meets With an Acupuncturist

Margaret and her mother decide to see an acupuncturist to discuss pain management options.

Deciding to Seek Acupuncture for TMJ

Patients may seek out a Licensed Acupuncturist based on information received from numerous sources including positive experiences reported by members of their social network.

Alternatively they may be referred by a health care provider.

Patients with chronic unresolved TMJ pain will often seek out acupuncture.

Evidence Base

The evidence base for acupuncture is limited by many  factors. However, TMJ pain has been shown to respond to acupuncture treatment in a number of studies.

Margaret's Present Disease History

Inquiry: Present Disease History

Ten Questions 

  • Body Temperature (Hot/Cold)
  • Sweat
  • Head/Body
  • Urine/Stool
  • Drink/Food/Taste
  • Ears & Eyes
  • Chest/Rib-side/Abdomen
  • Thirst/Beverages
  • Sleep
  • Children, Men, Women, Geriatrics

Summary of Findings on Inquiry

  • Cold & Heat
    • The patient reports slightly warm  sensation, in general.
  • Head & Body
    • Reports right-sided jaw pain that involves the neck and is associated with headaches. The pain is impacting her ADLs by reducing activities, reducing the volume and variety of food consumed, isolating her from social contacts, and interfering with sleep.
  • Preference for cold beverages
  • Sleep
    • Wakes due to pain with need to reposition.
  • Menarche at age 13, with regular cycle and flow. Some irritability and pain prior to Menses; the jaw pain can seem worse at this time.

Inquiry About Head and Body

Questions concerning sensations and experiences of the head and body,
including pain, help to elicit information about the region, type, and nature of the patient’s pain.

Current Prescribed Medications

  • Fioricet

Inspection & Palpation

  • Inspection of the body
  • Inspection of the tongue
  • Palpation of affected and associated regions
    • Arms
    • Neck
    • Shoulder
    • Jaw
    • Head
  • Palpation of radial pulse

Examination by Acupuncturist

Margaret’s Findings on Examination

  • Tongue
    • Narrow, pale red to pale, heat speckles, thin white fur
  • Pulse 
    • 75 bpm, string like, more force on right side, deep forceless on left

Chinese Medicine Interpretation of Findings

  • Trauma disrupts the flow of qi and blood in the affected region leading to pain
  • The experience of pain can disrupt the “free coursing of the liver” leading to signs of stress, irritability, and heat, can be characterized as “liver depression” or “liver qi stagnation”
  • Disruption of sleep and diet puts pressure on the middle burner, the residence of the spleen and stomach, which, through the transformation of food, provides the energy needed by the body for its activities

Acupuncturist Reviews Findings With Margaret and Her Mother

Disease and Pattern

  • Most diseases in Chinese medicine are associated with a pattern based on presenting signs and symptoms. 
  • In this case, the pattern diagnosis is less relevant than  the damage done by trauma to the channel sinews resulting in stagnation of qi and blood causing pain. There are signs of liver qi stagnation as well.

Assessment

Assessment: Qi and blood stagnation due to trauma affecting the channel sinews
of the stomach, large intestine, small intestine, and tripper burner. Liver qi depression with heat rising.

Treatment Plan

Acupuncture in the US is often delivered weekly. Based on professional practice and
the delivery of care in China, as well as on published studies, this may be suboptimal. Cost, access, and convenience can prevent more frequent treatment.

Treatment

Several acupuncture modalities would be provided:  

Acupuncture Treatment

Acupuncture treatment would be provided to specific points selected on the basis of palpation and traditional theory as well as to associated distal points and points selected to address clinical issues specifically related to jaw pain, neck pain, and headache. Additionally points would be selected to course the liver qi and clear heat.

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