acupuncture, trigger points and musculoskeletal pain 3rd ed

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  1. 1. To Oina, my wife, for her patience and forbearance during the writing of this book. The phenomena of pain belong to that borderland between the body and soul about which it is so delightful to speculate from the comfort of an armchair, but which offers such formidable obstacles to scientific inquiry. J. H. Kellgren (1948) Extracts from reviews of the first edition: I warmly recommend this book to anyone who wants to learn more about this often neglected area of common musculoskeletal pain conditions Journal of the Royal College of Physicians of London This is a book that should belong to physicians, neurologists, rheumatologists and teachers of medical students Pain Endorsements of the new edition: Peter Baldry is one of the most respected practitioners of Medical Acupuncture in the UK. This new edition is yet another first-class book, which adeptly combines the theory and practice of treatment of trigger points for musculoskeletal pain. An eminently readable and informative text; this is a tour du force and an essential acquisition for those practitioners who want a clear practical guide for the treatment of musculoskeletal pain using trigger point treatment and the scientific understanding that underpins the treatment. Jacqueline Filshie, Consultant in Anaesthesia and Pain Management, Royal Marsden Hospital, London and Surrey; Secretary of the British Medical Acupuncture Society In this fine comprehensive book, Dr Baldry removes much of the mystique from acupuncture as a technique for musculoskeletal pain relief. Using a fully scientific integration of Eastern and Western knowledge, coupled with the relevant literature on clinical effectiveness of acupuncture, he provides an ideal, evidence-based text for the practitioner. From the beginner to the expert, anyone with an interest in the nature of muscle pain, its pathophysiology and treatment will be informed by this book: the entry-level therapist will gain a better understanding based on sound scientific evidence, while the experienced clinician will be rewarded with a well-written guide to what is significant in everyday clinical practice. Clinicians of several medical specialties (neurologists, orthopaedic surgeons, general practitioners, pain specialists, physiatrists) and other practitioners (acupuncturists, physiotherapists, nurses, occupational therapists) will find this book an indispensable reference in their daily work. For those who wish to implement acupuncture in the clinic, this textbook is an invaluable resource for responsible practice. In total, this book offers an innovative approach to the diagnosis, understanding and treatment of myofascial trigger point pain using acupuncture that integrates all current concepts of neurophysiology and neuroanatomy principles. Dr Peter Baldry is to be congratulated for conceptualizing, editing and writing such a truly valuable asset for every clinical practice. Dr George Georgoudis, Research Physiotherapist, University of Manchester, UK; Lecturer, Technological Educational Institute of Athens, Department of Physiotherapy, Greece; Tzanio General Hospital of Pireaus, Greece For Elsevier Ltd Commissionning Editor: Karen Morley Project Development Manager: Kerry McGechie Project Manager: Derek Robertson
  2. 2. Distributed in the United States of America by Redwing Book Company, 44 Linden Street, Brookline, MA 02146. Longman Group UK Limited 1993 Harcourt Brace and Company Limited 1998 Harcourt Publishers Limited 2000 Elsevier Ltd 2005 No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without either the prior permission of the publishers or a licence permitting restricted copying in the United Kingdom issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1T 4LP. Permissions may be sought directly from Elseviers Health Sciences Rights Department in Philadelphia, USA: phone: (1) 215 238 7869, fax: (1) 215 238 2239, e-mail: You may also complete your request on-line via the Elsevier homepage (, by selecting Customer Support and then Obtaining Permissions. First edition 1989 Second edition 1993 Third edition 2005 Translated into Japanese 1995 Translated into German 1996 ISBN 0 443 06644 2 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress Note Knowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the author assumes any liability for any injury and/or damage. The Publisher Printed in China The Publishers policy is to use paper manufactured from sustainable forests
  3. 3. Quod est ante pedes nemo spectat: coeli Scrutantur plagas. (What is before ones feet no one looks at; they gaze at the regions of heaven.) Ennius, quoted by Cicero, De Divinat., 2, 13. This is an important and valuable book that needed to be written. Musculoskeletal or myofas- cial pain is an all too common and extraordinarily neglected subject of medicine; it is barely men- tioned in many textbooks of medicine. In reality it is a ubiquitous condition that causes a great deal of pain and suffering and one which, unfortu- nately, either slips by unrecognized or is passed off as trivial or untreatable. In this book Dr Peter Baldry has shown how musculoskeletal pain can be simply and effectively treated by acupuncture. But this book is much more than that because it is really three books in one. The first part presents an interesting historical background to Chinese acupuncture and its spread to the outside world, particularly to the West. The second part deals with the principles of trigger point acupuncture wherein, over the course of six chapters, the reader is presented with a detailed and critical account of the evidence for and the nature of trigger points and the way in which acu- puncture can be used to deactivate them. Dr Baldry spares no effort to provide the reader with an up-to- date and accurate account of the neurophysiology of pain and the possible ways in which acupunc- ture can be used to control it. He also grasps the dif- ficult and important nettle concerning the scientific evaluation of acupuncture. The results of properly controlled experiments and trials demonstrating the efficacy of acupuncture are slowly but surely accumulating and Dr Baldry discusses these criti- cally and points the way to the further rigorous studies that are urgently needed. The third part of the book gives a detailed and splendidly practical account of the many different forms of muscu- loskeletal pain and the way that these can be treated with acupuncture. Even for the reader who does not intend to use acupuncture, this book still serves a most valuable purpose by drawing attention to the very large number of common musculoskeletal pain condi- tions that are all too commonly overlooked. A par- ticularly helpful feature of Dr Baldrys book is the rich admixture of case histories of his own patients, from which the medical reader can learn the correct way to diagnose and subsequently to treat these painful conditions. There seems little doubt that, through unfamil- iarity with this condition, much time and effort are often expended unnecessarily both by the medical profession and by patients seeking the cause and treatment of pain problems that are, in fact, mus- culoskeletal in origin. Dr Baldry has performed a most valuable service in writing this eminently readable book and I wish it the very considerable success that it richly deserves. John W. Thompson vii Foreword Prelims.qxd 13*10*04 14:30 Page vii
  4. 4. The aims of this book It is because traditional Chinese acupuncture is per- force inextricably bound up with archaic concepts concerning the structure and function of the body that most members of the medical profession in the Western world view it with suspicion and scepti- cism and assign it, together with various other seemingly esoteric forms of therapy, to what is called alternative or complementary medicine. Moreover, it is evident that attempts during the past 40 years to place Chinese acupuncture on a more rational and scientific basis have done little to dispel this attitude. My reason for writing this book is to bring to the attention of doctors and physiotherapists a 20th- century-evolved scientific approach to acupunc- ture for the relief of pain emanating from trigger points in the myofascial pain syndrome and from tender and trigger points in the fibromyalgia syn- drome, and to take acupuncture (so far as the alle- viation of nociceptive pain of this type is concerned) out of the category of alternative or complementry medicine by describing a method of employing it that has been developed as a result of observations made by physicians during recent years and is now fast becoming incorporated within the frame- work of present-day orthodox medical practice. It is because there have been so many advances in our knowledge concerning the pathophysiology, diagnosis and treatment of the myo


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