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TCM Management of Pain

As covered by previous articles, the mechanism of pain in TCM is ‘不通则痛’ or ‘不荣则痛’. For management of pain, TCM techniques such as acupuncture, cupping, tuina (推拿) massage, moxibustion may be used. On top of that, herbal medication is available in the form of oral medication and topical ointment or plasters.


In this article, we discuss the common TCM approaches in pain management as well as the prognosis of pain.


TCM approaches in pain management


i) Acupuncture
acupuncture

Acupuncture involves the insertion of fine needles into acupoints. Often of minimal pain, acupuncture is a very common technique used clinically to help with pain relief. It causes localised effects such as reduction in swelling and relief of muscle tension. A study has found that the use of acupuncture produces anti-inflammatory and analgesic effects through a self-limiting inflammatory response-inflammatory reflex[1]. Not only that, another source explains that acupuncture starts a cascade of biochemical reactions that initiates tissue remodelling, which contributes to analgesic effects and relaxation of the connective tissue[2].


Acupuncture is not just limited to pain relief, it can also help with other internal conditions as well, making it a versatile technique with a myriad of uses. It reduces stress by increasing the release of endorphins and dopamine, and reducing cortisol levels. It brings about systemic effects by regulating body systems such as the endocrine system and immune system.


Overall, acupuncture is safe and does not involve any use of medication. There may be post-session discomfort such as muscle aches, soreness, fatigue, and bruises. Drinking more water and resting after acupuncture can help relieve post-session discomforts.



ii) Cupping
cupping

Cupping uses the vacuum force created by fire to apply suction on the skin by means of a cup. For pain that worsens when exposed to cold/damp environments, cupping is especially useful as it uses heat in the technique, which can dispel the cold and dampness from the body. Cupping can also be used for a larger area of pain.


However, it is not suitable for areas that are small, boney or hairy (for example: joint areas, neck, head) as these areas affect the cup’s ability to form an enclosed vacuum space with the skin. People with skin conditions or broken skin are not suitable for cupping therapy. Post-cupping therapy involves muscle aches and soreness, dark cup marks and bruising, and blistering (common for people with damp body type). Resting, light massages and warm compresses can help alleviate post-session bruising and soreness. For blisters, please avoid squeezing the blister, and keep the area clean and intact. If the skin is broken, antiseptic measures may be required to prevent infection.


iii) Tuina
tuina

Tuina is a type of TCM therapy that aids in improving blood circulation. It is not just a massage, Tuina involves the stimulation of acupoints to facilitate the flow of energy along meridians. Using techniques such as pressing, kneading, lifting and manipulation of bone/joints, Tuina is effective in relieving muscle tensions and improving joint mobility. Therefore, it is suitable for a myriad of pain conditions.

Did you know that Tuina is not just limited to pain conditions? It can be used for paediatric conditions and internal medicine issues too.


Tuina therapy may see some pain and discomfort during and after the session. Slight bruising may occur as well. Do note that Tuina is generally not suitable for people with brittle bones or with broken skin. It is not advisable to have Tuina done in the area if there is a tumour nearby.


iv) Moxibustion
moxibustion

Moxibustion involves burning of moxa sticks over acupoints. It is known as a type of heat therapy that is especially good for people with cold body type or have pains characterised by cold. The moxa stick is traditionally made of mugwort leaves. When burnt, it releases heat which is capable of dispelling cold and warming the meridians. Typically, it is used on acupoints. The thermal stimulation of acupoints can regulate the body’s Qi and blood circulation, enhance body constitution and prevent diseases. Moreover, when ignited, the moxa releases a unique fragrance that helps to relax the body and mind, reduce stress and alleviate anxiety. While its primary purpose is not aromatherapy, it does have a similar effect to aromatherapy. 


Moxibustion tends to emit a lot of smoke, so it needs to be done in a well-ventilated room. The moxa stick is kept to be at a suitable distance from the skin to prevent burns. The usage of moxa boxes can help to fix the moxa stick at a specific point during the treatment. Nowadays, many clinics use heat lamps as an alternative to moxibustion.



v) Herbal Medication

Herbal medication is the usage of herbs or herbal formulas to help with pain relief. The herbal medication can be delivered to the body by two main paths: internal route (oral), or external route (through skin). Oral medication can come in the form of powder, syrup, raw herbs (require boiling) or capsules/tablets. As pain can be classified into excess or deficiency patterns, and can present differently in each individual, herbal medication is often customised to the individual’s needs.


herbal medication, tcm

At Chong Hoe Healthcare, we have various external medications that are concocted using our own traditional recipes passed down through the generations. As these formulas contain herbs that circulate blood, they are not suitable for pregnant women.

  • 跌打药精 (Chong Hoe Injury Rub, only available in-store) is alcohol-based and contains herbs that improve blood circulation and reduce swelling. This product is good for injuries and sprains, especially those that are swollen. 

  • 强力特效风湿跌打膏 (Medicated Rub for Rheumatism and Sprains) contains herbs that dispel cold-dampness and improve circulation. This rub is suitable for individuals with pains that worsen with exposure to cold or have chronic pain. Application of this rub requires some massaging to help with the absorption of the ointment.

  • Notoginseng Herbal Pain Relief Patch (特效田七舒痛宁片) is a medicated plaster that is convenient to apply. Among other herbs that are effective in improving Qi and blood conditions, it contains notoginseng as one of its main ingredients. Notoginseng is a herb that is prized for its ability to promote blood circulation and reduce inflammation. In other forms, notoginseng can also help with growth and development of children and other internal medicine conditions. Avoid applying this plaster on infected skin or open wounds. and it is not advisable to keep the plaster on the skin for too long. If any skin irritation occurs, stop application of plaster immediately.


Prognosis of pain

Prognosis of pain conditions vary depending on the root cause. Typically, acute pain requires a shorter recovery time. On the other hand, if the pain involves degeneration of tissues and bone, ligament/tendon tear, or is autoimmune-related, we tend to see a longer recovery time. Early intervention of pain management strategies can improve prognosis of the condition, potentially recovering faster. Certain body constitutions make recovery slower, especially involving dampness, or with deficiencies in the body.


In conclusion, there is a wide range of TCM methods available. Depending on the type and onset of pain, further examination such as X-ray, blood tests etc may be required. Complementing physiotherapy/occupational therapy with TCM pain management strategies can be beneficial as well. Our TCM physicians will assess your condition before recommending a suitable care plan. If you do have any medical reports, you may bring along with you during your visit to our clinic.


References:

1.Jin, B. X., Jin, L. L., & Jin, G.-Y. (2019). The anti-inflammatory effect of acupuncture and its significance in analgesia. World Journal of Acupuncture - Moxibustion, 29(1), 1–6. https://doi.org/10.1016/j.wjam.2019.03.003 

2. Langevin, H. M. (2013, April 30). The Science of Acupuncture. The Scientist Magazine®. https://www.the-scientist.com/the-science-of-acupuncture-39379 



Author: Physician Aw Ching Yi Eunice

(Find out more about her at chonghoehealthcare.com/eunice-aw)







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