The Successful Treatment of Pain Associated with Scar Tissue Using ...

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Jun 24, 2014 - Excessive scars, also known as keloids and hy- pertrophic scars, are benign fibrotic proliferation due to the overproliferation of fibroblasts.
J Acupunct Meridian Stud 2014;7(5):262e264

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Journal of Acupuncture and Meridian Studies journal homepage: www.jams-kpi.com

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The Successful Treatment of Pain Associated with Scar Tissue Using Acupuncture Sheng Fang* Oriental Medicine Department, Oregon College of Oriental Medicine (OCOM), Portland, USA Available online 24 June 2014

Received: Aug 21, 2013 Revised: May 18, 2014 Accepted: May 20, 2014 KEYWORDS acupuncture; pain; scar; Wei Ci

Abstract In this case report, a 48-year-old female who had suffered severe scar pain for 3 months was treated with acupuncture using the Wei Ci technique (surrounding the dragon). Scar tissue usually forms after deep trauma, such as piercings, burns, and surgery, to the dermis. In Chinese Medicine, scar tissue causes local Qi and blood stagnation which lead to pain. The Wei Ci technique (surrounding the dragon) and distal points Hegu-LI-4, Taichong-LIV-3, Zusanli-ST-36 were used. The patient received a total of eight treatments in 5 weeks. The scar pain decreased from 7 to 1 or 2 on a Likert scale of 0e10, with 0 being no pain and 10 being the worst pain. Acupuncture may have a good short-term pain-relieving effect on scar pain but its longterm scar-pain-relieving effects are still unclear.

1. Introduction Scar tissue usually forms after deep trauma, such as piercings, burns, and surgery, to the dermis. Globally, about 75 million patients develop scars after surgery each year [1]. Excessive scars, also known as keloids and hypertrophic scars, are benign fibrotic proliferation due to the overproliferation of fibroblasts. The reason why scars form is unclear. It might be genetically related. Current * Oriental Medicine Department, Oregon College of Oriental Medicine, 75 North West Couch Street, Portland, OR 97209, USA. E-mail: [email protected] (S. Fang). pISSN 2005-2901 eISSN 2093-8152 http://dx.doi.org/10.1016/j.jams.2014.05.001 Copyright ª 2014, International Pharmacopuncture Institute.

treatment strategies include intralesional corticosteroid injection, radiotherapy, silicone-gel sheeting, and surgical manipulation. The use of combined treatment strategies usually achieves a better result than applying a single treatment strategy [2]. In Traditional Chinese Medicine, keloids and hypertrophic scars are known as Rou Gui Chuang (turtle type of scars) or Ban Heng Ge Da (hard scars) [3]. The common patterns include Qi and blood stagnation; heat toxin and blood stagnation, and Qi deficiency and blood stagnation. When an injury occurs, the local damage causes Qi and blood stagnation which lead to abnormal skin sensations (numbness, itching, etc.) and pain.

Pain associated with scar tissue If the Qi and blood stagnation is long term, they may block local Qi and blood movement and lead to deficiencies. The scar will be pink or pale pink and feel like rubber, without much itching or pain. The patient may also present with fatigue, pale face, or low voice. Treatment strategies include the use of internal herb formulae, acupuncture, and tropical herb plasters to move Qi and blood and to treat corresponding symptoms.

2. Case Report A 48-year-old female patient had a surgical scar on the upper right thigh on the Gall bladder channel (about 1 cun above Fengshi-Gb-31) for 1 year. The vertical scar was about 3 inches long, 1/4 inch wide, red color, tough, and hard. It was very sensitive to touch. The patient stated she had felt a stabbing pain in the scar area for 3 months. The pain level was 7 on a Likert scale of 0e10, with 0 being no pain and 10 being the worst pain. The pain could be alleviated by ice sometimes, and provoked by touch and pressure. The patient reported the following other relevant information: hot flashes and night sweats once or twice a week; dry eyes and photosensitivity; gas after meals sometimes; bowel movements twice a day, formed and slightly soft, with sometimes an incomplete feeling; menopause at the age of 43 years; and low energy levels, 2 on a scale of 0e10. The patient had a white greasy tongue coating, and a pale purple tongue body with scallops. Pulse was overall slippery-soft.

2.1. Diagnosis TCM disease diagnosis: Rou Gui Chuang (Turtle Type of Scars); pattern differentiation: Qi and blood stagnation; and Spleen-Qi deficiency. 2.1.1. Reasons for the diagnosis The patient’s surgical history and pain in a fixed location indicated the local Qi and blood stagnation. The tough-andhard red scar was the result of stagnation. When there was stagnation, there was pain. Touch and pressure made the pain worse because the pain was due to excessive stagnation. The purple tongue body also suggested stagnation. When a patient has spleen Qi deficiency, he/she feels tired and has low energy. The deficient spleen cannot transform and transport food effectively, so there is gas and slightly-soft stools with sometimes an incomplete sensation. A white greasy coating and slippery soft pulse also indicates Spleen-Qi deficiency. The Qi deficiency might contribute to the Qi and blood stagnation because the Qi is not strong enough to move stagnations.

2.2. Treatment The treatment mainly focused on pain management. Treatments were applied by a licensed acupuncturist with 11 years’ experience. Acupuncture points were the local Wei Ci points in the local scar area (8 needles) plus bilateral Hegu-LI-4, Taichong-LIV-3, and Zusanli-ST-36. For the local Wei Ci points, one needle was inserted 1 cun above the head of the scar at a 45-degree angle

263 pointing to the end of the scar. Three needles were evenly inserted 1 cun away from the lateral margin of the scar at a 45 angle pointing to the medial margin of the scar. Three needles were evenly inserted 1 cun aside from the medial margin of the scar at a 45 angle pointing towards the other three needles without touching them. One needle was inserted 1 cun beneath the end of the scar at a 45 angle pointing at the head of the scar. All needles were inserted about 1 cun deep, evenly rotated forward and backward. De Qi sensation was not required. For bilateral Hegu-LI-4 and bilateral Taichong-LIV-3, needles were inserted perpendicularly about a half cun deep, evenly rotated forward and backward. De Qi sensation was not required. This technique was to disperse and remove the stagnations. For bilateral Zusanli-ST-36, needles were inserted perpendicularly about 1 cun deep, rotated forward heavily and backward gently. De Qi sensation was required, preferably the warm sensation. This technique warmed and benefited the Spleen Qi. All the needles used were 0.20 mm  40 mm, DBC brand needles, made in Korea by DongBang Corporation, distributed by Lhasa OMS, Inc. Weymouth, MA. The needles were single use disposable stainless steel needles. Treatments were given twice a week for 3 continuous weeks, and then once a week for 2 continuous weeks. The holding time of the needles in the body was 20 minutes for each treatment. The patient refused herbs.

2.3. Results After the first treatment, the patient did not feel much change. The patient reported a decrease of the pain associated with the scar after the second treatment. At the end of the 3rd week, the patient occasionally felt the scar pain and she stated the pain level dropped to a 1 or 2 on a scale of 0e10. She felt the scar pain was under control and decided to receive treatment once a week for 2 more weeks, and then stop. At the end of the 5th week, the patient felt similar to what she felt at the end of the 3rd week. The scar still felt tough and hard, but was probably less red in color than it was during the first visit. No further follow-up was given. Overall the prognosis was good. If the patient continued the treatments, the pain may have been relieved completely.

3. Discussion In TCM theory, scar tissues are considered Qi and blood stagnations in the Ying and Wei level (the superficial levels) due to trauma. The Ying Qi and Wei Qi cannot move smoothly through the scar area to defend and to nourish it. So there may be pain, itching, numbness, or other abnormal feelings. In this case, the patient’s chief complaint was the scar pain. Acupuncture was reported to be effective in relieving pain [4,5]. Some reports showed acupuncture was effective in treating scar pain when applied alone or together with other TCM therapies [6,7]. However, there was no record in PubMed on using the Wei Ci technique to treat scar pain. Wei Ci (Surrounding the dragon) was developed from the classic needle technique called Yang Ci. Ling Shu chapter seven stated: “The fifth technique is called Yang Ci, one

264 needle in the center and four needles around. The needles are inserted shallowly to treat cold stagnation in a big area.” [8]. The Yang Ci technique is good for dispersing the superficial cold stagnation in a large surface area. The Wei Ci technique has a similar stagnation-removing effect as the Yang Ci technique. It also harmonizes Ying and Wei. Hegu-LI-4 and Taichong-LIV-3 were used together. This combination had a strong effect in moving Qi and Blood. It is called “Open the Four Gates”. Zusanli-ST-36 is a traditional Acu-point for Spleen-Qi deficiency. It also helps to harmonize the Qi and Blood in Ying and Wei level. After the stagnations were removed and Ying and Wei were harmonized, the pain was relieved. The 5-week treatment had a satisfactory result. But the patient declined to follow up at the later date, so the long-term effects of the treatment was unknown. More research is needed for testing acupuncture’s ability to resolve scar pain in the long term.

Disclosure statement The author affirms there are no conflicts of interest and the author has no financial interest related to the material of this manuscript.

S. Fang

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