Last week I wrote about sighthounds and lurchers possibly being ‘good acupuncture responders’.
The words we use to describe how patients react and respond to acupuncture become easily muddled and it is probably not important except when we try to explain how our interactions with patients should vary.
Good responder: these patients show a good clinical response to acupuncture, usually with just manual acupuncture. It appears that needle placement does not always have to be so precise (i.e. where the pain is) and they respond quickly, often dramatically well, and stay free of signs for weeks if not months. These patients will often become very sedated with the needling, but this is not necessarily the case. It may be easy to “over treat” these patients and make them worse, sometimes markedly so. These patients will usually improve after worsening and so it is often taken as a good sign, but if the patient is much worse then the treatment should be modified (less stimulation, less time, finer needles) and if they continue to be worse after every treatment then the possibility that they may have an altered pain state (central sensitization, disorders of central processing) should be considered.
Sensitive patients: often the term sensitive is used synonymously with “good responder”, but a patient who is sensitive to acupuncture would more usually mean sensitive to the insertion of the needles, in that they appear to find insertion aversive, even when trigger points are not being directly needled. It is important to make the distinction between patients who find the insertion uncomfortable because of their current pain state (allodynia or hyperalgesia – see next week’s blog) and those who will always find it uncomfortable.
There does not appear to be any correlation between sensitivity and response – some sensitive patients respond well, others not at all. Just because a patient finds needling uncomfortable does not mean that they do not need a more potent stimulus, e.g. with electroacupuncture. For these patients the use of fine needles, such as 0.16mm diameter, will allow them not only to have an acupuncture treatment but also to receive electroacupuncture should they need it (although this is more fiddly, it is possible with the more modern machines with light clips).
Strong reactors: these patients are more readily identifiable in the human population and experience profound alterations in the way they feel during or after an acupuncture treatment. These reactors could include the relatively rare “cathartic” reactions where patients laugh or weep uncontrollably and without knowing why they are doing so. More often they will feel profoundly sedated or euphoric. The sedative response is the one that is most easily identifiable in our animal patients. Whilst strong reactors are often good responders there does not always appear to be a direct correlation and the absence of a strong reaction does not mean that the acupuncture will be ineffective.