Key Highlights:

Unfortunately, the video portion of Special Presentation: PART III Neurofunctional Electroacupuncture: Science-based secrets to the treatment of Pain with Movement Disorders did not record. However, the audio and corresponding slides are available above. OR click on the below link for full transcript, also including slides from the presentation.

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Introduction & Overview

• The session aims to build foundations for transforming acupuncture practice into a neurofunctional, mechanism-based approach, emphasizing complexity and embracing high-level precision.
• Dr. Elorriaga stresses the importance of acquiring new language and concepts for understanding neurophysiology relevant to acupuncture.
• The approach rejects formulaic, cookbook prescriptions in favor of individualized, mechanism-based treatments that leverage an in-depth understanding of anatomy and physiology.

Key Concepts Reviewed from Part 2

• Mechanism-based vs. Formulaic Treatment: Mechanism-based approaches that focus on clear physiological goals outperform standardized protocols.
• Physiological Effects of Acupuncture:
• Improvement of vasomotor control and perfusion
• Removal of neuromotor inhibitions leading to increased strength
• Segmental modulatory responses enhancing articular, muscular, vascular, and visceral tissues
• Local metabolic improvements supporting tissue healing and remodeling, including bone tissue
• Neuromodulation of nociception at peripheral, spinal, and central neuromatrix levels to reduce pain perception
• Understanding peripheral nervous system microanatomy (segmental anatomy, plexuses, fascicular anatomy, edema types) and sensory/motor fiber classification is essential.
• Neuromotor system restoration is prioritized to improve movement and indirectly reduce pain due to somatic sensory-motor fiber interactions.

Neuromapping & Neurofunctional Treatment Strategy

• Integration of segmental and peripheral nervous system anatomy is key to mapping pain and movement disorders using dermatome, myotome, sclerotome concepts alongside peripheral nerve territories.
• Treatment focuses on “goals,” “targets,” and “inputs”:
• Goals: Physiological objectives like restoring perfusion or neuromotor function
• Targets: Anatomical or neurological sites related to dysfunction
• Inputs: Specific needle placements and stimulation parameters aimed to achieve goals
• Neuromapping is analogous to chess: careful, strategic needle placement akin to chess moves, requiring analytical skills and intentionality.

Categorization of Inputs

• Local Inputs: Needles placed near or on peripheral nerve trajectories or posterior primary rami (axial inputs) connected neurologically to the problem site.
• Segmental Inputs: Placement along nerves/plexuses relevant to the affected segments (e.g., femoral, obturator nerves).
• Systemic Regulatory Inputs: Includes distal, classical acupuncture points with strong neuroreflexogenic effects (e.g., LI4, LV3, GB34, PC6), auricular points, and distal arteriolar networks. These are powerful but less specific.

Motor Points & Trigger Points

• Motor points are the most effective single input, located where motor nerves penetrate muscles, having lower electrical resistance and eliciting painless muscle contractions via electrostimulation (e.g., with the Pointer Plus device at 10 Hz).
• Trigger points are functional, hypersensitive muscle spots that produce referred pain and sympathetic effects; though debated anatomically, they are clinically relevant.
• Deep needling with longer needles (up to 75 mm, sometimes longer in specific cases) is necessary to access deep muscles like the adductor magnus, offering superior clinical outcomes over superficial, traditional acupuncture.

Clinical Examples

• Case of a world-class athlete misdiagnosed with hamstring injury actually had adductor magnus spasticity treated successfully with deep local needling, enabling her to compete and win a silver medal.
• Treatment of sprinters and elite athletes using bilateral segmental inputs combined with local and systemic regulatory points demonstrated high effectiveness.
• Importance of bilateral segmental stimulation emphasized, but unilateral treatments are also viable when needed.

Technical & Safety Considerations

• Needle placement on the back should focus about one thumb width from the midline to reduce risks such as pneumothorax.
• Threading technique and parallel needle insertion on the trunk to avoid pleural or visceral injury recommended; a video on these techniques will be shared with participants.
• Electrical stimulation intensity should be comfortable, avoiding nociceptive activation; maximum benefit achieved with just enough intensity to produce smooth muscle contractions.

Philosophy & Practice Insights

• Treatments must be dynamic: re-assess and remap patients regularly as conditions change.
• Diagnosis is reframed as descriptive, non-denominational neuromapping rather than fixed categories, focusing on functional mechanisms rather than structural labels.
• The goal is precision and predictability with minimal needles and treatment time (initial practice with 5-needles, short sessions), progressing gradually toward efficiency and effectiveness.
• Treatments are generally longer than conventional sessions (3 to 6 hours per session commonly), allowing for thorough neuromodulation and integration with soft tissue techniques.

Discussion Highlights / Q&A

• Pregnancy is not a contraindication for electroacupuncture; it is a heightened physiological state with no increased risk of abortion or premature delivery from acupuncture.
• Longer needles (up to 10-12 cm) may be occasionally required, e.g., for lumbar plexus stimulation.
• Use of broader or systemic/yin-yang distal points alone is not sufficient; combining segmental, local, and systemic inputs achieves best results.
• Needle stimulation strategies minimize the need for rigid protocols, favoring tailored treatments for similar presentations and even the same patient on different days.
• Electroacupuncture is highly effective for conditions like sciatica with mechanical components, emphasizing the neurofunctional rather than structural etiology of pain.
• Bilateral treatments are generally preferred for segmental inputs, but unilateral localized treatments can be incorporated as needed.
• Books on neurofunctional electroacupuncture are limited; foundational knowledge must come from detailed texts on anatomy, neurophysiology, and kinesiology.