EXAMPLES OF AP THERAPY IN SA PRACTICE
AP is effective in a very wide range of human and animal conditions. For example, a database from >55 textbooks and clinical articles lists frequency-ranked prescriptions for >1100 human clinical conditions. Only a very small number of prime indications are discussed here. The text books listed in the references give more details on points for other areas.
Tables 1, 2 and 3 show examples of AP point selection for specific body regions, specific organs and some common conditions. These tables are based on the human system; the point coding used is similar to that used by IVAS, where BL41-54-40 for the outer line of the BL Channel between T2 to S4 to the popliteal crease; older texts put BL36 at T2-3, BL49 at S4 and BL54 at the popliteal crease.
In all the examples below, the depth of needling is given a minimum and maximum range depending on the size of the patient.
1. EMERGENCIES
Common emergencies include respiratory and/or cardiac arrest under general anaesthesia, haemorrhagic or traumatic shock. Resuscitation points include:
GV26 (in the midline of the nasal philtrum, level with the lower canthi of the nostrils; depth 0.5-1.5 cm towards the nasal septum)
KI01 (between metatarsal bones 3-4, approached from the anterior or posterior edge of the plantar pad; depth 0.5-1.5 cm)
Tip of the tail (needle the last coccygeal vertebra from the free end of the tail; depth 0.3-1.0 cm)
Ting (Terminal) points on the digits, beside or behind each nailbed.
GV26 is the most important of these points for its effect on the respiratory centre. It has a marked effect as a sympathicomimetic and in improving cerebral circulation. In respiratory arrest without cardiac arrest, needling for 10-30 seconds is usually sufficient (Rogers, 1977; Janssens et al 1979).
In other forms of shock (trauma, haemorrhage) the needles are left in situ for 10-40 minutes, twirling strongly every 5 minutes. Emergencies with cardiac arrest require strong needling for 5-15 minutes and points with cardiac effects should be added, such as:
PC06 (on the medial aspect of the forearm between radius and ulna, about 1/5 distance from carpus to elbow; depth 1-3 cm)
BL15 (1.5-3.0 cm paramedian to the dorsal midline behind the spine of 5th thoracic vertebra; depth 1-4 cm)
CV14 (midline, behind the tip of the xiphoid cartilage; depth 1-3 cm at 45 degree angle anteriorly)
PC06 is the most important of these three points for cardiac conditions. PC06 is also effective in conditions of the lung, diaphragm and stomach.
2. PAIN SYNDROMES
AP is excellent in treating myofascial pain; pain and stiffness in arthropathy; hip dysplasia; spinal pain (root "disc" syndromes); acute traumatic pain (Chan et al 1996). It also helps to relieve pain from smooth muscle spasm (various types of colic and bronchospasm etc).
MYOFASCIAL SYNDROMES: Muscle lameness (strain, rheumatism, claudication "myositis" etc) is very common in greyhounds and is a major cause of poor racing performance. The dog may not be visibly lame (although in many cases is lame). The common feature of myofascial syndromes is the presence of exquisitely tender areas ("nodules", TPs, AhShi points) in the muscles or fascia. They can be found in any muscles but are more common in the neck and shoulder muscles, paravertebral area and thigh muscles. There is often a history of good racing performance coming to an abrupt end. There need not be a history of known injury. Undoubtedly, most of these begin as minor muscle tears, but chilling or draughts may also precipitate "muscle rheumatism" or myositis. (In horses, there is often a history of virus infection in the stable in the previous 2-18 months). It is possible that there may be nutritional causes also but I have no experience of this. AP is a highly effective therapy. Recent cases usually respond in 1-4 sessions at 1-3 day intervals. Chronic cases need 1-8 sessions at intervals of 3-7 days.
The most important part of the examination is to determine the location of the affected parts of the muscles and the TPs in nearby (and occasionally distant) muscles. This is done by careful palpation using the thumb or index finger. Where possible the muscles should be palpated with a pincer grip (between thumb and index finger), for example, the triceps, forearm, leg and thigh muscles, TPs are often found in the paravertebral areas from neck to tail. They may be uni- or bi-lateral.
Diagonal relationships often exist in musculoskeletal problems; muscle pain in the left neck is often associated with some tenderness in the right lumbosacral area and vice-versa.
Having carefully recorded the affected area(s) and the TPs, a few classical AP points known to influence the affected area are chosen (see Table 1). All TPs are treated also. In searching for these areas, one should check the major joints systematically.
a. Neck mobility: The neck is turned to the left, gently but firmly, in an attempt to make the nose touch the left flank. This is repeated to the right side. Normal dogs do not whine or resist this test. Vertical and rotation movement is also checked. If the dog resists or whines, the tender points usually are found on careful (inch by inch) palpation.
b. Shoulder and elbow joints and muscles are checked by full extension, flexion and abduction of the limb. This is followed by careful deep palpation of the muscles and joints.
c. The spine and paravertebral area is checked by running the thumbs down the spinal processes and also along the muscles on 2 or 3 lines (1, 2 and 3" from the mid-line), applying firm pressure, first left, then right, from the first thoracic to the base of the tail.
d. The hip and stifle are also checked by full extension, flexion and abduction, followed by joint and muscle palpation.
If tender points are found, they are noted and rechecked later (some nervous or fidgety dogs may give occasional "false positive" reactions to finger pressure but the recheck differentiates the true from the false reaction). The true TP usually elicits a strong yelp and the dog usually turns the head towards the pain and may try to bite.
The response to treatment of muscle lameness can be dramatic. If the case is not well improved by 4-6 sessions (with marked loss of TP sensitivity) the prognosis for AP therapy is poor. In general, if AP is to be successful, effective results should be seen by 3-6 sessions. Improvement may occur within 20 minutes and is usual by session 2 or 3. Full improvement however may require more sessions. Racing dogs should be given mild to moderate exercise during the course of therapy but racing should be postponed until they are fully sound and all TPs are absent.
ARTHROPATHY: AP is very effective as a therapy in trauma (sprain), arthritis and rheumatism of joints (especially in older dogs). Much of the pain and stiffness in arthropathy comes from the muscles and soft tissues around the joint rather than from the joint itself. The original pain signals may have come from the joint but they usually set up reflex "guarding" of the joint, with secondary triggers in the muscles and soft tissues above or below the joint. The secondary triggers may become the main foci of pain signals long after the irritation in the joint has eased.
AP can not alter the bone lesions in an arthritic joint but it can have antiinflammatory effects and can be very effective in treating the soft tissue foci of irritation. The net result after successful AP is greatly improved locomotion (less stiffness, less pain on movement). The approach to arthropathy is to tackle the causes if known. AP can be of value, even if little can be done to treat or alleviate the causes. It is important to locate AhShi points if present, as in myofascial syndromes. AhShi points are needled for about 20 minutes, together with local and distant points for the specific joint (see Table 1). Arthropathy usually is treated every 3-7 days. If results are poor by 6 sessions, AP is unlikely to be of value.
Janssens (1984) described AP therapy in 61 dogs with arthrosis. The mean duration before treatment was 36 weeks. AP was most successful in shoulder and stifle (80 and 72%), less so in hips (55%) and lease successful in elbow, carpus and tarsus (33%). Recovery averaged 24 days (3.5 sessions/case); 48% relapsed but with original success rates on re-treatment. Schoen (1984) reported good or excellent results in 63% of dogs with arthrosis. There were 24 dogs in the series. Patients treated successfully for arthrosis/arthritis may relapse in 6-12 months. They usually respond well and rapidly to further courses of AP, as required (Janssens 1984; Schoen 1984).
Purulent arthritis is unsuitable for AP as a sole therapy. If specific pathogens are involved, specific anti-microbial drugs are indicated but AP may be added for its immunostimulant effect.
HIP DYSPLASIA often manifests with muscle pain and lameness. Much of the pain and stiffness is due to excess joint mobility, with consequent strain on ligaments and soft tissues. Hip dysplasia is a very good indication for AP. Although AP does not alter the X-ray lesion, abnormal joint mobility can be curtailed if the muscle tonus around the joint can be improved.
The main points for hip dysplasia are AhShi points (if present) plus local points (in the vicinity of GB30) together with GB34 (between the upper head of the fibula and the tibia, from the lateral side). Three needles may be placed near the hip joint, one in GB30 and the other 2 about 2.5-3.5 cm on either side of it, angled towards the acetabulum. The needles are placed deep enough so that they almost touch the acetabulum. Sessions are about 7 days apart. Usually 3-4 sessions give excellent results. Relapses may occur and require further AP treatment. AP can be combined with homoeopathic remedies such as Arnica (soft tissue bruising), Hypericum (deep pain), Ruta (joint pain) or Rhus toxicodendron ("rheumatism").
An alternative approach is to implant 5-7 gold beads (1 mm diameter) around the rim of the acetabulum in one single session. The technique is inexpensive, safe, simple and fast. If gold beads are difficult to obtain, orthopaedic suture wire or 18 gauge, 18 carat gold wire, tied in tiny knots (with the ends clipped off) may be used instead. The implants are inserted using aseptic techniques under general anaesthesia, using a wide-bore (14-16 gauge) needle and a stilet to deposit each implant. The first implant is deposited at the uppermost edge of the acetabulum ("12 o'clock"). The remaining 4-6 implants are deposited between "9-12" and "12-3 o'clock".
It is not uncommon for the dog to jump up on its hindlimbs within 2 days after implantation. Although it is not essential, antibiotic cover is advisable in the post-operative period. Long-term success rates of more than 80% are claimed by some workers (Grady-Young, 1979).
DISC DISEASE, VERTEBRAL ARTHROSIS: As mentioned in relation to arthritis and hip dysplasia, the presence of lesions on X-ray need not cause pain or lameness and successful outcome to AP therapy often occurs in spite of persistence of the lesion. The pain and lameness in vertebral problems usually are due to muscle spasm and irritation of nerve roots and meninges. Vertebral arthrosis is treated similarly to disc disease.
Prognosis in disc disease: Before attempting to treat spinal disc syndromes, it is important to assess the degree of neurological damage. The prognosis is excellent in Grade 1 and 2 disc disease (mild to moderate damage, i.e. (pain only to pain + some paresis)). The prognosis is still very good in Grade 3 disc disease (severe, i.e. motor paralysis but with deep pain sensation intact), but additional nursing and care is always needed. In Grade 4 disc disease (where damage is very severe, with paralysis and total loss of superficial and deep pain reflexes), the prognosis in cases presented more than 48 hours after onset is about 33%. Grade 4 cases require a lot of care, work and nursing. Time to recovery in Grade 4 is >> Grade 3 >> Grade 2 >> Grade 1.
The approach to AP treatment of disc cases is to localise the affected area by finger palpation and other methods. One to two points are used (bilaterally) above and below the problem disc, together with Tender and Distant points as indicated in Table 1. Treat acute cases every 1-2 days, chronic cases every 3-7 days. If there are other symptoms (faecal/urinary retention etc), these must be treated also, usually by western methods.
In a series of 75 dogs with thoracolumbar disc disease, AP gave success rates of 97,95,85 and 33% in Grades 1, 2, 3 and 4 respectively. Mean time to complete recovery was 13, 24, 32, 76 days respectively, requiring a mean of 2, 3.4, 4.8 and 9 sessions respectively (Janssens 1983, 1984). In a series of 32 dogs with cervical disc disease, 70% had full recovery after 2.5 sessions (mean recovery time 14 days). 37% relapsed with similar results on re-treatment (Janssens 1984).
To ensure the best outcome, Janssens recommends good nursing (catheterisation of the bladder; treatment of cystitis; enemas or digital rectal evacuation; frequent turning to avoid pressure-sores etc, if required). He also advises confinement in a playpen to prevent any exaggeration of clinical Grade from further trauma to, or bleeding into, the nerve roots or spinal cord etc. However, Chan et al (1996) found that controlled mild exercise (supervised walking on a lead) shortened the recovery time and improved the success rate of AP in disk disease.
ACUTE TRAUMATIC PAIN: The human pain-point par excellence is GB34 (between the upper head of fibula and the tibia, needled from the lateral side). One or two local points are added (ipsilateral). However, if the tissues are badly mangled or are covered by a cast, points on the contralateral limb may help. Treat daily for 2-3 days. If the animal is in shock, GV26 + KI01 help to control shock (+ western therapy).
SMOOTH MUSCLE SPASM: Human colic can arise from spasm of smooth muscle in the coronary arteries, bileduct, gastrointestinal tract, urinary and female reproductive systems. These types of colic can be relieved (often in minutes) by AP. The main points for disorders of the internal organs are given in Table 2. In small animal practice, gastrointestinal colic is very rare, but is a good indication for AP, once surgical emergencies have been eliminated from the diagnosis. In acute cases treatment is given every 8-24 hours; in chronic cases every 1-2 days.
GASTRIC TORSION, with bloat and pain in dogs can be relieved in minutes by AP. The main points are PC06, ST36, CV12, BL21. The stomach tube can be passed easily after the torsion is relieved (Blakely, 1985). Megaoesophagus and "choke" can sometimes be helped by PC06, ST36, CV12,17,22, BL13,17,21.
FUNCTIONAL DISORDERS: AP is successful in many functional disorders such as vomiting, diarrhoea, autonomic upsets, shock etc. Table 3 lists AP points which may be used in many common conditions.
MINOR HORMONAL DISORDERS: AP can activate hypothalamus-pituitary and the endocrine system, if the target cells are capable of responding. It is of use in mild human disorders of the thyroid, adrenal, pancreas and gonads.
AP has been used to treat hormonal infertility, pseudopregnancy and skin conditions associated with hormonal upsets in small animals. It could be tried in mild cases of diabetes mellitus also. Table 3 includes points used in female and male infertility. In pseudo-pregnancy, points active on the ovary/tubes/uterus (Table 2) should be added. The success rate in oligospermia is not as high as in female hormonal infertility but it is worth trying in valuable stud dogs.
OBSTETRICS: AP can be very useful in inducing birth (oxytocin-effect) and in treating dystocia in women. It is also useful in dystocia in other species. The most important points in obstetrics (dystocia etc) are points active on the pelvic ligaments, cervix/vagina and uterus: animal-BaiHui (GV03 = lumbosacral space) or human GV03 (one space anterior to lumbosacral); GV04 and BL23 (near L2-L3); points from BL25-34 and points on the outer BL line in the lumbosacral area.
Needling points on the lumbosacral area (especially animal-Baihui (GV03)) helps cervical dilation. The other points help relaxation of the pelvic ligaments and uterine contraction. The net result is more room in the pelvis and better contractions. Needling should be continued for 10-15 minutes before further obstetrical intervention.
4. AP ANALGESIA FOR SURGERY
Electro-AP can induce hypoalgesia sufficient for surgery. Dogs are good subjects for AP analgesia. Cats are very poor subjects. Indications include: cases in which general anaesthetic poses a high risk (severely shocked, debilitated or toxic cases; subjects with severe disease of the lung, heart, liver or kidney etc). AP analgesia is also suitable for caesarian section, as it has no depressive effects on the foetus.
Advantages include: (a) can be used in "cocktail anaesthesia", or to reduce greatly the dose of anaesthetic or sedative needed; (b) suitable in high-risk cases (c) suitable in Caesarian section (d) suitable in prolonged surgery (up to 10 hours) (e) autonomic functions remain stable (f) faster post-operative recovery of appetite, gut and bladder function etc; faster post-operative healing and less infection; reduced post-operative pain (g) simple and inexpensive; can be used in national disasters etc, using manual needling alone.
Disadvantages include: (a) operative success without the need for chemical anaesthetics or sedatives etc varies from 50-95%, depending on the skill of the operator and the tolerance of the patient to prolonged restraint; (b) very good restraint is necessary; all sensory inputs except pain are registered and full motor power is retained; (c) light, deft surgery is needed, not for ham-fisted surgeons; (d) prolonged manipulation of viscera/organs or traction on mesentery can induce nausea/vomiting; (e) poor relaxation of abdominal muscles can cause "ballooning" of viscera; (f) an induction period of 10-20+ minutes is necessary; (g) it is not suitable for intra-thoracic operations in animals.
POINTS USED FOR AP ANALGESIA IN DOGS: Point combinations vary with the operative site and between operators.
a. BL23 (bilateral): suitable for most operations in dogs (Kitazawa)
b. SP06 (bilateral): suitable for most operations in dogs but Electro-AP (EA) of SP06 may cause convulsions in some dogs (Kitazawa).
c. LI04; ST36; InKoTen (between metacarpals 3 and 4) and BoKoKu (between metatarsals 3 and 4). All bilateral (8 points). Suitable for most operations (Kitazawa) but BL23 (bilateral) is better (Kitazawa).
d. PC06, TH08 (bilateral). Suitable for thorax, neck, head and thoracic limb (Ishizaki). Local points may be added (Ishizaki).
e. ST36, SP06 (bilateral). Suitable for abdominal, perineal and pelvic limb (Ishizaki). For anal surgery, needles left and right of anus are added (Ishizaki).
f. SP06, ST25,36 (bilateral) + periincisional needles was very successful in ovariohysterectomy in toxic pyometra (Arambarri et al 1975).
g. SP06 and GB34 were successful in caesarian section (Janssens).
Other point combinations, including ear points, are possible. Jan Still (Vet School, Medunsa, South Africa) has published a number of successful studies on AA in dogs and cats.
APA procedure: The animal is restrained in a special harness or by tying the limbs to the corners of the operating table. The needles are inserted deeply into the points. Limb points, such as ST36, SP06, TH08, PC06, are transfixed (i.e.) needle is pushed out through the skin on the opposite surface of the limb. The needles are taped or sutured in position to prevent dislodgement. The needles are connected in pairs to the electro-stimulator. Frequency is 2-15 Hz, square or spike, biphasic wave. Voltage is increased slowly to the tolerance of the animal. Voltage and frequency may be increased gradually every few minutes. After 15 minutes, pinprick, towel clamp or scalpel prick tests are applied every 5 minutes in the vicinity of the operative site. When pain reaction to test is negative, surgery can begin (usually 10-20 minutes after onset of stimulation). An indwelling intravenous catheter is advisable for routine use, in case short-acting barbiturates are needed for intubation (for gaseous anaesthesia) in the event of failure or severe vomiting. If pain reaction occurs during incision of skin or serosa or at the closure stage, small amounts of local anaesthetic may be injected. Alternatively, the voltage and frequency of the stimulator may be increased to tolerance. The stimulator is switched off at the end of the operation. For further details contact the author. A detailed review with references is available.
AP IN POST-OPERATIVE COMPLICATIONS
Post-operative complications include pain, inappetance, nausea/vomiting, retention of urine or faeces, wound infection and delayed healing. Even if it is not used during surgery as a means of inducing hypoalgesia, AP can be used post-operatively to speed the restoration of normal function and to improve wound-healing. The selection of AP points depends on the clinical signs and/or the target organs or functions to be helped.
Tables 1, 2 and 3 list points for various body regions, organs and conditions. For example, dogs after abdominal incision may require treatment for abdominal pain and constipation. Points can be selected from Tables 2 and 3 for these conditions. Treatment would be for 10-20 minutes twice daily for the first 2-3 days; then daily for 3-4 days.
In retention of urine, catheterisation time can be reduced greatly by needling points active on the bladder and micturition centres. These points include BL28, CV03 (bladder Shu and Mu points); BL31-34 (active on urinary-genital function) and SP06 or KI03 (active on lower abdominal functions).
To assist wound healing, local points (near the incision) can be used, or TENS may be used across the incision-site. In cases where wound healing is unsatisfactory, points from the immunostimulation list could be added to points for the affected area.
5. PRACTICAL METHODS OF AP POINT STIMULATION
1. AP Point injection (0.5-1.5 ml/point) is safe and fast; it requires only a few seconds/point but can be painful where many points need treatment. The injection-solution may be distilled deionised water, saline, procaine saline (0.5-1.0%), vitamin B12 solution, isotonic saline, Impletol, homoeopathic solutions, or combinations etc.
AP point-injection is ideal in dogs which need medication which is suitable for intramuscular or subcutaneous use. In those cases, the dose can be diluted and distributed via the AP or TPs. Injection of TPs with Impletol is the classic method of TP therapy.
The method also is suitable if AP is indicated but the practitioner believes that the client may be unreceptive to the idea. In that case, sterile saline, glucose-saline, dilute procaine or vitamin B12 solution etc can be injected into the correct points. A variation of this technique is to use the Dermojet (high-pressure spray penetration of the epidermis). This may be painful and animals learn to fear it after a few sessions. The Dermojet is very useful in cats.
2. Simple needling: Having located the tender points and/or the classic points relevant to the case, sterile, stainless-steel needles 26-30 gauge/ 2.5-7.5 cm long are inserted 1-4 cm deep. Depth and direction of needling vary with the points. The finest and shortest needles possible are used but in fractious animals, thicker needles may be used to facilitate insertion and removal of the needles.
Aim to induce DeQi (Teh Ch'i): Classical AP recommends pecking and twirling of the needles for 15-30 seconds after needle insertion. The needles are "pecked" (up and down) and "twirled" (rotated in opposite directions, 90o left, then 180o right then 180o left etc, to avoid twisting the tissues around the needle; the latter causes unnecessary pain). In humans, needle twirling in the correct position induces a strong paraesthesia radiating along the course of the nerve or Channel. This is called DeQi (the arrival of the energy), or the Propagated Channel Sensation (PCS). If this sensation is not obtained, the needle is not at the correct position and/or depth and the results are poor. In that case, the needle is withdrawn slightly, redirected, pushed in and twirled again, until DeQi is obtained.
Animals may react to needle twirling by trembling, or defensive action, but often they give no clear sign of DeQi. After attempting to induce DeQi, the needles are retained in position for 15-20 minutes; every 5 minutes, or so, the needles are twirled for a few seconds. Just before removal, the needles are twirled for a few seconds again. Some experts claim that leaving the needles in situ for 20 minutes without twirling is adequate.
One should not needle major arteries, body cavities, bone or joint spaces, nipples or vital organs etc. It is permitted (indeed mandatory in many cases) to keep soft tissue and nerve trauma to a minimum.
3. Electro-AP (EA): This is most valuable in the induction of AP analgesia for surgery but EA can be used routinely in AP therapy also. The needles are inserted to the correct depth and are connected in pairs to the output sockets of an AP electro-stimulator. To avoid the possibility of cardiac fibrillation, any one pair of leads should not cross the spine between vertebrae C2 and T10, i.e. each pair of electrodes should be on the same side of the spinal cord in these areas. Crossing the midline in the lumbosacral area is accepted.
For surgical AP analgesia the needles are taped firmly in position to prevent their being dislodged during the operation. The power is turned on and the output controls advanced from zero to tolerance. The needles usually beat to the frequency of the stimulator (at frequencies of 2-15 Hz). At higher frequencies, the muscle goes into local spasm, i.e. the needle vibration is not obvious. The best wave form for AP analgesia (APA) is square wave or spike wave biphasic. In electro AP therapy, the output voltage is set lower than in APA. In therapy, the stimulation is maintained for 5-20 minutes. In APA, it is maintained until near the final closure stage. Although EA looks impressive to the owner of the animal it has little if anything to offer (above simple needling) for most AP indications. Exceptions are: peripheral and central nerve paralysis and in APA for surgery. EA is preferable in these cases.
If more needles are used than can be stimulated simultaneously, the leads are alternated between needles as required.
4. Ultrasound: Standard equipment may be used. A contact medium (jelly or solution, or water) should be used between the probe and the points. Some instruments have a range of probes of different diameters for various parts of the body (including probes for use in the rectum, vagina, ears and nose for local infections etc in these orifices). Output is set at 0.25-1.0 W. Time of application is 15-60 seconds/point. The technique is painless, non-invasive and very often effective. Long hair may make contact difficult or impossible.
If results are disappointing after the first few sessions, point injection or simple AP should be tried.
5. LLLT-AP: Three types of low-power laser are used: Helium-Neon (He-Ne, red light); infrared (invisible); diode lacers (not true lasers but emitting light varying from visible to invisible frequencies). It is not possible to give critical assessment of which type of laser (visible v invisible; pulsed v unpulsed) is best, as comparative trials need to be done.
Low-power lasers usually produce no sensation of pain. Thus, they are ideal for treating animals like cats (which are not good subjects for multiple needling) and when treating points in painful areas of the body such as the ears and digits.
Wavelengths vary from 632 (visible red) to 1100 (invisible infrared) nM. The laser light is emitted via a fibre-optic cable or other outlet. The power output is low in most lasers (0-10 mW/cm2). Higher power lasers (10-50 mW/cm2) are also available.
Penetration of most lasers is superficial (1-2 cm). Thus, they are especially useful for superficial conditions such as: skin wounds; trauma; abrasions; ulcers; granulomas; mucosal ulcers; corneal ulcers (LASER should not be beamed at the retina). It is also useful in tendinitis and myositis of superficial muscles. The higher wavelengths, higher power outputs and pulsed lasers may penetrate deeper into the tissues, especially in large animals.
When used on local lesions (such as an infected wound), LLLT (<5 mW/cm2) is applied in grid movement (moving all the time) to the wound for 5-15 minutes. Higher power lasers (20-50 mW/cm2) need much less time. Those claiming LLLT success via AP points claim a great advantage in the short time of application, 5-30 seconds/point. However, exposure time depends on mean output power (MOP, in mW). It is essential to deliver sufficient power density (J/cm2) to the irradiated area. Calculation of optimal laser dose is discussed in the paper on LLLT.
A survey by IVAS (1984) on LLLT in AP suggested that the local use of LLLT was the main application. Although there were claims that LLLT could activate AP points (especially those close to the surface and in the ears), there was not agreement on that claim. In spite of some claims to the contrary from China and other countries (see "AP for immune-mediated disorders" by Rogers (1991)), LLLT, according to other users, had failed to influence organic diseases and deep-seated muscles in many attempts. Also, many respondents found that AP gave better results than LLLT at that time. However, most of the older lasers emitted <10 mW/cm2 and their penetration depth was limited. Since than, more powerful lasers (10-50 mW/cm2, with beam interruption (pulsing) at 2000-10000 Hz, are available. These lasers (especially pulsed Infra-Red lasers) can be used as a substitute for needles in AP, also in large animals. However, more research is needed on the benefits and limitations of LLLT as full substitutes for other types of AP stimulation.
LLLT is not thought to be suitable for routine AP analgesia, although Zhou (1984) claimed good success with 2.8-6 mW He-Ne laser in density and orofacial surgery.
6. FURTHER TRAINING
Possibilities for further training in AP include:
a. Home-study of human and vet AP texts, such as those listed in the references, is essential.
b. Formal study of human AP at specialist AP schools, colleges or seminars is advisable. As mentioned, transposition of human principles to small-animal patients is relatively easy and is very successful. Many medical AP societies and study-groups welcome vets as members.
c. Formal study of vet AP is advisable. Courses are given by national vet AP societies or by the International Vet AP Society (IVAS).
IVAS runs a training course in the USA. It has run the course in Europe and Australia in recent years. If there is demand for the course and national groups can carry the costs, IVAS may be able to run the course elsewhere. The total course time is 120 hours, divided into 4 sessions/year.
Each candidate is expected to attend the full course, study the recommended texts, pass a 3-hour written examination and submit 5 fully documented case reports. Having fulfilled these requirements, the candidate receives IVAS accreditation. IVAS also acts as a clearing-house for clinical and research information on AP and produces a quarterly Newsletter. Contact: IVAS, c/o David Jagger, 5139 Sugarloaf Rd., Boulder, CO 80302-9217, USA (Fax: 1-303-449-8312).