maintenance of commonly encountered pain states and their involvement with the Autonomic Nervous System remains unknown and is an important area of research that may well resolve many of the questions involving common pain states. Melzack, in a recent article on the role of compensation in chronic pain states, appears to support the importance of these concepts. Patients who failed to respond to conventional forms of therapy were sometimes cured if the physician recognised that abnormal autonomic nervous system activity may persist indefinitely after a brief injury or that trigger spots may develop at the site of even relatively minor injury. Major procedures such as cordotomies may fail, but simple ones such as trigger point injections, may produce sudden remarkable recovery and subsequent return to work.
Many GPs have responded to their patients’ needs by adding pain management tools to their practices. These tools frequently include pain assessment techniques, Acupuncture, Manipulation, Relaxation Training and Re-education of job task and posture. Clinical acupuncture in particular is one of general practice’s growth areas.
From the early 1970s when only a few medical practitioners used acupuncture, there is now widespread use and integration of alternate stimulation techniques developed from Traditional Chinese Acupuncture. (Stimulation techniques developed from Traditional Chinese Acupuncture include Dry needling, Electro-acupuncture and TENS, Trigger point injection and dorsal column stimulation.)
The results of controlled studies which have been extensively reviewed show good evidence for the short term effectiveness of acupuncture in many pain states. The long term studies, particularly where the well trained acupuncturist has been given the freedom of (traditional) normal practice profiles, have been encouraging, with success rates far higher than those associated with the placebo response.