P. E. Baldry

Acupuncture, Trigger Points and Musculoskeletal Pain

Book review by Anthony Campbell. Copyright © Anthony Campbell (1999).

Many people think of acupuncture entirely in traditional terms, as depending on ancient Chinese notions of physiology and cosmology, but in fact there is also a modernised version which accepts that sticking needles into people can relieve the symptoms of disease but holds that the effects of acupuncture can be explained in terms of modern anatomy and physiology. This is both a theoretical and a practical difference. Baldry, who is a former consultant physician, belongs in the modernist camp. However, even among modernists there are differing views about how acupuncture might work. An influential school of thought, to which Baldry belongs, equates modern acupuncture almost entirely with trigger points.

One problem with presenting this view to doctors (unlike, say, physiotherapists) is that doctors don't learn about trigger points in their normal medical training. Medical texts used to contain vague references to disorders such as 'muscular rheumatism' and 'fibrositis', but the pathological basis of these things was unclear. The modern theory of trigger points is based largely on the work of two American physicians, Janet Travell and David Simons, who have written the most authoritative account of the subject in their two-volume textbook 'Myofascial Pain and Dysfunction'. Yet although this book is well known to specialists the ideas it contains have made little impact on the main body of doctors. Baldry's views are very much in line with those of Travell and Simons and these underpin his approach to acupuncture, but because of their relative unfamiliarity to a good proportion of his potential readers he finds it necessary to explain the theory in some detail.

Before embarking on this, however, he provides a brief historical survey of the origins and development of acupuncture in China and the gradual spread of awareness of acupuncture to the West. This provides the necessary background for his main subject, which is how we are to understand acupuncture in a modern context. To this end he includes a useful account of present-day understanding of the neurophysiology of pain; this is valuable in its own right and there are plenty of references for those who want to pursue the subject further. However, his principal reason for including this material is to show how it relates to trigger points and acupuncture. A number of writers have remarked on the similarities between classic acupuncture points in the Chinese system and trigger points as described in Western texts, and Baldry takes the same line. Acupuncture points and trigger points, while not always identical, clearly have much in common with each other, and Baldry's position is that whatever is valuable in the classic system should be reinterpreted today in terms of trigger points.. As a conventionally trained Western clinician, Baldry is at pains to show that acupuncture based on trigger points is scientifically respectable. He does this by including a chapter on the scientific evaluation of acupuncture, although there is unfortunately a paucity of good clinical trials in acupuncture, for reasons which Baldry explains fully.

Discussion of the basis for modern acupuncture takes up nearly half the book. It will interest the scientifically minded reader but I suspect that quite a few practitioners will skim this part quickly before turning to the second half, which is a practical manual that describes how to locate and inactivate trigger points in the various body areas. The treatments are amply illustrated with good-quality line drawings and a number of case histories are provided. There are plenty of practical tips and the descriptions of treatment are easy to follow. This part of the book is ideal for a practising acupuncturist who wants to use the techniques described.

An approach to acupuncture based almost entirely on trigger points is vulnerable to the criticism that it only allows the practitioner to deal with 'simple' musculoskeletal problems and is inadequate for the management of the more complex disorders and dysfunctions addressed by traditional acupuncture. I would not myself admit that musculoskeletal disorders are always 'simple' in this sense, but I do think it is true that there are a number of effective acupuncture treatments that don't depend on trigger point inactivation and are not even primarily concerned with pain relief. These presumably work by other mechanisms still to be discovered. In other words, I should say that trigger points are certainly very important but are not the whole story in modern acupuncture.

For anyone wishing to learn trigger point acupuncture, and also for anyone who wants to read an up-to-date review of the neurophysiology of pain in relation to acupuncture, this is an excellent textbook.

%T Acupuncture, Trigger Points and Musculoskeletal Pain
%A P.E. Baldry
%I Churchill Livingstone
%C Edinburgh, London, New York, Philadelphia, San Francisco, and Toronto
%D 1998
%G ISBN 0 443 0550 1
%P 347 pp
%O Second Edition
%O Foreword by John W. Thompson
Titles | Authors | Subjects