By Dr John Quintner
Samuel Hahnemann [1755-1843] was the originator of homeopathy, a system of medical treatment devised under the principle summed up by the phrase, “like is cured by like” (Hahnemann 1796). Drugs which when given to healthy persons cause certain specific symptoms are to be given to patients when they present to their doctors with the very same symptoms.
Hahnemann argued that only infinitesimally small doses were needed because the disease produced an “abnormal sensitiveness” to the given drug, provided that the correct remedy had been chosen. Another principle was that a second dose should not be given until the first had ceased to act.
When homeopathy was introduced it became popular in the 19th century and probably served a useful purpose in checking the dangerously excessive drugging, bloodletting, purging, and induced vomiting that were then prevalent in conventional medical practice (Guthrie 1945; Ackerknecht, 1968).
The dogmatism of Hahnemann’s system separated it from the mainstream of scientific development (Ackerknecht, 1968) but its survival as a cult with a relatively small following suggests that it may still, at least partially, fulfil the role of alternative medicine (Relton et al. 2017).
Dry needling for musculoskeletal pain
The technique of “dry needling” so-called myofascial trigger points (MTrPs) (Simons et al. 1999) became popular with physical therapists during the 1990s and has remained so to this day (Dunning et al. 2014).
Remarkably, the practice is based upon the same principle as that devised by Hahnemann – “like is cured by like”.
In this case, the “disease” being treated is “myofascial pain” localised to a trigger point (TrP) within voluntary muscle or other soft tissues. Those who believe that this is true postulate the existence of a lesion caused by “direct trauma or overuse” (Martín-Pintado-Zugasti et al. 2018).
The recommended therapy for “myofascial pain” is to insert a needle directly into the muscle where the TrP is thought to reside. However, post-injection pain is not uncommon and is caused by “tissue injury produced by the needle and the following inflammatory reaction” (Martín-Pintado-Zugasti et al. 2018). Animal experimental studies have been confirmatory of such an injury (Domingo et al. 2013).
Some self-styled experts consider that benefit from needling can be attributed to the destruction of the allegedly dysfunctional motor endplates that produce the MTrPs, as well as the related sarcomere shortening of myocytes (the so-called “taut bands”) (Dommerholt et al. 2006).
Problem of post-injection pain
Martín-Pintado-Zugasti et al. (2018) claim that post-injection pain is “fundamentally different from the pathophysiology of the MTrP itself”. They base their opinion solely on the way in which some patients describe that pain as being different to their original pain. They did not consider the possibility that the original pain might have been wrongly attributed to the MTrP and that the tissue being needled did not in fact harbour a source of nociception (“tissue damage”) (Quintner et al. 2015).
In healthy subjects the number of needle insertions and the pain perceived during needling is positively correlated with the intensity of post-needling soreness (Martín-Pintado-Zugasti et al. 2015). This observation suggests that there is a direct relationship between the amount of tissue damage caused by the needle and the intensity of post-needling soreness.
Karel Lewit [1916-2014], a prominent proponent of dry needling, noted that a “reactivation of pain may occur several hours later or on the following day” and that this usually lasts for 1-2 days (Lewit 1979). Simons et al. (1999) recommended that therapists wait until the soreness has resolved before repeating the procedure.
Defying logic, it has even been suggested that soreness following dry needling might be seen as a “positive sign rather than a negative experience that requires special care” (Dommerholt et al. 2015).
From the evidence reviewed above, it seems inescapable that an actual lesion is being created in muscle through dry needling in a futile attempt to heal a muscular lesion that has never been shown to exist.
In other words, Hahnemann’s homeopathic principle that “like is cured by like” lives on, but now in the guise of “dry needling” – a cultish “alternative” treatment option that lies well outside the mainstream theory and practice of scientific medicine.
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