探討中西醫針刺法對慢性肌肉疼痛治療之療效

Study on Effectiveness of East-West Integrated Needling Acupuncture Method in Chronic Muscle Pain Management

慢性疼痛治療每年醫療花費很多、止痛劑副作用多，治療方法以梁子安之中西醫整合針法：先辨證、證pain pattern 來選「穴」後才下針。尋找傳統針灸穴位相近或相似之myofascial trigger point 為下針「治療穴」，針入後以有引起Twitch response 為「得氣」之指標。然後再以病患之疼痛症狀是否已經馬上改善為是否針對「穴」之判斷。如果病患之疼痛症狀沒有馬上改善就視為針錯「穴」而須從新辨證、選「穴」、下針、重複是否「得氣」是否馬上改善PDCA 。Travell 的『Myofascial PainSyndrome, Trigger Point Mannual 』提供針刺指導原則。結果：男性32.3% 、女性67.7% ，平均年齡49.4 歲，發病時間已經46.4 月；慢性疼痛患者經治療後之簡易疼痛量表前後測顯示有明顯差異改善。不只疼痛指數減輕（ 前測平均數4.42 ，標準差1.4 ；後測平均數3.29 ，標準差1.5 ，P=0.000） ，日常生活幹擾也減輕。意外發現肩關節疼痛患者之疼痛指數比其他肩頸部、腰臀部、上臂部、下肢部患者之疼痛指數高、痛苦；有無肩關節疼痛患者治療後改善量也有之顯著差異。肩關節疼痛前後測顯示有明顯差異改善。疼痛指數，日常生活幹擾減輕更顯著。結論：慢性疼痛是可以經由使用中西醫整合針法成功減輕疼痛，改進睡眠及改善日常生活品質。肩關節疼痛患者雖然需要較為長一些時間治療，但還是會治癒的，因他們受得苦些，所以醫師應花多些時間解釋及鼓勵病患。

Chronic pain treatment spent lots of money each year. All pain killers are with side effect. We use Neoh East-West Integrated Needling Method for treatment in this study: Differential diagnosis by TCM and pain pattern to choose the point for needling. Using traditional acupuncture point or trigger point similar to TCM point. Twitch response as the “De Qi” indicator. If patient pain did not relief, the point is considering “wrong” point. PDCA management method is use to ensure better result. Travell’s “Myofascial Pain Syndrome, Trigger Point Manual” is used as guide book. Result: 32.3% male, 67.7% female, average age was 49.4y/o, average suffering pain for 46.4 months; patients simple pain scale showed significant improved after treatment. Not only pain scale decrease(pre-test mean4.42,S.D.1.4; post test 3.29,S.D. 1.5, P=0.000), daily life interfering also decreased. We also noticed that patients with shoulder pain were suffering more pain and daily life interfering than those without shoulder pain, and thus they felt more significant improvement than others after treatment. Conclusion: Chronic pain can be treated with East-West Integrated Needling Method. Patient with shoulder pain should be given more time to treatment, reassurance and encouragement from physician since they suffer more.