The Use of Battlefield Acupuncture Prior to Botulinum Toxin A Administration: A 2-Patient Case Series

Abstract

Background: Botulinum toxin type A injection is a common and safe procedure used for the treatment of overactive muscles through local injection. This toxin inhibits the release of acetylcholine in the neuromuscular junction. The benefits usually last only 3-6 months; thus, repeated injections are often required. The procedure, however, can be difficult if a patient's spasticity and pain prevents access to the muscles for injection or if a patient is anxious. Battlefield Acupuncture (BFA), a technique developed by Richard C. Niemtzow, MD, PhD, MPH, in 2001, is a form of auricular acupuncture using a very specific sequence of gold Aiguille semipermanente needles inserted into the ear. BFA can be very effective for reducing pain quickly, with few potential side-effects. Cases: BFA was performed prior to Botulinum toxin A injections on 2 patients who had either pain limitations or anxiety limitations during prior Botulinum toxin A injections. Case 1 was a 70-year-old male veteran with painful, right upper-extremity spasticity with hand contractures. Case 2 was a 69-year-old male veteran with spasticity who had anxiety related to his fear of needles. Results: Application of BFA prior to Botulinum toxin A injections enabled the 2 patients who either had pain limitations or anxiety limitations to tolerate the toxin injections much better. Conclusions: BFA is a safe and effective treatment option for rapid pain reduction, enabling Botulinum toxin A to be administered more easily to patients who have had pain or anxiety during prior injections.

Battlefield Acupuncture as a Treatment for Pain

“…Acupuncture is generally well tolerated and causes few adverse events. 8 Four of the 12 studies included in the present review did not have any BFA-related adverse events, 21,26,28,30 and five studies did not explicitly mention whether any adverse events or complications occurred. 22,23,27,31,32 The most commonly reported adverse events were dizziness or lightheadedness, which were reported in three studies.…”

“…We found five nonrandomized studies and one study in press, comprising two case series, 21,22 one cross-sectional study, 23 one cohort study, 24 and one cross-sectional cohort study 25 (Table 1). Four of the five studies were conducted in VHA facilities or affiliates 21,[23][24][25] and one occurred at an urban academic center. 22 All of the included case series described qualitatively positive outcomes in the form of self-reported pain relief and grimacing.…”

“…In a series of two patients with cerebral stroke sequelae, BFA allowed for the uneventful completion of botulinum toxin injections. 21 Each patient either had pain or anxiety limitations, which were improved enough by BFA to allow them to tolerate the injections. One patient with chronic pain secondary to hand contractures and upper extremity spasticity reported an immediate decrease in pain from 6/10 to 4/10 after acupuncture needle placement.…”

“…[26][27][28][29][30][31][32] Five studies were open label [26][27][28][29][30] and two were single-blinded. 31,32 Three studies examined the perioperative response to BFA, 26,31,32 two of which were in the setting of tonsillectomy, 20,21 and one followed shoulder surgery. 15 The remaining studies examined the efficacy of BFA in the setting of acute pain, 28,30 acute-on-chronic pain, 28 or chronic pain, 27,29 to include spinal cord injury-related neuropathic pain, 27 low back pain, 28 chronic pain, 29 and postpartum pain.…”