Why I wrote ‘Common Pain Syndromes’

As a clinician, I find it not only natural to pass on knowledge, I believe it is also an obligation. My initial idea for this book was to create a workbook for new medical graduates that summarised all the common musculoskeletal pain syndromes seen in primary care, their diagnostic features, investigations and conventional treatments, as few publications cover this important topic well. There are about 100 conditions listed in the book.

I then decided to include the concept of myofascial trigger points (TrPs) and how to palpate for 40 common ones. Like many other clinicians over millennia and across cultures, I observed that TrPs are often involved in the causation of pain. For example  TrPs such as one in the levator scapulae or the trapezius causing a recurrent headache, or a TrP in a piriformis causing crippling pain down the leg.

However, eradicating TrPs, especially chronic ones or ones resulted from severe injuries are difficult and frustrating. Over many years I tried different modalities of treatments, manual therapies, mobilisation methods, various massage techniques, stretches, numerous disciplines of exercises, and referrals to other practitioners. I also used acupuncture, cupping, moxa, heat treatments, non-steroidal anti-inflammatory drugs and injections into the TrPs with saline, local anaesthetic and corticosteroids, often without consistent success. Other doctors have also tried injecting them with botox (the PREEMPT protocol for treating chronic migraines), and that's not curative either.

In 2008, I learned a relatively new (50 year old) acupuncture technique called Yamamoto New Scalp Acupuncture (YNSA). It was extremely effective in eradicating TrPs. Consequently I included instructions on how to practise YNSA in this book, as I felt it would be incomplete without it.

As I began to run YNSA workshops at the NSW Australian Medical Acupuncture College (AMAC), I discovered a very efficient way to teach this method. An acupuncturist can practise effective YNSA in 30 minutes if they just use the J and K somatotope of the YNSA system, and watch the four YouTube videos (under Dr Joe Cheung) I made to support my book.

I hope that Common Pain Syndromes, A New Approach, passes on the art of treating TrPs that has served me very well in the last 17 years.

I know that new graduates will also find the conventional synopsis of the book useful, despite not practising acupuncture. It was the original reason and motivation for writing the book.

Dr Joe Cheung

Purchase the book here.

Watch the short tutorial video’s that accompany the book here.

Understanding Myofascial trigger points

First, what are trigger points?

A trigger point (TrP) can be defined as a focus of hyperirritability in a tissue, palpable as a nodule or a cord that, when compressed, is locally tender and can give rise to referred pain. Types of TrPs include myofascial, cutaneous, fascial, ligamentous and periosteal. This book focuses on myofascial TrPs.

Understanding myofascial trigger points

Myofascial TrPs were brought to medical attention by the late Dr Janet Travell, the personal physician to the late US President John F Kennedy. Dr Travell had a diverse background; she worked as a cardiologist and a pharmacology professor. Dr Travell co-authored a two-volume book with Dr David Simons, Myofascial Pain and Dysfunction: The Trigger Point Manual. Dr Travell observed that palpable tender muscular knots/cords/nodules or TrPs can cause pain at the site and refer to adjacent regions, often mimicking other conditions. For example, TrPs in the left latissimus dorsi can mimic angina, or TrPs in the piriformis and gluteus minimus can mimic lumbar radiculopathy. Travell and Simons painstakingly listed, studied and mapped the pain distribution of every trigger point for all the muscles in the body.

I believe that TrPs can result from:

1. Traumatic injury to a muscle, e.g. a fall or misstep straining some thigh muscles.

2. Constant contraction of a muscle due to repetitive strain, e.g., an antalgic gait of a patient walking with a severe knee OA or heel pain, thereby straining the lumbosacral muscles.

3. Constant activation of a muscle to protect a nearby painful joint or structure, e.g. constant activation of the gracilis and quadriceps to protect the pain of an osteoarthritic knee joint, or constant activation of multiple shoulder muscles to protect the pain of a supraspinatus tear.

The above is a short excerpt from my book, which you can purchase here.

Watch the short tutorial video’s that accompany the book here.

Yamamoto New Scalp Acupuncture

What is YNSA

Yamamoto New Scalp Acupuncture (YNSA) is a ‘microsystem’ of acupuncture. A microsystem, or somatotope, is a small area or a miniature topographic map of the body located somewhere on the body, which can be utilised to treat the different anatomical parts it represents. The concept of a somatotope is not new. For example, maps of the body have long been used in various ancient traditions. In Egypt, India and China, reflexology treatments focused on a map of the body on the feet. Korean acupuncture uses a similar map on the hand, while French acupuncturists are known for their proficiency in treating the body through a map on the ear. The ear microsystem was discovered in the 1950s when a French MD Dr Paul Nogier from Lyon observed the Algerian practice of charring a spot on the ear to treat sciatic pain, and from that he developed a whole system of auricular acupuncture.

Dr Toshikatsu Yamamoto, MD, PhD, is a Western medical doctor in Japan who discovered a scalp microsystem by chance about 50 years ago. Again, quite accidentally, he discovered that a spot on the forehead was effective in treating shoulder pain, and from that, he mapped out somatotopes on the scalp representing the whole body. YNSA is a new map, one that does not follow the traditional Chinese acupuncture meridian system. It is particularly effective in treating MSK and neurological problems. Dr Yamamoto’s books have been translated into more than ten languages, including Chinese and Russian. He has established a rehabilitation hospital in Miyazaki, Japan, which draws patients from all over the world who suffer neurological and MSK problems resistant to other treatments.

The above is an excerpt from my book, which you can buy here.

Watch the short accompanying video tutorials here.