WET NEEDLING. N°2. The BMN, hypodermic & acupuncture needle

WET NEEDLING. N°2. The BMN, hypodermic & acupuncture needle

There are two ways to Wet Needling: WET NEEDLING direct and indirect.

**- Direct WET NEEDLING: The drug is injected directly into the Trigger Point located in the tense muscle band.

**- Indirect WET NEEDLING: The drug is injected into the tissue surrounding the Trigger Point, so that a portion of muscle can be anesthetized at the same time as Trigger Point.

·                     The Therapist and prior patient examination 

Wet puncture is a common and easy to administer treatment, its therapeutic or analgesic role, allows it to be integrated into a protocol of global treatment of myofascial pain with acupuncture, Mesopuncture facilitated by the use of BMN: It is a relatively safe procedure when used by experienced therapists.

The Therapist should be enabled to use injected drugs with a perfect knowledge of their Pharmacology.  

The treatment effective of musculoskeletal pain requires an identification precise of the cause and its location.

The optimal technique and treatment schedule for Wet Needling vary according to professionals.

It has been noted that the precise location of the Trigger Point is important as well as to the knowledge of the injected drug; it is also essential to obtain a local contracture response during Trigger Point injection for pain relief.

The criteria for identifying myofascial Trigger Points are coded: On palpation, hypersensitive spot, reproduction/worsening of pain usually felt by the patient and location of a taut band of muscle fibers. Reproduction of referred pain and local contractile response by palpation of the Trigger Point confirm the diagnosis.

Several studies confirm the reliability and sensitivity of the results of individual palpation, but the lack of reproducibility of the diagnosis between different examiners cannot more than feeding the controversy that attends the very existence of Trigger Point.

THE needle

The Therapist in the initial version of the Wet Needling uses a hypodermic needle inserted into the skin, allowing the liquid drug to cross the skin and reach the Trigger Point to deactivate it and thus relieve pain for a long time.
The insertion pain of a hollow hypodermic needle in a Trigger point, already painful, is accented by the mechanical distention due to the volume injected into the Trigger Point.

The variable that can be adjusted in this case can only be the reduction of the needle diameter: The usual diameter of hypodermic needle is 16G - 27G i.e. for common hypodermic needles, 0.45 mm. 

With the BMN hollow needle, the diameter is reduced to 0. 30mm, which corresponding to the Acupuncture needles diameter. A very small reservoir in deformable polymer surmounted this needle. 

The therapist fills the reservoir, before the consultation, with the liquid drug selected depending on the pathology to be treated.

THE INJECTABLE PHARMACIES

Even though the Wet Needling optimizes the efficiency of the Trigger Points treatment, it is easier to use the Dry Needling than Wet Needling.

In fact, the use of a liquid drug depends on the Therapist's medical expertise, his ability to prescribe and inject the drug, his perfect knowledge of the complete pharmacology of the selected liquid drug. In addition, the technique and treatment scheme vary between practitioners and are difficult to encode.

The liquid drug has a dual therapeutic action:

• A physical, mechanical effect due to the volume injected.

• A therapeutic effect, as in Mesopuntura, due to the pharmacological properties of the injected drug: Local injection of an anesthetic in the Trigger Point, for example, allows stretching of the muscle, without pain.

• A wide variety of drugs have been used in Trigger Points. Local anesthetics (procaine, lidocaine, bupivacaine), B-complex vitamin solutions, long-acting steroids, acetyl salicylate, botulinum toxin... 

Many other liquid drugs can be selected in particular, if the Trigger Point, coincides with the acupuncture point, then Wet Needling and Mesopuncture, are combined.

It is also possible to use liquid drugs without therapeutic effect, such as distilled water, it solution saline or drugs whose action is integrated in the physiological mechanism of recovery of the initial State of health, such as trace elements, homeopathic remedies...
In general, the duration of sedation depends on several factors, including the duration of action of the drug injected into the PA, ie its rate of elimination of the body, regardless of its pharmacological action.

Drugs with delayed elimination for several months such as drugs derived from Hyaluronic acid, may be of interest, especially in recurrent Trigger Points. The duration of sedation depends on several factors, including the duration of the action of the injected drug i.e., its elimination rate, regardless of its pharmacological action.