Inspired by Al-Sawat et al 2021, Chen et al 2021 & Ang et al 2021.[1–3]
SUI – stress urinary incontinence
key to acronyms
FSN – Fu’s subcutaneous needling
MTrP – myofascial trigger point
This is a set of papers rather loosely related by the term floating needles.
The paper that I most wanted to focus on is a case report of a needle fragment ‘floating’ around in the region of the obturator internus muscle and pelvic viscera. The second paper is a trial from Ningbo using a treatment called floating needle technique, and the final paper is a review of clinical papers on treatment of nocturnal crying in paediatric patients where the techniques are generally very brief or simply involve skin pricking, hence the needle floats above the point rather than being retained in it. That last comment is entirely my image and the term floating is not used in the paper at all.
Laparoscopic removal of a needle fragment
The case report is another successful laparoscopic removal of a needle fragment. I have reported on a similar case on the blog almost exactly 2 years ago: Laparoscopic needle fragment removal 2019. This time the needle fragment had migrated through the obturator internus muscle and appeared to penetrate the walls of both the bladder and rectum. The patient, a 34-year-old woman, presented with persistent perianal pain for 10 days following anterior vaginal wall repair and acupuncture therapy for vaginoplasty. Needle loss had occurred during the procedure. There is limited information in the report about the procedure that resulted in needle loss, but I imagine the patient must have been anaesthetised to allow vigorous enough needle manipulation to cause needle fracture in the perineum.
The image that conjures up is not dissimilar to the treatment described in the second paper, since this involved rapid manipulation of needles in the subcutaneous tissues in a number of locations including the pelvic floor in an attempt to treat SUI after childbirth. This floating needle technique is a relatively modern method with some similarities to FSN, sinew acupuncture and wrist ankle acupuncture, which were mentioned on a recent blog: EA for guinea pig OAK.
The target of needling is an MTrP in relevant muscles, but the needle is placed obliquely and subcutaneously 4–5cm away. The needle is rotated rapidly for 2 minutes followed by voluntary contraction and relaxation of the target muscle. Contraction for 10 seconds followed by relaxation performed 2–3 times. The muscles targeted were lower rectus abdominis, external oblique, the hip adductors, the medial quadriceps, and the pelvic floor. The paper then mentions subcutaneous lavage, but does not elaborate on what this involves, and I have been unable to find a description online.
Postpartum stress urinary incontinence
In this trial from Ningbo, 64 patients with postpartum SUI were randomised to midodrine and Kegel exercises or floating acupuncture combined with indwelling needles at CV3 and CV4. Midodrine is a sympathomimetic agent that acts on peripheral alpha-adrenergic receptors and Kegel exercises are a form of pelvic floor exercises.
The acupuncture intervention performed better than the conventional control, but the trial is small and has a high risk of performance and detection bias.
Finally, another recent publication with a needling procedure that is not commonplace in the West, because it involves the needling of babies and very young children. This was described as a systematic review of clinical studies, which included 10 case series and 2 case reports. The papers described the treatment of nocturnal crying with acupuncture, but rather alarmingly did not appear to include any diagnostic work-up prior to treatment. All papers came from mainland China.
A high success rate was claimed, and there was no reporting of adverse events. We are told that “most children recovered after one treatment”, and that the most frequently used points were Sifeng and PC9 – both on the palmar surface of the hand. I guess most of us would learn to keep quiet if we were threatened with repeated needling of our chubby little palms.
References
1 Al-Sawat A, Lee SJ, Lee CS. Laparoscopic removal of a migrating acupuncture needle from the obturator muscle: A case report. Asian J Surg 2021;:S1015-9584(21)00423-1. doi:10.1016/j.asjsur.2021.06.040
2 Chen F, Zhou J, Wu W, et al. Study on the therapeutic effect of floating needle therapy combined with pressing acupoint embedding for female stress urinary incontinence after childbirth: a randomized trial. Ann Palliat Med 2021;10:7786–93. doi:10.21037/apm-21-1382
3 Ang L, Song E, Lee HW, et al. Acupuncture Treatment for Nocturnal Crying in Pediatric Patients: A Systematic Review of Clinical Studies. Front Pediatr 2021;9:647098. doi:10.3389/fped.2021.647098
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