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Med Acupunct. 2018 Oct 1;30(5):282-284. doi: 10.1089/acu.2018.1302. Epub 2018 Oct 15.

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

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VA Maryland Health Care System, Geriatric and Extended Care Service, Loch Raven Medical Center, Baltimore, MD.
University of Maryland, School of Medicine, Baltimore, MD.
VA Maryland Care System, Physical Medicine and Rehabilitation Service, Baltimore, MD.
Sinai Hospital, Baltimore, MD.


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; Botulinum toxin A injection; CVA; pain management

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