Medical Acupuncture Online Journal, Volume 12 #2, poster 4

OBJECTIVE
    To demonstrate the use of the Curious Meridian, Distinct Meridian, and French Energetics treatment for managing and resolving chronic groin pain.
PROBLEM
    Chronic, severe left groin pain for 10 years.
History
    A 38-year-old man presented with a 10-year history of left groin pain in May 1999. He developed acute, severe, and nontraumatic pain in the left groin area in 1991. He was initially diagnosed with and treated for epididymitis with several courses of antibiotics. He repeatedly saw a urologist for persistent left groin pain, and was treated with doxazosin mesylate for the possible prostate problem causing his symptoms. He continued to have a constant ache in the left groin area radiating into the anterior thigh that was aggravated by any physical activity. A hot bath relieved the pain. One year later, he developed a bowel problem (diarrhea/cramping) and was diagnosed with Crohn's colitis. He then started conventional therapy with Azacol and steroids, and later with mercaptopurine to maintain remission of Crohn's disease. His bowel condition remained asymptomatic, but his left groin pain persisted unchanged. For over 10 years, he saw different specialists and tried various medications to suppress pain, the latest being tramadol hydrochloride. The pain failed to improve with steroid injection into the left groin and paraumbilical area, and the patient was referred to my office by a pain specialist.
Past Medical History
    Crohn's colitis diagnosed 9 years ago, in remission for 8 years, and normal results of colonoscopy 2 years ago.
Family/Social History
    Single, nonsmoker, heterosexual, nondrinker, with a stressful job. Attempted to run 3 times a week, but had to take pain medication before and after exercise because his symptoms were significantly exacerbated.

Medication
    Tramadol, 1/2 to 1 tablet 3-4 times a day, and mercaptopurine, 25 mg/d, as an investigational drug for irritable bowel disease.
Allergies
Sulfa drugs.
Review of Systems
    Remarkable for sleep occasionally interrupted by pain, low energy, intermittently lower libido, diminished appetite, recent sinusitis, occasional heartburn, belching, and bloating. No other symptoms.
Physical Examination
    Physical examination revealed a slim, middle-aged man with tenderness to palpation in the left groin and a small area on the left anterior superior thigh. Also, focal tenderness around the umbilicus.
Acupuncture Point Palpation
    Tender over ST 25 bilaterally, ST 30, 31, 36; SP 6, 9, 12;
BL 22, 23, 25; and KI 3. Japanese abdominal Hara diagnosis
evaluating Curious Meridians was positive for sensitive points
ST 25, LI 4, 10, and 11.

DIAGNOSIS
    Left groin pain, chronic for 10 years. Etiology: possibly related to Crohn's disease vs obturator neuropathy vs other.
Acupuncture Diagnosis
    SP and KI channel deficiency and an excess on the ST and LI meridians. Curious Meridian evaluation showed areas of sensitivity on palpation corresponding to Hand Yang Ming Mai.
TREATMENT
    For the initial 2 treatments, Tai Yin N+1 was used, combined with Curious Meridian Hand Yang Ming, to achieve symptomatic pain relief and initially to avoid needling in the groin area (the patient was shy and needle-phobic). Auricular therapy also was used: Shen Men, Sympathetic, Thalamus, Colon.
The 3rd and subsequent treatments included:

Ming Men + BL 25 (LI Shu) + BL 22 (TH Shu).
Distinct Meridian SP - ST to address pelvic/groin pain.
Followed by or alternating with Tai Yin/Yang Ming principal meridian to address the SP deficiency/excess on ST meridian. For the initial few treatments, both distinct and principal meridians were used in 1 session, and later, the distinct and principal
Auricular therapy: Shen Men, Sympathetic, Colon, Esophagus, Stress in weekly sessions.

    On the 5th visit, the patient was instructed to use moxa at home on the Curious Meridian Hand Yang Ming Mai master point LI 4, coupled with ST 43 on the right side only. This was done to provide pain relief at home, and to prolong the interval between treatments.
Outcome
    Initially quick, but only short-term improvement was achieved in left groin pain. After changing to a distinct meridian SP/ST and frequent Shu point stimulation and Tai Yin/Yang Ming principal meridian, longer-lasting pain relief was achieved.
    Adding home moxa treatments allowed the patient to present for treatment less frequently (every 2-3 weeks), and after his 6th treatment, he had minimal discomfort. He discontinued taking tramadol after his 8th treatment, and began maintenance acupuncture treatment every 2-3 months. He became pain-free after the 10th treatment.
    The patient is able to exercise without pain. He hired a personal trainer to help him improve his exercise endurance and build muscle. He is more calm and balanced; he tolerates stress on his job significantly better. Results of colonoscopy done at the time of his 8th visit were normal.

AUTHOR INFORMATION
Dr Alice Brunecky is Board-certified in Internal Medicine, and practices Medical Acupuncture in her private practice in Broomfield, Colorado. She is current President of the Rocky Mountain Chapter of AAMA.

Alice Brunecky, MD
Alpine Medical Acupuncture
7050 W 120th Ave, #121
Broomfield, CO 80020
Phone: 303-438-2050