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New name needed for multiple puncture technique / Dry needling

Discussion in 'General Issues and Discussion Forum' started by richardrobley, Apr 13, 2012.

  1. richardrobley

    richardrobley Active Member

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    If you are afraid of needles, and many people are, being told you need a procedure called 'dry needling' or 'multiple puncture technique' seems to turn people white with fear. Who came up with this name? I want to come up with a new term that does not scare people, something like...... Imune response treatment??
    Any other ideas?
  2. Admin2

    Admin2 Administrator Staff Member

  3. bob

    bob Active Member

    It's your practice - you can can it what you like. How about 'cuddley wuddley fwuffy bunny wabbit treatment'?

    You could get a fluffy rabbit hand puppet and secretly hide the needle in its mouth and pretend that the rabbit is nuzzling your patients feet as well if you like? It's up to you isn't it? You will still be sticking needles in them. Not quite sure how this could be incorporated into evidencing your consent process though. I'd start with scented forms.
  4. richardrobley

    richardrobley Active Member

    That might work, lol.
  5. blinda

    blinda MVP

    Hi Richard,

    As Bob intimated, you can`t really avoid telling them that you`re going to use a needle for LA and multiple puncturing of the lesion, no matter how you dress it up. Similarly, many pts don`t like the term `nail surgery`, but you still have to be explicit in your explanation of the procedure and associated risks and benefits, as I`m sure you know.

    It was suggested by a colleague of mine, who was also my mentor in LA techniques, that we could call it Percutaneous Immune System Stimulation....but it didn`t go down too well ;)

  6. I suppose you could call it "Falknor's Immune Stimulation Technique". The funny thing is that it is the local anesthetic injection hurts, which always involves sticking a needle into the patient, not the needling technique itself that hurts!
  7. Connie D

    Connie D Member

  8. blinda

    blinda MVP

    Not so sure about that acronym either...but I do think that Falknor should be credited with publishing the earliest literature on this highly successful treatment for VPs.
  9. Don't like FIST? Thought it was a knockout name.:rolleyes:
  10. efuller

    efuller MVP

    I don't know if even that would help. I had a pet rabbit. After he would "needle" someones hand he would give you a little bite. But this wasn't dry needling.

  11. W J Liggins

    W J Liggins Well-Known Member

    I understand that for some, 'fisting' has quite a different connotation!

    I hasten to add that I don't move in those circles myself - literally - or, well, literally!

    All the best

  12. richardrobley

    richardrobley Active Member

    I've noticed dentists always seem to use the phrase 'I'm just going to pop a bit freeze in your gum' as they walk towards you with the needle hidden behind their backs, sneaky buggers!
  13. On further thought, here is a good name for Falknor's needling tecnnique for plantar verrucae:

    Verrucae Innoculation Procedure

    Verrucae Innoculation Procedure (VIP) is nice and short, to the point and does get rid of the potentially upsetting "needling" from the name which could be a problem for needle-phobic patients. In addition, I never really cared for having people's names attached to procedures or products.

    I think I will start calling it by this name....I like it.:D

    ....and we can say the name was created here on Podiatry Arena!!
  14. Nice

    Does that make us vipers?
  15. richardrobley

    richardrobley Active Member

  16. RossPod

    RossPod Member

    Fear of a name increases the fear of the thing itself... Always wanted to use that Harry Potter line.
  17. blinda

    blinda MVP

    Actually, I call it `verrucae treatment`. I don`t really see the need to give it a name. Do you have a special name for sal acid treatment? When a patient presents with a VP I explain all the treatment options, including no treatment, and detail the procedure of each modality.

    That said, I do tell them that the only discomfort they will feel is the initial LA injection and that needling the lesion can be regarded as a form of inoculation (so we`re singing from the same sheet, Kevin), similar to the jabs you have in the arm. This allays much fear for the needle phobic.

  18. yvonneg

    yvonneg Member

    I call it VISIT - one VISIT does it!
    Verruca Immune Stimulation Injection Therapy, catchy...... We have been using that name to advertise it and it has been doing well.
  19. That IS catchy.

    Discomfort. For the needle phobic. Yeah, whatever.

    I think I'll stick to dry needling. I am far more often in the position of trying to talk people OUT of verruca treatments (of any kind) than wanting to talk them into it.

    Look at it...
  20. blinda

    blinda MVP

    Yep, that`s what I say; "discomfort - no more painful than a jab in the arm".....if done right;)

    Ah, now you see I`ve revised that bit. It isn`t Dry Needling as we dont use a solid needle nor perform intramuscular stimulation. Well I suppose it depends on how deep you go, and your opinion on trigger points.....
  21. blinda

    blinda MVP

    K. Spoke to Dad. We`re on for the `least painful method of anaesthetising the foot` challenge. See you there :drinks
  22. Always fun ;). But for the true needle phobic the amount of pain is irrelevant....
  23. blinda

    blinda MVP

    Indeed. True needle phobics are not suitable candidates for this. Had to refuse at least 3 patients on those grounds.

    "I can put my head in a guillotine and play with a snake. But no – no needles!" - Alice Cooper.
  24. carolethecatlover

    carolethecatlover Active Member

    Auto - Innoculation.
  25. Naive but happy me- it works "as an inoculation"(inoculation has one "n" by the way); we know that how? And, I'm guessing they're already infected. It works by "immune stimulation" and we know that because...?

    Here's a party. Here's some poop. RVT- ritualistic verruca treatment? PVT- placebo verruca treatment? But y'all know that the efficacy of this is beyond the ritual and the placebo effect by now, right? Because y'all are performing an invasive procedure on people that has been shown to have better results than non-invasive placebo's- right?

    You could always call it "snivel": Sticking Needles Into Verrucae Evidence Lacking.

    Never mind. At least you're not treating an invisible entity, which two observers cannot agree upon the location of, using a treatment which is no better than a placebo like the "trigger point" advocates. http://www.youtube.com/watch?v=mpGN0RWdJ9c

    "Lesson learned
    wish me luck"
  26. blinda

    blinda MVP

    If you`re interested; the attached article is one of many on immunology of HPV, explaining specific immunity against HPV capsid by evoking cytokines for viral immunity, in already infected individuals.

    As I am sure you are well aware, viral proteins within a cell stimulate production of cytotoxic T cells (which then seek out and destroy the targeted cells) when the infected cell is damaged and leak said proteins. But HPV`s are clever fellas, they do not cause cell lysis, in fact they positively avoid damaging their host cell, so there is no release of viral proteins to the dendritic cells, thus; no antigen presentation to the immune system. The hypothesis is; (and appears to be supported by the fact that after needling just one lesion, all lesions regress) destruction of the affected tissue will initiate the desired immune response by causing cell lysis. Kinda.

    Attached Files:

  27. bob

    bob Active Member

    Hello Simon. Do you treat patients? What treatments do you offer to your patients if so? I am not trying to be inflammatory, I am just curious. I have met several podiatrists throughout the years who have varying tasks that they perform throughout their days - some academic podiatrists who solely work within universities and do not see patients, people who work solely in private practice, people who work solely in the NHS, and so on... Apologies if this is off topic and feel free to ignore it if you like.
  28. If it's effective because of a more elaborate placebo effect, and giving it a fancy name enhances it, I'll take it!

    If its effective because of inoculation? I'll take that too!

    Either way it's a win!
  29. DTT

    DTT Well-Known Member


    Yes painless podiatry is what we should ALL be striving for IMO , so ROB your comment is not only irresponsible but totally wrong:mad:

    NO amount of pain is irrelevant !! it is VERY relevant to the patient whoever they are and as a clinician we should all be aware of that ( as I thought I had made clear ???:rolleyes:)

    Yes the duel is on between you and Bel on the arranged date ( including my theory on digital block I hope) and may the best technique win.
    Looking forward to it

    D ;) ( AKA Dad)
    Bloody kids :empathy:
  30. Definition of inoculation:

    The verrucae inoculation procedure is an inoculation procedure as long as the virus that is being introduced into the body by repetitive needling is being used as a means to produce or boost immunity to the virus that causes verrucae plantaris. Even though this seems quite obvious to most of us that have successfully used this procedure on numerous patients, we still don't know if the resolution of the verrucae plantaris lesion is due to increased immunity from the inoculation procedure or from some other cellular mechanism. We still await that research.

    However, my hypothesis, from my clinical knowledge and practical experience in using this procedure countless times both in treating mosaic verrucae and also on verrucae plantaris lesions on contralateral foot from the side of needling treatment, is that the mechanism of the cure with Falknor's needling technique is directly due to a true inoculation of the verrucae plantaris virus into the body which results in a boost in immunity from that inoculation. Of course, those that have not seen the remarkable results from this procedure may not be so confident in the mechanism of action of this procedure.
  31. Yet you are not introducing the virus into the body, since it is already there and we do not know whether the process boosts immunity to the virus yet- agreed?

    Or by some other mechanism altogether, which is my point. You are giving a highly specific name to a therapy which suggests you know exactly how that therapy works. Clearly the mode of action is uncertain given the current level of knowledge. It might work by boosting immunity, but it might not too. The name you have given it may turn out to be a misnomer.
  32. timharmey

    timharmey Active Member

    Could say that there is some debate how orthotics work, but we are happy to say we treat people with orthotics , following that logic it has to be needling, i.e it is not how we do it but what we use, but I suppose that would lead to surgery being renamed blading so maybe not !
  33. Dad

    Read what I said again. Of course we are all trying for painless podiatry and yes, its always important. I never said it wasn't. However to the true needle phobic, (as opposed to someone who merely hates injections), the phobia is entirely separate from the perceived level of pain. A true needle phobic is no more concerned with the level of pain than an arachnaphobic is comforted by the reassurance that "a little spider cannot hurt you" or a claustrophobic is reassured by the fact that being stuck in a lift is quite painless. So although they don't like pain any more than anyone else, and we should make the same level of effort to ensure they don't suffer any, the pain is far less important to them than the phobia of the needle. Thats why they go through agonisingly painful dental treatment with no LA, because the pain is less important to them than the phobia of the needle.

    But A true needle phobic won't come within 200 yards of a treatment called "dry needling" unless their life is in immediate danger so they're not that relevant to us;). The more common presentation is someone who has a phobia of the type of pain one has with injections and they're the ones we go to such lengths to make it painless for.

    And I'm looking forward to working with bel and you to experiment with all the variations on the technique we discussed to try to find the least painful. :drinks
  34. DTT

    DTT Well-Known Member

    Ask yourself a question son :rolleyes: whether you are needle phobic or not, if you are in a lot of pain everyday with a VP that is driving you mad, where would you be more likely to go if all other modalities fail?

    Would it be to someone that will jab a needle straight into a nerve and make you cry out in pain wiggle it about and damage that nerve , not to forget pushing the "flatulance button" at the same time:eek: ?
    To someone that can give reassurance in understanding the phobia in a relaxed atmosphere and give a pain free procedure ?

    Why should this group of patients be even more upset by the horror stories ( like the "friends" tell patients when they come in for nail surgery) that makes them carry on with a poor quality of life when a pain free tx is available ?

    I do take on board the confines of phobia that you describe, but for those with no choice ?

    I dunno son you choose

    Dad :empathy: Bloody Kids ;)
    Last edited: Apr 18, 2012
  35. blinda

    blinda MVP

    OK Pedantic Pete. We are not introducing the virus to the `body`, we`re introducing it to the `immune system`. Yes, the infection is already established, but the immune system is unaware of its presence, as I said in my last post. I am happy to use the term inoculation as it has been well documented that humoral immunity to the virus can be achieved by stimulating the release of pro-inflammatory cytokines, which in turn induce wart regression via a localised, natural immune response.

    `Tis true we do not have a full understanding of the mechanism of cell-mediated immunity in relation to HPV, thus my reluctance to `give it a name`, but there is enough evidence to conclude that induction/introduction of cytokines to the subcutaneous tissues and blood cells stimulates or enhances both the innate immune response and the cellular arm of acquired immunity. I know it`s not your bag, but immunophysiology of the skin is fascinating and I could go on for hours....but I wont bore you any more.
  36. Isn't it a case of the immune system being aware of its presence, but not responding effectively?

    From the paper you attached:
    "evidence suggests that although the immune system reacts to HPV infection, it does
    not respond effectively or quickly.16"
  37. Del, you're preaching to the choir! I was merely making a point about the nature of a phobia as opposed to a fear. The rather brutal process you described is obviously not something anyone should want or indeed tolerate! I would never and have never done such a thing.
  38. blinda

    blinda MVP

    Could well be, in some instances. Hence, the statement; `it stimulates or enhances both the innate immune system and the cellular arm of acquired immunity`. As any expression of viral proteins is limited to superficial epithelial cells, there is a reduced presentation of these to the immune system, i.e. not enough to trigger a systemic response. Of course, it aint really that simple. HPV also encodes specific functions to inhibit immune responses. The attached paper by Frazer, succinctly explains the relationship between HPV and the innate and adaptive immune systems. He states “Such inhibition would be expected to reduce specific antiviral defence mechanisms and also effective presentation of antigen to the host immune system”.
  39. DTT

    DTT Well-Known Member

    I know that Donut :D

    It was a generalism on choice not a personal thing, Ive always known you to be an excellent practitioner in all respects.
    Thats was all the comments were about" choice to the patient"
    Cheers mate
  40. If it's the cell lysis that is important, why is cryotherapy, which presumably causes cell lysis, shown to be no better than a placebo / duct tape?

    And indeed, if it's the lysis that counts, how does hypnotherapy work?


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