Interesting! I opened this to post the same question. I am thinking of needling away from the most sensitive spots, for TPs and also along the nerve pathways. What are you thinking?

Yes, I would start more proximately and work my way down towards the involved area. Certainly makes sense to move down along the nerve pathways, and eventually ending up into the involved area. I think, also kneeling on the opposite side, makes of neurological sense, and certainly including the thoracic spine needling, for example, mid thoracic for upper extremity lower thoracic for lower extremity. Hope that helps.

Frank

I have had good success needling patient's with CRPS.

Typically they tolerate it better than other interventions because it's not a repetitive friction stimulus. Needle in. Needle out.
It's best to start with a conservative approach, talk more, needle less. Addressing the paravertebral points and proximal homeostatic work well to manage distal symptoms without directly needling the symptomatic tissue. When you eventually progress to local needling, I'd recommend starting with 1/2 needles and progressing depth/number as you go.

I like to start my sessions with the needling because they tend to tolerate other desensitization exercises better after a needling session.

I have a patient with history of right great toe surgery in December to remove/replace cartilage, but post op developed burning/stinging pain in the medial arch of her foot and both dorsum & plantar surface of her toe. She had L3/L4 sympathetic nerve blocks -- 2 of them. Pain is much better since the second one. Only has it now if she is standing for longer periods of time. The top of the foot is red when she wakes up in the morning, while most other times it looks more normal. She reports "ROM is still really limited, but it doesn't hurt anymore." Describes symptoms as stinging pain in the top of the foot -- occasional dull pain on the medial aspect of the foot. Usually, symptoms are 2/10 with 4/10 at worst.

We tried one session of dry needling. Her QST was high 13/16. I did a total of 5 needles - 3 in her tibial nerve distribution muscularly, 1 at the tibial nerve and 1 beneath the retinaculum for the medial plantar nerve. They were left in situ for 10 minutes as she had only a mild dull ache in the retinaculum needle during the treatment. She had a reaction of nausea which started about 20 minutes after the needling and lasted until the next day. Other than that no increase in symptoms, also no change in her foot so far. She has not been back in because she is going away for the weekend, so I'm not sure what muscularly she is feeling from a tenderness standpoint.

Sounds like with your suggestions I was WAY too aggressive????... Clearly, I influenced the parasympathetic nervous system, but was it a normal reaction or over reaction?

Going forward, what would you recommend in terms of dosage. Stick with only the homeostatic points? Less needles? Less time?? Repeat what I did & see how she responds??

Any feedback you could provide would be greatly appreciated. I've been seeing some really good results with other patients so far, but this was the first adverse reaction. The patient is willing to try again, but was just concerned that the second session could ramp up those symptoms?? I thought, more likely they would be less severe with more exposure but was not 100% certain.