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

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.