Fu's Subcutaneous Needle (FSN), invented by Dr. Zhonghua Fu in 1996, is a method for the treatment of

myofascial pain Myofascial pain syndrome (MPS), also known as chronic myofascial pain (CMP), is a syndrome characterized by chronic pain in multiple myofascial trigger points ("knots") and fascial (connective tissue) constrictions. It can appear in any body part. ...

and trigger points related to

Traditional Chinese Medicine Traditional Chinese medicine (TCM) is an alternative medicine, alternative medical practice drawn from traditional medicine in China. A large share of its claims are pseudoscientific, with the majority of treatments having no robust evidence ...

(TCM) and invented by Dr. D. Simons and Dr. Janet G. Travell. FSN does not follow the rules and principles of TCM and the chosen insertion points do not coincide with traditional acupuncture points. The similarities are limited to the distal insertion of the needle to the affected area, the needle itself being a non-injection needle, and the fact that both needles are manipulated and act on soft connective tissue. FSN abstains from the

muscle Muscle is a soft tissue, one of the four basic types of animal tissue. There are three types of muscle tissue in vertebrates: skeletal muscle, cardiac muscle, and smooth muscle. Muscle tissue gives skeletal muscles the ability to muscle contra ...

and deep

fascia A fascia (; : fasciae or fascias; adjective fascial; ) is a generic term for macroscopic membranous bodily structures. Fasciae are classified as superficial, visceral or deep, and further designated according to their anatomical location. ...

layers and is confined to only the subcutaneous layer where collagen fibers are most abundant. As the subcutaneous layer is poorly innervated, pain is less than other needling therapies. FSN is also currently being used to treat non-musculoskeletal conditions; however more research is to be carried out to conclude its effectiveness.

Mechanism

FSN and traditional acupuncture may both share the same mechanism of action in terms of the measurable or physiological effects they relate on the body. The described effects of FSN on the body are by means of

mechanotransduction In cellular biology, mechanotransduction ('' mechano'' + '' transduction'') is any of various mechanisms by which cells convert mechanical stimulus into electrochemical activity. This form of sensory transduction is responsible for a number o ...

as the swaying of the needle reportedly triggers a response on the

connective tissue Connective tissue is one of the four primary types of animal tissue, a group of cells that are similar in structure, along with epithelial tissue, muscle tissue, and nervous tissue. It develops mostly from the mesenchyme, derived from the mesod ...

, specifically the

collagen fibers Type I collagen is the most abundant collagen of the human body, consisting of around 90% of the body's total collagen in vertebrates. Due to this, it is also the most abundant protein type found in all vertebrates. Type I forms large, eosinoph ...

by stimulating signal transduction and

gene expression Gene expression is the process (including its Regulation of gene expression, regulation) by which information from a gene is used in the synthesis of a functional gene product that enables it to produce end products, proteins or non-coding RNA, ...

fibroblasts A fibroblast is a type of biological cell typically with a spindle shape that synthesizes the extracellular matrix and collagen, produces the structural framework ( stroma) for animal tissues, and plays a critical role in wound healing. Fibrobla ...

of the

subcutaneous tissue The subcutaneous tissue (), also called the hypodermis, hypoderm (), subcutis, or superficial fascia, is the lowermost layer of the integumentary system in vertebrates. The types of cells found in the layer are fibroblasts, adipose cells, and ma ...

. A drawing or magnetic effect on connective tissue has been observed upon needle manipulation as the contraction and shape changes of fibroblasts cause pulling of collagen fibers and secondary alignment of fibroblasts and collagen fibers. During manipulation of the needle, collagen fibers would wind and tighten around the needle shaft, and dispersing of

nociceptive In physiology, nociception , also nocioception; ) is the sensory nervous system's process of encoding noxious stimuli. It deals with a series of events and processes required for an organism to receive a painful stimulus, convert it to a molecular ...

substances and PH balance has also been observed in

skeletal muscles Skeletal muscle (commonly referred to as muscle) is one of the three types of vertebrate muscle tissue, the others being cardiac muscle and smooth muscle. They are part of the somatic nervous system, voluntary muscular system and typically are a ...

.Langevin et al, 2001 As collagen fibers are most abundant in the subcutaneous layer, this may explain why FSN exhibits a more immediate effect than traditional acupuncture in relieving muscle dysfunction as the FSN comes into contact with more connective tissue during needle manipulation.

Development

Zhonghua Fu runs a clinic in

Nanjing Nanjing or Nanking is the capital of Jiangsu, a province in East China. The city, which is located in the southwestern corner of the province, has 11 districts, an administrative area of , and a population of 9,423,400. Situated in the Yang ...

, China, affiliated with Nanjing University of Chinese Medicine. At the FSN clinic for pain medicine, FSN is used as the sole means to treat

musculoskeletal disorder Musculoskeletal disorders (MSDs) are injuries or pain in the human musculoskeletal system, including the joints, ligaments, muscles, nerves, tendons, and structures that support limbs, neck and back. MSDs can arise from a sudden exertion (e.g. ...

s and some chronic benign visceral disorders. Fu originally trained as a TCM doctor, completing his masters in acupuncture. While practicing and teaching traditional acupuncture in

Guangzhou Guangzhou, Chinese postal romanization, previously romanized as Canton or Kwangchow, is the Capital city, capital and largest city of Guangdong Provinces of China, province in South China, southern China. Located on the Pearl River about nor ...

, he realized that several innovations were needed to improve and accelerate the acupuncture effect. Because some techniques for painful problems in the ancient ''

Huangdi Neijing ' (), literally the ''Inner Canon of the Yellow Emperor'' or ''Esoteric Scripture of the Yellow Emperor'', is an ancient Chinese medical text or group of texts that has been treated as a fundamental doctrinal source for Chinese medicine for mo ...

'' were punctured obliquely surrounding some painful spots, Fu thought inserting horizontally was a good choice, and then FSN came into being after a number of trials. After completing his Ph.D., Fu conducted research in his lab for two years on

arthritic Arthritis is a general medical term used to describe a disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, swelling, and decreased range of motion of the affected jo ...

rats. During these trials, when the needle was inserted into the local point of sensitivity, there were no profound changes in VAS and

range of motion Range of motion (or ROM) is the linear or angular distance that a moving object may normally travel while properly attached to another. In biomechanics and strength training, ROM refers to the angular distance and direction a joint can move be ...

. Notable changes in VAS and range of motion were observed however when the needle was inserted parallel to the skin surface.

The FSN needle

The FSN needle is a modified trocar needle similar to an I.V. Catheter and has been patented in China. There are 3 parts to the needle: soft tube, protecting sheath, and needle core. The needle core is 31 mm in length and 1 mm in diameter. Each needle is individually packaged and sterilized with

ethylene oxide Ethylene oxide is an organic compound with the chemical formula, formula . It is a cyclic ether and the simplest epoxide: a three-membered ring (chemistry), ring consisting of one oxygen atom and two carbon atoms. Ethylene oxide is a colorless ...

gas.

Notes

{{Reflist

References

* Anderson, G.B., (1999). "Epidemiological features of chronic low back pain". ''The Lancet'' (1) 354 * Langevin, H.M., Bouffard, N.A., Badger, G.J., Churchill, D.L., Howe, A.K., (2006). "Subcutaneous tissue fibroblasts cytoskeletal remodeling induced by acupuncture: evidence for a mechanotransduction-based mechanism". ''J Cell Physiol'' (3) 207 * Langevin, H.M., Churchill, D.L., Cipolla, M.J., (2001). "Mechanical signalling through connective tissue: A mechanism for the therapeutic effect of acupuncture". ''FASEB J'' (1) 15 Acupuncture Products introduced in 1996