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studies are often nonspecific.5 On radiographs and magnetic
resonance imaging (MRI), the absence of abnormalities in the
area of the expected pain source can lead to the conclusion that
symptoms have nonorganic etiology.5 Yet, abnormal findings
on shoulder and spine images do not necessarily correspond to
the manifestation of pain.5 Approximately 1 in 25 patients seen
for a presumed shoulder or neck problem may have neck–
shoulder crossover, in which a pathology in one area may be
mistaken for or coexist with the other area.5
The present case report describes the results obtained
using the Chinese Balance Acupuncture protocol of Richard
Teh-Fu Tan, OMD, LAc, to treat chronic neck–shoulder
pain. One of the unique features of this acupuncture method
is that it is fully based on the Meridian Theory—the diag-
nostic tool historically used in an ancient system for acu-
puncture treatment.6
CASES
Patient 1
A 70-year-old Caucasian male presented at an outpatient
pain clinic with the chief complaint of chronic right shoulder–
neck pain that he had had for *1 year (Fig. 1). Based on his
X-ray, the patient was diagnosed with pain in the right
cervical facet irradiating to the shoulder, caused by degen-
erative changes in the cervical facet (Fig. 2). About 3
months before, he had already visited the outpatient pain
clinic. He was prescribed Traumeel! ointment three times
per day, a medial branches block C-3–C-6, and a right
cervical facet block C-5–C-7. None of these procedures
affected the pain. The patient was prescribed acupuncture
treatment.
Patient 2
A 65-year-old Caucasian male presented at an outpatient
pain clinic with the chief complaints of mostly right
shoulder–neck pain and weakness in both hands. The patient
FIG. 1. The neck–shoulder area of pain shown by the patient (in
gray).
KOTLYAR ET AL.
FIG. 2. The X-ray depicting neck facet degenerative changes of
Patient 1.
had had these symptoms for *4 months. Based on his
computed tomography (CT) scan, he was diagnosed with
C-2–C-7 disc prolapse and cervical thecal sac compression.
An ultrasound showed tendinitis of the right shoulder and
right C-6 root lesion, and an electromyogram examination
revealed mild sensory axonal polyneuropathy. The patient
was prescribed 1 60-mg capsule of Duloxetine Delayed-
Release Capsules (Cymbalta!) per day, 1 dose of acet-
aminophen (Rokacet Plus!) 3 times per day, and a cervical
epidural steroid injection. The patient refused to receive the
epidural steroid injection and was prescribed acupuncture
treatment.
Patient 3
A 71-year-old Caucasian male was referred to the pain
clinic with the chief complaints of headache and chronic left
and right neck–shoulder pain that he had had for *1.5
years. Based on his CT examination, he was diagnosed with
diffuse idiopathic skeletal hyperostosis, stenosis in the
cervical region, and pain in the cervical facet. Prior to the
referral to treatment at the pain clinic, he was treated with
600 mg per day of oral etodolac, a nonsteroidal anti-
inflammatory drug (NSAID). During the treatment period of
20 days, the NSAID treatment decreased the intensity of his
pain to a certain extent. He was prescribed acupuncture
treatment.
Patient 4
A 41-year-old Caucasian male was referred to an outpa-
tient pain clinic with the chief complaint of chronic left
shoulder–neck pain that he had had for *15 years.
About 15 years before, this patient underwent surgery to
immobilize recurrent shoulder dislocation by screw fixation.
Postsurgery, pain in the left shoulder appeared and later
became exacerbated to neck–shoulder pain. About 6 years
later, the patient was operated on again twice to excise the
immobilizing screw. Based on a CT examination,