Molecular Targeting by Needle-puncture

M-puncture

The scans are normal. So why does it still hurt?

There is a way of understanding long-standing pain that locates the problem not in damaged tissue but in the functioning of the nerve circuit. This is a record of that view, and of M-puncture, the treatment built on it โ€” written for patients and for physicians alike.

01 First principles

Long-standing pain is a different illness from acute pain

Pain at first is an alarm

A sprained ankle hurts because the body is signalling that something is damaged and should be protected. When the injury heals, the pain goes with it. The alarm has done its work.

But alarms can break

Once pain has continued for months, the situation changes. The nerves carrying the signal become sensitised, and they begin generating pain independently of whatever started it.

Think of a smoke alarm. At first it sounded only when there was a fire. After years of being triggered it now goes off whenever anyone walks past. At that point the problem is no longer the fire โ€” it is the alarm. Searching for a fire will not help, and there may not be one to find. The alarm is what needs fixing.

A dog that becomes a wolf

Professor Lee Young Jin used to explain this to patients with an analogy.

You have a dog guarding the house. The owner does not look after it, does not feed it properly, does nothing when a thief comes and the dog barks. After long enough the dog is so stressed that it turns savage โ€” it becomes a wolf. Once the dog has become a wolf, is there any point asking why? It is a wolf now, and the wolf has to be dealt with. That wolf is chronic pain. Lee Young Jin, patient column, 2013 ยท translated from the Korean

A nerve that existed to protect the body turns, under long enough strain, into something that torments it. Once that has happened, reversing the state it is now in matters more than tracing how it began.

Why it does not show on CT or MRI

CT and MRI show structure. They show whether a bone is displaced, a disc has herniated, a cartilage surface has worn.

But a sensitised nerve is not a change in structure. It is a change in how the tissue behaves, and it does not appear on a scan โ€” much as a computer that has become slow can look perfectly intact when you open the case.

"Nothing abnormal on imaging" and "nothing wrong" are therefore not the same statement. A normal scan does not mean the pain is absent, and it does not mean it is imagined.

The reverse also holds. With age, disc degeneration and joint changes are found in most people, and a great many of them have no pain at all. What shows on the scan and what hurts do not necessarily travel together.

Why surgery can succeed and the pain remain

If the pain was arising from the nerve rather than the tissue, then an operation that corrects the tissue leaves the cause untouched. This is how a technically successful operation and persisting pain end up in the same patient. It does not mean the surgery was done badly. It means it was aimed elsewhere.

This way of understanding persistent pain is now widely used in pain medicine. The terms are central sensitisation and nociplastic pain. If a clinician has used those words with you, this is the same thing described here.

02 Corrections

Common misconceptions about long-standing pain

Nothing showed up on the tests, so it must be in my head

It is not. Pain is generated by nerves, and the sensitivity of a nerve does not show on imaging. A normal scan means the bone and cartilage are broadly intact. It does not mean there is no pain.

If it hurts, I should move as little as possible

Usually the opposite. Once the acute phase has passed, continued disuse wastes muscle and stiffens joints, which leaves the area more vulnerable. Steady movement within a range that does not aggravate the pain is generally better.

The MRI shows a disc problem, so that must be the cause

Not necessarily. Disc degeneration and joint change are found routinely in people with no pain at all. What appears on the image and what is hurting now do not always correspond.

It is my age, so nothing can be done

Degeneration and pain are separate questions. Two people with the same degree of joint wear may differ entirely in whether it hurts. Filing it under age means missing what can in fact be addressed.

If I keep taking painkillers it will eventually settle

Medication plays a different role in acute and in long-standing pain. Analgesics reduce what is felt now; they do not reverse a sensitised nervous system. If the period of getting by on medication keeps extending, the approach is worth reviewing.

I have heard pain gets worse if you put up with it โ€” am I making it worse?

Endurance is not the objective. The longer pain continues, the more readily the nervous system produces it. Rather than enduring it for longer, the useful step is establishing why it persists.

03 Self-assessment

Does my pain fit this pattern?

If several of the following apply, it is worth considering whether the problem lies more with the nerve than with the tissue. This is not a diagnosis โ€” it is a list to begin a conversation from.

  • The pain has continued for three months or more
  • Investigations have not found anything that adequately explains it
  • Something was found, but the pain is far worse than that finding would suggest
  • Injections, physiotherapy or procedures have helped only briefly, or not at all
  • Surgery was performed and the pain remained, or returned
  • The painful area moves about, or has spread beyond where it started
  • Light touch or pressure hurts more than it should
  • Pain flares markedly when tired, sleep-deprived or under stress
  • Movement is now avoided in anticipation of pain

Seek medical assessment first if any of these apply

  • Weakness in an arm or leg, or numbness that is progressing
  • Difficulty controlling bladder or bowel
  • Unexplained weight loss or fever
  • Severe pain at rest at night that prevents sleep
  • Pain that began abruptly after a fall or impact
  • A history of cancer, infection or osteoporosis

04 The treatment

What M-puncture actually does

M-puncture stands for Molecular Targeting by Needle-puncture โ€” targeting a molecular-level problem with a needle. Its object is to reverse the sensitised nerve circuit described above.

A very fine needle โ€” finer than an acupuncture needle โ€” is used to stimulate the affected nerve directly, with injections added as required. There is no incision and no general anaesthesia, and normal activity can resume immediately afterwards.

The procedure comprises the following elements

  1. Locating and stimulating the site where the nerve circuit is disordered, with a fine needle
  2. Injecting substances that support nerve recovery
  3. Settling long-standing inflammation around the nerve
  4. Releasing tissue around the nerve that has stiffened and is compressing or tethering it
  5. Adding magnetic stimulation across the nerve circuit
  6. Where indicated, adding pain- or immune-related injections

The response itself indicates direction

One practical use of this method is that it helps establish whether surgery is genuinely required. If the pain improves, the problem lay with the nerve. If an adequate course produces no change, a tissue problem becomes more likely. Where opinions differ between clinicians about whether to operate, this offers a way of finding out before deciding.

It is not appropriate for all pain. Where the structure itself must be corrected โ€” a fracture, or a compressed nerve producing progressive weakness โ€” other treatment comes first. Response varies between individuals in any treatment, and the decision belongs in consultation.

05 Principle

Why it aims at the circuit, not the tissue

If the previous section was about what the treatment does, this one touches, as briefly as possible, on why.

Long-standing pain begins less in the sore spot than in the nerve that carries it. As that change spreads to the spinal cord and brain, the pain sustains itself and disturbs sleep, mood, and concentration. So rather than working on the painful tissue, M-puncture aims at that nerve circuit — with a very fine needle, and by ‘zone’ rather than a single point.

Seeing long-standing pain as ‘a disease of the circuit’ is not this treatment’s claim alone; it is a view today’s pain medicine shares (nociplastic pain and central sensitization).

Go deeper → How the change that begins in the nerve (the C-fiber) spreads, the authors’ ‘third type’ of pain (NNPS), and what the procedure actually targets — set out alongside the textbook. The principle of M-puncture — how it reads the pain circuit · ํ•œ๊ตญ์–ด

06 A second axis

When bacteria are what keeps the pain going

Even when a sensitised nerve has been settled, pain returns if whatever was irritating it remains in the body. Repairing the alarm achieves little while the smoke continues.

Sometimes that smoke is bacterial. And bacteria have more than one route by which they generate pain.

The first route โ€” input arising from the gut

The gut is home to a large microbial population. When that balance is lost and bacteria or fungi overgrow, the gas and inflammatory products they generate pass beyond the gut and circulate.

These substances act to make nerves more sensitive. Hydrogen sulfide in particular is known to open the channels through which pain signals travel, and to produce heightened pain sensitivity at sites well away from the gut. The effect is to lower the pain threshold throughout the body.

And this route does not act on pain alone. The same input surfaces as bloating, as halitosis, as a head that will not clear, sometimes as a skin complaint. Pain is only one of them โ€” the account of those scattered symptoms traced back to a single source is set out separately at Neo-Skepticism.

The second route โ€” bacteria resident in tissue

Not all of it is in the gut. Bacteria can persist in joints, bone or soft tissue, sustaining low-grade inflammation.

Such states are readily missed, because blood tests and imaging can be entirely normal while the pain continues. It is not unusual for years to pass under a different diagnosis. This is not speculative; it describes conditions already well documented.

What I have seen in practice

Among patients presenting with gut complaints, long-standing pain is a frequent companion, and after eradication treatment that pain settles too, though it was never treated. These are patients who did not consult me about pain at all.

I took it at first for an incidental change. As it kept recurring, that became difficult to sustain. And the improvement holds after the drug is stopped.

Whether it originated in the gut or in tissue I have not yet been able to determine. Both routes may be present in the same patient. Either way the object is the same โ€” reducing what has been generating the pain.

If these are present alongside the pain

Where the following accompany chronic pain, the bacterial question is worth raising.

  • Frequent bloating or excessive gas
  • Long-standing constipation or diarrhoea
  • Pain or fatigue worsening after eating
  • Pain in several areas rather than one, or spread widely
  • Persistent fatigue and poor mental clarity
  • Troublesome breath odour
  • Investigations remain normal while the pain continues
  • Pain treatments help temporarily and it keeps returning

How the two axes interlock

Needle treatment and bacterial reduction are aimed at different points. The first reverses a circuit that has already become sensitised; the second reduces the input that was keeping it sensitised. They do not overlap โ€” each does its own work.

This is why I use them together. A circuit settled with the needle will flare again if the source of irritation is untouched, and removing the source leaves a thoroughly sensitised circuit that does not readily recover on its own. Treating both axes gives a different result.

Not every patient with pain needs this. It applies where the signs above appear alongside the pain, and the two are examined together rather than the pain in isolation.

A step on from Professor Lee's "detoxification"

The final element of the M-puncture procedure was "pain- or immune-related injections where indicated." Professor Lee described this in terms of detoxification, a subject he pursued at sufficient length to publish a separate book on it. The idea that reducing what has accumulated in the body also reduces pain was present in this treatment from the beginning.

I approach that same element with bacteria as the specific target. What has to be reduced is not an unspecified "toxin" but overgrown bacteria and fungi, the gases and metabolites they generate, and organisms persisting in tissue. Once the target is defined, both the means of confirming it and the means of reducing it follow.

And this is not accomplished with a single injection. Four things have to move together.

Diet

Which organisms flourish is determined substantially by what is eaten. Reducing what sustains the overgrowth comes first. This may run counter to general "healthy eating" advice and needs adjusting per patient.

The wider routine

Sleep, spacing of meals, stress and bowel habit are all considered. If the gut is not moving, whatever else is done will simply accumulate again. These overlap considerably with the measures discussed in pain treatment.

Active eradication

Where indicated, antibiotics and antifungals are used actively. Diet and routine alone frequently fail to displace an established overgrowth. Because a single agent leaves organisms outside its spectrum to fill the space, several classes are combined for broad coverage.

And afterwards

Reduction is not the end of it. What follows is establishing conditions in which the overgrowth does not return โ€” which brings the work back to diet and routine.

The use of antibiotics and antifungals is a matter for clinical judgement based on investigation and course. It is not treatment to be started or stopped independently. Which agents are used, and how, is not covered here.

Further reading โ†’ The conditions in which bacteria resident in musculoskeletal tissue are established to cause chronic pain, the mechanism by which hydrogen sulfide opens nociceptive channels, which investigations may be informative, and what remains unresolved โ€” set out with references. Bacteria and Chronic Pain โ€” In the Gut, and in the Tissue

07 Daily life

What helps alongside treatment

A sensitised nervous system does not settle on treatment alone. If the conditions that drive that sensitivity remain in daily life, it rises again. These are the things always discussed alongside treatment in pain practice.

Sleep

Pain is worse the day after poor sleep. Pain preventing sleep, and lost sleep worsening pain, is a common cycle. If one thing is to be addressed first during treatment, it is sleep.

Moving, a little and often

Better than overdoing it and spending days recovering. Within a range that does not aggravate, small amounts daily. It is a process of the body relearning that this much movement is safe.

Reducing fear

Avoiding activity in anticipation of pain narrows what can be done, and the narrower it becomes the more it hurts. Knowing precisely what is safe is itself often enough to reduce pain.

A pain diary

Two weeks of noting when it is worse and when it eases will usually reveal a pattern. It also tells a clinician far more than "it just hurts all the time."

Stress and tension

This does not mean the pain is psychological. Sustained tension genuinely increases nerve sensitivity. It is worth examining together what was happening on the days it flared.

Preparing for the consultation

When it began, where it is, what brings it on. What treatment has been given and with what result. Those three alone change the quality of a consultation.

08 Lineage

Where this treatment came from

Chan Gunn Vancouver, Canada. Established intramuscular stimulation (IMS), placing a needle deep into muscle to restore nerve function. The direct ancestor of M-puncture.
Clifford Woolf Reported the sensitisation of the central nervous system to pain, which became the foundation of the modern understanding of chronic pain.
Dong Whee Jun Authored Jun's M-Puncture and pain model. Originator of the pain model.
Dong Whee Jun ยท Young Jin Lee Jun & Lee's M-puncture and pain model, second edition. Professor Lee updated the theory and organised it into a system usable in clinical practice.
M-puncture certificate course Practical training for physicians, teaching examination and technique region by region over two days. The last course ran in 2018.
Young Jin Lee Still in active practice. His focus has since moved elsewhere, and the M-puncture teaching has stopped.

Go deeper → The three editions, the name change (‘acupuncture’ → ‘needle-puncture’), the editor’s verifiable record, and where the theory stands on evidence — set out with sources. The lineage and sources of M-puncture · ํ•œ๊ตญ์–ด

09 Practice notes

A practical record for physicians learning the technique

This part is for physicians. The theory survives in the textbook, but how the hand is actually used is written down nowhere. What was learned in the course, and what has accumulated in practice, is recorded here region by region against a common template.

In progress

The structure below is set out; the content is still being written.

Presentations addressed

Disc herniation with radiculopathy ยท spinal stenosis ยท degenerative spondylolisthesis ยท sacroiliac dysfunction ยท facet syndrome ยท post-laminectomy pain

What to exclude first

To be written

What examination establishes

To be written

How the site is found

To be written

What the needle meets

To be written

Common errors

To be written

Patterns that respond, and that do not

To be written

Number of sessions and interval

To be written

Safety and contraindications

To be written

10 About this record

What is disappearing is not the theory but the hand

M-puncture is a system for treating chronic pain that was set out in Korea in the late 2000s. More than a thousand physicians took the training at one point. The official site has since closed, and the last course ran in 2018.

Why it is disappearing

Not because the theory was wrong. The theory survives in print, and the view of chronic pain as a problem of the nervous system is now more widely accepted, not less.

The reason lies elsewhere, in my view. The procedure depends heavily on the sense of the person performing it.

Understanding what a patient means by their pain and being able to meet it; identifying, among several painful areas, the one that actually needs the needle; and taking that site far enough to release it properly โ€” these have to come together for the result to follow. If one is off, the same protocol followed exactly will not work.

And this part does not transfer well through a two-day course. The theory and the sequence can be taken away; the hand cannot. That, I think, is why a treatment more than a thousand physicians were taught has not survived widely. Most of them left with the protocol. The sense did not go with it.

This record therefore is not aimed at setting down the sequence. It is an attempt to put into words the part that resists being put into words โ€” what the needle meets, where people go wrong, which patients respond and which do not. None of this is written in any book, and it goes when the person doing it stops.

One thing to add

What I do will not be exactly what I was taught by Professor Lee. I work with my own method and my own feel, and that follows from the nature of the procedure itself. Rather than a standardized one โ€” a medial branch block at a named level, an epidural block โ€” this is worked much further out in the periphery, where each point has to be found one at a time. To it I have added an approach that reduces bacteria.

June-sang Yang

Physician ยท compiler

I learned M-puncture directly from Professor Lee Young Jin and continue to use it in practice. I have seen in the clinic that there are patients for whom this method clearly helps.

This record is not intended to attract patients. It carries no clinic details and no enquiry form. Reaching the patients for whom this view is useful, and the physicians who might carry the technique forward, is enough.

ORCID 0000-0001-7122-1386

What survives of the source material

  • Jun & Lee's M-puncture and pain model, second edition2013
  • Jun's M-Puncture, first edition2009
  • Theory pages of the original siterecovered
  • Index of 90 chronic pain conditionsrecovered
  • Certificate course curriculum2014 ยท 2017
  • Press coverage2009โ€“2013

11 FAQ

Frequently asked questions about M-puncture

What is M-puncture?

A treatment viewpoint that reads long-standing (chronic) pain as a problem of the nerve circuit rather than tissue damage, and aims at that circuit. The name is short for Molecular Targeting by Needle-puncture. See the principle page for detail.

How is M-puncture different from acupuncture (IMS / dry needling)?

Its root is indeed the IMS family. The difference is what it targets โ€” not the painful tissue but the nodes of the pain circuit (the nerve), approached by โ€˜zoneโ€™ rather than a single point. The lineage is set out in lineage and sources.

Is M-puncture the same as โ€˜nociplastic painโ€™?

The thing it targets is much the same. What the authors called a โ€˜molecular lesionโ€™ in 2009, pain medicine has since 2017 taken into its standard framework as nociplastic pain and central sensitization.

My scans (CT/MRI) are normal โ€” so why does it hurt?

Those scans image tissue and donโ€™t capture changes in the nerve circuit well. This is common when long-standing pain is a problem of the circuit rather than the tissue. (โ†’ first principles)

Is M-puncture evidence-based?

M-puncture is an approach grounded in the treatment theory of Prof. Young Jin Lee. Its diagnostic frame (chronic pain as a disease of the nerve circuit) was, ahead of its time, already what pain medicine standardized from 2017 on as nociplastic pain and central sensitization. This site guarantees no particular result or cure. (โ†’ lineage and sources)

Who created M-puncture?

The pain modelโ€™s original author is Dong Whee Jun; the person who organized it into a clinical system is Young Jin Lee (co-author of the 2013 revised edition).

Can I still receive M-puncture treatment?

Formal teaching and branded activity under the name M-puncture stopped around 2018. A few physicians who learned it still carry it on in practice โ€” this siteโ€™s editor among them. The site itself is a public archive of material that has disappeared, not a place to recruit patients.

What do bacteria have to do with chronic pain?

Input from the gut and organisms settled in tissue may be a โ€˜second axisโ€™ that keeps pain going. (โ†’ bacteria and pain)