Acupuncture relieves pain in patients with bone marrow examination

Electroacupuncture is able to significantly reduce pain in patients undergoing bone marrow aspiration and biopsy and decrease some of the complications of pain according to a report published in journal Advanced Biomedical Research.

Bone marrow aspiration and biopsy plays an important role in the evaluating blood disorders, diagnosing and staging of malignancies and defining various infectious diseases. It is a painful procedure. In spite of using local anaesthesia and medication, pain relief in bone marrow examination is often unsatisfactory and the procedure has many adverse effects such as hypertention, tachycardia, arrhythmias and increased risk of stroke etc.

Researchers in Iran conducted a randomized, double-blinded study to evaluate pain relief effect of acupuncture in patients undergoing bone marrow examination. Fifty patients were divided into two groups; one group was treated with electroacupuncture at acupoint LI4 and LI11 bilaterally plus local anaesthesia, while group two was received placebo acupuncture plus local anaesthesia treatment. Acupuncture was given 15 mins before starting bone marrow examination procedure for duration of 25 mins. Visual Analogue Scale was used to measure the pain scores induced by bone marrow examination procedure. It was found that pain scores were significantly reduced in acupuncture group compared to placebo group. The rise of systolic blood pressure and pulse rate were lower in acupuncture group compared to placebo group.

Authors suggest that acupuncture can be used as an adjunctive treatment in bone marrow examination procedure.

Reference:

Shokrani O et al., Electrical stimulation of acupuncture points for analgesia during bone marrow aspiration and biopsy: A randomized double-blind placebo-controlled trial. Adv Biomed Res. 2014 May 28;3:125.   http://www.ncbi.nlm.nih.gov/pubmed/24949296

Acupuncture is effective in treating De Quervain’s tenosynovitis

Symptoms of De Quervain’s tenosynovitis can be relieved by acupuncture treatment and its effectiveness is as good as local injection of corticosteroid, according to a report published in Journal of Acupuncture and Meridian Studies.

De Quervain’s tenosynovitis, named after the Swiss surgeon Fritz de Quervain who described it first in 1895, is a painful condition affecting the tendons on the thumb side of the wrist. The cause of this condition is not clear. It is believed that any activity relying on repetitive hand or wrist movement such as working in the garden, playing golf etc can make it worse. Common approaches for tenosynovitis include rest, physiotherapy, pain killers and local injection of corticosteroid which is the most common and effective treatment option. However local corticosteroid injection has many side effects including irritation, soft tissue calcification and skin defect etc.

Researchers in Iran conducted a clinical trial to compare the effectiveness of acupuncture and local corticosteroid injection on patients with tenosynovitis.  Thirty patients were allocated to two groups. Patients in group one were treated with acupuncture on specific acupoints for 30 mins a day for 5 days. Patients in group two were given local corticosteroid injection. The degree of disabilities and pain of affected wrist were assessed by using the Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) and the Visual Analogue Scale (VAS) before and after treatment. It was found that by the 2 weeks and 6 weeks after treatment respectively, both treatments significantly reduced the disabilities and pain of affected wrist. Although corticosteroid injection was slightly more effective than acupuncture there is no significant difference between two treatments.

Authors suggest that acupuncture is an effective alternative treatment for tenosynovitis with little adverse effect.

Reference:

Hadianfard M et al., Efficacy of Acupuncture versus Local Methylprednisolone Acetate Injection in De Quervain's Tenosynovitis: A Randomized Controlled Trial. J Acupunct Meridian Stud. 2014 Jun;7(3):115-21.  http://www.ncbi.nlm.nih.gov/pubmed/24929455

Acupuncture needle penetrating the stomach cavity was removed by endoscopic-assisted device

In a case report, acupuncture needle penetrating the stomach cavity of a woman patient after acupuncture therapy was removed by endoscopic-assisted device according to a publication in journal Clinical Endoscopy.

Doctors in Seoul, Korea reported that a 47-year-old woman was presented with a 2-day history of abdominal pain after recently having received acupuncture treatment for abdominal discomfort in a local clinic. Her abdominal condition worsened after acupuncture and was admitted into the hospital. Her vital signs were stable; blood test and chest radiography were not found abnormal changes.

However, abdominal computed tomography revealed a high-attenuated linear image embedded in the posterior wall of stomach antrum. Esophagogastroduodenoscopy found a needle penetrating the stomach. The needle was removed and retrieved from the stomach. The patient was treated with antibiotics for 2 days and recovered completely.

Although acupuncture is a safe therapy this case report showed that complication could happen if the strict rule of treatment is not followed.

Reference:

Lee SW et al., A Needle Penetrating the Stomach Cavity after Acupuncture. Clin Endosc. May 2014; 47(3): 258–261.   http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4058545/

Acupoint injection of Enercel improved neurological function in patients with amyotrophic lateral sclerosis

Acupuncture could significantly improve neurological functions in patients with amyotrophic lateral sclerosis as shown in a case report in journal Acupunct Meridian Study.

Amyotrophic lateral sclerosis (ALS), one of motor neuron diseases, is a neurodegenerative disorder. It is characterized by the rapidly progressive muscle weakness leading individuals to loss their strength and the ability to move their arms, legs and body, and accompanied by impaired swallowing, speech and breathing. The cause of the disease is not known and there is no cure for the condition. The available medication such as Rilutek has been shown only to temporally prolong survival time with many side effects.

Researchers in the United State reported an acupuncture case study after seeing markedly improvement in patients with ALS. Two patients with ALS were treated with acupoint injections of Enercel (an herbal preparation consisting of small diluted amount of a variety of plants). Neurological conditions were assessed before and after treatment and the follow-up. The treatment was carried out at the specific acupoints once a day, 5 days a week for 4 weeks.

Patient 1 was a 59-year-old female with one year history of ALS. Before treatment, she showed a flaccid paralysis of all extremities and impaired speech and swallowing. After treatment she demonstrated a significant improvement in motor strength in her hands and feet, in speech and swallowing. A 3-month follow-up assessment found her clinical status slowly worsened but was still improved compared with baseline.

Patient 2 was a 49-year-old male with 16-month history of ALS and had an impaired speech and a mild motor loss of upper extremities and the left leg. Following 4-week treatment his motor function returned to normal and his speech is understandable. The patient continued to have the same treatment during 3-month follow-up and his improvement was maintained.

The case study showed that acupoint injection with Enercel significantly improved neurological conditions in patients with ALS. However, continuous treatment may be necessary to maintain the improvement.

Reference:

Liang S et al., Significant neurological improvement in two patients with amyotrophic lateral sclerosis after 4 weeks of treatment with acupuncture injection point therapy using enercel. J Acupunct Meridian Stud. 2011 Dec;4(4):257-61.   http://www.ncbi.nlm.nih.gov/pubmed/22196509

Long-term active acupuncture therapy modified brain pain circuitry for migraine

Chronic acupuncture stimulation at the active acupoints has potential effect of regulating some disease-affected brain regions and brain pain circuitry in patients with migraine, according to a report recently published in journal PLOS one.

Migraine attack is sometimes unbearable to the patients and the impact on their families is huge. Loss of productivity due to migraine is enormous to the society. Although the exact cause of migraine is still unknown it is regarded as a central nervous system disorder. Acupuncture is effective in relieving migraine but how it works is not well understood.  

Scientists in China conducted a randomized controlled clinical trial, using functional magnetic resonance imaging technique, to compare the difference in brain activation pattern elicited by active acupoints and inactive acupoints in 80 patients with migraine. Pain was measured by using Visual Analogue Scale prior to and following acupuncture treatment. It was found that acupuncture stimulation at active acupoints SJ5, GB20, GB34 and GB40 for 30 minutes once a day for 4 weeks produced a more extensive cerebral response, in particular in pain-related areas and cognitive components of pain processing. The changes in brain response are closely associated with reduction in pain rating scale. In contrast, stimulation at inactive acupoint SJ22, PC7, GB37 and SP3 induced much less brain responses in those pain-related areas and correlated to less reduction in pain rating.

Authors suggest that therapeutic effect of long-term acupuncture at active acupoint may be related to its enhancing the formation of psychophysical pain homeostasis in brain of patients with migraine.

Reference:

Zhao L et al., Effects of Long-Term Acupuncture Treatment on Resting-State Brain Activity in Migraine Patients: A Randomized Controlled Trial on Active Acupoints and Inactive Acupoints. PLOS one. 2014 Jun 10;9(6):e99538.    http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0099538

Mechanisms underlying versatile functions of acupoint Zusanli (ST36)

Acupoint Zusanli (ST36), located on the stomach meridian, is one of the most frequently used acupoints. It is believed to be one of the most important acupoints to tonify qi and blood and promote well-being according to the traditional Chinese medicine theory. Acupoint ST36 is used, in combination with other acupoints, to treat visceral conditions such as vomiting, abdominal distension and visceral pain, constipation, and hypertension, fatigue, depression, generalized pain, anxiety, palpitation, infection and many other things.  

The interesting in the mechanisms underlying the versatile functions of acupoint ST36 has attracted many scientific studies. It has been reported that stimulation at acupoint ST36 induces vagus nerve activity, on the one hand, leading to production of dopamine in the adrenal medullar, suppress the systemic inflammation resulting in controlling of sepsis; on the other hand, elevated vagus nerve activity increased superior mesenteric artery blood flow volume. Further brain imaging studies reported that stimulation ST36 acupoint can specifically induce the neural responses in pain-inhibiting areas in the brain. Those studies suggest stimulation acupoint ST36 rebalanced sympathetic and parasympathetic systems and explains in partial how stimulation the ST36 acupoint exerts its therapeutic effects on the conditions mentioned above.

The studies also showed that effects elicited by stimulation ST36 are acupoint specific as stimulation the non-specific points or other acupoints do not produce the same results.

Reference:

Kaneko S et al., Heart Rate Variability and Hemodynamic Change in the Superior Mesenteric Artery by Acupuncture Stimulation of Lower Limb Points: A Randomized Crossover Trial. Evid Based Complement Alternat Med, Volume 2013, Article ID 315982.   http://www.hindawi.com/journals/ecam/2013/315982/

Acupuncture analgesia is greater than morphine in patients with liver cancer

Acupuncture exerts prolonged pain relief compared to morphine in liver cancer patients, according to a study published in the American Journal of Chinese Medicine.

Liver cancer patients with transcathetel arterial chemoembolization experience unbearable pain and are often treated with analgesic drug morphine that has many adverse effects.

Scientists in China conducted a clinical trial to evaluate analgesic effect of acupuncture in comparison with morphine. Sixty liver cancer patients with transcathetel arterial chemoembolization were divided into two groups. One group was given wrist-ankle acupuncture treatment. Another group was treated with morphine. Pain rating was measured by using Visual Analogue Scale prior to and following treatment. It was found that both acupuncture and morphine showed significant and indistinguishable analgesic effects 1, 2 and 4 hour after treatment respectively. However acupuncture induced a greater pain relief than morphine 6 hour following analgesic intervention. Incident rates of abdominal distension were lower in acupuncture-treated group than morphine-treated group.

The study showed that acupuncture is a safe and effective analgesic therapy in cancer-related pain.

Reference:

Zeng K et al., Wrist-ankle acupuncture for pain after transcatheter arterial chemoembolization in patients with liver cancer: a randomized controlled trial. Am J Chin Med. 2014;42(2):289-302.  http://www.ncbi.nlm.nih.gov/pubmed/24707863

How does acupuncture alleviate symptoms in carpal tunnel syndrome?

Through its modulating brain activity acupuncture treatment is effective in alleviating pain and paresthesia in patients with carpal tunnel syndrome. However which brain areas are responsive to specific stimulation and pain reduction are not clear.

Researchers in the United State, using functional magnetic resonance imaging (fMRI) technique, assessed brain response to acupuncture and correlated changes in clinical symptoms in patients with carpal tunnel syndrome.

Patients with carpal tunnel syndrome were allocated to three groups. Group one was given acupuncture at local acupoints (PC7 and TW5) on the affected wrist. Group two was given acupuncture at distal acupoints (SP6 and LV4) on contralateral ankle, based on mirror point methods common in acupuncture practice. Group three was given sham acupuncture at non-acupoints. Symptom ratings were measured prior to and after fMRI scan. It was found that both local and distal acupoints significantly alleviated symptoms. Brain response to local acupoints in the somatosensory cortex and supplementary motor cortex and brain response to distal acupoints in the prefrontal cortex were associated with greater pain relief following acupuncture.

The study suggests that both acupoints either close to or distal to affected area are able to elicit therapeutic effect but induced responses in different brain areas.

Reference:

Maeda Y et al., Acupuncture-Evoked Response in Somatosensory and Prefrontal Cortices Predicts Immediate Pain Reduction in Carpal Tunnel Syndrome. Evid Based Complement Alternat Med. 2013;2013:795906.   http://www.hindawi.com/journals/ecam/2013/795906

Is acupuncture treatment, a worth additional cost in patients with asthma?

Although acupuncture treatment is an additional cost for many patients with different conditions, patients suffering from allergic asthma found it is worthwhile to have acupuncture treatment, according to a study published in Journal of Alternative and Complementary Medicine.

Scientists in Germany conducted a study to assess the economic aspects of additional acupuncture in patients with asthma compared to the patients with routine care, using direct and indirect cost difference and the incremental cost-effective ratio of acupuncture. They found that although acupuncture costs more than the control patients, treatment is associated with the superior effectiveness in terms of quality-adjusted life years and the incremental cost-effective ratio of acupuncture is improved.

Authors conclude that “Treating patients who have allergic bronchial asthma with acupuncture in addition to routine care resulted in additional costs and better effects in terms of patients' quality of life. Acupuncture therefore seems to be a useful and cost-effective add-on treatment.”

Reference:

Reinhold T et al., Acupuncture in patients suffering from allergic asthma: is it worth additional costs? J Altern Complement Med. 2014 Mar;20(3):169-77.    http://www.ncbi.nlm.nih.gov/pubmed/24256028

Acupuncture relieves acute low back pain caused by psoas muscle strain

Low back pain caused by psoas muscle injury is common but difficult to be treated due to its deep location. However, acupuncture stimulation at the BL52 acupoint specifically directed to the psoas muscle showed a fast pain relief in a patient with acute low back pain.

Psoas muscle is believed to be one of the most important muscles in the body. It is a deep hip muscle that originates on the vertebral bodies and transverse processes of lumbar vertebrae (L1-L5) and discs of thoracic 12/lumbar 1 to L4/5. The psoas functions as hip and thigh flexor, which makes it the major walking muscle. When the psoas becomes contracted due to the stress, injuries, poor postures and prolonged sitting it can cause many problems including low back pain, sacroiliac pain, sciatic, disc problems, knee pain and menstruation pain etc. Common approaches to psoas muscle pain, such as strengthening and stretching exercise, message and muscle relaxation, are not always satisfactory.

Dr. Kwan Leung Chia, in Australia, reported a case of acupuncture treatment of acute low back pain caused by psoas strain. A 65-year-old woman had a sudden onset of pain over the right low back and lasted for more than a week. The pain was rated 7/10. Because examination found active flexion of the hip exacerbated the pain more than other movements, psoas muscle strain was suspected as the cause of back pain. The patients did not feel much improvement about the pain after the first session of acupuncture. Then, Dr. Chia looked how best acupuncture needle can be inserted to psoas muscle by studying anatomical position of psoas major in relation to the low back on cadavers. It was found that needling BL52 at an angle of about 70^o would reach posterior portion of psoas muscle without damaging neighbouring tissues.  At the next session, the same acupoints were applied and large needle, 0.30mmx70mm were inserted into BL52 at an angle of about 70^o to the surface, and toward ipsilateral side of lumbar vertebrae to avoid damage visceral organs. The patient reported de qi sensation soon after needle being inserted into psoas muscle and felt less pain immediately after acupuncture. After another 5 sessions of acupuncture patient felt free of back pain.

The case study demonstrated that acupuncture needling to the specific muscle causing pain immediately relieve condition. It has been reported that acupuncture needle stimulation induces the local release of analgesic chemicals such as adenosine that exerts pain relief quickly.

Reference:

Chia KL, Electroacupuncture treatment of acute low back pain: unlikely to be a placebo response. Acupunct Med. 2014 May 15. pii: acupmed-2014-010582.   http://aim.bmj.com/content/early/2014/05/15/acupmed-2014-010582.extract

How does acupuncture help recovery of stroke patients?

Acupuncture has been used to help stroke recovery in China. Many studies reported that acupuncture improved motor function, balance, spastic states and muscle strength of stroke survivors. However how acupuncture improves recovery in stroke is not clear.

Recently researchers in China conducted the study, using functional magnetic resonance imaging (fMRI), to investigate the changes in activity connections between different brain regions of stroke patients. They found that there were significantly decreased activity connections between cortex and subcortical areas related to motor functions in the brain of stroke patients compared to healthy subjects. Acupuncture stimulation at acupoints important to motor functions markedly increased activity connections between cortex and those of subcortical areas, and also enhanced the activity connections between cortex and cerebellum which are important for many aspects of movement compared with prior treatment baseline.

The study confirms that one of the mechanisms underlying therapeutic effect of acupuncture is through modulating activities and connections in the brain. It seems reasonable to suggest that the earlier application of acupuncture the better outcome of stroke treatment.

Reference:

Xie Z et al., Acupuncture Enhances Effective Connectivity between Cerebellum and Primary Sensorimotor Cortex in Patients with Stable Recovery Stroke. Evid Based Complement Alternat Med. 2014;2014:603909.   http://www.ncbi.nlm.nih.gov/pubmed/24734108

Acupuncture improves certain aspects of motor symptoms in Parkinson’s disease

Electroacupuncture improved gait, balance and postural transitions in patients with Parkinson’s, suggests in a study published in journal Neurology.

Gait and balance disturbance, and postural instability are parts of motor dysfunction of Parkinson’s. They are predicators of falling risk and impaired quality of life and have emerged as major therapeutic concerns in Parkinson’s treatment.

In a pilot study, researchers in Arizona, the United States, using objective modalities based on innovative body worn sensors technology, assessed the effect of acupuncture on gait and balance in Parkinson’s patients. Eight patients with Parkinson’s were treated with electroacupuncture once a week for three weeks. Outcomes assessed at baseline prior to and at the end of the treatment. Measurements include many aspects of gait, balance and quality of life. At the end of treatment gait, balance and postural transitions were all markedly improved in acupuncture group compared to control group. Further, improvement in gait, balance and postural transitions in acupuncture group were significantly better compared to the pre-treatment scores, while there is no change in control group compared to baseline.

Authors conclude that electroacupuncture is an effective treatment in improving certain aspects of motor symptoms of Parkinson’s.

Reference:

Lei H et al., Objective Assessment of Electro-acupuncture Benefit for Improving Balance and Gait in Patients with Parkinson’s Disease (P3.074). Neurology April 8, 2014 vol. 82 no. 10 Supplement P3.074.    http://www.neurology.org/content/82/10_Supplement/P3.074

Acupuncture improves shoulder pain after laparoscopic surgery

Laparoscopic surgery is known as keyhole surgery or minimally invasive surgery. It allows operations in the abdomen performed through small incisions. Although laparoscopic surgery has many advantages such as shorter recovery time and less scarring, up to 80% of patients after laparoscopic surgery developed shoulder pain, ranging from mild to severe, and lasted up to 72 hours. The cause of shoulder pain is believed due to the use of carbon dioxide which irritates the diaphragm during and after surgery. The purpose of using carbon dioxide is to inflate the abdomen for better surgical view.

The conventional treatments of postlaparoscopic shoulder pain include the ways to remove carbon dioxide from abdomen after surgery and analgesic medication. However these treatments are often unsatisfactory and have many side effects.

Researchers in Israel conducted a clinical study to investigate whether individualized acupuncture relieve postlaparoscopic shoulder pain. Patients with postlaparoscopic shoulder pain were diagnosed based on a thorough physical examination including traditional tongue, pulse, facial and voice diagnosis according to classic traditional Chinese medicine theory; and were treated with customized acupuncture. Pain assessment was conducted prior to and two hours after acupuncture using Visual Analogue Scale 0 to 10. Results showed that shoulder pain and general pain after laparoscopic surgery were significantly reduced after acupuncture compared to base line assessment. No adverse effect was observed.

Authors concludes that individualized acupuncture relieve shoulder pain and general pain after laparoscopic surgery.

Reference:

Kreindler G et al., Treating postlaparoscopic surgery shoulder pain with acupuncture.  Evid Based Complement Alternat Med. 2014;2014:120486.    http://www.ncbi.nlm.nih.gov/pubmed/?term=Kreindler+g%2C+acupuncture