Acupuncture alleviated gait disturbance in patients with Parkinson’s

Acupuncture stimulation at some specific acupoints relieved gait disturbance immediate after acupuncture in PD patients according to a report published in the Journal of American Geriatrics Society.

Gait disturbance is one of the most common symptoms of Parkinson’s. A typical parkinsonian gait is characterised as slower speed, shorter arm swings, shorter stride length, longer double support time and faster cadence than healthy individuals. Gait dysfunction is regarded as one of the important symptoms of Parkinson’s and affects the quality of life of patients with Parkinson’s.

Recently doctors in Japan conducted a small clinical study to assess the short-term effect of acupuncture on gait disturbance in Parkinson’s. Patients with Parkinson’s were given acupuncture at following acupoints: ST36, SP6, LV3, LI4 and LI11. Gait function in PD patients were measured using a portable gait rhythmogram, a small device that measures three dimensional accelerations affecting gait associated with voluntary limb and trunk movements before and after acupuncture.

It was found that after acupuncture stride length, walking acceleration and gait speed, indicators of gait function significantly increased compared the baseline.

Authors suggested that acupuncture was as good as or better than the conventional treatment with gait disturbance in Parkinson’s. However, clinical study with controlled and large sample size should be conducted to evaluate efficacy of acupuncture treatment.

Reference

S Fukuda et al., Acupuncture for Gait Disturbance in Parkinson's Disease: Immediate Effects of Acupuncture Treatment. J Am Geriatr Soc. 2015 Oct;63(10):2189-90.    http://onlinelibrary.wiley.com/doi/10.1111/jgs.13690/abstract

Acupuncture helped restore function of a patient with severe dramatic brain injury

A patient suffered severe dramatic brain injury from a high-speed snowboarding accident, being initially unable to walk, having difficulty with speech, and suffering from poor eyesight. Following acupuncture treatment over 4 years, he now regained significant motor function, speech and vision and has returned to snowboarding. A case study was reported in the journal of Global Advances in Health and Medicine. 

  

A male patient, 21-year old at the time of accident, was admitted to the hospital in Colorado, the United States, following a high-speed snowboarding accident. Brain MRI and CT scans indicated diffuse axonal injury. The neck CT scan showed a non-displaced C6 vertebral body fracture and a non-displaced fracture of the left occipital condyle. He was diagnosed with severe traumatic brain injury that resulted in paralysis and then spastic hemiplegia of the dominant side. His left side was stiff, and his right side was more flaccid with tremors.

Following comprehensive inpatient care the patient was released from hospital for ongoing rehab and long-term care. Prior to acupuncture the patient had been doing occupational and speech therapy and were involved in physical therapy.

The patient came for acupuncture treatment in Southwest College of Naturopathic Medicine, Tempe, Arizona, United States, 3.5 months after injury. After initial assessment by the experienced acupuncturist, the acupoints selected initially were chosen to regulate and move the Qi and Blood and clear Wind according TCM. As an ongoing adaption to the patient protocol, supplemental acupoints were added as needed to address the relevant concerns including acute respiratory infection, constipation, insomnia, diplopia and balance. His acupuncture covered two separate treatment periods of 57 weeks and 38 weeks.

Overall, his vision has improved, tremors had decreased, and fine motor skills had improved following acupuncture. He was subsequently able to snowboard a number of times during the final year of treatment.

Authors suggest that acupuncture should be considered as a viable treatment addition for patients with traumatic brain injury; in particular, a patient-specific treatment protocol focusing on individual’s deficits appears to provide long-term benefits.

Reference

J Wolf et al., Restoration of function with acupuncture following severe traumatic brain injury: A case report. Global Adv Health Med. 2015;4(6):52-57.   http://www.gahmj.com/doi/full/10.7453/gahmj.2014.069

How does repeated verum acupuncture improve chronic pain in knee osteoarthritis?

Acupuncture has been effectively used to treat chronic pain conditions. However, the lack of understanding of underlying mechanisms of acupuncture, and reported cases of failure to produce greater clinical improvement, compared with sham acupuncture, have slowed down the incorporation of this modality into the mainstream of healthcare practice.

Functional magnetic resonance image (fMRI) showed that acupuncture stimulation caused changes in neuronal activity in many brain areas, including medial frontal cortex (MFC), hippocampus and periaqueductal gray (PAG). PAG is a pain-learning brain region as it is able to form long-term pain behavioural and nociceptive memory. Brain regional connectivity of PAG-MFC and PAG-hippocampus are believed to be associated with long-term pain learning process and pain memory.

Recently Dr. Jian Kong and colleagues in Harvard Medical School, the United States conducted a clinical study to assess the effect of repeated acupuncture specifically on brain regions known to support functions dysregulated in chronic pain conditions, such as knee osteoarthritis. Forty-nine patients with knee osteoarthritis were recruited and randomly divided into verum acupuncture and sham acupuncture groups. Patients in verum group were given acupuncture at ST35 and Xiyan points for the low-dose verum groups and additionally at GB34, SP9, GB39 and SP6 for the high-dose group, six times within one month. Treatments 1, 3, and 6 were conducted with the patient lying in a 3 Tesla MRI scanner. Treatments 2, 4 and 5 took place in a behavioural testing room. Sham acupuncture was performed with non-penetrating Streitberger needles at above acupoints.

It was shown at the end of study that verum acupuncture produced a significant decrease in knee pain and improved function in sport, and modulated connectivity of PAG-MFC and PAG-hippocampus, compared with sham acupuncture group.

Results of study have showed that repeated verum acupuncture might act by restoring the balance in the connectivity of the key pain brain regions, altering pain-related attention and memory. It also has implications for the assessment of the efficacy of acupuncture treatment with regard to reversal of chronic pain disorders.

Reference:

N Egorova et al., Repeated verum but not placebo acupuncture normalizes connectivity in brain regions dysregulated in chronic pain. NeuroImage: Clinical 9 (2015) 430–435.    http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0067485

How does acupuncture stimulation at GB34 help improve motor function in post-stroke hemiplegic patients?

Acupoint GB34 has been used to treat patients with stroke to help motor function recovery and is accompanied with the increased neuronal activities in motor-related brain regions according to a neuroimaging study published in journal of Brain Research.

Acupoint GB34 is one of the most common acupoints used in treating motor-related conditions in China for a very long time. However its underlying mechanism is not clear. Recently scientists in China explored the central mechanism of immediate effect of acupuncture stimulation at GB34 on the motor-related network of stroke patients with hemiplegic.

Functional magnetic resonance image (fMRI) was used to assess the changes in neuronal activities of different brain regions before and after acupuncture stimulation at GB34 and compare the changes between GB34 and sham acupoint. Function MRI data analysis showed that acupuncture at GB34 may increase motor-cognition connectivity, including visual-memory, motor task learning, and motor intention, meanwhile decrease compensation of unaffected motor cortex and ipsilateral synkinesis, which can definitely promote the rehabilitation of hemiplegia and spasm.

This study demonstrated the underlying mechanism of GB34 central action in post-stroke patient with hemiplegia.

Reference:

Chen X et al., A functional magnetic resonance imaging study on the effect of acupuncture at GB34 (Yanglingquan) on motor-related network in hemiplegic patients. Brain Res. 2015 Mar 19;1601:64-72.    http://www.ncbi.nlm.nih.gov/pubmed/25601007

What is the proper depth of acupoints in neck and shoulder region?

Although acupuncture therapy is safe with only minor side effect, some severe complications such as pneumothorax still happens. Such incidence could have been avoided if acupuncturists were equipped with a better understanding of the anatomical knowledge and appropriate depth of needle insertion, in particular in points scattered in the neck and shoulder regions where the risk of injuries of lung, heart, nerve and vessels are significantly high.

Recently, a group of scientists in Taiwan, China, conducted a clinical study, using magnetic resonance imaging (MRI) to (1) measure the mean depth of some frequently used acupoints around the neck and shoulder regions, and (2) understand that how variable factors such as body size (using body mass index-BMI) and gender would affect the measured depth of each acupoint. Three hundred and ninety-four participants were recruited in this study. Outcome measure included the measurement of distance of needle insertion tip (surface of skin) to any tissue that would cause possible or severe complications.

MRI analysis showed the mean depths of all participants, regardless of BMI and gender, are as follows, in centimetres: GB21=5.6, SI14=5.2, SI15=8.8, GV15=4.9, GV16=4.6, GB20=5.0, ST9=1.6, SI16=1.8, SI17=2.4, TE16=3.1, LI18=1.3. It was revealed that participants with higher BMI had greater depths and males tended to have greater depths in most of the points.

This is the first study to investigate the mean depth of acupoints around neck and shoulders. Acupuncturists should take information provided in consideration during the treatment to prevent complications.

Reference

Chou PC et al., Retrospective study using MRI to measure depths of acupuncture points in neck and shoulder region. BMJ Open 2015;5:e007819. doi:10.1136/bmjopen-2015-007819.  http://bmjopen.bmj.com/content/5/7/e007819.abstract

Acupuncture add-on treatment improved both motor and non-motor symptoms in Parkinson’s disease

Acupuncture plus anti-parkinsonian drug significantly improved motor symptoms and non-motor symptoms in patients with Parkinson’s, and particularly efficacious at early stage of Parkinson’s. Acupuncture add-on treatment also markedly reduced nitric oxide level serum compared with anti-parkinsonian drug along group. A clinical study was recently reported in the journal of Evidence-Based Complementary and Alternative Medicine.

Parkinson’s is caused by the loss of dopamine and other neurotransmitters in central nervous system and is characterized by the motor dysfunction such as bradykinesia, resting tremor, rigidity and gait and postural imbalance. Although many non-motor symptoms developed before or parallelly with motor symptoms they were not always diagnosed and properly treated. Anti-parkinsonian drugs such as dopamine agonists are used to treat motor-related symptoms and have some severe side effects e.g. involuntary movement; while many non-motor symptoms were left untreated or mistreated, leading to significantly downgrad the quality of life of the PD patients. 

Acupuncture has been used to treat resting tremor and many motor and non-motor symptoms. However efficacy of acupuncture treatment in Parkinson’s is inconsistent and controversial.

Recently researchers led by Dr. Z Wei in China carried out a clinical study to assess the efficacy of acupuncture add-on in PD in particular to evaluate on both motor and non-motor effect. Fifty patients with Parkinson’s treated with levedopa were divided into acupuncture add-on group (n=30) and drug alone group (n=20). While all patients were continually taking their route anti-parkinsonian drug levedopa, patients in acupuncture add-on group were given electroacupuncture at bilateral GF20, LI4 and central DU14 and DU16 for 30 each time, once every 3 days. Ten-treatment was a course and two course in total within 2 months. Outcome measures for both motor-function (UPDRS III scores) and non-motor conditions such as depression and sleep disturbance and questionnaire for quality of life were assessed before and after the treatment.

Data showed that acupuncture add-on treatment significantly improved many motor functions such tremor, bradykinesia, and rigidity and non-motor conditions e.g. depression and sleep disturbance compared with drug alone group. Biochemical studies revealed that many inflammatory-related markers such as TNF-alpha,IL-1beta,and PGE2 were significantly reduced in acupuncture add-on group compared with drug alone group.

Authors concluded that acupuncture add-on is effective on most motor symptoms and some non-motor symptoms in particular at the early stage of Parkinson’s. Anti-inflammatory effect may be the underlying mechanism of acupuncture add-on treatment in Parkinson’s.

Reference:

F Wang et al., Effect and Potential Mechanism of Electroacupuncture Add-On

Treatment in Patients with Parkinson’s Disease. Evidence-Based Complementary and Alternative Medicine, Volume 2015, Article ID 692795,11 pages.     http://www.hindawi.com/journals/ecam/2015/692795/

Acupuncture improved the clinical pregnancy rate during IVF

Electroacupuncture stimulation enhanced the clinical pregnancy rate in patients with decreased ovarian reserve during IVF and embryo transfer cycles, according to a clinical study published in the Journal of Obstetrics and Gynaecological Research.

Although IVF is commonly used to treat infertility the success rate is not satisfactory. As many women, undergoing IVF treatment, had a decreased or diminished ovarian reserve. Ovarian reserve is a capacity of the ovary to provide egg cells that are capable of fertilization, resulting in a healthy and successful pregnancy. So improve ovarian reserve is very important to enhance pregnancy rate during IVF.

Recently a group of researchers in China conducted a clinical study to assess the effect of acupuncture on pregnancy rate in patients with decreased ovarian reserve during IVF and embryo transfer cycles. Two-hundred-forty patients were randomly allocated into acupuncture group, placebo group, artificial endometrial cycle treatment group and control group.

Electroacupuncture was given to following acupoints: RN3, RN4, DU3, DU4, SP6, ST25, BL23 and EX-CA1; for 30min, once a day during ovulation cycle until the day of egg retrieval. Outcome measures include pregnancy-related perimeters such as, AFC, basal estradiol (E2) level, basal FSH level, basal luteinizing hormone (LH) level, AMH level, FSH/LH ratio, ovarian artery resistance index (RI), ovarian artery pulsatility index (PI), and systolic/diastolic flow velocity ratio (S/D).

At the end of treatment, if was found that the number of egg cells retrieved and average number of embryos transferred were higher in the acupuncture group and artificial endometrial cycle group than those of control groups. Antral follicle count and anti-Müllerian hormone levels were increased, whereas the estradiol level, follicle-stimulating hormone level, and follicle-stimulating hormone/luteinizing hormone ratio were significantly decreased following acupuncture and artificial endometrial group compared with control groups.

The study showed that electroacupuncture enhanced pregnancy rate in patients with decreased ovarian reserve during IVF and embryo transfer cycle.

Reference

Zheng Y, et al., Effects of transcutaneous electrical acupoint stimulation on ovarian reserve of patients with diminished ovarian reserve in in vitro fertilization and embryo transfer cycles. J Obstet Gynaecol Res. 2015 Oct 12. doi: 10.1111/jog.12810.  http://www.ncbi.nlm.nih.gov/pubmed/26455718

Acupuncture at forbidden acupoints may not be harmful during pregnancy

A review article regarding safety of obstetric acupuncture stated that acupuncture at forbidden acupoints does not increase the risk of adverse pregnancy outcome in controlled clinical trials. The paper was published in the journal of Acupuncture in Medicine.

It has long been regarded that some acupoints, such as, SP6三阴交, BL27小肠俞, BL28膀胱俞, BL29中膂俞, BL31上髎, BL32次髎, BL33中髎, BL60中髎, BL67至阴 should not be used during pregnancy. These acupoints are called “forbidden” acupoints because they are historically believed to be abortifacient among traditional acupuncture practioners. However, the forbidden acupoint argument is not widely upheld by the practioners of Western medical acupuncture, assumed that the concerns are historical rather than evidence-based.

Recently Dr. DJ Carr in London, Britain reviewed scientific evidence concerning forbidden acupoints to help acupuncture practioners and researchers to make decisions regarding their use.

He collected the data from 1). A total of 15 clinical trials (n=823 women, n=4549–7234 treatments), following acupuncture at one or more forbidden points. 2). Observational studies, including one particularly large retrospective cohort of 5885 pregnant women needled at forbidden points at all stages of pregnancy, 3). Systematic review and meta-analysis of trials of acupuncture for term labour induction and scrutiny of case series of miscarriage and IUFD indicate there is no reliable evidence that acupuncture/EA at forbidden points can induce miscarriage or labour even under favourable circumstances. 4). Laboratory experiments on pregnant models have demonstrated that repeated EA at forbidden points throughout gestation does not influence rates of post-implantation embryonic demise or cause miscarriage, fetal loss or resorption.

The review study suggests that 1). Acupuncture at forbidden points is not associated with increased rates of adverse pregnancy outcome in observational studies. 2). Acupuncture at forbidden points does not induce miscarriage or labour. 3). Acupuncture at forbidden points does not cause harm to pregnant models.

Reference:

DJ Carr, The safety of obstetric acupuncture: forbidden points revisited. Acupunct Med 2015;0:1–7. doi:10.1136/acupmed-2015-010936.   http://aim.bmj.com/content/early/2015/09/11/acupmed-2015-010936.abstract

Acupuncture enhanced therapeutic effect of speech-therapy in patients with stuttering

In stuttering patients, laser acupuncture treatment could help maintaining the therapeutic effect of speech-therapy and reduce stuttering relapsing; according to a recent clinical study which was published in the journal of Advanced Biomedical Research.

Stuttering is a speech disorder in which sounds, syllables or words are repeated or prolonged, disrupting the normal flow of speech. These speech disturbance may accompanied by struggling behaviours, such as rapid eye blinks or tremors of lips. Stuttering can make it difficult to communicate with other people, which often affect person’s quality of life. Although the cause of stuttering is not clear around 9% of people with a family history of stuttering are link with genetic alternation. Stuttering may occur after a stroke, head injury or other type of brain trauma. The common approach for stuttering treatment is speech-therapy, which is effective in many cases but is tend to relapse in some cases. 

Recently a clinical study was conducted to assess the effectiveness of laser acupuncture on patients with stuttering. Twenty patients with stuttering were randomly divided into acupuncture plus speech-therapy group (n=10) and speech-therapy alone group (n=10). Single blind laser acupuncture was given at following acupoints: H5, LI4, P6, SI17, St9, CV23, CV24, and EX5 for 30 seconds. Outcome measures included by the percentage of stuttered syllables (% SS) and the speech rate based on the number of syllables per minute (SPM), which were evaluated before, immediate after laser acupuncture and 3 month after intervention.

It was shown that laser acupuncture enhanced effect of speech-therapy judged by the improvement of percentage of SS and SPM compared with speech-therapy alone treatment. Laser acupuncture helped reduce the relapsing of stuttering 3 month after treatment compared with control group.

The study showed that in patients with stuttering laser acupuncture improved the effect of speech-therapy and reduced relapsing of stuttering during follow-up observation. However, more studies with bigger sample sizes and improvement in study design are needed to confirm the effectiveness of acupuncture on stuttering.

Reference

B Shafiei et al., Determining the effect of laser acupuncture in treating stutterers in comparison with speech therapy. Adv Biomed Res. 2015; 4: 8.    http://www.ncbi.nlm.nih.gov/pubmed/25625114

Acupuncture to neck may cause cerebral air embolism

A patient with homolateral cerebral air embolism, probably caused by acupuncture insertion into the left anterior neck, was recently reported in the Journal of Stroke Cerebracardiovascular Diseases.

A 64-year-old male patient with post-stroke hemiplegia had an acupuncture treatment including the needle insertion into the anterior neck, and several hours later he developed subcutaneous emphysema into his left anterior neck and chest wall. He was admitted into the hospital with early seizure followed by unconsciousness and focal neurologic deficits. Initial brain scan showed small, multiple air bubbles in the corticomedullary junction area of the left cerebral hemisphere. The patient regained consciousness 2 days later in hospital.

The second scan, taken 6 days after the event, showed no air bubbles in the cerebral hemisphere but massive cerebral edema. The patient's condition continued to improve during his hospital stay. He was discharged 3 weeks later with minimal neurologic deficits.

The report suggested the unilateral cerebral artery air embolism was thought to be caused by direct infiltration of air to the common carotid artery following acupuncture.

Although this is a rare case report it reminded acupuncture practioners that knowledge of human anatomy and acupuncture technique skill are very important for the safety of patients.

Reference:

Chang DI et al., A case of intracerebral air embolism following acupuncture. J Stroke Cerebrovasc Dis. 1995;5(4):238-40.   http://www.ncbi.nlm.nih.gov/pubmed/26486954

Acupuncture is more effective than anti-inflammatory drug ibuprofen in relieving symptoms in carpal tunnel syndrome

Patients with carpal tunnel syndrome receiving acupuncture felt greater symptomatic relief than those taking ibuprofen according a clinical study published in the Journal of Acupuncture and Meridian Studies.

Recently Dr. Hadi Momeninejad and colleagues in Iran carried out a clinical study to assess the effectiveness of acupuncture treatment in mild to moderate carpal tunnel syndrome. Fifty patients with mild to moderate carpal tunnel syndrome were divided into acupuncture group and ibuprofen group. Patients in the former group were given acupuncture at acupoints PC-7 (Daling), PC-4 (Ximen), PC-6 (Neiguan), PC-8 (Laogong), HT-2 (Qingling), HT-7 (Shengmen), HT-8 (Shaofu), LU-9 (Taiyuan), and LI-11 (Quchi), for 20 min twice a week for 4 weeks. Patients in the latter group were given ibuprofen 400mg, three-time a day for 10 days. The outcome measures include the visual analog scale (VAS) score, the score on the Boston Carpal Tunnel Questionnaire for Functional Status and Symptom Severity (BCTQ FUNCT and SYMPT), and the electrodiagnostic findings at the baseline and end of 4-week treatment.

At the end of treatment, patients with acupuncture had greater improvement in pain, numbness, tingling and performing daily activities e.g. doing house work compared with those treated with ibuprofen. The VAS score, BCTQ FUNCT and SYMPT and electrodiagnostic findings were significantly improved in patients with acupuncture compared with their baseline and drug control group.

The study showed that acupuncture is a very effective and alternative treatment to mild and moderate carpal tunnel syndrome.

Reference

M Hadianfard et al., Efficacies of Acupuncture and Antiinflammatory Treatment for Carpal Tunnel Syndrome. J Acupunct Meridian Stud 2015;8(5):229e235.   http://www.sciencedirect.com/science/article/pii/S200529011400226X

How does acupuncture suppress focal epilepsy and improve epilepsy-induced sleep disruption?

Acupuncture therapy can control focal epilepsy and improve epilepsy-induced sleep disruption through modulation of opioid receptors in the brain, according to an epilepsy model study recently published in Journal of Biomedical Science.

In epilepsy, focal seizure refers to a seizure that starts in, and affects just a part of brain. It might affect a large part of hemisphere or just a small area of one of brain lobes. Symptoms of focal seizure depend on the affected brain area and their function. Some simple focal seizures are sometime called “warnings” or “auras” because for some people simple focal seizure can develop into secondarily generalized seizure. So it is important to have an effective treatment for focal seizure and prevent it develop into more severe generalized seizure. Acupuncture is effective in treat focal epilepsy. However the underlying mechanism is unclear.

Recently scientists in Taiwan, China tried to elucidate the mechanism of acupuncture action on a focal epilepsy model with sleep disruption. Before acupuncture epileptic model showed a focal epilepsy and decreased rapid eye movement sleep and non rapid eye movement sleep. Acupuncture at acupoint BL20 with low-frequency 30 min a day for 3 consecutive days suppressed focal epilepsy and epilepsy-induced sleep disruption. The therapeutic effect of electroacupuncture was blocked by naloxone, an opioids receptor antagonist.

The authors suggest that low-frequency electroacupuncture is beneficial to focal epilepsy and its action is modulated through brain opioid receptors.

Reference:

Yi PL et al., Low-frequency electroacupuncture suppresses focal epilepsy and improves epilepsy-induced sleep disruptions. J Biomed Sci. 2015 Jul 7;22(1):49. doi: 10.1186/s12929-015-0145-z.    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4491875/

How does acupuncture exert long-lasting reduction of blood pressure in patients with hypertension?

Electroacupuncture weekly stimulation alone at specific acupoints had a long-lasting reduction of blood pressure in hypertensive patients who did not receive anti-hypertensive medication. According to a randomized controlled clinical trial that was published in the journal of Medical Acupuncture recently.

Although conventional anti-hypertensive medication is able to reduce blood pressure back to normal range in patients with hypertension, long-term medication of those drugs induce many adverse effects. This has sparked a growing interest in alternative medical treatment such as acupuncture.

Recently a group of clinical doctors led by Professor JC Longhurst in the United State carried out a randomized controlled clinical trial to assess the effectiveness and underlying mechanism of eletroacupuncture on hypertension. Sixty-five patients with mild to moderate hypertension, not receiving any medication, were randomly divided into treatment group (n=33) and control group (n=32). Patients in treatment group were given electroacupuncture at acupoints PC5-6+ST36-37, which are thought to have anti-hypertensive effects, for 30min, once a week for 8 weeks. Patients in control group were given electroacupuncture at acupoints LI6-7+GB37-39 which are thought to be irrelevant to blood pressure. Patients were assessed with 24-hour ambulatory blood pressure monitoring to measure the peak and average systolic BP and diabolic BP. Biochemical studies undertaken to look the changes in plasma levels of norepinephrine, renin and aldosterone before and after 8-week treatment.

At the end of 8-week treatment, patients in treatment group had a significant decrease in systolic BP and diabolic BP compared with control group. Four-week follow up found that long-lasting blood pressure-lowering acupuncture effect was still observed in 14 of 33 patients in treatment group. Biochemical studies showed plasma level of norepinephrine, renin and aldosterone, which were initially elevated, was reduced by 41%, 67% and 21% respectively in those patients.

The study showed that electroacupuncture at specific acupoints alone was able to reduced both systolic BP and diabolic BP. Modulation of renin-aldosterone and sympathetic systems were likely linked to long-lasting actions of electroacupuncture.

Reference

Li P et al., Long-Lasting Reduction of Blood Pressure by Electroacupuncture in Patients with Hypertension: Randomized Controlled Trial. MEDICAL ACUPUNCTURE, Volume 27, Number 4, 2015.    http://online.liebertpub.com/doi/full/10.1089/acu.2015.1106

Dose nonmechanical and nonpsychological therapeutic qi exist in acupuncture?

According to traditional Chinese medicine the effectiveness of acupuncture resides in qi, a term or concept that has no equivalent in western culture. The de qi sensation is characterized as grasp and controlled at acupoints and along meridians and is to unblock the blocked point along meridian and rebalance the qi within the body. This therapeutic qi is supposed to be independent of mechanical and psychological factors. However the modern needle stimulation, which requires no participation of practioner, is to activate the body by different stimulating modes, leading to physical changes.

Recently researchers in Switzerland performed a randomized, controlled, single-blinded, two-phase crossover study to investigate whether the hypothetical therapeutic qi can be sensed by test participants when mechanical and psychological influence are ruled out or controlled. The researchers used two novel devices; one allows the insertion of acupuncture needle without touching it and the other holds the needle in place and prevents the transmission of movement from the needle handle to the tip.

The study was designed two phases: the first is intervention treatment with needle inserted into acupoint PC6, then practioner held the end of needle between their thumb and index fingers without rotating and thrusting the needle. The second phase is control treatment in which the end of needle is untouched.  

Thirty volunteers were recruited for the study. They experienced both interventions due to a crossover design and had to decide which phase was and which phase was without touch and stimulation. Participants were asked to record their subjective sensations on a questionnaire.

It was found that 79% of test participants believed that they had received stimulation when it had actually been preformed, and 93% sensed the difference between treatment and control phases. The study showed that participants were able to sense the transmission of therapeutic qi in the absence of mechanical and psychological influence.

The authors suggest that experimental setup in the study can be used to make physiological measurement of therapeutic qi accessible.   

Reference:

RJ Hochstrasser et al., Perception of Therapeutic Qi, a Nonmechanical, Nonpsychological Factor in Acupuncture That Originates from the Therapist. J Acupunct Meridian Stud 2015;8(4):203e208.    http://www.sciencedirect.com/science/article/pii/S2005290114002325

Acupuncture enhanced anaesthetic effect of inferior alveolar nerve block in patients with irreversible pulpitis

Preoperative acupuncture stimulation at LI4 acupoint significantly improved analgesic of inferior alveolar nerve block for the teeth with symptomatic irreversible pulpitis. The study was reported in the Journal of Endodontics.

Pain control is one of the most challenges during an endodontic surgery for dentists especially in mandibular posterior teeth with irreversible pulpitis. To anaesthetize the mandibular posterior teeth, inferior alveolar nerve block is usually applied. However the procedure does not always provide satisfactory anaesthesia for patients with irreversible pulpitis.

The Dr NM Majd and colleagues in Iran performed a randomized triple-blind clinical trial to assess the effect of preoperative acupuncture on the success rate of inferior alveolar nerve block for teeth with symptomatic irreversible pulpitis. Forty patients with irreversible pulpitis were randomly divided into two acupuncture and control groups. In acupuncture group patients were given acupuncture at LI4 acupoint for 15 min, and then inferior alveolar nerve block was administered. In control group patients were given sham acupuncture, with a mimicking acupuncture procedure without inserting needle into LI4 acupoint and then given inferior alveolar nerve block injection.

It was found that the success rate of inferior alveolar nerve block was 60% in acupuncture group compared with only 20% in control group. Further patients in acupuncture group reported no side effect up to 48 hours after the procedures.

Authors suggest that preoperative acupuncture treatment significantly increased effectiveness of inferior alveolar nerve block for mandibular teeth with irreversible pulpitis.

Reference:

NM Majd et al., The Effect of Acupuncture on the Success of Inferior Alveolar Nerve Block for Teeth with Symptomatic Irreversible Pulpitis: A Triple-blind Randomized Clinical Trial. J Endod. 2015 Jun 16. pii: S0099-2399(15)00447-1.   http://www.ncbi.nlm.nih.gov/pubmed/26092771

Acupuncture significantly improved acute low back pain

Acupuncture helped pain relief significantly in patient with acute low back pain and analgesic effect of acupuncture lasted up to 3 days after a treatment. A clinical study of efficacy of acupuncture on low back pain in the emergency department was reported in journal of Evidence-Based Complementary and Alternative Medicine.

Low back pain is one of the most common complaints from patients in the emergency department. Although there are many pain relief medications available and some are quite temporarily effective many associated side effects make them not suitable for many patients. Acupuncture has been used to treat both acute and chronic pain in China since the beginning use of acupuncture.

Recently a group of scientists and physicians led by Dr. LC Lo in Taiwan, China carried out a clinical study to assess the efficacy and safety of acupuncture treatment to acute low back pain in emergency department. Recruited patients with acute low back pain were divided into verum acupuncture group (n=45) and sham acupuncture group (n=14). Due to most patients were unable to maintain a face-down posture during treatment acupoints were selected at the limbs according to traditional Chinese meridian system. Within verum group patients were given acupuncture at LI4, LI10, ST36, GB34 and LR3 acupoints for 15 min. The control group were received sham acupuncture by pasting seed-patches next to the acupoints used in verum group. Outcome evaluations include the visual analogue scale and heart rate variability and adverse events. The visual analogue scale was graded from 0 points (no pain) to 10 points (the worst possible pain) and was measured 3 times, before, after treatment and 3-day follow-up.

Data from study showed that verum acupuncture significantly reduced low back pain soon after treatment and the therapeutic effect of acupuncture maintained 3 days after acupuncture compared with sham acupuncture. There were no obvious alternations in heart rate variability and no adverse effect was reported.

The authors suggested that acupuncture produced an immediate pain relief in patients with low back pain in emergency department. Acupuncture could be a very viable alternative for pain management for those patients.

Reference

LC Lo et al., Efficacy and Safety of Acupuncture for Acute Low Back Pain in Emergency Department: A Pilot Cohort Study. Evidence-Based Complementary and Alternative Medicine. Volume 2015, Article ID 179731,8 pages.    http://www.hindawi.com/journals/ecam/2015/179731/

Acupuncture treatment improved phonotraumatic vocal fold injury

Acupuncture stimulation at voice-related acupoint significantly improved vocal function and healing of vocal folds lesion in patients with dysphonia. Data from a clinical study was recently reported in the Journal of Voice.

Dysphonia is a common condition and occurs around 6% of the population and even higher in specific group such as teacher. Dysphonia is caused by the vocal nodules, polyps and chronic laryngitis. Conventional approaches include behavioural voice therapy and surgery. The former requires extended period of treatment and the later is invasiveness which are not a viable option for many patients. It is reported that around 10-20% of patients with dysphonia did not respond to those treatment regime at all. Acupuncture has been used to treat dysphonia in China for a long time.

Recently a group of multi-national researchers led by Dr. EML Yiu in Hong Kong, China  carried out a randomized control clinical study to assess the efficacy of acupuncture treatment on dysphonia. One-hundred thirty-two patients with dysphonia were divided into genuine acupuncture group (n=40), sham acupuncture group (n=44) and control group (n=39). In genuine group acupoints including Hegu, Leique, Renying, Zhaohai on two sides and Lianquan were stimulated for 30 mins, twice a week for 6 weeks. In sham group, blunted needles were touched on skin of those acupoints mentioned in genuine group. Patients in control group did not receive any treatment. Outcome measures included vocal function test, changes in vocal folds pathologies and quality of life questionnaire.

At the end of treatment it was found that there was a significant improvement in vocal function and quality of life in patients of both genuine and sham treatment groups compared with control group. However, significant improvement in vocal folds pathologies was only found in genuine acupuncture group not in sham acupuncture group. There was no side effect reported.

Authors suggested that acupuncture treatment produced a significant improvement in vocal function and healing of vocal folds injury and could be a very effective alternative treatment for patients with dysphonia.

Reference:

EML Yiu et al., Is Acupuncture Efficacious for Treating Phonotraumatic Vocal Pathologies? A Randomized Control Trial.  J Voice. 2015 Aug 19. pii: S0892-1997(15)00152-6. doi: 10.1016/j.jvoice.2015.07.004.  http://www.jvoice.org/article/S0892-1997(15)00152-6/abstract

What are the most frequently used acupoints for vascular dementia treatment?

Acupuncture has been used to treat vascular dementia in China for a very long time. However therapeutic effect of acupuncture on the vascular dementia is inconsistent in part, due to the different selection of acupoints used in the treatment. So finding the acupoints with better efficacy remains challenging.

Recently a group of scientists and clinicians led by Professor FR Liang in China carried out a study to find out the most frequently appeared acupoints in treatment of vascular dementia. The data was published in journal of Evidence-Based Complementary and Alternative Medicine.

Professor Liang and colleagues employed a technique called data mining that is an analytic process designed to explore a large amount of data in search of consistent patterns between variables, and then to validate the findings by applying the detected patterns to a new subset of data, ultimately predicts the more effective acupoints.

Two-hundred and thirty-eight acupuncture prescriptions for vascular dementia were analysed by data mining technique. It was found that Baihui (GV20), Sishencong (EX-HN 1), Fengchi (GB 20), Shuigou (GV 26), and Shenting (GV 24) emerged as the most frequently in the analysis and were potential acupoints for vascular dementia treatment.

Many studies reported that needling Baihui (GV20) improved calculation ability and short-term memory and corrected the changes in personality of patients with vascular dementia. Needling Shuigou (GV26) improved naming ability and short-term memory. A SPECT study showed that stimulation at Baihui (GV20) activated the inner temporal system, thalaencephalon system and prefrontal cortical system, while needling Shuigou (GV26) activated prefrontal cortical system.

Authors suggest that Baihui (GV 20), Sishencong (EX-HN 1), Fengchi (GB 20), Shuigou (GV 26), and Shenting (GV 24), emerging higher frequencies in the analysis, may have better therapeutic effects on vascular dementia.

Reference:

S Feng et al., Discovery of Acupoints and Combinations with Potential to Treat Vascular Dementia: A Data Mining Analysis. Evidence-Based Complementary and Alternative Medicine Volume 2015, Article ID 310591, 12 pages.   http://www.hindawi.com/journals/ecam/2015/310591/

What the role does acupuncture play in perioperative medicine?

Perioperative medicine evolved from clinical anaesthesia and is about the medical care of patients starting from the time of contemplation of surgery through the operative period to full recovery, but not counting the operation or procedure itself. Perioperative medicine is a large and constantly developing area encompassing involvement in many different clinical areas.

The use of acupuncture in perioperative medicine dated back to 31/08/1958 when a tonsillectomy was completed under acupuncture without using any other anaesthetics in Shanghai, China. From that time acupuncture has been used in surgery to enhance the effect of anaesthetic medicine and promote recovery after operation. Recently Dr. Xiong and colleagues in China provided an update on the benefits of acupuncture in perioperative medicine in a review article published in the British Journal of Anaesthesia.

It is well known that acupuncture stimulation at some specific acupoints exerts analgesic effect which has been used to reduce the consumption of anaesthetics and analgesics, such as opioids. This is importance because higher doses of drugs are generally associated with high risk of morbidity, longer duration of recovery and higher cost.

Use of acupuncture reduces many anaesthetic-related adverse effects such as nausea, vomiting, haemodynamic instability and intubation-related complication. Many studies showed that acupuncture therapy can rebalance haemostasis and alleviate stress response by modulating sympathetic nerve function.

Acupuncture enhances post-operative analgesia. Many studies reported that acupuncture prolonged anaesthetic effect and significantly reduced the use of pain killers following surgery. Further acupuncture exerts organ-protective effect after surgery. Acupuncture exerts modulatory effect on heart, increasing cardiac output, stroke volume, and decreasing total peripheral resistance and central venous pressure. Acupuncture improves postoperative pulmonary function, and protects brain against brain oedema, and increases blood circulation to other important organs such as liver and kidney.

The authors suggest that better selection of acupoint, advanced techniques used to stimulate acupoints and good timing of acupoint stimulation will maximise the benefits of acupuncture in perioperative medicine.

Reference:

Lu et al., Perioperative acupuncture modulation: more than anaesthesia. British Journal of Anaesthesia115 (2): 183–93 (2015).    http://bja.oxfordjournals.org/content/115/2/183.short

How does acupuncture relieve primary sciatica?

It has been know that acupuncture helps relieve pain in patients with sciatica. However how acupuncture exerts its action is not well understood. Recently a clinical study reported that arginine vasopressin, a hormone secreted in the particular areas of brain, played an important role in electroacupuncture analgesia. The study has been published in journal of Neuropetides.

Primary sciatica, also called piriformis syndromes, is a neuromuscular disorder that occurs when the sciatic nerve is compressed or otherwise irritated by the piriformis muscle. Primary sciatica usually starts with pain, tingling or numbness in the buttocks. Pain can be severe and extend down the length of sciatic nerve; and can be triggered by climbing, sitting for long periods of time or by applying firm pressure directly over piriformis muscle. However, most cases of sciatica are not due to piriformis syndrome. So many tests including MRI may be required to rule out other causes of sciatic nerve compression such as a herniated disc. Conventional approaches for primary sciatica include physiotherapy and anti-inflammatory medication which only provides temporary solution.

Recently Dr. XY Zhao and colleagues in China performed a clinical study to investigate the role of arginine vasopressin in the analgesic of acupuncture in patients with primary sciatica. Patients were divided into acupuncture group (n-45) and sham group (n=32). Patients in acupuncture group were given electroacupuncture at ST36 acupoint for 60 min while patients in sham group were given acupuncture at non-specific acupoint. Cerebrospinal fluid and serum were collected before, 30 min, 60 min and 120 min after acupuncture to detect the changes in arginine vasopressin levels. It was found that acupuncture stimulation at ST36 significantly increased the arginine vasopressin concentration in the cerebrospinal fluid but not in the serum. The increase in cerebrospinal arginine vasopressin level corresponded the pain relief level.

Arginine vasopressin in brain is reported to participate modulation of analgesia through its action to enhance the secretion of the endogenous opiate peptide such as beta-endorphin and dynorphin which are involved in pain modulation.

This study provides more evidence of central action of acupuncture analgesic effect.

Reference:

XY Zhao et al., The role of arginine vasopressin in electroacupuncture treatment of primary sciatica in human. Neuropeptides. 2015 Aug;52:61-5. doi: 10.1016 /j.npep.2015.06.002.   http://www.ncbi.nlm.nih.gov/pubmed/26142756

Acupuncture treatment alleviates frequent migraine headache

A randomized, patient/assessor blinded, controlled clinical trial found that acupuncture treatment significantly reduced migraine days, severity of migraine and improved the quality of life of patients with frequent migraine headache attack. The trial was recently reported in the journal of Evidence-Based Complementary and Alternative Medicine.

Frequent migraine refers the migraine headache attack occurs more than 5 days a month. If the attack occurs more than 15 days a month it is defined as chronic migraine. Migraine is the19th prevalent health condition according a report published by the International Migraine Society. 50% of chronic migraineurs and 27% of episodic migraineurs prefer non-pharmacological therapies including acupuncture due to the side effects of pharmacological treatment.

Dr. Y Wang and colleagues in Australia performed a clinical trial to determine the short and long-term effects and safety of acupuncture, compared with sham acupuncture on frequent migraine patients. Fifty patients with chronic migraine were divided into real acupuncture group (n=26) and sham acupuncture group (n=24). Acupoints selected include mandatory acupoints and supplementary acupoints based on individual diagnosis of Chinese medicine syndrome of migraine. A total of 16 real acupuncture treatment sessions were delivered within 20-week treatment period. The primary outcome measures include a 0-10 Visual Analogue Scale and a Six-Point Likert Scale for measuring intensity of migraine. The secondary outcome measures include severity and quality of migraine, the relief medication usage for migraine and quality of life.

At the end of treatment it was found that patients within real acupuncture group reported a significant reduced migraine days, less severe migraine and increased pain pressure thresholds compared with sham acupuncture treatment. The improvement of migraine was maintained at the end of 3 month follow-up compared with sham acupuncture group, but not at the end of one-year follow-up. No severe adverse effect was observed. The trial blinding was successful.

The authors suggest that acupuncture is an effective and safe treatment for short-term relief of frequent migraine in adults.

Reference:

Y Wang et al., Acupuncture for Frequent Migraine: A Randomized, Patient/Assessor Blinded, Controlled Trial with One-Year Follow-Up. Evidence-Based Complementary and Alternative Medicine. Volume 2015, Article ID 920353, 14 pages.    http://www.hindawi.com/journals/ecam/2015/920353/

Acupuncture helps improve chronic fatigue reported by a clinical trial

Acupuncture therapy improved fatigue in patients with chronic fatigue syndrome (CFS) and idiopathic chronic fatigue (ICF). A multiple, nonblinded, randomized controlled clinical trial reported the data in journal of Trials recently.

Reports showed that chronic fatigue syndrome and idiopathic fatigue have negative impact on health, happiness and productivity. Patients with either CFS or ICF felt their quality of life being degraded. The illness is a huge burden to the society. A report in 2008 estimated that the total annual cost of CFS or ICF to the society in the United States was extensive and approached $24.0 billion.

A group of scientists in Korea assessed the effectiveness of acupuncture on patients with either CFS or ICF in a clinical trial. Patients in acupuncture group were treated at acupoints GB20, GV20, BL11, BL13, BL15, BL18, BL20 and BL23 for 15 min a day, 2 or 3 times a week, 10 sessions within 4 weeks. Patients in control group only received normal care. Outcome measures include Fatigue Severity Scale, a short form of the Stress Response Inventory, the Beck Depression Inventory, the Numeric Rating Scale, and the EuroQol-5 Dimension.

It was found that acupuncture significantly improved all outcome measures, in particular Fatigue Severity Scale, the primary outcome measure, at 5 weeks and Stress Response Inventory scale 13 weeks after treatment. There were no treatment-related serious adverse effects.

The authors stated that the quality of this study was improved by performing a pragmatic clinic trial which evaluates whether interventions work in everyday clinical practice settings to better reflect real clinic situation through multi-institutional clinical trial design. This implies the results of the study were more reliable than other trial settings.

Reference:

Kim JE et al., Acupuncture for chronic fatigue syndrome and idiopathic chronic fatigue: a multicenter, nonblinded, randomized controlled trial. Trials (2015) 16:314.   http://www.trialsjournal.com/content/16/1/314

Acupuncture alleviates some cancer-related symptoms

Scientist in the Integrative Medicine Service, Memorial Sloan Kettering Cancer Centre of the United States carried out many clinical trials to evaluate the effectiveness of acupuncture as an alternative therapy for many cancer-related symptoms. Recently they summarised their results to determine acupuncture’s role in managing cancer-related symptoms.

They reported that true acupuncture 1) significantly alleviated pain, reduced dysfunction and dry mouth after neck dissection in head and neck cancer patients; 2) markedly reduced lymphedema and arm circumference in the affected arm of patients with breast cancer; 3) obviously improved salivation production in dry mouth symptom; compared with sham acupuncture.

Both true acupuncture and sham acupuncture 1) significantly improved dyspnea of lung or breast cancer patients with dyspnea; 2) significantly reduced hot flash in patients with breast cancer; 3) significantly alleviated postoperative ileus in patients undergoing elective colectomy.

 Acupuncture was less effective in relieving fatigue after chemotherapy.

Authors suggest that acupuncture is a potential candidate for the treatment of some common cancer-related symptoms.

Reference:

B Javdan & B Cassileth, Acupuncture Research at Memorial Sloan Kettering Cancer Center. J Acupunct Meridian Stud 2015;8(3):115e121.    http://www.jams-kpi.com/article/S2005-2901(15)00052-7/abstract