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