Acupuncture has been recommended as one of the favourable nonpharmacologic treatments for low back pain by American College of Physicians

Recently, acupuncture, an important part of traditional Chinese medicine, has been recommended as one of the favourable nonpharmacologic therapies for low back pain by American College of Physicians. Two reports published on journal of Ann Intern Med in February 2017 by Chou et al., 2017, and Qaseem et al., 2017 made the recommendation.

Lower back pain is one of the most common reasons for clinic visits in the United States. It is associated with increased healthcare costs as well as lost wages and decreased work productivity. Acute back pain generally lasts less than 4 weeks and usually resolves on its own. Subacute low back pain is defined as lasting 4 to 12 weeks, while chronic back pain lasts over 12 weeks. Up to 30% of patients report persistent low back pain up to 1 year after experiencing an acute episode. One in five report substantial limitations in activity, according to background information in the articles.

To develop the guideline, the ACP reviewed randomized controlled trials and systematic reviews of studies evaluating noninvasive, nondrug, and drug therapy for low back pain in adults. To be included, studies had to be published in English between January 2008 and November 2016. The authors identified earlier studies using the 2007 ACP/American Pain Society systematic reviews. The agency evaluated outcomes including reduction or elimination of back pain and number of back pain episodes, improvement in back-specific function, improvement in health-related quality of life, reduction in work disability, patient satisfaction, and adverse events. The guidelines and evidence reviews also underwent peer review and a public comment period.

Overall, the new guidelines emphasize conservative treatment. First-line therapy should incorporate nondrug therapies. New evidence supports acupuncture in acute low back pain alongside with massage, or spinal manipulation; and tai chi and acupuncture in chronic low back pain alongside exercise, multidisciplinary rehabilitation, yoga, motor control exercise, progressive relaxation. Nonsteroidal anti-inflammatories (NSAIDs) or muscle relaxants should be considered when nondrug therapy fails. The guidelines strongly discourage the use of opioids (which can be associated with addiction and accidental overdose).

Reference

Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, Fu R, Dana T, Kraegel P, Griffin J, Grusing S, Brodt ED. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017 Apr 4;166 (7):493-505.  https://www.ncbi.nlm.nih.gov/pubmed/28192793

Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians. Ann Intern Med. 2017 Apr 4;166 (7):514-530.   http://annals.org/aim/article/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice

Acupuncture improved the symptoms and quality of life in patients with lumbar spinal stenosis

Acupuncture treatment showed that it could relieve pain and improve quality of life in patients with lumbar spinal stenosis (LLS). The report was published in Journal of Acupuncture and Meridian Studies.

Lumbar spinal stenosis is a narrowing of the spinal canal in the lower back, known as lumbar area. This usually happens when bone or tissue-or both-grow in the opening of the spinal canal, caused commonly by spondylosis or degenerative arthritis. Neurogenic pain of LLS is normally exacerbated by walking, standing and/or maintaining certain postures and relieved with sitting or lying. Other symptoms of LLS include sensory loss and weakness of legs, reflecting involvement of spinal nerve roots within lumbar spinal canal. Although medication is effective in relieving symptoms temporarily and surgical procedures will improve the conditions in some cases, none of the treatments is curative.

Dr. MJ Hadianfard and colleagues in Iran conducted a clinical study to assess the effectiveness of acupuncture on patients with LLS. Twenty-four patients with LLS were recruited for the study and were given acupuncture on following acupoints: bilateral BL-23, BL-25, BL-26, BL-37, BL-40, BL-54, BL-57, LI-4, BL-60, DU-3, DU-4, and DU-20 for 30 minutes per session, three sessions a week and 10 sessions in total. The visual analogue scale (VAS) and Short Form-36 Health Survey (SF-36) were monitored for pain and quality of life before treatment, immediate after final treatment and 6-week follow-up. Patients did not receive other treatments during the course of acupuncture treatment.

It was shown that acupuncture treatment significantly improved pain and quality of life such as emotions, vitality, general health, bodily pain, and physical well-being not only immediate after final treatment and but maintained 6-week after treatment. There was no adverse effect reported.

The study demonstrated that acupuncture was able to relieve pain and improve the quality of life of patients with LLS.

Reference:

Hadianfard MJ et al., Effect of Acupuncture on Pain and Quality of Life in Patients with Lumbar Spinal Stenosis: A Case Series Study. J Acupunct Meridian Stud. 2016 Aug;9(4):178-82.    https://www.ncbi.nlm.nih.gov/pubmed/27555222

Unanticipated ripple effect of acupuncture research

Since the report of acupuncture by James Restone in the United States in early 1970s, acupuncture as a modality has been significantly increased its popularity in the Western countries. Effectiveness of acupuncture for many conditions such as pain has been widely recognized. However, for acupuncture research the major impetus in the United States occurred in 1998, when the National Centre for Complementary and Alternative Medicine (now the National Centre for Complementary and Integrative Health) was established within the National Institutes of Health. Since then development of acupuncture research made good progress regarding to effectiveness of acupuncture and understanding of mechanisms of action of acupuncture.

Recently, Professor Hugh MacPherson and colleagues summarised some unexpected and broad-reaching discoveries that materialize when biomedicine and acupuncture encounter in the context of objective and systematic scientific exploration.

1.    Acupuncture stimulation increased release of endorphins leading to wider range of analgesia research.

2.    Increased interesting in connective tissue research in health and disease because insertion of acupuncture needle into connective tissue produce many local changes lead to mechanotransduction study.

3.    Toward better understanding of placebo effect. The use of the sham acupuncture needle as a unique placebo device has assisted researchers in identifying key components of treatment that may enhance the effect of placebo.

4.    Acupuncture-related devices that have beneficial effect on biomedicine, such as transcutaneous electrical nerve stimulation units for analgesia and acupressure bands for relief of nausea.

5.    Pragmatic clinical trials. Acupuncture research in pain helped the evolution of clinical research towards more pragmatic randomized controlled trials, as a part of comparative effectiveness research.

Those unexpected ripple effect of acupuncture research identified by authors not only are the clearest examples of this scientific cross-fertilization, but provide additional rationale for continued support of research evaluating acupuncture therapy.

Reference

MacPherson H, et al., Unanticipated Insights into Biomedicine from the Study of Acupuncture. J Altern Complement Med. 2016 Feb;22(2):101-7.    https://www.ncbi.nlm.nih.gov/pubmed/26745452

Acupuncture helps relieve pain in people with endometriosis

Endometriosis is a chronic, estrogen-dependent disorder characterised by growth of endometrial tissue in sites other than the uterus, most commonly in the pelvic cavity, but also in other parts of the body. The cause of endometriosis is not known, but many factors are thought to be involved in its development. These include retrograde menstruation; an abnormal quantity or quality of endometrial cells; embryonic cells giving rise to deposits in distant sites around the body; and the production of antibodies against endometrial cells.

This ectopic endometrial tissue responds to the hormonal changes of the menstrual cycle, with subsequent bleeding, inflammation, and pain. If the ovaries are affected, endometriotic ovarian cysts may develop. Common symptoms include dysmenorrhoea, dyspareunia, non-cyclical pelvic and abdominal pain, and subfertility. The prevalence is estimated to vary from 2-22% of women and, in women with dysmenorrhoea, the incidence of endometriosis is 40-60%.

Recently some review articles showed that acupuncture is specifically of benefit in people with endometriosis. Acupuncture provides effective pain relief, by stimulating nerves located in muscles and other tissues, leading to release of endorphins and other neurohumoral factors, and changing the processing of pain in the brain and spinal cord. Acupuncture reduces inflammation by promoting release of vascular and immunomodulatory factors. Acupuncture exerts regulating levels of prostaglandins.

The authors of articles suggest that acupuncture can be used as an independent or complement therapy for the treatment of endometriosis.

Reference:

Lund I, Lundeberg T. Is acupuncture effective in the treatment of pain in endometriosis? J Pain Res. 2016 Mar 24;9:157-65. http://www.ncbi.nlm.nih.gov/pubmed/27069371

Kong S et al., The Complementary and Alternative Medicine for Endometriosis: A Review of Utilization and Mechanism. Evidence-Based Complementary and Alternative Medicine, Volume 2014 (2014), Article ID 146383, 16 pages.  http://www.hindawi.com/journals/ecam/2014/146383/

Acupuncture helped alleviate pain after thyroid surgery

Better management of postoperative pain in patients undergoing thyroid surgery is important for recovery. It was reported that acupuncture had a synergistic effect in relieving pain in patients after thyroidectomy according a study published in journal of Surgery.

Appropriate control of postoperative pain following thyroid surgery is essential for a speedy recovery. Conventional pain relief medications such as opioids and/or non-opioids normally are effective in relieving or stopping pain after surgery. However, they induced many unwanted side effects such as worsening of anesthetics-induced nausea and vomiting, sedation and slowing of gastric emptying and gastro-intestine motility and many more. Acupuncture has been reported to be effective in relieving postoperative pain in many conditions only with minimal side effect.

Dr. M Iacobone and colleagues in Italy performed a randomised, controlled clinical trial to assess the efficacy of acupuncture in reducing pain after thyroid surgery. One hundred forty patients with thyroidectomy were randomly divided into control group (n=79) and acupuncture group (n=70). Patients in control group were treated with analgesic acetaminophen, and patients in acupuncture group were treated with acupuncture plus acetaminophen. Acupuncture was give at acupoints LI4 and PC6, ca. 30 min before surgery and in the morning of postoperative day 1, for 30 min with or without electro stimulation. Pain was assessed according to the intraoperative pain measured by remifentanil consumption during anesthesia and postoperative pain, measured by Numeric Rating Scale, the McGill Pain Questionnaire, and acetaminophen consumption.

Overall, patients with acupuncture required less acetaminophen at day 2 and day 3 after operation compared with controls. Patients with electroacupuncture performed better than manual acupuncture. They required less remifentanil and acetaminophen than controls at day 2 and 3 after surgery and showed a trend toward better Numeric Rating Scale and McGill scores from day 1 to 3 after surgery compared with controls. Patients in acupuncture also experienced less side-effects than control group.

Authors suggested that acupuncture may be effective in reducing pain in patients following thyroid surgery.

Reference:

Iacobone M et al., The effects of acupuncture after thyroid surgery: A randomized, controlled trial. Surgery 2014;156:1605-13.   http://www.sciencedirect.com/science/article/pii/S0039606014005406

Acupuncture alleviates pain caused by the first bite syndrome

Acupuncture significantly reduced a facial pain called “first bite syndrome” which is not satisfactorily treated by conventional approaches, according to a report published in the American Journal of Otolaryngology.

First bite syndrome refers to facial pain characterized by a severe cramping or spasm in the parotid region triggered at the beginning of a meal by chewing, swallowing or even simple contact with generally acidic food. It is potential sequelae of surgery of the upper cervical region involving the infratemporal fossa, parapharyngeal space, and/or deep lobe of the parotid gland. The incidence, risk factors, treatment options and outcomes of first bite syndrome are poorly understood. Pharmacologic and surgical treatments are used to treatment the condition but none of them prove to be effective in the long-term.

Recently Dr. FR Fiorini and colleagues in Italy used acupuncture to treat two patients (a male and a female) with first bite syndrome after upper neck surgery for a plomorphus adenoma of the parotid gland and a cervical sympathetic chain neurinoma. Electroacupuncture was applied on relevant acupoints and lasted for 30 min a session, once a week for 6 weeks. A self-coded questionnaire comprising of qualitative and quantitative description of pain was performed. The scores range from 8 to 44, corresponding to the lowest and the highest discomfort possible. At the end of acupuncture, the scores dropped from 33 to 25 in the female patient, and from 30 to 15 in the male patient.

The authors found that acupuncture was very effective in treating the condition and suggest that acupuncture may represent a therapeutic alternative in future treatment. 

Reference:

Fiorini FR et al., Potential use of acupuncture in the treatment of first bite syndrome. Am J Otolaryngol. 2015 Jan 30. pii: S0196-0709(15)00043-5.   http://www.ncbi.nlm.nih.gov/pubmed/25783766

Acupuncture significantly reduced pain associated with scar tissue

Manual acupuncture treatment significantly relived pain associated with scar tissue, a case report published in the Journal of Acupuncture and Meridian Studies.

Scar tissue usually forms after deep trauma, such as burns and surgery to the dermis. Excessive scar also known as hypertrophic scar are benign fibrotic proliferation due to the overproliferation of fibroblasts. Current treatments include intralesional corticosteroid injection, radiotherapy and surgical manipulation which are associated with adverse effects.

Dr. Sheng Fang in the United State treated a female patient with a surgical scar on the upper right thigh for a year and wrote a case report. The scar was about 3 inches long, 1/4 inch wide, red colour, tough, and hard. It was very sensitive to touch. Patient mentioned she felt a stabling pain in the scar area for 3 months. The pain intensity level was 7 on the Likert Scale of 0-10 (0 being no pain and 10 being the worst pain). Acupuncture treatment consisted of Wei Ci points in the local scar area (8 needles) plus bilateral LI4, LIV3 and ST36 acupoints. Treatments lasted 20 mins each time, twice a week for 3 weeks. After second treatment patient reported a decreased pain associated with scar. At the end of 3 week treatment patient only occasionally pain. The pain intensity level dropped to 1-2 on a scale of 0-10. Then treatment was once a week for further two weeks. Patient felt the pain maintained at the similar level as the third week treatment. No further follow-up was carried out.

The case report suggests that acupuncture markedly reduced pain associated with scar tissue.

Reference:

Fang S, The successful treatment of pain associated with scar tissue.  J Acupunct Meridian Stud 2014;7(5):262-264.   http://www.jams-kpi.com/article/S2005-2901(14)00092-2/abstract

Acupuncture complements with Western medicine in treating with hypertension and psychological symptoms

Acupuncture treatment, alongside with conventional medicine, helps reduce higher blood pressure, calm the patient’s fear and other psychological symptoms and enhance recovery of a patient treated in the intensive care unit of the hospital. According to a case report published in the journal of Complementary Therapies in Medicine.

The report recorded the extreme physiological and emotional shifts manifested in the patient’s tongue on a daily basis which was rarely observed in other hospital settings.

Dr. Kreindler and colleagues, in the Bnai-Zion Medical Center, Israel, reported a case study of individualized acupuncture treatment according to the changes in the tongue of the patient. They reported that an 85-year-old female patient suffering from hypertensive crisis was administered into intensive care unit. Her doctor requested acupuncture treatment in order to provide integrative care for her. The changes in patient’s tongue and pulse were recorded on the daily basis. During the course of medication, cardiac catherterization and recovery, different acupoints were selected according to traditional Chinese medicine (TCM) diagnosis, including main symptoms, tongue and pulse diagnosis.

It was found that blood pressure of patient normalized within hours after acupuncture and medication. Acupuncture markedly reduced pain, anxiety and improved the wellbeing during the course of treatment and recovery.

The authors suggest that combination of conventional medicine and TCM carries potential to supplement each other and to provide a better patient care.

Reference:

Kreindler GM et al., A tongue’s tale — A case report of traditional Chinese medicine integration in the cardiology department. Complementary Therapies in Medicine, Volume 22, Issue 6, Pages 1041–1046, December 2014.   http://www.complementarytherapiesinmedicine.com/article/S0965-2299%2814%2900156-3/abstract

Acupuncture effectively reduced symptoms of posttraumatic stress disorder

Acupuncture treatment to veterans with posttraumatic stress disorder (PTSD) significantly reduced PTSD severity and improved pain, depression and physical and mental health functioning. It was reported in the journal of Med Care.

PTSD is an anxiety disorder and develops after a terrifying ordeal that involved the physical harm or the threat of physical harm, such as serious road accidents, violent personal assault, warfare and natural disasters e.g. earthquake. PTSD was first brought to public attention in relation to military combat veterans. Someone with PTSD will often relieve the traumatic event through nightmare and flashback, and may experience the feeling of irritability, guilty and isolation. These symptoms are often severe and persistent enough to have a significant impact on person’s day-to-day life. The common treatments include psychotherapy e.g. cognitive behavioural therapy and medication such as antidepressants. Those treatments are not always satisfactory.

Dr. Engel and colleagues in the United State carried out a randomized clinical trial to assess the effectiveness of acupuncture in the treatment of patients with PTSD. Fifty-five patients with PTSD were divided to two groups, one was treated with acupuncture plus usual PTSD care, and another group was only treated with usual PTSD care as a control. Acupuncture lasted ca. 60 min each time, twice weekly for 4 weeks. Primary outcome measurements include the changes in PTSD symptom improvement on PTSD checklist and the Clinician-administered PTSD scale. The secondary outcomes include improvement in depression, pain severity, mental and physical health functioning. The outcomes were monitored at the end of treatment, 4 and 8 weeks following treatment.

It was reported that acupuncture significantly reduced PTSD severity compared with usual PTSD care alone. Acupuncture also markedly improved the symptoms in the secondary outcome measurements such as pain severity, depression and mental and physical health functioning. The therapeutic effects of acupuncture maintained to the last follow-up monitoring.

The study indicates that acupuncture is very effective in treating PTSD and associated symptoms.

Reference:

Engel CC et al., Randomized Effectiveness Trial of a Brief Course of Acupuncture for Posttraumatic Stress Disorder. Med Care. 2014 Dec;52 Suppl 5:S57-64.    http://www.ncbi.nlm.nih.gov/pubmed/25397825

Acupuncture significantly reduced pain caused by orthodontic adjustment

Acupuncture treatment performed before orthodontic therapy markedly reduced post-adjustment pain in patients with fixed appliances, according to a report published in the Dental Press Journal of Orthodontics.

It has been acknowledged that dental therapy including orthodontic treatment, even if analgesic and anaesthetic medication are used, by most people, cause pain or even light distress. Considering high rate of patients complaining about pain suffered during orthodontic therapy, different methods have been considered for its pain control, such as Lower-power laser application, transcutaneous electrical nerve stimulation etc. However, the results in many cases are not satisfactory.  

Doctor Boleta-Ceranto and colleagues in Brazil carried out small clinical study, performed acupuncture before orthodontic adjustment in orthodontic patients to assess its pain control effect. Eleven patients with fixed appliance who needed monthly adjustment were treated acupuncture at acupoints LI4 and ST6 for 20 mins before orthodontic adjustments. Analogue Visual Scare was used to measure the level of pain three months without acupuncture and 3 months following acupuncture treatment.

It was found that acupuncture treatment produced a statistically significant reduction in pain level index for all patients. No incidence was reported.

The study concluded that acupuncture is a safe and effective treatment in reducing pain caused by orthodontic post-adjustment procedure.

Reference:

Boleta-Ceranto et al., Orthodontic post-adjustment pain control with acupuncture. Dental Press J. Orthod. vol.19 no.4 Maringá July/Aug. 2014.   http://www.scielo.br/scielo.php?pid=S2176-94512014000400100&script=sci_arttext

Acupuncture help relieve pain and improve bone density in postmenopausal osteoporosis

Acupuncture treatment relieves pain, improves bone density and rebalances immune responses in postmenopausal osteoporosis according to a study published in journal Zhongguo Zhen Jiu (Chinese Acupuncture and Moxibustion).

Postmenopausal osteoporosis is one of most common of osteoporosis. It is closely associated with the changes in the hormone. Hormone replacement therapy is effective in relieving osteoporosis but it has many unwanted effects. Acupuncture is used to treat the condition but the mechanism of its action is not clear.

Scientists in China conducted a randomized clinical study to compare the efficacy of different acupuncture techniques with conventional treatment. Patients with postmenopausal osteoporosis were divided into three groups: warm acupuncture, electroacupuncture and medication groups (n=30 each group). The subjects were given warm acupuncture or electroacupuncture at acupoints BL11, BL23 and GB 39 for 30 mins daily for 30 days. Bone density value, Visual Analogue Scale and inflammatory indicators such as interlukin-6 and tumour necrosis factor-alpha were measured before and after treatment.

Although pain was markedly reduced in three groups warm acupuncture was significantly more effective than other modalities. Warm acupuncture also produced a significant increase in bone density value and anti-inflammatory effect, followed by electroacupuncture and medication.

The study suggests that warm acupuncture has better efficacy in relieving pain and improving bone density than electroacupuncture and conventional medication.

Reference:

Cai GW et al., [Clinical research on warm acupuncture therapy for pain in postmenopausal osteoporosis]. Zhongguo Zhen Jiu. 2014 Jan;34(1):25-7.  http://www.ncbi.nlm.nih.gov/pubmed/24673048

Why some people do not respond well to acupuncture-induced analgesia?

A gene called 5’-AMP-activated protein kinase (AMPK), in the hypothalamus of brain is found to determine your responsiveness to acupuncture analgesia, according to a study published in the journal BMC Complementary and Alternative Medicine.

Although acupuncture is now widely used to treat a range of pain conditions, there are some subjects, in many acupuncture analgesia experimental and clinical studies did not respond well, which is difficult to explain.

Researchers in Korea conducted an experimental study to find the factors in the brain determining the sensitivity to acupuncture analgesia in a pain model. Using molecular biotechnologies such as cDNA microarray analysis and reverse transcription polymerase chain reaction, they looked the expression levels of different genes in the hypothalamus, a pain responder region in brain of the subjects. It was found that the levels of gene AMPK was significantly higher in the pain responder subjects than those of non-responder subjects. Further studies showed that inhibition of AMPK expression in the brain attenuated acupuncture-induced analgesic effect in responder subjects.

The studies demonstrated that the levels of AMPK gene expression in the hypothalamus region of brain may determine the individual differences in the sensitivity to acupuncture-induced analgesia.

Reference:

Kim SK et al., Expression levels of the hypothalamic AMPK gene determines the responsiveness of the rats to electroacupuncture-induced analgesia. BMC Complementary and Alternative Medicine 2014, 14:211 doi:10.1186/1472-6882-14-211.   http://www.biomedcentral.com/1472-6882/14/211

Laser acupuncture relieves pain in patients with temporomandibular joint disorders.

Laser acupuncture help relieve pain in patients with temporomandibular joint disorders. It is reported in Journal of Formosan Medical Association.

Temporomandibular joint disorders (TMD) are conditions affecting jaw joint, including pain, dysfunction of mastication muscles and temporomandibular joint. The symptoms comprise pain in the joint area and nearby, reduced jaw movement, noise from temporomandibular joint during jaw movement. TMD is a common problem affecting 20-40% of people aged between 20 and 40 and can become chronic and difficult to manage, leading to a detrimental to quality of life. It is thought the cause of TMD include wear and tear to the inside of the joint, arthritis such as rheumatoid arthritis and gout, and injury to the joint. Conventional treatments include medication, local injection and surgery which can relieve symptoms but are not always satisfactory.

Scientists in Taiwan ran a clinical study to evaluate the effectiveness of laser acupuncture on TMD. Twenty patients with TMD were treated with laser acupuncture at four acupoints (ST6, ST7, LI4 and Ashi point) once a week for total four weeks. The Visual Analogue Scale (1-10) was used to measure pain intensity before and after treatment.

At the end of treatment the average pain score was significantly reduced from 6.3±1.6 before treatment to 2.5±2.2 after treatment. Six of 17 patients with TMD felt pain free and 11 of 17 patients showed various degree of pain relief following the treatment. There was no adverse effect after treatment.

The study indicates that laser acupuncture could be an effective alternative treatment for temporomandibular joint disorders.

Reference:

Huang YF et al., Clinical effectiveness of laser acupuncture in the treatment of temporomandibular joint disorder. Journal of the Formosan Medical Association (2014)113, 535e539.   http://www.sciencedirect.com/science/article/pii/S0929664612003944

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 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

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

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

Scalp acupuncture stops chronic phantom limb pain in a traumatic amputee

Phantom limb pain is often excruciating and almost impossible to treat. However in a case report, Taiwanese researchers claim that scalp acupuncture stops chronic phantom limb pain and phantom limb sensation, published in Acupunct Med, the official journal of British Medical Acupuncture Society.

Phantom limb pain appears to come from where the amputated limb used to be and is often excruciating. Phantom limb sensations, which are not painful, may be felt in the absent limb. It has been reported that three quarters of amputees develop phantom pain, which is described as shooting, stabbing and burning. Phantom pain can last for many years but sometimes it gets better as time passes. It is believed that damage to nerve endings and altered neuronal activities in the brain as a result of the loss of sensory input from amputated limb are important factors in the development of phantom pain. Medications and motor cortex stimulation are often recommended treatments and have the limited effects.

A case study of scalp acupuncture to an amputee with chronic phantom limb pain and sensation was conducted in Taiwan. A 71-year-old woman with her right arm being amputated surgically below the elbow developed phantom pain and sensation. She was treated with barbiturates, antidepressants, muscle relaxants and analgesics for two years. However, the drugs did not improve her conditions. She was then treated with scalp acupuncture at the line MS7 and Sishencong, twice a week for three weeks. Immediately after the first treatment the patient noted a significant relief of pain and sensation. After the second acupuncture the pain, measured by Visual Analogue Scale, was 4 compared 10 before the acupuncture. A six-month follow up showed that the patient was free from both phantom limb pain and sensation.

It is believed this is the first report of using scalp acupuncture to treat phantom limb pain and sensation. This suggests that scalp acupuncture can be an excellent alternative approach to those patients who do not respond well to the conventional treatment.  

Reference:

Tseng CC et al., Successful treatment of phantom limb pain and phantom limb sensation in the traumatic amputee using scalp acupuncture. Acupunct Med. 2014 May 22. pii: acupmed-2014-010556.    http://aim.bmj.com/content/early/2014/05/22/acupmed-2014-010556.extract