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