Acupuncture needles with direct electrical stimulation helped speed up nerve regeneration and function recovery after forearm ulnar nerve injury – a case report

A male patient with deep cutting wound and total rupture of right proximal forearm ulnar nerve was treated with direct electrical stimulation of acupuncture needles plus daily rehabilitation activities recovered most of function and returned to work around three months of after surgery. A case study reported in journal of Complementary Therapies in Medicine.

A 32-year old male patient, in Taiwan, China, suffered a deep cut from a broken washbasin and total rupture of right proximal forearm ulnar nerve and partial rupture of many associated tendons. The wound immediately underwent irrigation and muscle and ulnar nerve repair surgery. Two weeks after operation, electroacupuncture was applied, using 2 needles inserted in the cubital tunnel along the site of the injured ulnar nerve and 10 needles inserted according to the origins of muscles innervated by the ulnar nerve and affected by the injury, and other 4 needles were inserted along the suture scar line to avoid possible soft tissue contractures. The procedure was executed once a week for 6 months plus daily rehabilitation activities.

The outcome was monitored using the Rosén and Lundborg (R&L) protocol and DASH scores once a month. The results gathered on the first day of intervention were regarded as the baseline.

It was found that pain/discomfort domain was the first to reach stable amelioration after the first month. The motor and sensory and domains reached stable growth in third and fourth months, respectively. The patient returned to work in third month after operation.

Authors suggested that direct electrical stimulation at the proximal site of the injured nerve can augment nerve regeneration by means of acceleration of axon regeneration, earlier target muscle reinnervation, improvements in axonal conduction speeds, and up-regulation and electrophoretic movement of neurotrophic and neurogrowth factors such as BDNF and its trkB receptors.

Reference

Tang YJ et al., Direct electrical stimulation on the injured ulnar nerve using acupuncture needles combined with rehabilitation accelerates nerve regeneration and functional recovery—A case report. Complementary Therapies in Medicine 24 (2016) 103–107.    http://www.complementarytherapiesinmedicine.com/article/S0965-2299(15)30024-8/abstract

Acupuncture is effective in treating melasma

Melasma (also called Cholasma in pregnant women) is a commonly acquired dermatological condition characterized by hyper-pigmented patches on the sun exposed area of skin, mostly on the face. Acupuncture with facial acupoints alone or plus body acupoints were reported to improve melasma, according to a randomized clinical study published in journal of Complementary Therapies in Clinical Practice.

Melasma is a type of hyper pigmentation. It is caused by the build up of excess melanin, which creates patches of darker skin. It can be a side effect of the contraceptive pill, pregnancy, and hormone replacement medications. The frequent location of melasma on the face makes it a significant cosmetic condition that has a strong emotional impact on the individual, affecting their quality of life to an extent that they frequently seek treatment. Presently, a combination of hydroquinone (HQ) with steroids and tretinoin is considered the first line of treatment for the condition. However, concerns of the safety and side effects associated with long-term use of HQ are raised.

Recently scientists in Thailand conducted a randomized clinical study to assess the effect of facial acupuncture with or without body acupuncture on the melasma. Forty-one patients with melasma were divided into facial acupuncture only group (n=20) and facial acupuncture plus body acupuncture group (n=21). Facial acupuncture was performed with needles inserted at the rims of melasma and at the angle of 15 degree with needle tips towards the lesion centre. Body acupuncture was performed at 11 acupoints. The duration of treatment was 30 min a session, two sessions a week for a total 8 consecutive weeks.  Assessment of the melasma area and darkness of its pigmentation were carried out before and after treatment.

At the end of 8-week treatment it was found that facial acupuncture with or without body acupuncture significantly reduced the melasma area and darkness of its pigmentation compared with the base line. There was no recorded side effect.

This was the first randomized clinical study of effectiveness of facial acupuncture on melasma. Authors suggested that facial acupuncture could be a safe and cost-effective treatment for patients with melasma.

Reference:

L Rerksuppaphol et al., Randomized clinical trial of facial acupuncture with or without body acupuncture for treatment of melasma. Complementary Therapies in Clinical Practice 22 (2016) 1-7.    http://www.sciencedirect.com/science/article/pii/S1744388115300128

What is optimal stimulation frequency of electroacupuncture to decrease blood pressure in human?

Electroacupuncture has been used to treat hypertension due to its modulation on autonomic nervous system. Stimulation frequency at 1 HZ is reported to be the most effective to decrease blood pressure in human subject according to a report published in the journal of Clinical Autonomic Research.

Electroacupuncture is used to treat patient with hypertension, because it is less dependent on practioner’s skill, and the frequency and duration of stimulation can be precisely controlled.  However, there is no study in human subject about the optimal stimulation frequency in reducing blood pressure.

Recently a group of scientist leading by Dr. Hidehiro Nakahara in Japan conducted a clinical study to investigate the effects of varying stimulation frequencies of electroacupuncture on time-dependent changes in blood pressure and heart rate in humans. Twenty healthy human subjects were recruited for the study. Electroacupuncture was performed at acupoint Ximen (PC4) for 6 mins, at an intensity of 1 V, pulse width of 5 ms, using following stimulation frequencies: 0.5, 1, 5 and 10 HZ. The beginning of electroacupuncture was blinded to subject. Blood pressure and heart rate were monitored two mins before acupuncture and during 6 mins electroacupuncture stimulation. 

The data showed that electroacupuncture stimulation at 1 HZ produced the maximal reduction in blood pressure and heart rate compared with other stimulation frequencies. Further, reduction effect became more pronounced with increase in stimulation duration.

The present study provided fundamental data for potential use of electroacupuncture in the treatment of cardiovascular conditions.

Reference:

H Nakahara et al., Electroacupuncture most effectively elicits depressor and bradycardic responses at 1 Hz in humans. Clin Auton Res. 2015 Dec 22.   http://link.springer.com/article/10.1007%2Fs10286-015-0330-x

How does acupuncture alleviate major depressive disorder?

Major depressive disorder is a recurrent and debilitating mental disorder. Acupuncture is very effective to alleviate the symptoms of major depressive disorder, by increasing the level of serotonin in the brain, according to a report recently published in the journal Neuroscience Letter.

It is reported that major depressive disorder affects about 7% of the population over age of 18 in the United State, according to the National Institute of Mental Health. Psychological, physiological and social symptoms of the disorder persist for weeks and are bad enough to interfere with work, social life and family life. Although the exact cause of major depressive order is unclear it is believed that decreased level of serotonin, a neurotransmitter, in the brain area hippocampus is closely linked to the disorder. Up to 80% of patients with major depressive disorder were reported to be treated with selective serotonin reuptake inhibitors. Although the drugs produced temporary symptomatic relief, severe side effects occurred with long-term use. Although acupuncture is used to treat the disorder its mechanism of action is not known.

Scientists in China recently conducted a study to explore the potential mechanism of acupuncture treatment on major depressive disorder. The study was performed on major depressive disorder model. Electro-acupuncture stimulation was applied at acupoints ST36 bilaterally and CV4 for 20 min once daily for 14 consecutive days. Outcome included behavioural and biochemical assessments tested before and after acupuncture. Data showed that depressive behaviour was significantly improved by acupuncture compared untreated group. Biochemical studies showed that the concentration of serotonin in the hippocampus was markedly elevated following acupuncture stimulation.

The study suggested that acupuncture stimulation at acupoint ST36 and CV4 increased the level of serotonin in the brain leading to the symptomatic relieve in depressive model.

Reference:

JJ Le et al., Electroacupuncture regulate hypothalamic-pituitary-adrenal axis and enhance hippocampal serotonin system in a rat model of depression. Neurosci Lett. 2016 Jan 7. pii: S0304-3940(16)30004-0.  http://www.ncbi.nlm.nih.gov/pubmed/26773866

Dose different acupuncture directions affect therapeutic efficacy?

 Acupuncture manipulation, which regulates the quality of stimulation, involves frequency, duration, depth, direction and many other aspects. It has been reported that different manipulation techniques exert different effect, possible due to different influence on cellular responders in subcutaneous tissues. For example, the activities of natural killer cell, T lymphocyte subsets, activation of many local neuroactive molecules and modulators. However, effect of acupuncture needle direction and its underlying mechanism are less clear.

Recently, scientists in China conducted a clinical study to investigate 1). The metabolic mechanism of acupuncture direction using metabonomic techniques by analysing metabolic profiles of urine samples of patients with posterior circulation ischemia and healthy subjects; 2). Effect of different acupuncture direction on therapeutic efficacy. Sixty patients with posterior circulation ischemia and thirty healthy subjects were recruited for the study. Acupuncture was performed at acupoint GB20, for 6 min, 3-4 times each week for a total 14 treatments. Patients were randomly divided into two groups. Group A: the needle tip was directed toward the contralateral paropia, twirling with a frequency of 120 times per minute, depth 0.5–0.8 cun. Group B: the needle tip was directed toward the prominentia laryngea, twirling with a frequency of 120 times per minute, depth 0.5–0.8 cun. Morning urine samples were collected from healthy subjects, patients of pretreatment and posttreatment of group A and B.

The results showed that significant differences in urine biomarker contents were observed between patients and healthy subjects. After treatment, the urine biomarker contents of patients of both treatment groups returned to levels similar to those of the healthy control group. Further, urine biomarker contents of group A were closer to those of the control group than the biomarker contents of group B.

The study presented that manipulation of the needle tip at the GB20) acupoint toward the contralateral paropia adjusted metabolite levels more readily in patients with posterior circulation ischemia to levels similar to those healthy subjects. It suggested that different acupuncture needle direction might play an important role of therapeutic outcome.

Reference

L Ju et al., Metabonomic study of the effects of different acupuncture directions on therapeutic efficacy. Journal of Chromatography B, 1009 (2016) 87–95.   http://www.ncbi.nlm.nih.gov/pubmed/26708629

Patient’s acupuncture deqi peception correlates to practioner’s perception

According to traditional Chinese medicine, effectiveness of acupuncture resides in qi or energy. Patients report different sensations when acupuncture needle being inserted and manipulated. These sensations including heaviness, numbness, soreness, distension, are called deqi, an indication of therapeutic effect of acupuncture. It is believed that acupuncturists also feel tenseness around the needle after needle insertion and manipulation. However there is no report about co-existence of acupuncture perception for both subject and acupuncturist.

Recently Dr. CS Yin and colleagues in Korea conducted a clinical study to quantitatively document the subject’s and acupuncturist’s perception during acupuncture. Eighty-one participants acted as subjects or acupuncturists. Acupuncture stimulation was performed at acupoint LI4 and ST36 and needling was conducted through 4 phases: insertion into shallow, middle, and deep depths, followed by twirling manipulation. Outcome measures include 1). Subject’s acupuncture perception scale, a self-report comprised 20 items under 5 domains; 2). Acupuncturist’s acupuncture perception, a self-report comprised thick, tangled, solid and empty feeling.

It was found that subject’s acupuncture perception significantly correlated to acupuncturist’s perception. Acupuncture perception varied over four phases of needling, with a tendency rated higher when inserted deep.

The study confirms that deqi perception can be felt by both subject and acupuncturist and correlated each other well. This suggests that any feedback from subject by asking, observing and palpating will help acupuncturist modulate the needling procedure and adjust them to an optimal one which can maximise therapeutic effect of acupuncture.

Reference

CS Yin et al., Deqi is double-faced: the acupuncture practitioner’s and the subject’s perspective. Evidence-Based Complementary and Alternative Medicine, Volume 2015, Article ID 635089.     http://www.hindawi.com/journals/ecam/2015/635089/

Acupuncture helped alleviate tinnitus

Scalp acupuncture treatment markedly alleviated tinnitus in a clinical study according to a report published in Brazilian Journal of otorhinolaryngology.

Tinnitus is a condition of hearing of sound that comes from inside of your body rather than from an external source. It is estimated that around 5-15% of the population has some kind of tinnitus. Although tinnitus can occur at any age, it is more prevalent among those aged between 60-69 years. It is not clear what causes tinnitus, although it is believed that inner ear damage, middle ear infection, earwax build-up and other brain-related conditions are closely linked to the tinnitus. Normally if the underline cause is found, tinnitus will disappear following effective treatment of relevant cause. However, there is no effective treatment for many people with tinnitus when the cause is unclear.

Recently Dr. Doi MY and colleagues in Brazil conducted a clinical study to assess the effectiveness of scalp acupuncture on tinnitus. Fifty patients with tinnitus were divided into acupuncture group and control group. Patients in the acupuncture group were treated with scalp electro-acupuncture with needles inserted bilaterally on the vestitulocochlear line for 40 mins, twice-a-week for 5 weeks. Patients in control group did not receive any kind of acupuncture. A visual analog scale consisting of visual graphic tool was used to determine the intensity or discomfort of tinnitus before and after acupuncture. The THI questionnaire was used to help patients to assess the changes before and after acupuncture.

At the end of study it was found that scalp electro-acupuncture significantly improved tinnitus, judged by changes in visual analog scale, compared with baseline scores and control group. Acupuncture treatment also markedly improved the quality of life of patients with tinnitus according the THI questionnaire compared to baseline and control group.

Reference:

Doi MY et al., Effectiveness of acupuncture in individuals with tinnitus: randomized controlled trial. Braz J Otorhinolaryngol. 2015 Nov 14. pii: S1808-8694(15)00206-2. doi: 10.1016/j.bjorl.2014.12.011.    http://www.ncbi.nlm.nih.gov/pubmed/26654962