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Acupuncture Point Anatomy Found

Acupuncture Point Anatomy Found | Acupuncture for the Nervous system and brain | Scoop.it

on 03 January 2015.

 

 

Researchers have discovered an anatomical structure located at acupuncture points. Wang, et. al., have identified a “vessel-like structure” made of “calcitonin gene related peptide (CGRP)-positive neurofibers in local tissues” at acupuncture points. The researchers discovered that “CGRP-positive nerve fibers were found to distribute in the dermis and subcutaneous layers of local tissues of acupoint ST 44, ST 36 and ST 32, mainly concentrating around the vessel-like structure.” They add, “CGRP-positive neurofibers are an important element in the local tissues of acupoint ST 44, ST 36 and ST 32 regions….”

Miyauchi, et. al., note, “The calcitonin gene-related peptide (CGRP) plays important roles as a neurotransmitter/neuromodulator in the central nervous system, and as a potent vasodilator when secreted from peripheral, perivascular nerves through its specific receptors.” Wang, et. al,. used a laser confocal microscope to make the discovery of CGRP positive nerve fibers at acupuncture points. This research solves one piece of the biological mystery behind the structure and mechanism of acupuncture’s effective actions on human health.

CGRP is a type of neurotransmitter. Nerve fibers that are positive for the presence of CGRP play many roles in human physiology. For example, Hara-Irie, et. al., note that “CGRP-positive nerve fibers could be a crucial element in bone metabolism during bone growth and development.” Kunst, et. al., from the Yale School of Medicine (New Haven, Connecticut) note that CGRP is “a wake-promoting neuropeptide that regulates sleep maintenance at night.” Evans, et. al., from the University of Miami School of Medicine (Miami, Florida) note that CGRP is “a potent vasodilator neuropeptide.” The density of nerve fibers containing CGRP located at acupuncture points may correlate to the ability of acupuncture to stimulate signal conduction and induce health benefits.

Hongbao Ma of the Department of Medicine, Michigan State University (East Lansing) notes, “Calcitonin gene-related peptide (CGRP) is a 37 amino acid vasoactive neuropeptide that is widely distributed in central and peripheral nervous systems in mammals. CGRP was discovered in 1982 by molecular cloning of calcitonin (CT) gene.” Ma adds, “CGRP is secreted by primary afferents and causes primary hyperalgesia, and its expression increases in (the) dorsal horn under sensitization conditions. CGRP plays (an) important role in blood pressure system.” Given the discovery of CGRP in 1982, it is not unusual that the vessel-like physical structures of CGRP associated with acupuncture points have only recently been discovered.

Russell, et. al. note, “CGRP is a highly potent vasodilator and, partly as a consequence, possesses protective mechanisms that are important for physiological and pathological conditions involving the cardiovascular system and wound healing. CGRP is primarily released from sensory nerves and thus is implicated in pain pathways. The proven ability of CGRP antagonists to alleviate migraine has been of most interest in terms of drug development, and knowledge to date concerning this potential therapeutic area is discussed.”

Ling Zhao et. al., conclude that acupuncture is effective in the treatment of migraines and reduces pain intensity levels. Zhou et. al., find acupuncture effective in the prevention of migraines and links acupuncture’s therapeutic benefits to its ability to stimulate MLCK expression. The expression of myosin light-chain kinase (MLCK) is involved in the regulation of smooth muscle contraction. The researchers document a correlation between acute migraine attacks and decreases of MLCK via the CGRP signal system. The researchers discovered that applying acupuncture to acupoint GB20 (Fengchi) successfully upregulates MLCK expression and has “preventative and curative” effects for migraine patients.

In another investigation, Morry Silberstein, et. al., conclude that acupuncture points are related to both unmyelinated and myelinated afferent nerve fibers in a unique neuroanatomical structure not found in other areas of the body. The researchers used light microscopy on silver stained sections of acupuncture point P6 (silver stained human cadaver sample) and used confocal light microscopy on a live subject for acupuncture points GB20 and SP6. Control sites were compared with the acupuncture points.

At acupuncture points, it was discovered that a nerve bundle extended to the dermal-epidermal junctions. Each bundle branched into 2 sections perpendicular to each other. This anatomical phenomenon was not observed at the control sites. The researchers concluded that this acupoint neuroanatomical finding suggests that, “acupuncture may incise afferent unmyelinated axonal branch points, disrupting both neural transmission to the spinal cord and crosstalk along meridians, while simultaneously stimulating larger, myelinated afferents, thus explaining both the immediate and long-lasting effects of acupuncture.”

In another body of research by Chenglin, et. al., CT scans reveal unique anatomical structures of acupuncture points. A CT (computerized tomography) scan is a series of X-rays used to create cross-sectional images. In a study published in the Journal of Electron Spectroscopy and Related Phenomena, researchers used in-line phase contrast CT imaging with synchrotron radiation on both non-acupuncture points and acupuncture points. The CT scans revealed clear distinctions between the non-acupuncture point and acupuncture point anatomical structures. Acupuncture points have a higher density of micro-vessels and contain a large amount of involuted microvascular structures. The non-acupuncture points did not exhibit these properties.

The researchers note that the state-of-the-art CT imaging techniques used in this study allow for improved three-dimensional (3D) imaging of a large field of view without artifacts. This greatly improves imaging of soft tissue and allowed the researchers to view this important finding.

The acupuncture points ST36 (Zusanli) and ST37 (Shangjuxu) were shown to have distinct structural differences from surrounding areas. At the acupuncture points, microvascular densities with bifurcations “can be clearly seen around thick blood vessels” but non-acupuncture point areas showed few thick blood vessels and none showed fine, high density structures. The acupuncture points contained fine structures with more large blood vessels that are several dozen micrometers in size plus beds of high density vascularization of vessels 15-50 micrometers in size. This structure was not found in non-acupuncture point areas. 

The researchers note that the size of an acupuncture point “can be estimated by the diameter of microvascular aggregations….” They also commented that other research has identified unique structures of acupuncture points and acupuncture meridians using MRI (magnetic resonance imaging), infrared imaging, LCD thermal photography, ultrasound and other CT imaging methods. The researchers commented that many studies using these technological approaches have already demonstrated that physical structures exist at acupuncture points. They note that “the high brightness, wide spectrum, high collimation, polarization and pulsed structure of synchrotron radiation” facilitated their discovery. They concluded, “Our results demonstrated again the existence of acupoints, and also show that the acupoints are special points in mammals.”

In another study, researchers used an amperometric oxygen micro-sensor to detect partial oxygen pressure variations at different locations on the anterior aspect of the wrist. The researchers concluded that partial oxygen pressure is significantly higher at acupuncture points. Below are images from the study measuring the increase of partial oxygen pressure combined with an overlay of the local acupuncture point locations. The images map the lung, pericardium and heart channels and their associated local points. Acupuncture points P7 and P6 clearly show high oxygen pressure levels as do the other acupuncture points in the region.

 

 

 

These measurements were not taken at needled acupuncture points. They were taken at the natural resting states of acupuncture points absent stimulation. A truly unique finding, acupuncture points exhibit special oxygen characteristics. Acupuncture points and acupuncture channels are scientifically measurable phenomena in repeated experiments. High oxygen pressure levels indicate the presence of pericardium, lung and heart acupuncture points and channels.


References:
Wang, C., W. J. Xie, M. Liu, J. Yan, J. L. Zhang, Z. Liu, and L. N. Guo. "[Distribution of calcitonin gene related peptide positive neurofibers in local skin tissues of" Neiting"(ST 44)," Zusanli"(ST 36) and" Futu"(ST 32) regions in the rat]." Zhen ci yan jiu= Acupuncture research/[Zhongguo yi xue ke xue yuan Yi xue qing bao yan jiu suo bian ji] 39, no. 5 (2014): 377-381.

Kunst, Michael, Michael E. Hughes, Davide Raccuglia, Mario Felix, Michael Li, Gregory Barnett, Janelle Duah, and Michael N. Nitabach. "Calcitonin Gene-Related Peptide Neurons Mediate Sleep-Specific Circadian Output in Drosophila." Current Biology (2014).

Ma, Hongbao. "Calcitonin gene-related peptide (CGRP)." Nat Sci 2 (2004): 41-47.

Russell, F. A., R. King, S-J. Smillie, X. Kodji, and S. D. Brain. "Calcitonin Gene-Related Peptide: Physiology and Pathophysiology." Physiological reviews 94, no. 4 (2014): 1099-1142.

Miyauchi, K., N. Tadotsu, T. Hayashi, Y. Ono, K. Tokoyoda, K. Tsujikawa, and H. Yamamoto. "Molecular cloning and characterization of mouse calcitonin gene-related peptide receptor." Neuropeptides 36, no. 1 (2002): 22-33.

Evans, Bornadata N., Mark I. Rosenblatt, Laila O. Mnayer, Kevin R. Oliver, and Ian M. Dickerson. "CGRP-RCP, a novel protein required for signal transduction at calcitonin gene-related peptide and adrenomedullin receptors." Journal of Biological Chemistry 275, no. 40 (2000): 31438-31443.

Hara-Irie, F., N. Amizuka, and H. Ozawa. "Immunohistochemical and ultrastructural localization of CGRP-positive nerve fibers at the epiphyseal trabecules facing the growth plate of rat femurs." Bone 18, no. 1 (1996): 29-39.

Zhao, Ling, Ji-xin Liu, Ying Li, Wei Qin, and Fan-rong Liang. "EFFECTS OF LONG-TERM ACUPUNCTURE TREATMENT ON RESTING-STATE BRAIN ACTIVITY IN MIGRAINE PATIENTS: A COMPARATIVE STUDY ON ACTIVE ACUPOINTS AND INACTIVE ACUPOINTS." Journal of Integrative Medicine 3 (2014): 234.

ZHOU Pei-juan, LI Bai, WANG Ai-cheng, LIU Chun-yan, WANG Yu, [Effect of Fengchi Point on the Expression of Myosin Light Chain Kinase on Middle Meningeal Artery of Migraine Model rats,] Acta Chinese Medicine and Pharmacology, 2014,(5), R285.5.

Morry Silberstein, Katharine Adcroft, Aston Wan, and Masimilliano Massi. Medical Acupuncture. Afferent Neural Branching at Human Acupuncture Points: Do Needles Stimulate or Inhibit?, doi:10.1089/acu.2011.0823. Department of Chemistry, Curtin University, Perth, Western Australia, Australia. Department of Pain Management, St. Vincent's Hospital Melbourne, Victoria, Fitzroy, Victoria, Australia.

Chenglin, Liu, Wang Xiaohu, Xu Hua, Liu Fang, Dang Ruishan, Zhang Dongming, Zhang Xinyi, Xie Honglan, and Xiao Tiqiao. "X-ray phase-contrast CT imaging of the acupoints based on synchrotron radiation." Journal of Electron Spectroscopy and Related Phenomena (2013).
Author Affiliations:

Minyoung Hong, Sarah S. Park, Yejin Ha, et al., “Heterogeneity of Skin Surface Oxygen Level of Wrist in Relation to Acupuncture Point,” Evidence-Based Complementary and Alternative Medicine, vol. 2012, Article ID 106762, 7 pages, 2012. doi:10.1155/2012/10a6762.

Zhang Y, Yan X H, Liu C L, et al. Photoluminescence of acupuncture points “Waiqiu” in human superficial fascia [J]. J Lumin. 2006, 119-120:96-99.

Julia J. Tsuei, Scientific Evidence in Support of Acupuncture and Meridian Theory: I. Introduction. IEEE Engineering in Medicine and Biology Magazine. 1996, 15(3):58-63.

Song X J, Zhang D. Study on the manifestation of facial infrared thermography induced by acupuncturing Guangming (GB 37) and Hegu (LI 4) [J]. Chinese Acupuncture & Moxibustion. 2010, 30(1):51-54.

Liu P, Zhou G Y, Zhang Y, et al. The hybrid GLM‒ ICA investigation on the neural mechanism of acupoint ST36: An fMRI study [J]. Neuroscience Letters, 2010, 479: 267-271.

Fei L, Cheng H S, et al. The experimental exploration and the research prospects about the material basis and the functional characteristics of the meridian [J]. Chinese Science Bulletin, 1998, 439(6):658-672.

- See more at: http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1415-acupuncture-point-anatomy-found#sthash.4ajNI0nQ.dpuf


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Acupuncture MRI Shows Lasting Pain Relief

Acupuncture MRI Shows Lasting Pain Relief | Acupuncture for the Nervous system and brain | Scoop.it
Acupuncture MRI Shows Lasting Pain Relief

on 18 December 2014.

Acupuncture induces lasting pain relief. Doctors using MRI neuroradiology scans captured images showing how acupuncture accomplishes enduring analgesia. The researchers state that the MRI images reveal that “acupuncture and pain mobilize overlapping brain regions and the same intrinsic networks.” They add that “acupuncture consists of specific brain activation–modulating patterns that outlast the needling period….” 

The researchers note that “most acupuncture studies conclude that the acupuncture-induced decrease in pain perception consists of acupuncture specific brain activations….” The current study concurs with prior research findings. In this investigation, the team of doctors tested pain relief in humans induced by manual needling of acupuncture points LI4, LV3 and ST36.

The LI4 and LV3 acupuncture point combination is a classic Traditional Chinese Medicine (TCM) prescription for pain relief. Together, these acupuncture points are called Si Guan, roughly translated as the four gates or four bars. They are a set of four acupuncture points located bilaterally on the hands and feet. ST36, translated as leg three miles and located on the lower leg, is also indicated for the TCM function of activating the channels and alleviating pain.

The researchers note that sham acupuncture and true acupuncture are different. They cite “a recent individual meta-analysis based on data from 29 randomized clinical trials with a total of 17,922 patients reported clear differences between real acupuncture and sham procedures for several chronic pain conditions.” Published in the Archives of Internal Medicine, the researchers conclude that acupuncture is effective for the treatment of chronic pain including neck and back pain, shoulder pain, osteoarthritis and headaches.

The new MRI findings demonstrate that the effective actions exerted by true acupuncture points are specific to certain brain networks. A great deal of research on the brain pathways and biochemical mechanisms relating to acupuncture treatments has been published within the last two years. One of the more intriguing studies demonstrates that a biochemical responsible for pain reduction is activated by acupuncture. 

The analgesic biochemical is a chemokine called CXCL10. Acupuncture stimulates its expression which, in turn, reduces pain and inflammation by activating natural opioids in the body. In general, chemokines attract white blood cells to sites of infection to assist in immune system responses. The chemokine CXCL10, when activated by electroacupuncture, triggers powerful anti-inflammatory responses. 

Electroacupuncture was shown to stimulate several other important responses including the augmentation of interferon (IFN)-gama and mRNA expression and increases in opioid peptide containing macrophages. The researchers add that electroacupuncture “elicited long-term antinociception,” reduced sensitivity to pain. The researchers found that CXCL10 regulates “opioid-containing macrophages as (a) key regulator of electroacupuncture-induced antinociception.”

The study measured that acupuncture “suppressed selected pro- and enhanced anti-inflammatory cytokines” and “increased the production of the cytokine IFN-gamma and the chemokine CXCL10 at the site of inflammation leading to an increase in opioid-containing CXCR3+ macrophages.” In addition, “Macrophage-derived opioid peptides could activate opioid receptors on peripheral sensory neurons and suppressed inflammatory pain. Taken together we identified a new molecular pathway of acupuncture-induced analgesia.”

Prior to this research, it was known that acupuncture caused opioid peptide releases in the spinal cord, brain and peripheral nervous system. The new research extends “these findings by demonstrating that electroacupuncture stimulated the increased numbers of leukocytes (macrophages) containing the three opioid peptides END, ENK, and DYN and that all three opioid peptides mediated antinociception to thermal and mechanical stimuli….”

Refereneces:

Theysohn, Nina, Kyung-Eun Choi, Elke R. Gizewski, Ming Wen, Thomas Rampp, Thomas Gasser, Gustav J. Dobos, Michael Forsting, and Frauke Musial. "Acupuncture-Related Modulation of Pain-Associated Brain Networks During Electrical Pain Stimulation: A Functional Magnetic Resonance Imaging Study." The Journal of Alternative and Complementary Medicine (2014). 
Author affiliations:
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
Complementary and Integrative Medicine, University of Duisburg-Essen, Essen, Germany.
University Clinic of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria.
Department of Neurosurgery, University Hospital Essen, Essen, Germany.
National Research Center in Complementary and Alternative Medicine, Department of Community Medicine, Faculty of Health
Science, University of Tromsø, Tromsø, Norway.

Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis. Arch Intern Med. Published online September 10, 2012. doi:10.1001/archinternmed.2012.3654.

Schiapparelli P, Allais G, Rolando S, et al. Acupuncture in
primary headache treatment. Neurol Sci 2011;32 Suppl
1:S15-18.

Wang, Ying, Rebekka Gehringer, Shaaban A. Mousa, Dagmar Hackel, Alexander Brack, and Heike L. Rittner. "CXCL10 Controls Inflammatory Pain via Opioid Peptide-Containing Macrophages in Electroacupuncture." PloS one 9, no. 4 (2014): e94696.

- See more at: http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1409-acupuncture-mri-shows-lasting-pain-relief#sthash.wqwIy3Ip.dpuf

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Western and Chinese physicians to jointly look into efficacy of TCM on dry eyes

Western and Chinese physicians to jointly look into efficacy of TCM on dry eyes | Acupuncture for the Nervous system and brain | Scoop.it
Western and Chinese physicians to jointly look into efficacy of TCM on dry eyes PUBLISHED ON DEC 8, 2014 4:00 PM 6 35 0 0PRINTEMAIL Western and TCM doctors will look into how effective TCM treatments are when it comes to dry eyes in a new study funded by the Ministry of Health. -- PHOTO: ST FILE
BY KASH CHEONG  

SINGAPORE - You can say that Western and Traditional Chinese Medicine (TCM) doctors are seeing eye to eye over this study.

In a novel study funded by the Ministry of Health, Western and TCM doctors will look into how effective TCM treatments are when it comes to dry eyes.

The Singapore Eye Research Institute (Seri) and the Singapore Chung Hwa Medical Institution, which has certified TCM physicians, hope to recruit 150 patients for the study. The patients will be divided into three groups: 50 patients will be treated with only eye drops, another 50 with acupuncture and eye drops and the other 50 with herbal remedies and eye drops. They will receive treatment for four weeks before doctors at Seri evaluate their conditions with state-of-the-art equipment.

All patients will be recruited at Chung Hwa and they will be screened for lung and kidney deficiency as Chinese physicians believe that dry eyes are a symptom of these. The herbal remedies and acupuncture target the dry eye condition, but they will also treat the lung and kidney deficiency to some extent.

A pilot study by Chung Hwa last year shows promise. After herbal and acupuncture treatments, most of the 90 patients said their dry eyes had improved.

"Though some scientific tests were done to ascertain these, more rigorous tests with Seri will help us ensure that these treatments work," said Chung Hwa's Head of Opthamology Pat Lim.

Patients recruited for the new study will be 40 to 85 years old and display symptoms of eye irritation, burning or watering.

Currently, there is no definitive cure for dry eyes. Eye drops treat only its symptoms. Special eye drops may also be expensive and induce side-effects, said Seri's principal investigator for the study Louis Tong.

"Given that there is an increasing interest in holistic care in Singapore and the rise of scientifically-trained TCM practitioners, a study like this is timely," he added.

- See more at: http://www.straitstimes.com/news/singapore/health/story/western-and-chinese-physicians-jointly-look-efficacy-tcm-dry-eyes-201412#sthash.t4s4Ha7N.dpuf

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Acupuncture and massage therapy for neuropathic pain following spinal cord injury: an exploratory study -- Norrbrink and Lundeberg 29 (2): 108 -- Acupuncture in Medicine

Acupuncture and massage therapy for neuropathic pain following spinal cord injury: an exploratory study -- Norrbrink and Lundeberg 29 (2): 108 -- Acupuncture in Medicine | Acupuncture for the Nervous system and brain | Scoop.it

Home > Volume 29, Issue 2 > ArticleAcupunct Med 2011;29:108-115 doi:10.1136/aim.2010.003269Original papersAcupuncture and massage therapy for neuropathic pain following spinal cord injury: an exploratory studyCecilia Norrbrink1,2, Thomas Lundeberg3

+Author Affiliations

1Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden2Neuro-Spinal Division, Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden3Foundation for Acupuncture and Alternative Biological Treatment Methods, Sabbatsbergs Hospital, Stockholm, SwedenCorrespondence toCecilia Norrbrink, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm 18288, Sweden; cecilia.norrbrink@ki.seAccepted 11 February 2011Published Online First 6 April 2011Abstract

Objective The study sought to explore the possibility of using acupuncture and massage therapy for relieving neuropathic pain following spinal cord injury (SCI).

Design 30 individuals with SCI and neuropathic pain were assigned to treatment of either massage or acupuncture, with 15 individuals in each group. Both groups received treatment twice weekly for 6 weeks. Treatments were evaluated at the end of treatment and 2 months later (follow-up).

Results Data were analysed on an intention-to-treat basis. Within the groups, ratings of present pain, general pain, pain unpleasantness and coping improved significantly at the end of treatment after acupuncture compared to baseline values, and following massage therapy ratings of pain interference on the Multidimensional Pain Inventory improved. At follow-up no significant improvements were seen.

Between-group differences were seen regarding ratings of worst pain intensity at the end of treatment, and regarding pain unpleasantness and coping with pain at follow-up, both in favour of acupuncture.

At the end of treatment, eight of the 15 individuals receiving acupuncture and nine receiving massage reported an improvement on the Patient Global Impression of Change Scale, and at follow-up six patients in the acupuncture group and one patient in the massage group still reported a favourable effect from the treatment.

Few side effects were reported and neither dropout from the study did this due to adverse events.

Conclusion Neuropathic pain following SCI is often only partially responsive to most interventions. Results from this study indicate, however, that both acupuncture and massage therapy may relieve SCI neuropathic pain. For this reason, larger randomised controlled trials are warranted for assessing the long-term effects of these treatments.

Introduction

We lack knowledge of how to treat neuropathic pain due to spinal cord injury (SCI) satisfactorily. Treatment is therefore a great challenge for care givers.1 Current treatment recommendations are based on the few studies of this patient group and on algorithms for treating peripheral neuropathic pain. With these tools we can sometimes relieve such pain following SCI to some extent, but rarely enough for the individuals to be satisfied. The lack of satisfaction can also be related to the fact that many of the drugs used have severe unwanted side effects.

Regarding other treatments, sensory stimulation with transcutaneous electrical nerve stimulation has been studied mainly in peripheral neuropathic pain conditions and is considered to be an effective complement.2 In some individuals with central neuropathic pain, transcutaneous electrical nerve stimulation may induce pain alleviation3 but often less than in peripheral neuropathies.

In rodent studies, acupuncture has been studied after peripheral nerve injury and is effective for hyperalgesia4 and allodynia,5 6 signs considered as consequences of nerve damage and associated with neuropathic pain.

Treatment with acupuncture has, however, not been extensively studied in peripheral or central neuropathic pain conditions in humans. Only two randomised controlled studies have been carried out7 8 and both report no or very little difference between acupuncture and the control treatment. However, in one of these studies verum acupuncture was compared to sham acupuncture, defined as needle insertions in deep muscles but not in acupuncture points followed by needling stimulation. This type of control is controversial since it is most likely not an inert treatment.9 Two uncontrolled studies showed positive effects compared to baseline values when treating diabetic neuropathy10 and HIV-related neuropathic pain.11

In SCI, a within-subject-design study using acupuncture showed promising results for treating overall pain but less good for the cohort with central neuropathic pain.12 Still, in 42% of those individuals, pain intensities were alleviated by at least two units on a 0–10 numerical rating scale (NRS)—which is not a negligible effect in this patient group.

Massage therapy has not been studied for treating neuropathic pain following SCI but it decreased anxiety13 in individuals with SCI.

In a previous survey14 individuals with SCI reported massage to be one of the most effective non-pharmacological treatments for SCI chronic pain but spoke less of acupuncture. Similar results have been reported in other studies.15 16

Based on these results an exploratory study was designed to assess the possibility of using medical acupuncture and massage therapy for relieving neuropathic pain due to SCI. Both treatment modalities activate endogenous pain inhibitory systems, however they are believed to act through different mechanisms.17 18

Methods and individualsIndividuals

Individuals with SCI and pain were recruited from a spinal unit in Stockholm, Sweden through advertisements and through mailed enquiries. Inclusion criteria were an SCI more than 2 years previously and pain diagnosed as neuropathic at or below level19 due to the SCI of more than 6 months duration. All individuals were asked not to change current pain medication or any other treatments during the treatment period but were allowed to stay on concurrent medication.

Study design

The study was carried out using a sequential controlled design. The first 15 individuals giving informed consent for the study and fulfilling the inclusion criteria were assigned to western medical acupuncture and the following 15 to massage. The assignation procedure was unknown to the individuals who were all willing to receive both acupuncture and massage. The treatment period consisted of 6 weeks with treatment twice weekly. The treatments were evaluated at the end of treatment and at follow-up 2 months later using a mailed questionnaire.

Acupuncture

Acupuncture points were chosen individually and needles were inserted in areas with preserved sensation. Points were chosen from a western medical perspective, that is, placed in areas with pain and in strong general acupuncture points. In addition, earpoint Shenmen and GV20 were selected as possible complements. Needle insertion was carried out using the recommended depth allowing for muscle stimulation.20 Stimulation was initially manual and from the third or fourth session four points were stimulated with high frequency (80 Hz) electroacupuncture (CEFAR Acus 4; Cefar AB, Lund, Sweden). Points stimulated in the upper extremity were either LI11–LI4, LI15–LI11 or LI15–LI4, and in the lower extremity ST32–GB34, ST32–ST36 or BL54–BL54. In total 13–15 points were used in each session. The intensity was high, giving non-painful paresthesia. During manual acupuncture de qi was elicited three times at each session of 30 min.

The acupuncture procedure is described according to the Standards for Reporting Interventions in Clinical Trials of Acupuncture.21

Massage

Classical massage therapy was carried out in areas with pain and preserved sensation with individuals lying on a massage table. The massage consisted of non-painful light pressure effleurage and petrissage. It was important that the massage did not cause discomfort for the individuals and therefore stimulation in areas with allodynia or unpleasant feelings from touch were avoided.

Outcome measuresPrimary outcome measures

The individuals rated their general and their worst pain intensities, and pain unpleasantness, during the last week using a visual analogue scale (VAS). They also rated present pain intensity at baseline, at the end of treatment (6 weeks) and at follow-up (2 months). In addition they rated the global pain-relieving effect on the Patient Global Impression of Change Scale (PGIC)22 at both end of treatment and follow-up.

A decrease of two units or more in pain intensity ratings on a 0–10 NRS23 has been considered clinically significant, and 1.8 units or more in individuals with SCI (defined as ‘my pain decreased to a meaningful extent’).24 Translated to a VAS with a range of 0–100, a decrease of 18 units or more was considered to identify a responder.

Secondary outcome measure

As secondary outcome measures the Hospital Anxiety and Depression Scale was used to rate anxiety and depression,25 the Multidimensional Pain Inventory—Swedish language version (MPI-S)26 part I, to assess the psychosocial consequences of pain, and a sleep questionnaire27 to assess quality of sleep. Further, Fugl-Meyer's Life Satisfaction instrument (LiSat – 9)28 29 was used. In the analysis only the global rating of life satisfaction was considered. In addition, individuals rated how well they were able to cope with their pain on an 11-point NRS anchored ‘not at all’ (0) and ‘very good’ (10).

Spasticity was assessed using the modified Penn Spasm Frequency Scale,30 for frequency and severity. Spasm frequency is reported from 0=no spasms to 4=spontaneous spasms occurring >10/h, and severity of spasms from 1=mild to 3=severe.

The study was approved by the Regional Ethics Approval Board in Stockholm, Sweden.

Statistics

Data were analysed on an intention-to-treat basis with missing data in dropouts replaced using the last-observation–carried-forward method.

Patient and treatment characteristics are presented using descriptive statistics: number of observations, mean and SD. Outcome variables are further presented by group using median and IQR before and after treatment.

Determination of the between-treatment difference measured with the PGIC was tested with the Mann–Whitney U test and the difference in number of respondents using the two-tailed Fisher exact test.

Svensson's rank-invariant method31 was used to estimate systematic changes in outcome variables (pain intensity, pain unpleasantness, coping, sleep quality, mood, life satisfaction, psychosocial consequences and spasticity) directly after treatment compared to baseline, and also 2 months after treatment compared to baseline.

Systematic group changes are explained by relative change in position (RP), that is, the proportion of individuals with a higher level minus the proportion of those with a lower level in the outcome variable. RP values range from −1 (all individuals decreased) to +1 (all individuals increased). Values close to 0 indicate a negligible systematic group change in the outcome measure. When RP≠0, the values after treatment are systematically higher (+) or lower (−) for the group than the initial values. RP was estimated together with the corresponding 95% CI. SE was calculated using the jack knife method. Differences between acupuncture and massage was estimated as the difference between RPstogether with the corresponding 95% CI. Negative differences between interventions (acupuncture vs massage) indicate that a larger proportion of individuals in the massage group decreased (or increased less) from baseline to the end of treatment, compared to those in the acupuncture group in the outcome variable.

All the tests were two-sided, and a significance level of 0.05 was chosen. All descriptive statistics were produced in STATISTICA V.7.0 (StatSoft, Tulsa, Oklahoma, USA) and RP values were calculated in SYSRAN V.1.0 (JK Biostatistics, Stockholm, Sweden) for Matlab V.6.0 (The MathWorks, Natick, Massachusetts, USA).

Results

Altogether 30 individuals were included in the study; 15 received acupuncture and 15 massage. The acupuncture group consisted of 12 males and 3 females with a mean age of 47.1 years (SD 11.1) and the massage group of 13 males and 3 females, mean age 49.8 (SD 9.2). Mean time since injury was 11.9 years (SD 12.3) in the acupuncture group and 12.9 years (SD 9.0) in the massage group. In the acupuncture group, 11 had a traumatic injury compared to 10 in the massage group.

Five of those receiving acupuncture and six of those receiving massage had tetraplegia. Ten of those in the acupuncture group and eight of those in the massage group were on concomitant pain medication including adjuvant analgesics.

Treatment

The acupuncture group received a mean of 10.5 treatments (SD 2.9) and the massage group 11.1 treatments (SD 2.1). One acupuncture patient's treatment was concluded after only eight sessions due to complete pain relief. Lacking compliance, one individual received only three sessions of electroacupuncture and thereafter manual stimulation.

Two individuals dropped out of the study, one in each treatment group, for reasons not related to the treatment itself. The acupuncture-group member moved abroad after one treatment and the massage-group member was hospitalised for pneumonia after eight treatments. One massage-group member did not return the follow-up questionnaire.

Adverse events

Compliance was high for both types of treatment. Almost half of those in the acupuncture group (n=7) reported being tired after the treatment initially and one reported a pain increase lasting 4–5 h after the treatment. Of those receiving massage, two reported soreness, one increased pain and one feeling extremely cold 4–5 h after the treatment resulting in poor sleep the first night after treatment.

Positive events

The acupuncture group reported the following positive side effects at the end of the treatment period: improved sleep (n=2), improved bladder (n=1) and bowel (n=1) function, decreased spasticity, less allodynia, more energy, less pain medication, feeling calm and relaxed (n=1 each). The massage group reported: improved function/less stiffness (n=6), improved sleep (n=5), improved relaxation (n=2), less spasticity (n=3), improved circulation (warm legs; n=2), less allodynia (n=2), fewer painful attacks (n=2), less medication (n=1).

At the follow-up individuals could report late-onset improvements. One patient reported improved sleep after acupuncture. In the massage group one reported using less muscle relaxants, and another increased wellbeing and mobility.

Primary outcome measures—pain and PGICBetween-group differences

At the end of treatment (6 weeks), there was a significant difference between the two groups in ratings of worst pain intensity (figure 1). There was also a significant change at follow-up (2 months) regarding ratings of pain unpleasantness; both in favour of acupuncture. No other differences between the two groups were detected.

View larger version: In a new window Download as PowerPoint SlideFigure 1

Between group differences at the end of treatment and at 2 months follow-up.

 

At the end of treatment, 8/15 individuals on acupuncture and 9/15 on massage reported an improvement on the PGIC (minimally improved–very much improved, figure 2). At follow-up 6/15 on acupuncture and 1/15 on massage still reported a positive outcome. The difference between the two groups was not statistically significant.

View larger version: In a new window Download as PowerPoint SlideFigure 2

Ratings of global pain relieving effect on the Patient Global Impression of change Scale.

 

Numbers of responders calculated as all those reporting a decrease in pain ratings of ≥18 mm measured with VAS are shown in figure 3. The differences seen were not statistically significant.

View larger version: In a new window Download as PowerPoint SlideFigure 3

Number of patients reporting a decrease of 18 units or more on a visual analogue scale at the end of treatment and at the 2 months follow-up. There were no statistically significant changes between those treated with massage and those treated with acupuncture calculated with Fisher's exact two-tailed test.

 

Ratings of general pain intensity and pain unpleasantness at end of treatment and follow-up are shown in figure 4 plotted against the baseline values.

View larger version: In a new window Download as PowerPoint SlideFigure 4

Ratings of pain intensity and pain unpleasantness plotted at end of treatment and follow-up

 Within-group differences

Ratings of general and present pain, and of pain unpleasantness, all decreased significantly at end of treatment with acupuncture but not after massage. In terms of median decrease in pain intensity ratings measured with VAS, this was similar in the two groups (table 1).

View this table: In this window In a new windowTable 1

Median values presented with IQR for primary and secondary outcome measures at baseline, end of treatment and follow-up

 

At follow-up no within-group differences were seen between pain variables.

Secondary outcome measures

At the end of treatment there were no between-group differences regarding the secondary outcome measures for pain or spasticity; but at follow-up, ratings of coping with pain as shown with a 0–10 NRS were in favour of acupuncture (figure 1). Within the groups, individuals on acupuncture reported improvement in coping with pain, and those on massage reported less pain interference. At follow-up no improvements were seen, but massage-group members reported worsened coping.

To see whether any of the assessed variables were important for ratings of coping with pain, a Spearman regression analysis was carried out. Pain intensity (r=−0.57), pain unpleasantness (r=−0.61), mood (r=−0.58), sleep (r=−0.55), MPI-pain severity (r=−0.67), MPI-pain interference (r=−0.59), MPI-perceived life control, (r=0.61) and MPI-affective distress (r=−0.65) all correlated moderately (r=0.50 to 0.69)32 with ratings of coping. Ratings of global life satisfaction had low (r=0.26–0.49) correlation with coping (r=0.46), and MPI- social support little if any (r<0.25; r=−0.06).

Discussion

In this exploratory study the average pain alleviation following a treatment course of acupuncture or massage was small but significant. It was larger for the affective component of pain than for the sensory component (intensity). At follow-up no significant effects on pain intensity or unpleasantness were maintained, but six of 15 acupuncture-group members versus one of 15 on massage still reported an improvement on the PGIC. Between-group differences, in favour of acupuncture, were seen only regarding ratings of worst pain intensity. Both methods presented few unwanted side effects and compliance was high. None dropped out due to adverse events.

The most pronounced effects were those of acupuncture on ratings of pain unpleasantness where a median decrease of 23/100 VAS units was seen immediately after the course. Acupuncture treatment reportedly modulates activity in limbic structures,33 which could partly explain these findings.

Effects of treatment on pain unpleasantness are not always assessed in clinical trials but they are recommended as an outcome measure.22

Ratings of pain intensity also decreased significantly after treatment with acupuncture. The median decrease in ratings of present pain intensity was 19/100 VAS units following acupuncture (general pain—15 units) and eight units following massage (general pain—14 units). In a large study of SCI neuropathic pain concluding that pregabalin has a positive effect on this type of pain,34 the mean reduction in pain scores on a 0–10 NRS was 1.92 before controlling for placebo. In a comparative study on gabapentin and amitryptiline35 in SCI and neuropathic pain, a mean decrease of VAS 2.14 was seen after treatment with amitryptiline and of VAS 0.75 after gabapentin.

Hanley et al24 reported that in SCI a reduction of 1.8 units or more on a 0–10 NRS was a clinically significant alleviation of pain, which we translated to 18 units on a 0–100 point VAS, and those reporting these values are defined here as responders. Even though no significant differences were seen between the two groups, immediately after the treatment course more individuals on acupuncture reported this amount of pain alleviation. Forty per cent (six of 15) versus 13% (two of 15) were responders regarding ratings of present and general pain intensity, figures similar to those found by Nayak et al12 in SCI and central neuropathic pain. Those authors found that 42% (five of 12 individuals) reported a decrease of at least two units on an NRS following 15 treatment sessions with acupuncture. Even though both studies used very small samples, these results are considered promising.

None of the present respondents reported worsening of pain using the PGIC, but one patient on acupuncture reported being minimally worse at the 2-month follow-up. Whether this was associated with the treatment course is not clear. In the study by Nayak and colleagues,12four of the total sample of 22 individuals reported an increase in pain intensity at end of treatment and that this persisted at follow-up. The reported average increase was 1.08 on a 0–10 NRS.

Nowadays it is recommended22 36 that the PGIC be added when evaluating the results of a clinical trial, since this instrument covers more aspects than only pain reduction. Our evaluation showed that the effects of both treatments rated on the PGIC were similar, with nine of 15 individuals (60%) on massage and eight of 15 (53%) on acupuncture reporting a favorable effect. At follow-up, six of 15 (40%) on acupuncture still reported an improvement but only one of 15 (7%) on massage. In a study on pregabalin for SCI neuropathic pain,3457% of those on active drug reported an improvement, using the PGIC immediately after the treatment period. This result is similar to those of both acupuncture and massage seen in the present study.

Both methods of sensory stimulation assessed in this study seemed to be able to decrease pain short-term in individuals with SCI and neuropathic pain. However, a difference between the two stimulation methods was seen: many individuals reported a small reduction following massage, but few reported a major alleviation following acupuncture. Three on acupuncture experienced a dramatic effect and long-term improvement. These long-term pain-alleviating effects have been attributed to activation of pain-inhibiting systems in cortical and subcortical pathways. While individuals with SCI and neuropathic pain may have symptoms in common, the origins and the mechanisms of their pain may vary. Different mechanisms can lead to different responses to therapy, and for this reason larger studies are warranted where possible effects can be studied in subgroups.

Both treatment modalities were safe and compliance was high. No individuals dropped out due to adverse events and no severe adverse events were reported. This is rare in pharmacological trials in the same patient group where the dropout rates are reportedly high with commonly used drugs: 16% on gabapentin, 18% on amitryptiline,35 30% on pregabalin,34 48% on tramadol37 and 50% on gabapentin.38

The treatments assessed had effects mainly on the primary outcome variable—pain. However, individuals also reported that their coping ability had improved after treatment with acupuncture. This might be associated with the decrease seen in pain ratings. Ratings of pain interference also decreased after massage. No other effects on mood, sleep quality, life satisfaction or spasticity were seen after either treatment modality.

This explorative study investigated few enrolled individuals, and with no placebo control. In addition the individuals were not randomised to the interventions. The results are therefore difficult to generalise.

However, within-group effects were significant following acupuncture treatment, and while few individuals responded very well, the effects seen in these individuals were long lasting, highlighting the need for larger randomised controlled studies. Also, the fact that both treatments were safe and had high compliance is important when considering their use in pain alleviation. Note, though, that knowledge about type and intensity stimulation, stimulation sites and number of treatments for optimal effect is lacking, so there might be more effective ways of treating neuropathic pain following SCI with acupuncture. The severity of the pain condition in this patient group indicates that the acupuncture course should maybe be longer than 12 sessions, with additional follow-up treatments.

Conclusion

Neuropathic pain following SCI is a condition unresponsive to many interventions. Results from this study indicate that both acupuncture and massage therapy may relieve SCI neuropathic pain and for this reason larger randomised controlled trials are warranted for assessing the long-term effects of these treatments.

Acknowledgments

This study was made possible by grants from The Swedish Association of Persons with Neurological Disabilities. Excellent support from Jan Kowalski, statistician, is gratefully acknowledged.

Footnotes

Competing interests None declared.

Ethics approval This study was conducted with the approval of the Regional Ethics Approval Board in Stockholm, Sweden.

Provenance and peer review Not commissioned; externally peer reviewed.

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Acupuncture Blog Chicago: Headaches & Migraines Dramatically Reduced by Acupuncture

Acupuncture Blog Chicago: Headaches & Migraines Dramatically Reduced by Acupuncture | Acupuncture for the Nervous system and brain | Scoop.it

Headaches are an increasingly popular reason to seek acupuncture treatment - with good reason. Acupuncture is very effective at treating all types of headaches. The article below is from acufinder.com and provides a good explanation of how Chinese Medicine can help along with some impressive research to back it up.
 
Are you plagued by chronic headaches?

More than 45 million Americans (one in six) suffer from chronic headaches, 20 million of whom are women. Scientific research shows that acupuncture can be more effective than medication in reducing the severity and frequency of chronic headaches. 

The pain that headache and migraine sufferers endure can impact every aspect of their lives.  A widely accepted form of treatment for headaches, acupuncture can offer powerful relief without the side effects that prescription and over-the-counter drugs can cause.

Headaches and migraines, as well as their underlying causes have been treated successfully with acupuncture and Oriental medicine for thousands of years. Acupuncture and Oriental medicine can be used alone in the management and treatment of headaches, or as part of a comprehensive treatment program.

Oriental Medicine does not recognize migraines and chronic headaches as one particular syndrome. Instead, it aims to treat the specific symptoms that are unique to each individual using a variety of of techniques such as acupuncture, tui-na massage, and energetic exercises to restore imbalances found in the body. Therefore, your diagnosis and treatment will depend on a number of variables including:

 *Is the headache behind your eyes and temples, or is it located more on the top of your head?
 *When do your headaches occur (i.e. night, morning, after eating)?
 *Do you find that a cold compress or a darkened room can alleviate some of the pain?
 *Is the pain dull and throbbing, or sharp and piercing?

Your answers to these questions will help your practitioner create a treatment plan specifically for you. The basic foundation for Oriental medicine is that there is a life energy flowing through the body which is termed Qi (pronounced chee). This energy flows through the body on channels known as meridians that connect all of our major organs.  According to Oriental medical theory, illness or pain arises when the cyclical flow of Qi in the meridians becomes unbalanced. Acupuncture stimulates specific points located on or near the surface of the skin to alter various biochemical and physiological conditions that cause aches and pains or illness.

The length, number and frequency of treatments will vary. Typical treatments last from five to 30 minutes, with the patient being treated one or two times a week. Some headaches, migraines and related symptoms are relieved after the first treatment, while more severe or chronic ailments often require multiple treatments.

Headaches Dramatically Reduced by Acupuncture

Since the early seventies, studies around the globe have suggested that acupuncture is an effective treatment for migraines and headaches.  Researchers at Duke University Medical Center analyzed the results of more than 30 studies on acupuncture as a pain reliever for a variety of ailments, including chronic headaches. They found that acupuncture decreases pain with fewer side effects and can be less expensive than medication.  Researchers found that using acupuncture as an alternative for pain relief also reduced the need for post-operative pain medications.

In a study published in the November 1999 issue of Cephalalgia, scientists evaluated the effectiveness of acupuncture in the treatment of migraines and recurrent headaches by systematically reviewing 22 randomized controlled trials. A total of 1,042 patients were examined. It was found that headache and migraine sufferers experienced significantly more relief from acupuncture than patients who were administered "sham" acupuncture. 

A clinical observation, published in a 2002 edition of the Journal of Traditional Chinese Medicine, studied 50 patients presenting with various types of headaches who were treated with scalp acupuncture. The results of this study showed that 98 percent of patients treated with scalp acupuncture experienced no headaches or only occasional, mild headaches in the six months following care.

In a case study, published in the June 2003 Issue of Medical Acupuncture, doctors found that acupuncture resulted in the resolution or reduction in the frequency and severity of cluster headaches, and a decrease or discontinuation of pain medications. It was concluded that acupuncture can be used to provide sustained relief from cluster headaches and to stimulate the body's natural production of adrenal cortisol to aid in discontinuing corticosteroids.

According to the July 2005 issue of the British Medical Journal, a randomized controlled trial in Germany found that acupuncture cut tension headache rates almost in half.  Researchers divided 270 patients who reported similarly severe tension headaches into three groups for the study. Over the project's eight-week period, one group received traditional acupuncture, one received only minimal acupuncture, and the third group received neither treatment. Those receiving the traditional acupuncture reported headache rates of nearly half that of those who received no treatments, suffering 7 fewer days of headaches. The minimal acupuncture group suffered 6.6 fewer days, and the non-acupuncture group suffered 1.5 fewer days.  The improvements continued for months after the treatments were concluded, rising slightly as time went on.


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Acupuncture for migraine prophylaxis - The Cochrane Library - Linde - Wiley Online Library

Acupuncture for migraine prophylaxis - The Cochrane Library - Linde - Wiley Online Library | Acupuncture for the Nervous system and brain | Scoop.it

AbstractBackground

Acupuncture is often used for migraine prophylaxis but its effectiveness is still controversial. This review (along with a companion review on 'Acupuncture for tension-type headache') represents an updated version of a Cochrane review originally published in Issue 1, 2001, ofThe Cochrane Library.

Objectives

To investigate whether acupuncture is a) more effective than no prophylactic treatment/routine care only; b) more effective than 'sham' (placebo) acupuncture; and c) as effective as other interventions in reducing headache frequency in patients with migraine.

Search methods

The Cochrane Pain, Palliative & Supportive Care Trials Register, CENTRAL, MEDLINE, EMBASE and the Cochrane Complementary Medicine Field Trials Register were searched to January 2008.

Selection criteria

We included randomized trials with a post-randomization observation period of at least 8 weeks that compared the clinical effects of an acupuncture intervention with a control (no prophylactic treatment or routine care only), a sham acupuncture intervention or another intervention in patients with migraine.

Data collection and analysis

Two reviewers checked eligibility; extracted information on patients, interventions, methods and results; and assessed risk of bias and quality of the acupuncture intervention. Outcomes extracted included response (outcome of primary interest), migraine attacks, migraine days, headache days and analgesic use. Pooled effect size estimates were calculated using a random-effects model.

Main results

Twenty-two trials with 4419 participants (mean 201, median 42, range 27 to 1715) met the inclusion criteria. Six trials (including two large trials with 401 and 1715 patients) compared acupuncture to no prophylactic treatment or routine care only. After 3 to 4 months patients receiving acupuncture had higher response rates and fewer headaches. The only study with long-term follow up saw no evidence that effects dissipated up to 9 months after cessation of treatment. Fourteen trials compared a 'true' acupuncture intervention with a variety of sham interventions. Pooled analyses did not show a statistically significant superiority for true acupuncture for any outcome in any of the time windows, but the results of single trials varied considerably. Four trials compared acupuncture to proven prophylactic drug treatment. Overall in these trials acupuncture was associated with slightly better outcomes and fewer adverse effects than prophylactic drug treatment. Two small low-quality trials comparing acupuncture with relaxation (alone or in combination with massage) could not be interpreted reliably.

Authors' conclusions

In the previous version of this review, evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient. Now, with 12 additional trials, there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care. There is no evidence for an effect of 'true' acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance. Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.

 Jump to…Plain language summaryAcupuncture for migraine prophylaxis

Migraine patients suffer from recurrent attacks of mostly one-sided, severe headache. Acupuncture is a therapy in which thin needles are inserted into the skin at defined points; it originates from China. Acupuncture is used in many countries for migraine prophylaxis – that is, to reduce the frequency and intensity of migraine attacks.

We reviewed 22 trials which investigated whether acupuncture is effective in the prophylaxis of migraine. Six trials investigating whether adding acupuncture to basic care (which usually involves only treating acute headaches) found that those patients who received acupuncture had fewer headaches. Fourteen trials compared true acupuncture with inadequate or fake acupuncture interventions in which needles were either inserted at incorrect points or did not penetrate the skin. In these trials both groups had fewer headaches than before treatment, but there was no difference between the effects of the two treatments. In the four trials in which acupuncture was compared to a proven prophylactic drug treatment, patients receiving acupuncture tended to report more improvement and fewer side effects. Collectively, the studies suggest that migraine patients benefit from acupuncture, although the correct placement of needles seems to be less relevant than is usually thought by acupuncturists.

 


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New MRI Acupuncture Study Finds Stomach & Heart Point Specificity

New MRI Acupuncture Study Finds Stomach & Heart Point Specificity | Acupuncture for the Nervous system and brain | Scoop.it

ON 13 MAY 2013.

 

A new study confirms that acupuncture’s medical benefits are acupuncture point specific for its effective actions on the stomach, intestines and heart. Researchers discovered that needling acupuncture point CV12 increases HRV, heart rate variability, an important ability of the human heart to vary its rate in reaction to bodily demands. Needling CV12 did not affect electrogastrogram signals, a measure of electric signals in the stomach and intestines. The converse is true of needling acupuncture point UB32. Applying an acupuncture needle to this point affects electrogastrogram readings but does not affect HRV.

AcupunctureThis is the latest in a series of investigations proving that specific acupuncture points have specific effects. In a related MRI acupuncture study, investigators note that acupuncture “induce(s) different cerebral glucose metabolism changes in pain-related brain regions and reduce(s) intensity of pain” for patients with migraines. PET-CT neuroimaging (positron emission tomography - computed tomography) revealed that the choice of acupuncture points used determines exact changes in brain glycometabolism in specific regions of the brain.

Researchers at the University of California School of Medicine (Irvine, California) came up with similar results, “Recent evidence shows that stimulation of different points on the body causes distinct responses in hemodynamic, fMRI and central neural electrophysiological responses.” The investigators reviewed MRI results and noted that “stimulation of different sets of acupoints leads to disease-specific neuronal responses, even when acupoints are located within the same spinal segment.”

This type of research demonstrates that acupuncture points have specific biophysical effects on human health. For centuries, Traditional Chinese Medicine (TCM) scholars have documented specific clinical results for individual acupuncture points and groupings of acupuncture points. Researchers investigated this theoretical and clinical construct with MRI imaging technology to test for acupuncture point specificity. Their findings agree with the traditional view that the functional medicinal actions of individual acupuncture points have unique biophysical affects and render specific beneficial clinical outcomes for patients.

Reference:
Minagawa, Munenori, Yasuzo Kurono, Tatsuyo Ishigami, Atsushi Yamada, Toshinori Kakamu, Ryoichi Akai, and Junichiro Hayano. "Site-specific organ-selective effect of epifascial acupuncture on cardiac and gastric autonomic functions." Autonomic Neuroscience (2013).

A PET-CT study on specificity of acupoints through acupuncture treatment on migraine patients. Jie Yang1, Fang Zeng1, Yue Feng1,Li Fang1, Wei Qin2, Xuguang Liu1, Wenzhong Song3, Hongjun Xie3 , Ji Chen1, Fanrong Liang1.

Point specificity in acupuncture. Chinese Medicine 2012, 7:4 doi:10.1186/1749-8546-7-4. Emma M Choi, Fang Jiang, John C Longhurst. Susan Samueli Center for Integrative Medicine, Department of Medicine, School of Medicine, University of California, Irvine CA

 

- See more at: http://www.healthcmi.com/Acupuncture-Continuing-Education-News/754-acupuncturecv12ub32#sthash.3DzPH8ng.vhv6rgfC.dpuf


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Acupuncture & Ginger Moxibustion Effective for Tinnitus - New Study

Acupuncture & Ginger Moxibustion Effective for Tinnitus - New Study | Acupuncture for the Nervous system and brain | Scoop.it
The study shows an effective way that acupuncture reduces or eliminates ringing in the ears, tinnitus.
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Acupuncture stimulates multiple brain regions, affecting a wide scope of pain dimensions

Acupuncture stimulates multiple brain regions, affecting a wide scope of pain dimensions | Acupuncture for the Nervous system and brain | Scoop.it
Acupuncture stimulates multiple brain regions, affecting a wide scope of pain dimensions

 

Acupuncture stimulates multiple brain regions, affecting a wide scope of pain dimensions

Saturday, April 27, 2013 by: PF Louis
Tags: acupuncture, pain control, brain regions

54233(NaturalNews) It's odd that studies are being done to "prove" certain medical arts have positive effects even after they've proven beneficial over centuries. This seems to be the case with Traditional Chinese Medicine's (TCM) and its most widely practiced methodology, acupuncture.

A meta-analysis is an overarching analysis of several clinical or laboratory study results with a similar purpose or theme to determine the validity of a basic thread or foundation.

The Kyung Hee University Acupuncture and Meridian Science Research Center in Seoul, Korea published the following study in March of 2013: "Inserting needles into the body: a meta-analysis of brain activity associated with acupuncture needle stimulation."

The researchers used 28 brain magnetic resonance image (MRI) studies from 51 acupuncture experiments and compared them with MRI studies from tactile stimulation experiments. The theme was pain and how needle stimulation affected the brain's pain centers.

Their meta-analysis result was "....better understanding of acupuncture needle stimulation and its effects on specific activity changes in different brain regions as well as its relationship to the multiple dimensions of pain. Future studies can build on this meta-analysis and will help to elucidate the clinically relevant therapeutic effects of acupuncture."

Does testing a 2500-plus year proven medical art make sense?Interesting that this meta/analysis comes from a culture that has been steeped in TCM since it was absorbed from China in 560 AD. By now they know it works, right? It has repeatedly demonstrated its efficacy for pain relief with anesthetic applications during major surgery.

So what would a meridian research center in Korea be doing with a study to prove acupuncture's efficacy for handling pain with MRI technology in a western medical style comparison study do a meta-analysis and end it with a "future studies" phrase?

That's a commonly used conservative phrase to invite more research funds and/or give others a chance to shoot down the results and maintain their monopoly. But it may all be necessary to giveacupuncture a real shot at opening up the insurance industry's purses for a very inexpensive medical approach.

Acupuncture sessions cost from $50 to $100 each, and generally they are spaced apart by a few days or more with ten to 20 sessions, sometimes less, to achieve desired results from an existing malady. Those rates are comparable to normal allopathic doctor's office visits without any procedures.

There are acupuncture colleges that offer supervised student rates at a third of that cost, but it's not the same as having a practitioner handle your case. When you use an acupuncture school for treatments, you're there for the students' benefit.

Either insurance companies are stupid, or they're beholden to Big Pharma, the FDA, and the AMA, otherwise known as the medical mafia.

They insist on a battery of double blind placebo peer reviewed studies to confirm efficacy on a much less expensive medical approach while accepting bogus reviews on extremely expensive therapies that often don't work well and render worsening side effects.

The major problem with doing studies to confirm acupuncture's efficacy is that it's based on a totally different paradigm than western allopathic medicine. The foundations are very different, yet western research continues to compare apples with oranges rather than understand and accept apples.

Currently, chiropractors and acupuncturists are struggling in a few key states to gain acceptance from the health insurance industry. Four states - California, New Mexico, Washington, and Maryland are offering acupuncture insurance coverage on some specific ailments. It appears that Alaska and Nevada will be next.

In order to convince insurance companies that cheaper can be better, TCM has to be translated into western allopathic terms. As long as the medical mafia considers empirical observation anecdotal and not "scientific," the studies to validate what's known to work will continue.



Learn more: http://www.naturalnews.com/040097_acupuncture_pain_control_brain_regions.html#ixzz30rsWn7EL

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Acupuncture for epilepsy - The Cochrane Library - Cheuk - Wiley Online Library

Acupuncture for epilepsy - The Cochrane Library - Cheuk - Wiley Online Library | Acupuncture for the Nervous system and brain | Scoop.it

AbstractBackground

Acupuncture in increasingly used in people with epilepsy. It remains unclear whether existing evidence is rigorous enough to support its use. This is an update of a Cochrane review first published in 2006.

Objectives

To determine the effectiveness and safety of acupuncture in people with epilepsy.

Search methods

We searched the Cochrane Epilepsy Group's Specialised Register (June 2011) and the Cochrane Central Register of Controlled Trials (CENTRAL issue 2 of 4, The Cochrane Library 2011), MEDLINE, EMBASE, and other databases from inception to June 2011. We reviewed reference lists from relevant trials. We did not impose any language restrictions.

Selection criteria

Randomised controlled trials comparing acupuncture with placebo or sham treatment, antiepileptic drugs or no treatment; or comparing acupuncture plus other treatments with the same other treatments, involving people of any age with any type of epilepsy.

Data collection and analysis

Two review authors independently extracted trial data and assessed trial quality.

Main results

Sixteen trials (15 in China and 1 in Norway) with 1486 participants met the inclusion criteria. Compared with control treatment, needle acupuncture was not effective in reducing seizure frequency (five trials). Compared with phenytoin (two trials), needle acupuncture may be better in achieving at least 75% or at least 25% reduction in seizure frequency. Compared with valproate (two trials), needle acupuncture may be better in achieving at least 50% or at least 75% reduction in seizure frequency, better quality of life (QOL), lower frequency of impaired concentration, and higher likelihood of at least 70% improvement in epilepsy score.

Compared with antiepileptic drugs (four trials), catgut implantation at acupoints may be better in achieving at least 50% reduction in seizure frequency. However, there was significant heterogeneity in this outcome. Catgut implantation may be better in achieving at least 75% or at least 25% reduction in seizure frequency, at least 70% or at least 40% improvement in epilepsy score, better quality of life and lower frequency of dizziness or impaired concentration. Compared with valproate alone (five trials), catgut implantation may be better in achieving seizure freedom or at least 75% reduction in seizure frequency. However, there was significant heterogeneity in the latter outcome. Catgut implantation may be better in achieving at least 25% reduction in seizure frequency and improvement in epilepsy score, QOL, and lower frequency of anorexia. All included trials had high risk of bias with short follow-up.

Authors' conclusions

The current evidence does not support acupuncture for treating epilepsy.

 Jump to…Plain language summaryAcupuncture for epilepsy

Patients with epilepsy are currently treated with antiepileptic drugs, but a significant number of people continue to have seizures and many experience adverse effects to the drugs. As a result there is increasing interest in alternative therapies and acupuncture is one of those. Sixteen randomised controlled trials were included in the current systematic review. However all included trials had high risk of bias and it remains uncertain whether acupuncture is effective and safe for treating people with epilepsy.

 

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Traditional acupuncture and multiple sclerosis - British Acupuncture Council

Traditional acupuncture and multiple sclerosis - British Acupuncture Council | Acupuncture for the Nervous system and brain | Scoop.it
Traditional acupuncture and multiple sclerosis

Multiple sclerosis is an autoimmune disorder which affects the central nervous system. The progress of the disease is characterised by alternating phases of progressively worsening symptoms and periods of remission where there are little or no symptoms. The relative lengths of remission and relapse vary, with the majority of patients presenting with the milder form and only 10 to 15% of patients presenting with progressively worsening symptoms from the outset and little or no periods of remission. The physical symptoms associated with MS commonly include problems with vision, balance, and more seriously loss of motor function. Conventionally, medical treatments for MS include drugs that modify its progress, such as Interferon, and physiotherapy and dietary advice.

The mechanisms that contribute to the development of MS include inflammation of neurones and progressive degeneration of the fatty or Myelin sheath, that surrounds and insulates the neurones and therefore interrupts the passage of nerve impulses moving down the neurones. Traditional acupuncture understands the progress of MS as, depending on how severely or rapidly the symptoms progress, as a gradual depletion of the body's qi, that eventually leads to chronic depletion of the body's foundation of yin and yang.

What evidence exists that traditional acupuncture can help with multiple sclerosis? The British Acupuncture Council has produced several research fact sheets which discuss the evidence available for the use of acupuncture in the treatment of many medical conditions, including MS (http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/multiple-sclerosis.html). Among the body of evidence to support the use of acupuncture in treating MS, is a study to asses the effect of acupuncture for patients with bladder dysfunction. The results showed a decrease in symptoms. 9 patients took part in the study, 8 completed it; no patients had a relapse and there were no reported side effects. More research needs to be carried out however, in order to clearly demonstrate the benefits of using traditional acupuncture to treat MS, and other degenerative neurological disorders.

What actually is it about traditional acupuncture which makes it entirely different from what conventional medical professionals do? ‘Traditional’ means that the practitioner is trained to use an approach to diagnosis and treatment that has evolved over the past few thousand years in China, Japan and other countries of East Asia. It is an authentic medical tradition which explains how each person’s symptoms and signs can be interpreted to establish a diagnosis of the underlying imbalances in their overall patterns of health and well-being. Each and every piece of information is relevant to building up this picture, and that can include changes seen in the complexion, in body shape and movement, changes in the tongue and information gained from palpation of the pulse and the body as a whole. This is a very heuristic and patient-centered approach that leads to a formal diagnosis in the technical terms of traditional Chinese medicine.

Once the practitioner has diagnosed the nature and cause of the imbalance a treatment plan will be devised which will be unique and specific to the patient. The treatment is then carried out by inserting ultra fine sterile disposable needles into selected acupuncture points on the body. Traditionally-trained acupuncturists may also use a heat treatment (moxabustion), cupping therapy or other forms of physical stimulation.

Each year 2.3 million traditional acupuncture treatments are carried out in the UK, making this one of the most popular complementary therapies. People seek acupuncture for a variety of conditions, from chronic illness to part of a health maintenance regime. Acupuncture is a holistic treatment, and so seeks to look at the person as a whole. Any symptoms observed give clues to the internal environment of the body and will be observed together to make the diagnosis. The major symptoms that occur in MS, such as fatigue, loss of motor & muscular function, and incontinence come from a gradual but steady depletion of, first the qi, and then more severely, the body's foundation of yin and yang. These, as in any other group of signs and symptoms can be diagnosed as we have seen, through questioning, examining the tongue, and palpating the pulses.

The British Acupuncture Council (BAcC), with around 3000 qualified members, represents the largest body of traditional acupuncturists in the UK and guarantees excellence in training, safe practice, professional conduct and continuing professional development.

BAcC registered acupuncturists are trained in relevant aspects of Western medicine including anatomy, physiology, pharmacology, pathology and aetiology. In addition, all BAcC registered acupuncturists are trained to recognise in their patients warning signs known as ‘red flags’. Red flags may indicate the presence of a life-threatening condition and such patients are immediately referred on to other healthcare practitioners for tests and treatment where appropriate.

To find a qualified acupuncturist or to ask a question about acupuncture please visit www.acupuncture.org.uk

References

Compson A et al (Eds). McAlpine's Multiple Sclerosis. Fourth edition. Philadelphia: Elsevier Inc, 2006.

Hawkins C Pathogenesis & Clinical Subtypes of MS In: Hawkins CP, Wolinsky JS (Eds). Principles of Treatments in MS. Oxford: Butterworth Heinemann, 2000

Tjon Eng Soe SH et al. Multiple Sclerosis. 2009: 15(11): 1376-7.
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Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): Extending the CONSORT Statement - MacPherson - 2010 - Journal of Evidence-Based Medicine - Wiley Online Li...

Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): Extending the CONSORT Statement - MacPherson - 2010 - Journal of Evidence-Based Medicine - Wiley Online Li... | Acupuncture for the Nervous system and brain | Scoop.it

Abstract

The STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) were published in five journals in 2001 and 2002. These guidelines, in the form of a checklist and explanations for use by authors and journal editors, were designed to improve reporting of acupuncture trials, particularly the interventions, thereby facilitating their interpretation and replication. Subsequent reviews of the application and impact of STRICTA have highlighted the value of STRICTA as well as scope for improvements and revision. To manage the revision process a collaboration between the STRICTA Group, the CONSORT Group, and the Chinese Cochrane Centre was developed in 2008. An expert panel with 47 participants was convened that provided electronic feedback on a revised draft of the checklist. At a subsequent face-to-face meeting in Freiburg, a group of 21 participants further revised the STRICTA checklist and planned dissemination. The new STRICTA checklist, which is an official extension of CONSORT, includes six items and 17 sub-items. These set out reporting guidelines for the acupuncture rationale, the details of needling, the treatment regimen, other components of treatment, the practitioner background, and the control or comparator interventions. In addition, and as part of this revision process, the explanations for each item have been elaborated, and examples of good reporting for each item are provided. In addition, the word “controlled” in STRICTA is replaced by “clinical,” to indicate that STRICTA is applicable to a broad range of clinical evaluation designs, including uncontrolled outcome studies and case reports. It is intended that the revised STRICTA, in conjunction with both the main CONSORT Statement and extension for nonpharmacologic treatment, will raise the quality of reporting of clinical trials of acupuncture.


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Acupuncture for migraine prophylaxis - The Cochrane Library - Linde - Wiley Online Library

Acupuncture for migraine prophylaxis - The Cochrane Library - Linde - Wiley Online Library | Acupuncture for the Nervous system and brain | Scoop.it

Authors' conclusions 

 

Implications for practice

Although the available results suggest that the selection of specific points is not as important as had been thought by providers, acupuncture should be considered as a treatment option for migraine patients needing prophylactic treatment due to frequent or insufficiently controlled migraine attacks, particularly in patients refusing prophylactic drug treatment or experiencing adverse effects from such treatment.

 

Implications for research

There is a clear need for further studies. A priority, in our opinion, should be to investigate whether the high response rates observed in conditions similar to routine care in Germany and the UK are reproducible elsewhere. As migraine is a chronic condition, it would be important for clinicians to know how long improvements associated with acupuncture treatment last and whether a further treatment cycle again leads to improvement. These latter questions might be best investigated in cohort studies. Available studies have been rather unsuccessful at identifying reliable predictors for treatment response (Jena 2008; Weidenhammer 2006); these issues could also be investigated in observational studies. For decision makers it would be important to know who is sufficiently qualified to deliver acupuncture. Studies from Germany did not find an association between factors such as amount of training or professional experience and treatment response (Jena 2008; Weidenhammer 2006), but these studies were limited to physicians. Randomized trials comparing outcomes after treatment by different types of practitioners are desirable, although large sample sizes would be needed. Such studies would also be interesting from a more scientific perspective because it is unclear to what extent the effects of acupuncture are mainly mediated by context variables and generalised (i.e., not specific to traditional points) needling effects, and what contribution correct point location makes. Although future sham-controlled trials might find 'specific' effects over sham interventions, we think that such studies should not have the highest priority unless they also address other important questions. Other aspects that deserve further research include questions such as which types of acupuncture work best, what is the optimal frequency and duration of sessions, and so on. Future comparisons with other non-drug interventions (such as relaxation) should have sufficient sample size. To facilitate future meta-analyses, it would be helpful if some standards for reporting outcome data were established.


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Can Tinnitus Be Cured By Acupuncture | tinnitus treatment

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Acupuncture Migraine Remedy Found

Acupuncture Migraine Remedy Found | Acupuncture for the Nervous system and brain | Scoop.it
Acupuncture eliminates migraines according to new discoveries using scientific investigations.
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Acupuncture and Tinnitus

Acupuncture and Tinnitus | Acupuncture for the Nervous system and brain | Scoop.it
Systematic Reviews

Park J et al. Efficacy of acupuncture as a treatment for tinnitus: a systematic review. Arch Otolaryngol Head Neck Surg 2000; 126: 489-92.

A systematic review of randomised controlled trials that looked at the efficacy of acupuncture as a treatment for tinnitus compared with any control intervention. Six randomized controlled trials were included, four of which used manual acupuncture and 2 electroacupuncture. Five of 6 studies used inconsistent acupoints. Three studies scored 3 points or more on the Jadad scale. Outcome measurements were visual analogue scale scores for loudness, annoyance, and awareness of tinnitus; subjective severity scale scores for tinnitus; or Nottingham Health Profile scores. Two unblinded studies showed a positive result, whereas 4 blinded studies showed no significant effect of acupuncture. The reviewers concluded that acupuncture had not been demonstrated to be efficacious as a treatment for tinnitus on the evidence of rigorous randomised controlled trials.

Controlled trials

Tan KQ et al. Comparative study on therapeutic effects of acupuncture, Chinese herbs and Western medicine on nervous tinnitus [Chinese]. Zhongguo Zhenjiu2007. 27: 249-51.

A randomised controlled trial that compared the clinical therapeutic effects of acupuncture, Chinese herbs and western medicine in 90 patients with nervous tinnitus. The effectiveness rates in the 3 groups were 73.3%, 40.0% and 33.3%, respectively, with significant differences among the 3 groups (p<0.05). The researchers concluded that acupuncture has obvious therapeutic effect on nervous tinnitus, and that its therapeutic effect is better than that of Chinese herbs and western medicine.


Okada DM et al. Acupuncture for tinnitus immediate relief [Portuguese]. Revista Brasileira de Otorrinolaringologia 2006. 72: 182-6.

A double-blind randomised study in 76 patients with tinnitus to assess the effects of acupuncture. A Visual Analogue Scale (VAS, 0 to 10 points) was used to assess the humming sensation experienced by the patients at baseline. The patients were then divided into a 'real' acupuncture group and a sham acupuncture group. After treatment, the humming sensation was assessed again. There was a significant difference (p<0,001) between the VAS scores pre and post needling in the real acupuncture group (p=0.0127). There was also a difference between the real and sham groups (p=0.017). The researchers concluded that there was significant reduction in tinnitus with acupuncture.


Azevedo RF et al. Impact of acupuncture on otoacoustic emissions in patients with tinnitus. Revista Brasileira de Otorrinolaringologia2007; 73: 599-607.

A study that assessed the effect of acupuncture on the cochlear function in 38 patients with tinnitus by analysing otoacoustic emissions. Measures of transitory otoacoustic emissions and suppression of otoacoustic emissions were obtained from all subjects before and after acupuncture. Patients were assigned to 'real' or sham acupuncture. There was a significant difference between the amplitude of otoacoustic emissions assessed before and after treatment in the real acupuncture group. No difference was observed with sham acupuncture. The researchers concluded that acupuncture had a significant effect on otoacoustic emissions in patients with tinnitus.


Jackson A et al. Acupuncture for tinnitus: a series of six n = 1 controlled trials. Complementary Therapies in Medicine 2006; 14: 39-46.

Controlled n=1 trials that explored patient perceived benefits of acupuncture for tinnitus. Six patients with tinnitus were included. Primary outcome was Daily Diary records related to four tinnitus symptoms: loudness of tinnitus; pitch of tinnitus; waking hours affected with tinnitus; quality of sleep. Secondary outcomes were the Tinnitus Handicap Inventory (THI) and Measure Your Medical Outcome Profile (MYMOP). Outcomes were measured during a course of 10 acupuncture treatments over a 2-week period, and also during a 14 day pre-treatment (phase A) and 14 days post-treatment (phase B). For the symptoms of loudness and pitch, there were variable treatment effects between patients. There was a trend (not statistically significant) to an overall reduction of loudness and pitch. For waking hours affected and quality of sleep, patients' responses were more consistent and there was a significant overall median reduction. The THI and MYMOP measures showed a trend towards improvement after treatment. The researchers concluded that the results of their study suggest that acupuncture may have a beneficial role in the treatment of tinnitus.

Case series

Shaladi AM et al. Auricular acupuncture plus antioxidants in the treatment of subjective tinnitus: A case series.Medical Acupuncture2009; 21: 131-4.

A case series that assessed the benefit of auricular acupuncture and antioxidants on subjective tinnitus. A prospective questionnaire including an 11-point scale of the subjective volume, an 11-point scale of the severity of tinnitus, and the Zung Self-Rating Anxiety Scale were used to assess the response to acupuncture. In all, 13 patients who had had symptoms of tinnitus for 3 to 5 years were evaluated at baseline, 1 month, and 4 months. Patients were given oral antioxidants and auricular acupuncture 2 times a week, for 4 weeks. From baseline to 1 month, there was a nonsignificant reduction in the subjective volume of the tinnitus and severity of the tinnitus; and also a nonsignificant reduction on the anxiety scale. No variation was registered between months 1 and 4, but patients reported improved sleep. The researchers concluded that auricular acupuncture plus oral antioxidants nonsignificantly reduced the noise and the intensity of subjective tinnitus.

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Correlation between the Effects of Acupuncture at Taichong (LR3) and Functional Brain Areas: A Resting-State Functional Magnetic Resonance Imaging Study Using True versus Sham Acupuncture

Correlation between the Effects of Acupuncture at Taichong (LR3) and Functional Brain Areas: A Resting-State Functional Magnetic Resonance Imaging Study Using True versus Sham Acupuncture | Acupuncture for the Nervous system and brain | Scoop.it
Evidence-Based Complementary and Alternative Medicine (eCAM) is an international, peer-reviewed journal that seeks to understand the sources and to encourage rigorous research in this new, yet ancient world of complementary and alternative medicine.
Abstract

Functional magnetic resonance imaging (fMRI) has been shown to detect the specificity of acupuncture points, as proved by numerous studies. In this study, resting-state fMRI was used to observe brain areas activated by acupuncture at the Taichong (LR3) acupoint. A total of 15 healthy subjects received brain resting-state fMRI before acupuncture and after sham and true acupuncture, respectively, at LR3. Image data processing was performed using Data Processing Assistant for Resting-State fMRI and REST software. The combination of amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) was used to analyze the changes in brain function during sham and true acupuncture. Acupuncture at LR3 can specifically activate or deactivate brain areas related to vision, movement, sensation, emotion, and analgesia. The specific alterations in the anterior cingulate gyrus, thalamus, and cerebellar posterior lobe have a crucial effect and provide a valuable reference. Sham acupuncture has a certain effect on psychological processes and does not affect brain areas related to function.

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Acupuncture and migraine

Acupuncture and migraine | Acupuncture for the Nervous system and brain | Scoop.it
Migraine sufferers Tina and Chris tell us how acupuncture helped alleviate migraine, whilst David Millard MBAcC offers some insight into the treatment

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Differential Activation Patterns of fMRI in Sleep-Deprived Brain: Restoring Effects of Acupuncture

Differential Activation Patterns of fMRI in Sleep-Deprived Brain: Restoring Effects of Acupuncture | Acupuncture for the Nervous system and brain | Scoop.it
Evidence-Based Complementary and Alternative Medicine (eCAM) is an international, peer-reviewed journal that seeks to understand the sources and to encourage rigorous research in this new, yet ancient world of complementary and alternative medicine.

 

Evidence-Based Complementary and Alternative Medicine
Volume 2014 (2014), Article ID 465760, 7 pages
http://dx.doi.org/10.1155/2014/465760ResearchArticleDifferential Activation Patterns of fMRI in Sleep-Deprived Brain: Restoring Effects of AcupunctureLei Gao,1 Ming Zhang,1 Honghan Gong,2 Lijun Bai,3 Xi-jian Dai,2 Youjiang Min,4 and Fuqing Zhou2

1Department of Medical Imaging, The First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Road, Xi’an, Shaanxi Province 710061, China
2Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province 330006, China
3The Key Laboratory of Biomedical Information Engineering, Department of Biomedical Engineering, School of Life Science and Technology, Xi’an Jiaotong University, Ministry of Education, China
4Acupuncture & Rehabilitation Department, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province 330006, China

Received 23 April 2014; Revised 15 May 2014; Accepted 16 May 2014; Published 15 June 2014

Academic Editor: Baixiao Zhao

Copyright © 2014 Lei Gao et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Previous studies suggested a remediation role of acupuncture in insomnia, and acupuncture also has been used in insomnia empirically and clinically. In this study, we employed fMRI to test the role of acupuncture in sleep deprivation (SD). Sixteen healthy volunteers (8 males) were recruited and scheduled for three fMRI scanning procedures, one following the individual’s normal sleep and received acupuncture SP6 (NOR group) and the other two after 24 h of total SD with acupuncture on SP6 (SD group) or sham (Sham group). The sessions were counterbalanced approximately two weeks apart. Acupuncture stimuli elicited significantly different activation patterns of three groups. In NOR group, the right superior temporal lobe, left inferior parietal lobule, and left postcentral gyrus were activated; in SD group, the anterior cingulate cortex, bilateral insula, left basal ganglia, and thalamus were significantly activated while, in Sham group, the bilateral thalamus and left cerebellum were activated. Different activation patterns suggest a unique role of acupuncture on SP6 in remediation of SD. SP6 elicits greater and anatomically different activations than those of sham stimuli; that is, the salience network, a unique interoceptive autonomic circuit, may indicate the mechanism underlying acupuncture in restoring sleep deprivation.

1. Introduction

Acupuncture is an important element of traditional Chinese medicine (TCM) that can be traced back for at least 4,000 years. In recent years, it has gained great popularity as an alternative and complementary therapeutic intervention in the Western medicine. Neuroimaging techniques have provided new insights into the anatomy and physiological function underlying acupuncture [1–13].

Acupuncture is widely used in insomnia clinically and empirically; however, the potential neural mechanism underlying the therapeutic effects of acupuncture remains little known. As one of the most prevalent health complaints worldwide, insomnia affects approximately 10% of the population in Western industrialized countries [14] and is associated with a marked reduction in quality of life, increased fatigue, cognitive impairments, mood disturbances, and physical complaints due to its chronic sleep loss [15]. Acute sleep loss, or sleep deprivation (SD), to some extent, is an alternative form of acute insomnia. Because of its maneuverability, much research work has been carried out in short-term sleep deprivation (24 h) and found that sleep deprivation adversely affects brain function and cognitive domains [16, 17].

 

 

 

 

Many studies have suggested a remediation role of acupuncture on Sanyinjiao acupoint for sleep disturbance [18,19]. The Sanyinjiao acupoint, also known internationally as Spleen 6 (SP6), is the junction point of the liver, spleen, and kidney meridians based on principles of TCM, and it is proposed to strengthen the spleen, resolve and expel dampness, and restore balance to the yin and blood, liver, and kidneys [20]. If acupuncture induces homeostatic force in renormalizing the neuronal responses, then activation patterns involved may be differentially affected by acupuncture or sham stimuli under conditions of SD. In the present study, we employed functional magnetic resonance imaging (fMRI) to insight the role of acupuncture on SP6 in sleep deprivation induced cortical activation. The use of fMRI to assess neuronal activity in response to acupuncture stimuli allows us to examine not only neuronal processes regulating acupuncture but also the biphasic regulation effects of acupuncture.

2. Materials and Methods2.1. Subjects

Sixteen healthy volunteers (8 females, mean age of  years) were recruited in this study after giving informed consent. Participants were selected from respondents to a web-based questionnaire. They should meet the following criteria: (1) of right hand according to the modified Edinburgh Handedness Questionnaire [21]; (2) of 20 and 24 years of age; (3) of habitual good sleeping habits (sleeping no less than 6.5 h each night for the past one month); (4) of no extreme morning or evening chromotype (score no greater than 22 on a modified Morningness-Eveningness Scale, [22]); (5) of no long-term medications; (6) of no symptoms associated with sleep disorders; (7) of no history of any psychiatric or neurologic disorders; (8) of no history of drug abuse and current use of antidepressant or hypnotic medications; (9) of acupuncture naive. Participants had an average of  years of education. This study was approved by the Medical Research Ethics Committee and Institutional Review Board of The First Affiliated Hospital of Nanchang University.

2.2. Experimental Protocol

All subjects were scheduled for three fMRI scanning procedures, one following the individual’s normal sleep and received acupuncture at SP6 (NOR group) and the other two after a night of total SD with acupuncture on SP6 (SD group) or sham (Sham group). The sessions were counterbalanced and approximately two weeks apart to minimize the residual effects of SD on cognition.

Acupuncture was performed at the acupoint SP6 on the right leg (Sanyinjiao, located in the medial lower leg, 9-10 cm above the prominence of the medial malleolus (ankle bone), and closed to the medial crest of the tibia). The needles used in the acupuncture protocol were sterile, disposable, and stainless steel acupuncture needles, which would not distort MR images, measuring 0.3 mm in diameter and 40 mm in length. The needle was inserted in SP6 with a depth of approximately 1.5 cm. Stimulation was then delivered by a balanced “tonifying and reducing” technique [1] and rotated manually clockwise and counterclockwise for 1 min at a rate of 60 times per min. Acupuncture was performed with “2 min stimuli-2 min rest-2 min stimuli” program during the task-state scanning. The procedure was performed by the same experienced and licensed acupuncturist on all subjects.

For the control of acupuncture manipulation, subjects also received the sham stimulation at a nonmeridian focus near SP6 (2-3 cm inwards from SP6) on the right leg using the same timing protocol as in the acupuncture run. The sham stimulation was delivered with the needle depth, stimulation intensity, and manipulation method identical to those used in the SP6 run.

2.3. fMRI Scanning Procedure

Functional scanning was incorporated with three runs in each session. Two resting-state runs, each lasting 4 min, were separated by a 6 min-6 seconds task-state block-designed run (Figure 1). Resting-state data were not presented in the current study. During the scanning, subjects lay supine on the scanner bed, wearing earplugs to suppress scanner noise and with the head immobilized by cushioned supports. They were instructed to keep their eyes closed and their minds clear and remain awake. In addition, the feelings of deqi were collected at the end of the session, including the soreness, numbness, fullness, heaviness, and dull pain. Subjects were asked to rate each component of the deqi feeling they had experienced during the stimulation period using a visual analog scale (VAS). The VAS was scaled at 0 = no sensation, 1–3 = mild, 4–6 = moderate, 7-8 = strong, 9 = severe, and 10 = unbearable sensations. Because the sharp pain was considered an inadvertent noxious stimulation, we excluded the subjects from further analysis if they experienced sharp pain (greater than the mean by more than two standard deviations). Among all the participants, only one experienced the sharp pain and was removed from further analysis.

Figure 1: Experimental paradigm. SP6 and Sham were located on the right leg. The arrows indicated the time points of needle insertion and withdrawal. The epoch of acupuncture manipulation lasted for “2 min-MA-2 min-rest-2 min-MA” as shown by the framework.2.4. MRI Data Acquisition

fMRI data were collected on a SIEMENS Trio 3.0 T scanner. Each subject lied on supine with the head in neutral position fixed comfortably by a belt and foam pads during the test. The scanning sessions included (1) localizer, (2) T1 MPRAGE anatomy (176 sagittal slices, thickness/gap = 1.0/0 mm, in-plane resolution = 256 × 256, FOV (field of view) = 240 mm × 240 mm, TR (repetition time) = 1,900 ms, TE (echo time) = 2.26 ms, and flip angle = 15°), (3) EPI-BOLD (36 axial slices, echo-planar imaging pulse sequence, thickness/gap = 5.0/1 mm, in-plane resolution = 64 × 64, TR = 3,000 ms, TE = 30 ms, flip angle = 90°, and FOV = 240 mm × 240 mm).

2.5. fMRI Data Analysis

All preprocessing and data analyses were performed by using SPM8 (Wellcome Department of Cognitive Neurology, London, UK). For each participant, the first 2 scans of each task-state run were discarded, and the remaining images were slice-time corrected and spatially realigned to the first volume of the first run to correct for motion. The structural scan was coregistered to a mean image of the realigned functional scans. The coregistered functional scans were then normalized to the Montreal Neurological Institute template brain (resampled voxel size = 3 × 3 × 3 mm3) and spatially smoothed with a Gaussian kernel of 8 mm.

To investigate the acupuncture effect, general linear model (GLM) was used to analyze the block-designed data. Vectors of stimulus onsets were created for each of the acupuncture and rest conditions and convolved with the canonical hemodynamic response function. A 480 s temporal high-pass filter was applied to the data to remove low-frequency artifacts. Contrasts for acupuncture versus rest in three groups (i.e., NOR, SD, and Sham) were created for each subject. Thresholds for active brain regions were set at a cluster extent of >10 voxels and a voxel level of . After individual analyses, a one way within-subject ANOVA and post hoc were performed and paired -test for group analysis was performed by using the same statistical parameters to compare regional brain activity with acupuncture versus rest for rested wakeful and sleep deprivation. Statistical analyses were performed by using SPM8. Only the coordinates from the largest cluster for each brain region are presented in the main tables for regions with multiple locations.

3. Results

4 subjects were excluded on discovery of excessive head motion or experienced the sharp pain during the task. A total of 12 participants (5 men) completed the fMRI protocol.

Rested-Wakeful Condition: Acupuncture versus Baseline. Under habitual sleep, responses to acupuncture versus baseline stimuli were found in left middle frontal area (MFA), medial frontal gyrus (MFG), precentral area (PreCG), postcentral area (PoCG), left putamen (PUT), anterior cingulate (ACC), right superior temporal gyrus (STG), insula (INS), and right inferior parietal lobe (IPL) (Figure 2(a), Table 1).

Table 1: Activations for NOR group during acupuncturing on SP6 compared with a resting baseline are shown. (, cluster >10 voxels, uncorrected).Figure 2: (a) Activations for NOR group during acupuncturing on SP6, compared with a resting baseline are shown. (b) Activations for SD group during acupuncturing on SP6, compared with a resting baseline are shown. (c) Activations for Sham group during acupuncturing on Sham, compared with a resting baseline are shown. (d) Group differences between Sham and SD. Cool color indicates that the Sham group had decreased activations compared with the SD group. All images were normalized to the standardized space defined by MNI using the structural MRI of each subject.

Sleep Deprivation Condition: Acupuncture versus Baseline. Under the sleep deprivation condition, greater neuronal activation was observed in the responses to acupuncture versus baseline. Activations were found in the right ACC, bilateral thalamus, bilateral INS, right MFG, bilateral STG, bilateral middle temporal gyrus (MTG), left PoCG, bilateral caudate (CAU), right uncal gyrus, left PUT, fusiform, right cerebellum anterior lobe, and so forth (Figure 2(b), Table 2).

Table 2: Activations for SD group during acupuncturing on SP6 compared with a resting baseline are shown (, cluster >10 voxels, uncorrected).

Sleep Deprivation Condition: Sham versus Baseline. Under the sleep deprivation condition, Sham induced activations in the left superior frontal gyrus (SFG), bilateral MFG, bilateral PreCG, bilateral thalamus, bilateral INS, left pons, and left cerebellum posterior lobe (Figure 2(c), Table 3).

Table 3: Activations for Sham group during acupuncturing on SP6, compared with a resting baseline are shown (, cluster >20 voxels, uncorrected).

Sleep Deprivation Condition: Sham versus Acupuncture. To investigate the differences between Sham HAM and SP6 in sleep-deprived condition, a paired -test was performed between SD and Sham groups. Results indicated that the group differences of activations were significantly decreased in the Sham group than that of in the SD group, including right INS/thalamus, bilateral MTG, right hippocampus, and left cerebellum (Figure 2(d); Table4).

Table 4: Group differences between Sham and SD are shown (, cluster >20 voxels, uncorrected).4. Discussion

The present study investigated the activation patterns of acupuncture in SP6 in different sleep conditions. We found that acupuncture in SP6 increased regional brain activity primarily in the ACC, INS, basal ganglia, and limbic system after sleep deprivation, while Sham induced activations in the left SFG, bilateral MFG, bilateral precentral area, bilateral thalamus, bilateral INS, left pons, and left posterior lobe of the cerebellum. Although acupuncture also elicited increases the regional brain activity in the MFC/ACC, insular, and IPL during rested wakeful, both the extent and intensity of activation were reduced and much less widespread. Our findings may suggest that sleep deprivation alters neuronal activity, which predisposes individuals to contraction and enhanced responses to acupuncture and may partly explain the biphasic regulation effects of acupuncture.

Sleep constitutes an approximate one-third of the human lifetime, and many hypotheses have been proposed about its role in physiological functions, including homeostatic restoration, thermoregulation, tissue repair, immune control, memory processing, and consolidation [23, 24]. Sleep deprivation has been shown to have a negative impact on the brain and health [17]. Sleep deprivation falls under the category of “fatigue” and “sleepless” in TCM and stands for “excessive lassitude,” “visceral dysfunction,” deficiency of “qi and blood,” and yin-yang disharmony, though not yet been severe [25]. The remediation is to re-establish the equilibrium between them. Applying pressure at this acupuncture meridian can refresh the mind, sedate, nourish spleen and stomach, nourish liver, and produce other health effects [26].

In the present study, we found different neuronal activity patterns evoked by acupuncture under sleep deprivation and rested wakeful. In NOR group, a state of physical fitness, SP6 acupuncture evoked activations may indirectly reflect the neuronal responses of these regions, including MPFC, insula, putamen, lateral parietal lobes, and sensorimotor areas, which are frequently recruited in executive-control, sensory information processing, visceral regulation, social emotion, and self-awareness. Activations in these regions may be consistent with its widespread functions of SP6 in mental [27], gynecological [20, 26], and neurological diseases [27] as recorded.

In the SD group, more widespread brain regions were activated and the activation level as well as the strength was significantly higher than that of NOR and Sham group. Besides the above-mentioned activations in the NOR, ACC and insula were especially significantly activated both in extent and intensity. A prominent cognitive role of the ACC is processing errors and conflict [28, 29]. Salience network, composed of the anterior insular cortex and ACC, has received increasing attention [30–32]. This brain network is supposed to be implicated in multiple functions, ranging from attention to interoception and subjective awareness [33, 34]. The salience network integrates external sensory stimuli with internal states, and the anterior insula acts as a hub, mediating interactions between large-scale networks involved in externally and internally oriented cognitive processing [34,35]. Most remaining nodes in the salience network are subcortical sites for emotion, homeostatic regulation, and reward [34]. Regions such as the lateral prefrontal cortex (PFC) and lateral parietal cortex are consistently recruited by cognitively demanding tasks and are critical for guidance of thought and behavior [36, 37]. In sleep deprivation, SP6 may exert an everlasting influence over the short-time period, as well as less maladaptive stimulation.

In Sham group, significant activations in the thalamus, pons, and basal ganglia were involved. This may indicate the impact of activations on the sleep deprivation itself. Under the extreme sleepy condition, more brain regions were involved in the compensation of maintaining the awareness and alert (thalamus and pons), while deactivations that occurred in the regions support advanced cognitive functions, dorsolateral prefrontal cortex, anterior cingulate cortex, and parietal lobes. It is generally believed that the Sham mainly relates to the processes of maladaptive stimulation [1, 2]. But much of the effects represent sleep deprivation, emotional and visceral processing—the left medial prefrontal. Naturally, we would suppose that low activation level of brain salience network in response to salient Sham stimuli could be explained as a failure in remediation, because such response would indicate that more stimuli are necessary to produce salient stimuli in Sham.

Interestingly, in the first individual level analysis the extent of activations in NOR was greater than SD and Sham group, and second level group statistics vice versa, that is, a relatively weak group effect in NOR and greater group effects both in SD and Sham. We speculated that the reasons for this inconsistent were likely to reflect the biphasic regulation effects of acupuncture. In the NOR group, acupuncture in SP6 reveals sparse results which may relate to its multiple functions. In sleep deprivation, an imbalance occurs; acupuncture stands for a homeostatic force to renormalize the yin and yang, biphasic regulation effects of acupuncture. Another study also reported similarities. Our results support this hypothesis that the effects of acupuncture were closing to launch homeostatic regulation [9, 38].

5. Limitations

There are several limitations in this study. First, in a relatively small sample in our study, the results for group comparison were not corrected for multiple comparisons; therefore, they should only be considered an exploratory analysis. Second, some flaws exist in our protocol, for example, a lack of sham stimuli in rested wakeful condition. The remediation of acupuncture in sleep deprivation cannot be totally inferred. Third, block design permits the observation of an immediate acupuncture effect rather than its post effects which are more valuable clinically. The mechanism still need to be further evaluated.

6. Conclusion

Different activation patterns suggest an important role of acupuncture on SP6 in remediation of SD. SP6 elicits greater and anatomically different activations than the same stimuli, that is, the salience network. A unique interoceptive autonomic circuit may, partly, indicate the mechanism underlying acupuncture in restoring sleep deprivation.


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[Clinical effect of electroacupuncture - PubMed Mobile

[Clinical effect of electroacupuncture combined with psychologic interference on patient with Internet addiction disorder].AuthorsZhu TM, et al. Show allJournal

Zhongguo Zhong Xi Yi Jie He Za Zhi. 2009 Mar;29(3):212-4. Article in Chinese.

AffiliationAbstract

OBJECTIVE: To observe, adopting randomized controlled method, the therapeutic effect of electroacupuncture (EA) combined with psychologic interference in patients with internet addiction disorder (IAD).

METHODS: Forty-seven patients with IAD were assigned to two groups treated respectively with psychotherapy alone (A, 23 cases) and EA plus psychotherapy (B, 24 cases). The psychotherapy was conducted by cognition and behavior method, once every 4 days, for 10 times totally. EA was applied at acupoints Baihui, Sishencong, Hegu, Taichong, Neiguan, Sanyinjiao, etc. once every other day, for 20 times. Changes of scoring by IAD self-rating scale (ISS), anxiety self-rating scale (SAS), self-rating depressive scale (SDS), Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA) and self-rating sub-health scale (SRSHS) before and after treatment were observed.

RESULTS: The total effective rate was 91.3% (21/23) in Group B, better than that (59.1%, 13/22) in Group A. By the end of this study, all scores in Group B, except HAMD, were significantly lower than those in Group A respectively, i.e., for IAD, 33.20 +/- 4.53 vs. 44.00 +/- 5.81; for SAS, 30.90 +/- 6.30 vs. 39.60 +/- 5.80; for SDS, 35.38 +/- 4.59 vs. 39.60 +/- 6.33; for HAMA, 7.50 +/- 2.54 vs. 12.70 +/- 3.68; for SRSHS, 39.60 +/- 5.66 vs. 48.40 +/- 6.91, showing statistical significances (P < 0.05).

CONCLUSION: Using psychologic interference alone or combined with EA can significantly reduce the ISS score and significantly reduce anxiety and improve self-conscious health status in patients with IAD, but the effect obtained by the combined therapy is better.

PMID 19548435 [PubMed - indexed for MEDLINE]
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Acupuncture for acute stroke - The Cochrane Library - Zhang - Wiley Online Library

Acupuncture for acute stroke - The Cochrane Library - Zhang - Wiley Online Library | Acupuncture for the Nervous system and brain | Scoop.it

AbstractBackground

Acupuncture-like sensory stimulation activates multiple efferent (nerve) pathways leading to altered activity in numerous neural systems. Acupuncture is widely accepted by Chinese people and it is increasingly requested by patients and their relatives in Western countries.

Objectives

To assess the effectiveness and safety of acupuncture in patients with acute stroke.

Search methods

We searched the Cochrane Stroke Group trials register (last searched August 2003), the Chinese Stroke Trials Register (August 2003), the Chinese Acupuncture Trials Register (August 2003), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 3, 2003), MEDLINE (1966 to 2003), EMBASE (1980 to 2003), Alternative Medicine Database (1985 to 2003), CINAHL (1982 to 2003) and the Chinese Biological Medicine Database (1981 to 2003). Reference lists of systematic reviews and identified trials were handsearched.

Selection criteria

Randomised and quasi-randomised trials of acupuncture started within 30 days of stroke onset, compared with placebo/sham acupuncture or open control in patients with acute ischaemic and/or haemorrhagic stroke.

Data collection and analysis

Two reviewers selected trials for inclusion, assessed trial quality, and extracted the data independently. Authors of trials were contacted for missing data.

Main results

Fourteen trials involving 1208 patients were included. Ten trials included patients with only ischaemic stroke. When acupuncture was compared with sham acupuncture or open control, there was a borderline significant trend towards fewer patients being dead or dependent (Odds ratio (OR) 0.66, 95% confidence interval (CI) 0.43 to 0.99), and significantly fewer being dead or needing institutional care (OR 0.58, 95% CI 0.35 to 0.96) in the acupuncture group after three months or more. There was also a significant difference favouring acupuncture in the mean change of global neurological deficit score during the treatment period (standardized mean difference (SMD) 1.17, 95% CI 0.30 to 2.04). Comparison of acupuncture with sham acupuncture only showed a statistically significant difference on death or requiring institutional care (OR 0.49, 95% CI 0.25 to 0.96), but not on death or dependency (OR 0.67, 95% CI 0.40 to 1.12), or change of global neurological deficit score (SMD 0.01, 95% CI -0.55 to 0.57). Severe adverse events with acupuncture (dizziness, intolerable pain and infection of acupoints) were rare (6/386, 1.55%).

Authors' conclusions

Acupuncture appeared to be safe but without clear evidence of benefit. The number of patients is too small to be certain whether acupuncture is effective for treatment of acute ischaemic or haemorrhagic stroke. Larger, methodologically-sound trials are required.

 Jump to…Plain language summaryAcupuncture for acute stroke

There is no clear evidence of benefit from acupuncture in acute stroke. In China, acupuncture is used to treat many acute and chronic conditions, including stroke. We reviewed evidence from randomised controlled trials investigating acupuncture in patients with acute stroke, to determine whether acupuncture was safe, and whether it could reduce the number of patients who died, or were left needing help with everyday activities. The review showed no clear effect of acupuncture on either outcome. Serious adverse effects were uncommon, and occurred in about one in every hundred patients treated. Results from much larger randomised trials are needed to assess accurately the benefits and harms of acupuncture in acute stroke.

 

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Acupuncture for Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents - The Cochrane Library - Li - Wiley Online Library

Acupuncture for Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents - The Cochrane Library - Li - Wiley Online Library | Acupuncture for the Nervous system and brain | Scoop.it

Abstract

Background

Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood psychiatric disorder with features of inattention, hyperactivity and impulsivity. There is increasing interest in complementary and alternative therapies such as acupuncture; however, it remains unclear whether the use of acupuncture in children and adolescents with ADHD is supported by the existing evidence.

Objectives

To assess the efficacy and safety of acupuncture as a treatment for ADHD in children and adolescents.

Search methods

We searched CENTRAL (The Cochrane Library 2010, Issue 2); MEDLINE (21 May 2010); CINAHL (21 May 2010); EMBASE (21 May 2010); ERIC (21 May 2010); PsycINFO (21 May 2010), Chinese Biological Medicine Database (10 May 2010); Chinese Scientific Periodical Database of VIP INFORMATION (10 May 2010); China Periodical in China National Knowledge Infrastructure (10 May 2010); and Chinese Evidence-Based Medicine Database (10 May 2010). We handsearched Chinese language journals and conference proceedings.

Selection criteria

Randomised controlled trials and quasi-randomised controlled trials comparing acupuncture with placebo or sham acupuncture, or conventional treatment. Participants under the age of 18 years with any type of ADHD were included. Papers in any language were included.

Data collection and analysis

Two review authors (S Li, B Yu) independently determined the studies to be included in the review based on inclusion and exclusion criteria and extracted the data using pre-developed extraction forms. The risk of bias within the trials was assessed by the same review authors in relation to allocation concealment, blinding and withdrawals. The measures of ADHD outcomes were extracted from core symptoms rating scales and additional secondary outcomes were considered.

Main results

No studies met the inclusion criteria for this review.

Authors' conclusions

A comprehensive search showed that there is no evidence base of randomised or quasi-randomised controlled trials to support the use of acupuncture as a treatment for ADHD in children and adolescents. Due to the lack of trials, we cannot reach any conclusions about the efficacy and safety of acupuncture for ADHD in children and adolescents. This review highlights the need for further research in this area in the form of high quality, large scale, randomised controlled trials.

 

 Jump to…Plain language summaryAcupuncture for ADHD in children and adolescents

Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood psychiatric disorder with features of inattention, hyperactivity and impulsivity. In general, effective treatment for ADHD relies on comprehensive therapy. Acupuncture is a complementary and alternative medicine (CAM) therapy that seems to have few side effects.

Being considered a relatively simple, inexpensive and safe treatment compared to other conventional interventions, acupuncture is used widely in oriental countries. According to the basic theory of Traditional Chinese Medicine (TCM), ADHD is caused by 'liver yang overactive', 'effulgent gallbladder fire', 'heart-spleen qi deficiency', 'non-interaction of heart and kidney' and 'yin-yang disharmony'. Thus, ADHD in children presents as clinical symptoms of over-activity, restlessness, recklessness, impoliteness and stubbornness. 'Yin-yang' and 'Qi-xue' are very important concepts in TCM. In a meridian system, the main interpretation of 'yin' and 'yang' is symmetry and balance. Acupuncture could help keep internal yin and yang in balance. It is also believed in TCM theory that acupuncture can strengthen the vital essence of the human body, which is called 'Qi' in China, and remove the blockage of channels. Qi could move between yin and yang to coordinate them in harmony so as to make an amiable, stable and peaceful internal environment.

Acupuncture is increasingly practiced as a therapeutic intervention in Western countries. However, it remains uncertain whether the existing evidence is strong enough to justify the use of acupuncture as a treatment for ADHD.

No trials were included in this review. The review authors concluded that there is inadequate evidence to draw any conclusions about the efficacy or safety of acupuncture for ADHD in children and adolescents. There is an urgent need for further large scale, multicenter, randomised, controlled, double-blinded studies of acupuncture with standardized evaluation of outcomes for ADHD in children and adolescents.

 

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THE MECHANISM OF ACUPUNCTURE AND CLINICAL APPLICATIONS from the International Journal of Neuroscience

THE MECHANISM OF ACUPUNCTURE AND CLINICAL APPLICATIONS from the International Journal of Neuroscience | Acupuncture for the Nervous system and brain | Scoop.it

International Journal of Neuroscience

Original

THE MECHANISM OF ACUPUNCTURE AND CLINICAL APPLICATIONS

 

2006, Vol. 116, No. 2 , Pages 115-125 (doi:10.1080/00207450500341472) MEHMET TUGRUL CABÝOGLU1†, NEYHAN ERGENE1 and UNER TAN21Department of Physiology, Selçuk University, Faculty of Meram Medica, KonyaTurkey2Department of Physiology, Cukurova University, Faculty of Medical, AdanaTurkey†Correspondence: MEHMET TUGRUL CABÝOGLU, Hamidiye Mah., Ince Minare Sok., 1. Nizam Apt., No:9/102 Selçuklu, Konya, 42040, Turkey

 

 

This study presents the result of the studies explaining the effects of acupuncture on various systems and symptoms. It has been determined that endomorphin-1, beta endorphin, encephalin, and serotonin levels increase in plasma and brain tissue through acupuncture application. It has been observed that the increases of endomorphin-1, beta endorphin, encephalin, serotonin, and dopamine cause analgesia, sedation, and recovery in motor functions. They also have immunomodulator effects on the immune system and lipolitic effects on metabolism. Because of these effects, acupuncture is used in the treatment of pain syndrome illnesses such as migraine, fibromyalgia, osteoarthritis, and trigeminal neuralgia; of gastrointestinal disorders such as disturbance at gastrointestinal motility and gastritis; of psychological illnesses such as depression, anxiety, and panic attack; and in rehabilitation from hemiplegia and obesity.

Keywordsacupuncture, beta endorphin, endogen opioids, encephalin, serotonin


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The National Institutes of Health (NIH) Consensus Development Program: Acupuncture and neuro-endocrine function research

The National Institutes of Health (NIH) Consensus Development Program: Acupuncture and neuro-endocrine function research | Acupuncture for the Nervous system and brain | Scoop.it

Conclusions

 

Acupuncture as a therapeutic intervention is widely practiced in the United States. There have been many studies of its potential usefulness. However, many of these studies provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebo and sham acupuncture groups.

 

However, promising results have emerged, for example, efficacy of acupuncture in adult post-operative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma for which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program.

 

Further research is likely to uncover additional areas where acupuncture interventions will be useful.

 

Findings from basic research have begun to elucidate the mechanisms of action of acupuncture, including the release of opioids and other peptides in the central nervous system and the periphery and changes in neuroendocrine function. Although much needs to be accomplished, the emergence of plausible mechanisms for the therapeutic effects of acupuncture is encouraging.

 

The introduction of acupuncture into the choice of treatment modalities readily available to the public is in its early stages. Issues of training, licensure, and reimbursement remain to be clarified. There is sufficient evidence, however, of its potential value to conventional medicine to encourage further studies.

 

There is sufficient evidence of acupuncture's value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value.


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