Category Archives: Acupuncture

Acupuncture, Acupuncture Blogs

Acupuncture Fibromyalgia Relief Confirmed

Acupuncture is an effective treatment modality for the alleviation of fibromyalgia. Researchers at the Physical Medicine and Rehabilitation Department of Ataturk University conclude that acupuncture improves two biochemical markers and clinical outcomes for patients with fibromyalgia. Objective measures show that acupuncture increases serum serotonin levels while simultaneously reducing Substance P levels. For subjectives, the researchers document lasting subjective improvements including less pain, fatigue, and anxiety. [i]

Fibromyalgia is a chronic condition with a variety of symptoms including widespread pain, sleep problems, fatigue, and cognitive difficulties. Fibromyalgia is frequently comorbid with depression and anxiety. The exact mechanism of the disease is has not been fully identified within allopathic and hospital medicine, but it is thought that serotonin and Substance P play an important role.

Serotonin is a neurotransmitter involved with mood, sleep, sexual behaviour, and pain regulation. Independent research confirms that fibromyalgia patients have lower serum serotonin levels compared with healthy individuals. Substance P is a neuropeptide involved in pain sensitivity, depression, and peripheral neurogenic inflammation. [ii] Excess levels of Substance P may play a role in the pathology of fibromyalgia, especially since Substance P has an active role in pain perception.

The study measures levels of these two biochemical markers along with several clinical parameters, both before and after treatment with acupuncture. A total of 75 female participants were recruited for the study. Exclusion criteria included usage of non-steroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors, tricyclic antidepressants, and other antidepressant drugs within the past 15 days. Those who had smoked tobacco, suffered from bleeding diathesis, or had painful conditions other than fibromyalgia were also excluded.

The patients were randomized into three groups; acupuncture, sham acupuncture, and simulated acupuncture. All three groups were similar in terms of mean age and body mass index. The mean duration of disease was 4.44 years, 3.94 years, and 5.09 years respectively. The following acupuncture points were selected for the study:

  • Dazhui (GV14)
  • Jianzhongshu (SI15)
  • Hegu (LI4)
  • Quchi (LI11)
  • Shenmen (HT7)
  • Neiguan (PC6)
  • Qihai (CV6)
  • Taichong (LV3)
  • Zusanli (ST36)
  • Sanyinjiao (SP6)

The points were needled bilaterally using 0.25 × 25mm sterile stainless steel filiform acupuncture needles. The needles were retained for 30 minutes per acupuncture session, without manual manipulation during needle retention.

The sham acupuncture group was included to act as a control and to identify the physiological effects of inserting needles into the skin at non-acupuncture points. Sham points were selected within an approximate 1–2cm radius of the true acupoints used in the acupuncture study group. These were identified using an electronic acupuncture point detector to find areas with a weaker signal compared with the genuine acupuncture points.

The simulated acupuncture group was included as a control and to identify the psychological effects of acupuncture treatment. Small, round adhesive bandages were applied to the same points as those used in the acupuncture group. Small needles (0.25 × 15mm) were inserted shallowly into the bandages, but were not allowed to penetrate the skin.

The three groups were blinded using a three section folding hospital screen with the bottom of one of the sections detached allowing the screen to be rolled up. A treatment couch was pushed into this space, and with the patient in position, the screen was dropped over the neck area to block their view. The needles at Dazhui and Jianzhongshu were inserted first, with patients in a seated position. Patients were then asked to recline in a supine position, safely resting in the space between the foldable head and body sections of the couch while the remaining needles were inserted. For all three groups, treatment was administered twice weekly for a total of four weeks.

 Results
Serum serotonin and Substance P levels were monitored before and after treatments using a commercial enzyme immunoassay kit, along with several other clinical parameters. A Visual Analogue Scale (VAS) was used to measure widespread pain. The Fibromyalgia Impact Questionnaire (FIQ) was used to measure work status, depression, anxiety, morning tiredness, pain, stiffness, fatigue, and well-being. The Nottingham Health Profile (NHP) was used to measure quality of life including pain, energy, physical mobility, emotional reactions, social isolation, and sleep. Finally, the Beck Depression Inventory (BDI) was used to measure a total of 21 different items including mood, social withdrawal, insomnia, and fatigue. The number of tender points (NTP) for each patient was also taken into account. All parameters were measured at baseline and after treatment. Follow-up visits were performed one month and three months after completion of treatment.

Patients in the acupuncture group experienced significant improvements in VAS (p<0.001), FIQ (p<0.001), BDI (p<0.001), NTP (p<0.001), and some aspects of NHP following treatment. Most of these improvements continued at the three month follow-up. Patients in the sham acupuncture group experienced significant improvements in VAS (p<0.01), FIQ (p<0.05), BDI (p<0.01), and NTP (p=0.001) following treatment. However, only the improvements in FIQ and NTP continued at the three month follow-up. Patients in the simulated acupuncture group experienced significant improvements in VAS (p=0.001), BDI (p<0.01), and NTP (p=0.01), but these improvements discontinued by the three month follow-up.

These findings indicate that sham acupuncture and simulated acupuncture provide a short-term placebo effect but do not provide long-term results. True acupuncture produced greater short-term results and also produced long-term positive patient outcomes. This indicates that the effective action of true acupuncture is not due to the placebo effect.

Serum serotonin levels increased significantly in the acupuncture and sham acupuncture groups (p<0.001 and p<0.01 respectively), with the increase in the acupuncture group being significantly greater than both sham and simulated acupuncture (p<0.01). Serum Substance P levels significantly decreased in the acupuncture group (p=0.001). There were no significant changes in serum Substance P in the sham group, and there was a significant increase (p=0.001) in the simulated group.

This study suggests that acupuncture is an effective treatment for patients with fibromyalgia, with the ability to improve a wide variety of symptoms, increase serum serotonin levels, and reduce serum Substance P levels. Genuine acupuncture treatment is superior to sham or simulated acupuncture, with improvements in symptoms lasting for several months after completion of all treatments. Contact your local licensed acupuncturist to learn more.

 

References:
[i] Wolfe F. et al “Serotonin levels, pain threshold, and fibromyalgia symptoms in the general population.” The Journal of Rheumatology [01 Mar 1997, 24(3):555-559].
[ii] Harrison S. Geppetti P. “Substance P” The International Journal of Biochemistry & Cell Biology Volume 33, Issue 6, June 2001, Pages 555-576.

Acupuncture, Acupuncture Blogs

Acupuncture Cocaine Addiction Prevention

Acupuncture regulates cocaine seeking behavior. University researchers document that acupuncture suppresses addictive behavioral and neurochemical changes caused by cocaine intake. In a controlled laboratory experiment, researchers have documented a specific acupuncture point that blocks deleterious cocaine induced changes. Specifically, application of acupoint HT7 (Shenmen) suppresses cocaine’s stimulation of increases “in locomotor activity and the expression of pCREB and c-Fos in the NAc.” [1] 

The nucleus accumbens (NAc) is an area of the brain active in motivation and reward. This reward circuit has dopaminergic terminals extending from the ventral tegmental area (VTA) of the brain to the NAc. Regulation of c-Fos and pCreb (phosphorylated cAMP-response element binding protein) are active in the circuitry. Drugs, including cocaine, increase levels of c-Fos and pCREB. Acupuncture applied to HT7 downregulates overexpression of cFos and pCREB in the NAc caused by cocaine intake.

The researchers determined that decreases of both pCREB and c-Fos in the NAc and cocaine induced behavioral activities are directly proportional to the depth of needling at HT7. Superficial needling was not as effective as deep needling. The research team posits that HT7 needling may exert its therapeutic actions by stimulating ulnar nerve A-fibers. Conceptually, they suggest that deeper needling recruits more A-fibers and therefore creates a greater peripheral sensory signal to the brain.

Cocaine intake increases dopamine (DA) levels in the NAc. The researchers find that only needling of HT7, and not control points, reduces overexpression extracellular dopamine levels in the NAc caused by cocaine intake. The researchers point out another intriguing topic. They discovered evidence indicating that acupuncture reduces cocaine seeking behavior by counteracting long-term potentiation in VTA dopaminergic neurons caused by repeated cocaine intake.

Long-term potentiation is a process wherein there are signal increases between synaptic neurons caused by repeated activities. This process is active in memory, learning, and also addiction. Long-term potentiation in NAc and VTA synapses is active in cocaine addiction related behaviors. The research indicates that the regulatory effects of needling HT7 on DA levels in the NAc counteract the long-term potentiation effects of cocaine intake. The researchers note, “our results showed that HT7 stimulation significantly reduced cocaine priming-induced reinstatement. Also, our previous findings have shown that HT7 acupuncture suppressed stress-induced relapse to cocaine-seeking behavior and neuronal activation in the NAc shell.” [2] This is groundbreaking research; naturally, we look forward to more follow-up investigations to confirm these findings concerning long-term potentiation.

The researchers note that HT7 may reduce cocaine addiction by increasing GABA levels in the ventral tegmental area of the brain. Needling HT7 increases both GABA levels and firing rates in the ventral tegmental area. The researchers posit that the GABA increase causes a decrease in the activity of dopaminergic neurons in the ventral tegmental area and NAc, thereby causing a “reduction of relapse to cocaine-seeking behavior.” [3] The researchers conclude that “acupuncture at HT7 effectively reduces cocaine-primed reinstatement and cocaine suppression of GABA neuron activity and NAc DA release. Our results suggest that acupuncture may attenuate cocaine-seeking behavior by regulating DA neurons via activation of neurons in the VTA.” [4]

 Important Points
The data shows that acupuncture reverses the inhibition of GABA release in the ventral tegmental area of the brain caused by cocaine intake. The effect was active when needling HT7, but not when needling LI5 (Yangxi). This indicates point specificity relative to the effects of acupuncture’s effective actions on the brain.

Needling HT7 to 1 mm did not produce the same level of effective actions as needling to a 3 mm depth. Cocaine increases pCREB and c-Fos expression in the NAc area of the brain. Needling HT7 to 1 mm decreases this effect but the 3 mm depth produced significantly greater results. The data indicates a depth dependent response to acupuncture.

Electroacupuncture to bilateral HT7 for a total of five minutes increases the rate of firing for ventral tegmental area GABA neurons. Cocaine intake decreases the firing rate; however, electroacupuncture reversed this effect. The researchers note that “electro-acupuncture significantly reduced cocaine inhibition of VTA GABA neuron firing rate.” [5]

Cocaine increases dopamine release in the NAc. Repeated intake increases this effect. Acupuncture applied to HT7, and not at PC6 (Neiguan), significantly reversed this effect by decreasing the excessive dopamine levels caused by cocaine intake. This indicates point specificity for this effect.

Acupuncture needling to HT7, but not to LI5 (Yangxi), reduced cocaine seeking behavior. This did not affect behavior toward food intake, only toward cocaine use. A blocking agent tested the pathways of effective action. The researchers determined “acupuncture attenuated cocaine-primed reinstatement of cocaine seeking through activation of GABA neurons in the VTA.” [6]

 Objective Results
Documentation of results was confirmed with several instruments. Locomotor activity was monitored with a video tracking system. Microdialysis confirmed results in the VTA and NAc. Immunohistochemistry confirmed pCREB and c-Fos results. Liquid chromatography measured GABA and dopamine levels. Neuron activity was documented using electrophysiological recordings.

 Summary
According to the National Institute on Drug Abuse (NIH, USA), cocaine is responsible for approximately 6 percent of all drug abuse treatments. Among users, approximately 68% seeking treatment smoke crack. There are no specific U.S. Food and Drug Administration (FDA) approved drugs for the treatment of cocaine addiction at this time, although many drugs are being tested. The National Institute on Drug Abuse documentation notes that “Researchers are currently testing medications that act at the dopamine D3 receptor, a subtype of dopamine receptor that is abundant in the emotion and reward centers of the brain. Other research is testing compounds (e.g., N-acetylcysteine) that restore the balance between excitatory (glutamate) and inhibitory (GABA) neurotransmission, which is disrupted by long-term cocaine use.” [7]

The current research on needling acupoint HT7 indicates its therapeutic actions are active in GABA neurotransmission and dopamine release. This pathway of effective action is consistent with scientific inquiries into the development of cocaine abuse treatments. The research does not indicate that acupuncture is a cure, but it does indicate that acupuncture is a helpful treatment modality in reversing cocaine addiction.

 Notes
[1] Jin, Wyju, Min Sun Kim, Eun Young Jang, Jun Yeon Lee, Jin Gyeom Lee, Hong Yu Kim, Seong Shoon Yoon et al. “Acupuncture reduces relapse to cocaine‐seeking behavior via activation of GABA neurons in the ventral tegmental area.” Addiction biology 23, no. 1 (2018): 165-181.

Research Team:
Daegu Haany University (Daegu, South Korea)
Brigham Young University (Provo, Utah)
Uniformed Services University of the Health Sciences (Bethesda, Maryland)
Wonkwang University (Iksan, South Korea)
Korea Institute of Oriental Medicine (Daejeon, South Korea)
[2] Yoon SS, Yang EJ, Lee BH, Jang EY, Kim HY, Choi SM, Steffensen SC, Yang CH (2012) Effects of acupuncture on stress-induced relapse to cocaine-seeking in rats. Psychopharmacology (Berl). 
[3] Jin, Wyju, Min Sun Kim, Eun Young Jang, Jun Yeon Lee, Jin Gyeom Lee, Hong Yu Kim, Seong Shoon Yoon et al. “Acupuncture reduces relapse to cocaine‐seeking behavior via activation of GABA neurons in the ventral tegmental area.” Addiction biology 23, no. 1 (2018): 165-181.
[4] Ibid.
[5] Ibid.
[6] Ibid.
[7] drugabuse.gov/publications/research-reports/cocaine/what-treatments-are-effective-cocaine-abusers

Acupuncture, Acupuncture Blogs

Acupuncture Carpal Tunnel Syndrome Relief Confirmed

Researchers find acupuncture effective for the treatment of carpal tunnel syndrome (CTS), a local entrapment neuropathy affecting the wrist and hand that causes pain, numbness, and dysfunction. The research team documents acupuncture’s beneficial influence on the morphology of the median nerve and improvement of clinical symptoms.

According to researchers conducting the investigation, “while previous studies investigated the effect of acupuncture on clinical symptoms and electromyographic studies, to the best of our knowledge, its effect on median nerve morphology was not investigated before.” [1] This study demonstrates that acupuncture influences morphology of the median nerve, which opens up a host of possible future studies that may build upon this foundation of knowledge.

Median nerve compression in the carpal tunnel region of the wrist results in pain, numbness, and tingling in the fingers or hand, as well as possible weakness and atrophy of the hand muscles innervated by the median nerve. [2] More prevalent among women, it is correlated with overuse, diabetes mellitus, rheumatoid arthritis, hypothyroidism, and pregnancy. [3]

Diagnostically and prognostically, musculoskeletal ultrasound imaging has been growing in popularity for monitoring this condition because of its ease and cost effectiveness. Musculoskeletal ultrasound shows the cross-sectional area (CSA) in the wrist level of the median nerve and this study documents correlations between median nerve cross-sectional areas and electrophysiological changes within the CTS affected limb.

A total of 27 female patients (45 limbs) with CTS were diagnosed with electromyographic tests for the purposes of this investigation. The patients were similar in age, BMI (body mass index), duration of disease, and severity of CTS. Exclusionary criteria were the following: radicular pain, polyneuropathy, radial or ulnar nerve diseases, severe CTS, trauma history, prior hand surgery.

In patients with bilateral CTS, both extremities were included in the same group. All patients were informed about the study and provided consent. They were randomly divided into two groups (acupuncture and control). The mean duration of the disease was 18.3 months and 19.3 months respectively. Both groups used night wrist splints for CTS for 4 weeks, while only the acupuncture group received acupuncture treatments. The following nine acupoints were selected for the study:

  • Daling (PC7)
  • Ximen (PC4)
  • Neiguan (PC6)
  • Laogong (PC8)
  • Qingling (HT2)
  • Shenmen (HT7)
  • Shaofu (HT8)
  • Taiyuan (LU9)
  • Quchi (LI11)

The median nerve cross-sectional area was measured at the proximal carpal tunnel with musculoskeletal ultrasound, with the scaphoid and pisiform bones used as bony landmarks for the proximal tunnel where the cross section was measured. [4] Needles of size 0.25 × 25 mm were inserted into the points and were retained for 25 minutes per acupuncture session. Treatments were conducted two or three days per week for four weeks, totaling ten sessions.

 Results
The median nerve cross-sectional area was measured by using musculoskeletal ultrasound on the patients while seated and positioned similarly (elbow at 90 degree flexion with the forearm in supination position). Cross-sectional areas of size 9 mm or greater had previously been determined as a possible diagnostic measure for CTS. [5]

Pain severity, hand function, and musculoskeletal ultrasound measurements were taken before and after treatments. The visual analog scale (VAS: 0–10 cm) measured pain severity. The Duruoz Hand Index (DHI) and Quick Disabilities of the Arm, Shoulder and Hand (DASH) scores were used to assess hand functions and disability. All electrophysiological tests were performed by using a Nihon Cohden Neuropack machine.

Compound muscle action potential (CMAP: normal >6.8 mV) measured the reaction of the abductor pollicis brevis muscle to stimulation at the wrist and elbow. Sensory nerve action potential (SNAP: normal >10 uV) measured the reaction of wrist stimulation to signals traveling in the opposite direction of normal signals in the nerve fiber (antidromic) of the second finger. Motor distal latency (normal <3.8 ms), sensory nerve conduction velocity (SNCV: normal >40.4 m/sec), and motor nerve conduction velocity (M-NCV: normal >49.4 m/sec) were also measured before and after treatment.

Acupuncture group positive outcomes proved significant. The median nerve cross-sectional area decreased from 11.6 to10.6 mm, motor distal latency decreased from 4.3 to 4.1 ms, and SNAP increased from 16.7 to17.6 uV. Also in the acupuncture group, VAS decreased from 9 to 4.8, CMAP increased from 12.9 to 14.8 mV, DHI decreased from 47 to 37, Quick DASH decreased from 67.2 to 56.8, S-NCV increased from 31 to 33.2 m/sec, and motor nerve velocity increased from 57.4 to 59 m/sec.

The improvement within the acupuncture group when comparing baseline values with the results highlights the success of acupuncture in decreasing clinical symptoms of CTS. It also highlights its ability to transform median nerve morphology such that acupuncture can reduce the cross-sectional area. The results within the control group were not as significant as the acupuncture group, highlighting the efficacy of acupuncture in treating neuropathic disorders compared with night splint monotherapy.

The researchers cited several investigations showing acupuncture’s positive influence on CTS. Recent studies have used magnetic resonance imaging to show how acupuncture may alter brain activity and the limbic system of CTS patients. [6,7,8] Acupuncture produces anti-inflammatory effects in the median nerve within the carpal tunnel, as well as effects that can be compared to ibuprofen, night splints, and oral or injected steroids. [9,10,11]

 Summary
Acupuncture generates beneficial morphological changes in the median nerve of patients with carpal tunnel syndrome and reduces or eliminates symptoms. Based on the scientific evidence, acupuncture is a reasonable treatment option. Consult with a local licensed acupuncturist to learn more.

 References:
1 Ural, Fatma Gülçin, and Gökhan Tuna Öztürk. “The acupuncture effect on median nerve morphology in patients with carpal tunnel syndrome: an ultrasonographic study.” Evidence-Based Complementary and Alternative Medicine 2017 (2017).

2. S. Tanaka, D. K. Wild, P. J. Seligman, V. Behrens, L. Cameron, and V. Putz-Anderson, “The US [musculoskeletal ultrasound] prevalence of self-reported carpal tunnel syndrome: 1988 national health interview survey data,”American Journal of Public Health, vol. 84, no. 11, pp. 1846– 1848, 1994.

3. R. J. Spinner, J. W. Bachman, and P. C. Amadio, “The many faces of carpal tunnel syndrome,” Mayo Clinic Proceedings, vol. 64, no. 7, pp. 829–836, 1989.

4. Ural, Fatma Gülçin, and Gökhan Tuna Öztürk. “The acupuncture effect on median nerve morphology in patients with carpal tunnel syndrome: an ultrasonographic study.” Evidence-Based Complementary and Alternative Medicine 2017 (2017).

5. J. T. Mhoon, V. C. Juel, and L. D. Hobson-Webb, “Median nerve ultrasound as a screening tool in carpal tunnel syndrome: correlation of cross-sectional area measures with electrodiagnostic abnormality,” Muscle and Nerve, vol. 46, no. 6, pp. 871–878, 2012.

6. A. U. Asghar, G. Green, M. F. Lythgoe, G. Lewith, and H. MacPherson, “Acupuncture needling sensation: the neural correlates of deqi using fMRI,” Brain Research, vol. 1315, pp. 111–118, 2010.

7. V. Napadow, J. Liu, M. Li et al., “Somatosensory cortical plasticity in carpal tunnel syndrome treated by acupuncture,” Human Brain Mapping, vol. 28, no. 3, pp. 159–171, 2007.

8. V. Napadow, N. Kettner, J. Liu et al., “Hypothalamus and amygdala response to acupuncture stimuli in carpal tunnel syndrome,” Pain, vol. 130, no. 3, pp. 254–266, 2007.

9. M. Hadianfard, E. Bazrafshan, H. Momeninejad, and N. Jahani, “Efficacies of acupuncture and anti-inflammatory treatment for carpal tunnel syndrome,” Journal of Acupuncture and Meridian Studies, vol. 8, no. 5, pp. 229–235, 2015.

10. Ho, Chien-Yi, Hsiu-Chen Lin, Yu-Chen Lee, Li-Wei Chou, Ta-Wei Kuo, Heng-Wei Chang, Yueh-Sheng Chen, and Sui-Foon Lo. “Clinical effectiveness of acupuncture for carpal tunnel syndrome.” The American journal of Chinese medicine 42, no. 02 (2014): 303-314.

11. Yang, Chun-Pai, Nai-Hwei Wang, Tsai-Chung Li, Ching-Liang Hsieh, Hen-Hong Chang, Kai-Lin Hwang, Wang-Sheng Ko, and Ming-Hong Chang. “A randomized clinical trial of acupuncture versus oral steroids for carpal tunnel syndrome: a long-term follow-up.” The Journal of Pain 12, no. 2 (2011): 272-279.

Acupuncture, Acupuncture Blogs

Acupuncture and the American College of Physicians

The American College of Physicians formally recommends acupuncture for the treatment of back pain. Published in the prestigious Annals of Internal Medicine, clinical guidelines were developed by the American College of Physicians (ACP) to present recommendations based on evidence. Citing quality evidence in modern research, the ACP notes that nonpharmacologic treatment with acupuncture for the treatment of chronic low back pain is recommended. The official grade by the ACP is a “strong recommendation.”

A strong recommendation is also made by the American College of Physicians for the treatment of both acute and subacute lower back pain with heat, massage, acupuncture, and spinal manipulation. The recommendations were approved by the ACP Board of Regents and involves evidence based recommendations from doctors at the Penn Health System (Philadelphia, Pennsylvania), Minneapolis Veterans Affairs Medical Center (Minnesota), and the Yale School of Medicine (New Haven, Connecticut). The target audience for the American College of Physicians recommendations includes all doctors, other clinicians, and the adult population with lower back pain. The ACP notes, “Moderate-quality evidence showed that acupuncture was associated with moderately lower pain intensity and improved function compared with no acupuncture at the end of treatment .” In agreement, the National Institute of Neurological Disorders and Stroke (National Institutes of Health) notes that acupuncture is an effective treatment modality for the relief of chronic lower back pain.

 References
1. Qaseem, Amir, Timothy J. Wilt, Robert M. McLean, and Mary Ann Forciea. “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of PhysiciansNoninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain.” Annals of Internal Medicine (2017).

2. Qaseem, et al. Annals of Internal Medicine (2017).

3. Katz J.N. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences.J Bone Joint Surg Am200688 Suppl 2214.

4. Lam M. Galvin R. Curry P. Effectiveness of acupuncture for nonspecific chronic low back pain: a systematic review and meta-analysis.Spine (Philadelphia, Pennsylvania 1976) 201338212438.

5. ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet. Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health.

6. Nahin, Richard L., Robin Boineau, Partap S. Khalsa, Barbara J. Stussman, and Wendy J. Weber. “Evidence-based evaluation of complementary health approaches for pain management in the United States.” In Mayo Clinic Proceedings, vol. 91, no. 9, pp. 1292-1306. Elsevier, 2016.

7. Martin DP, Sletten CD, Williams BA, Berger IH. Improvement
in fibromyalgia symptoms with acupuncture: results of a randomized
controlled trial. Mayo Clin Proc. 2006;81(6):749-757.

8. MacPherson, H., A. Vickers, M. Bland, D. Torgerson, M. Corbett, E. Spackman, P. Saramago et al. “Acupuncture for chronic pain and depression in primary care: a programme of research.” (2017).

9. Leslie Lingaas. ucsf.edu/news/2014/04/113966/acupuncture-helps-young-patients-manage-pain. Acupuncture Helps Pediatric Patients Manage Pain and Nausea, 2014.

10. Lin, Lili, Nikola Skakavac, Xiaoyang Lin, Dong Lin, Mia C. Borlongan, Cesar V. Borlongan, and Chuanhai Cao. “Acupuncture-induced analgesia: the role of microglial inhibition.” Cell transplantation 25, no. 4 (2016): 621-628.

11. Cevic, C and Iseri, SO. The effect of acupuncture on high blood pressure of patients using antihypertensive drugs. Acupuncture & electro-therapeutics research 2013; 38(1-2).

Acupuncture, Acupuncture Blogs

Acupuncture Alleviates Rheumatoid Arthritis Swelling And Pain

Acupuncture is an effective treatment modality for the the alleviation of rheumatoid arthritis. Researchers conclude that acupuncture alone or in combination with additional treatment modalities alleviates rheumatoid arthritis, restores bodily functions, and improves quality of life. [1] In a meta-analysis, the researchers note that acupuncture exerts its effective actions through several biological mechanisms. The acupuncture research indicates that acupuncture produces anti-inflammatory, antioxidative, and immune system regulatory actions. 

Three acupuncture points were common across the research reviewed in the China Medical University and Tri-Service General Hospital meta-analysis. The researchers note that ST36 (Zusanli) was the most commonly tested acupoint in patients with rheumatoid arthritis. GB34 (Yanglingquan) and LI4 (Hegu) were also commonly applied.

The results indicate that acupuncture applied to the aforementioned acupoints and others produces changes in specific inflammatory biomarkers. Acupuncture regulates the following: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), interleukins, nuclear factor kappa B (NF- B), and tumor necrosis factor alpha (TNF-). Another meta-analysis (Wang et al.), confirms that acupuncture regulates both ESR and CRP in rheumatoid arthritis (RA) patients. [2] In an important finding, researchers (Han et al.) conclude that acupuncture successfully downregulates “TNF- and VEGF [vascular endothelial growth factor] in peripheral blood and joint synovia to improve the internal environment which is beneficial for RA.” [3]

In another study under review in the meta-analysis (Dong et al.), investigators used laboratory conditions to test the efficacy of electroacupuncture at acupoints ST36 (Zusanli) and BL60 (Kunlun). The researchers indicate that the “toll-like receptor (TLR) signaling pathway contributed to the development and progression of RA and acupuncture could reduce the expression of TLR4, thus leading to anti-inflammation.” [4] In addition, many other studies indicate that acupuncture improves quality of life.

The research team drew conclusions after a full review of each individual study in the meta-analysis. Based on the data, the researchers note, “acupuncture alone or combined with other treatment modalities is beneficial to the clinical conditions of RA without adverse effects reported and can improve function and quality of life and is worth trying.” [5] They add that additional well-designed randomized controlled trials are recommended to confirm these findings.

The conclusions were based on several parameters. The primary outcomes were determined by quantifying pain levels, morning stiffness, pain related disability, joint swelling characteristics and diameter, number of swollen joints, skin temperature, and arthritis index. Serum levels of inflammatory and anti-inflammatory biomarkers plus antioxidant levels were recorded for objective measurements. In addition, positron emission tomography (PET) scans were used to monitor changes in inflammation along with X-rays of the hands. Quality of life was assessed using the rheumatoid arthritis quality of life questionnaire (RAQoL), Pittsburgh sleep quality index, health assessment questionnaire (HAQ), and the short form-36 health survey. Overall, the meta-analysis reveals extensive use of subjective and objective instruments to verify the data and conclusions.

The majority of studies included in the meta-analysis were randomized controlled trials and several were double-blinded. The trials were human clinical trials and controlled laboratory experiments. Many acupuncture points were used in the clinical trials. As stated earlier, ST36, GB34, and LI4 were most commonly administered.

The researchers note that there is a difficulty in using only one acupuncture point prescription for all patients diagnosed with rheumatoid arthritis. According to Traditional Chinese Medicine (TCM) principles, rheumatoid arthritis may be divided into many diagnostic subcategories such as wind, cold, dampness, and heat. In addition, these categories are further differentiated according to syndrome presentation location and overall constitution of the patient. As a result, there is a need for heterogenous acupuncture point prescriptions. In TCM, no one set of acupoints for this biomedically defined condition is applicable to all patients. As a result, this makes study design a difficult proposition.

Despite these difficulties, the researchers conclude that acupuncture is effective for the alleviation of rheumatoid arthritis. Many of the findings mapped pathways of effective action. One interesting finding was that acupuncture enhances antioxidative effects by increasing serum superoxide dismutase (SOD) and catalase activities in rheumatoid arthritis patients. This indicates that acupuncture reduces oxidative stress and subsequent inflammation. Moreover, acupuncture “triggered release of endorphins” and regulated the immune system; levels of IgG, IgA, and IgM were successfully downregulated. [6]

 Summary
Rheumatoid arthritis is an autoimmune disorder. Inflammation may occur in any location (including internal organs); however, the hands and knees are among the most common regions affected by the disorder. In joints, inflammation affects synovial membranes causing a fluid build-up and degradation. No singular blood test defines the diagnosis, although ESR, CRP, rheumatoid factor, and anti-cyclic citrullinated peptide antibodies are tests are helpful in making a determination. Ultrasound , MRI, and X-ray imaging are also important tools for confirming a diagnosis.

The meta-analysis results indicate that acupuncture benefits patients with rheumatoid arthritis. Acupuncture prevents or slows joint destruction, reduces pain levels, and increases mobility. However, acupuncture is not presented as a cure. Nonetheless, acupuncture is an important treatment option that may significantly improve quality of life. To learn more, contact a local licensed acupuncturists about treatment options.

 References:
[1] Chou, Pei-Chi, and Heng-Yi Chu. “Clinical Efficacy of Acupuncture on Rheumatoid Arthritis and Associated Mechanisms: A Systemic Review.” Evidence-Based Complementary and Alternative Medicine 2018 (2018).
[2] C. Wang, P. de Pablo, X. Chen, C. Schmid, and T. McAlindon, “Acupuncture for pain relief in patients with rheumatoid arthri- tis: a systematic review.,” Arthritis & Rheumatology, vol. 59, no. 9, pp. 1249–1256, 2008.
[3] R. X. Han, J. Yang, T. S. Zhang, and W. D. Zhang, “Effect of fire-needle intervention on serum IL-1 and TNF-alpha levels of rheumatoid arthritis rats,” Zhen Ci Yan Jiu, vol. 37,no. 2, pp. 114–118, 2012.
[4] Z.-Q. Dong, J. Zhu, D.-Z. Lu, Q. Chen, and Y.-L. Xu, “Effect of Electroacupuncture in “Zusanli” and “Kunlun” Acupoints on TLR4 Signaling Pathway of Adjuvant Arthritis Rats,” American Journal ofTherapeutics, 2016.
[5] Chou, Pei-Chi, and Heng-Yi Chu. “Clinical Efficacy of Acupuncture on Rheumatoid Arthritis and Associated Mechanisms: A Systemic Review.” Evidence-Based Complementary and Alternative Medicine 2018 (2018).
[6] Ibid.

Acupuncture, Acupuncture Blogs

Acupuncture Alleviates Neck Pain, Restores ROM

Acupuncture and herbs alleviate cervical spondylosis, a disorder caused by disc degeneration in the neck that results in pain and range of motion impairment. Hubei University of Medicine Dongfeng Hospital researchers conclude that acupuncture combined with herbs successfully relieves pain and regulates excess sympathetic nervous system outflows for patients with cervical spondylosis. [1] Other improvements were also observed, including reductions in dizziness, palpitations, and neck dysfunction. 

Common presentations of cervical spondylosis are neck and shoulder pain, numbness, hypersensitivity, and impaired fine motor function of the arms. However, cervical spondylosis is also a cause of symptoms relating to spinal cord compression or dysfunction. These symptoms include blurred vision, headaches, vertigo, tinnitus, nausea, palpitations, poor memory, and abdominal discomfort. [2]

It has also been suggested that increased sympathetic nervous system outflows due to compression of the cervical spinal cord region could put cervical spondylosis sufferers at an increased risk of cardiovascular events. [3] Blood viscosity is also a predictor of cardiovascular events, with increased viscosity increasing the risk of heart attacks and strokes. The study documents that the acupuncture and herbal medicine regimen reduces blood viscosity, which may produce important cardiovascular benefits.

 Chinese Medicine
The researchers conducted a randomized clinical trial using the scientific method. To provide a historical basis for the herbs and acupuncture points chosen for the study, the researchers presented Traditional Chinese Medicine (TCM) principles used for the selections. Cervical spondylosis is a disorder primarily belonging to the Du Mai (Governing Vessel) and Taiyang channels. Understood in anatomical terms, this correlates to the spine and paraspinal regions of the body.

TCM principles stipulate that an underlying deficiency of upright qi leaves cervical spondylosis patients vulnerable to pathogenic invasion by wind, cold, and dampness. This correlates to the conceptualisation that internal weakness facilitates greater vulnerability to wear and tear along with other stresses on the human body, including environmental influences. The result is pain in the back and neck region. Acupuncture is applied to improve local blood circulation, relax the musculature, relieve spasms, and reduce inflammation and swelling (especially in the region of nerve roots).

 Results
We’ll take a close look at the herbs and acupuncture points used to get the results. First, let’s delve into the outcomes. The subjective component of outcomes was determined using the visual analog scale (VAS) for pain and speed of resolution of other symptoms. Objective measurements include the quantification of blood viscosity.

VAS scores were rated by the patients in two study groups on a scale of 0–10, with 0 indicating a total absence of pain. By the end of the study period, both groups showed a significant reduction in pain (p<0.05). In the herbal medicine monotherapy group, mean VAS scores reduced from 6.91 pre-treatment to 2.86 by the end of the study. Reductions in the acupuncture plus herbs group were significantly greater, falling from 6.89 pre-treatment to just 1.22 by the end of the study (p<0.05).

Resolution of other symptoms such as dizziness, neck dysfunction, chest distress, and palpitations was also monitored closely. In the herbal medicine monotherapy group, dizziness took a mean 12.82 days to resolve, compared with just 7.89 days in the acupuncture plus herbs group. Neck dysfunction took a mean 13.79 days to resolve in the herbal medicine monotherapy group, compared with 9.41 days in the acupuncture plus herbs group. Chest distress and palpitations resolved in a mean 9.88 days in the herbal medicine monotherapy group, compared with 6.94 in the acupuncture plus herbs group. All symptoms resolved significantly and more quickly in the acupuncture plus herbs group (p<0.05). The results indicate that a combined treatment protocol is appropriate for optimal treatment of cervical spondylosis.

Resolution of pain and other symptoms were taken into account to give the total effective rates for both groups. In the herbal medicine monotherapy group, there were 24 cases of complete resolution, 20 cases of partial resolution, and 16 cases of unresolved symptoms, yielding a total effective rate of 73.33%. In the acupuncture plus herbs group, there were 40 cases of complete resolution, 16 cases of partial resolution, and 4 cases of unresolved symptoms, yielding a total effective rate of 93.33%.

Blood viscosity reduced significantly in both groups (p<0.05). Mean pre-treatment systolic blood viscosity measurements were 4.39 mPa.s (pascal-seconds) in the herbal medicine monotherapy group and 4.29 mPa.s in the acupuncture plus herbs group. Mean pre-treatment diastolic measurements were 9.26 mPa.s and 9.25 mPa.s respectively (p>0.05). Following treatment, measurements in the herbal medicine monotherapy group fell to 4.21 mPa.s systolic and 8.67 mPa.s diastolic blood viscosities. Reductions in the acupuncture plus herbs group were significantly greater, with mean systolic viscosity falling to 4.05 mPa.s and mean diastolic viscosity falling to 8.13 mPa.s (p<0.05).

 Participant Intake
A total of 120 participants aged 25–65 years were recruited for the study and were randomized to receive either an herbal decoction (n=60) or an herbal decoction plus acupuncture treatments (n=60). In the herbal medicine monotherapy group, the mean age was 50.22 years, mean duration of disease was 2.31 years, and mean body mass index (BMI) was 22.57. Of the 60 participants in this group, 13 suffered from hypertension, 10 from dyslipidemia, and 9 from diabetes. In the acupuncture plus herbs group, the mean age was 50.63 years, mean duration of disease was 2.25 years, and mean BMI was 22.10. Of the 60 participants in this group, 12 suffered from hypertension, 11 from dyslipidemia, and 10 from diabetes. There was no statistically significant difference in baseline characteristics between the two groups prior to the treatment regimen in the clinical trial (p>0.05).

Participants receiving concurrent treatment with other therapies, or that were unable to complete the study period, were excluded. Other exclusion criteria included patients with gastric bleeding or gastric ulcers, blood, liver, or kidney disease, psychological disorders, malignant tumors, and pregnant or lactating women.

 Herbal Decoction
The participants in both groups were prescribed an herbal decoction consisting of the following ingredients:

  • Sheng Mu Li 30g
  • Zhen Zhu Mu 30g
  • Ge Gen 20g
  • Quan Xie 12g
  • Tian Ma 12g
  • Gou Teng 12g
  • Dan Shen 9g
  • Chuan Xiong 9g
  • Sang Ji Sheng 12g

The herbs were boiled in water to produce 200–300 ml of liquid. Each decoction was taken once daily for a total of two months.

 Acupuncture Points
In addition to the above herbal decoction, participants in the acupuncture plus herbs group received treatment using the following acupoints:

  • Huatuojiaji (MBW35)
  • Ashi points
  • Hegu (LI4)
  • Shenmai (BL62)

The patients were asked to rest in a prone position. Following disinfection with iodine, 0.3 × 40 mm needles were inserted to a depth of approximately one cun. Huatuojiaji points level with the three intervertebral spaces above and below the affected vertebra were selected. Ashi points were applied to the local area.

All points were stimulated manually using a balanced reinforcing-reducing method. After obtaining deqi, a G6805-II electro-stimulator was connected and set to a frequency of 30 Hz. Electrical stimulation was applied for 30 minutes with the intensity adjusted according to each patient’s individual tolerance levels. Acupuncture was administered on alternating days for a total of two months.

 Summary
The findings indicate that the prescribed herbal decoction combined with acupuncture successfully alleviates pain and other symptoms associated with cervical spondylosis, and is more effective than using an herbal decoction monotherapy. Furthermore, these therapies significantly reduce blood viscosity. The focus was to improve local circulation and promote faster healing based on the principle of invigorating the blood. These changes may also decrease the risk of heart attacks and strokes in patients with high blood viscosity. To learn more, contact a local licensed acupuncturist.

 Notes
[1] Yi Jinke, Xu Yingle, Wang Wenke, Xu Penghui (2018) “Clinical effects of decoction combined acupuncture in treatment of sympathetic cervical spondylosis” Jilin Journal of Chinese Medicine Vol.38(8) pp. 966-968.
[2] Yuqing Sun, Aikeremujiang Muheremu, Wei Tian (2018) “Atypical symptoms is patients with cervical spondylosis; Comparison of the treatment effect of different surgical approaches” Medicine Vol. 97 (20) e.10731.
[3] Mohita Singh, indu Khurana, Zile Singh Kundu, Anup Aggarwal (2016) Link of sympathetic activity with cardiovascular risk in patients of cervical spondylosis” International Journal of Clinical and Experimental Physiology Vol.3 (1) pp.41-44.

Acupuncture, Acupuncture Blogs

Acupuncture Alleviates Depression And Benefits The Brain

Acupuncture restores brain connectivity and benefits patients with major depression disorder (MDD). Utilizing functional magnetic resonance imaging (fMRI), researchers at the Guangzhou University of Chinese Medicine hospital document that acupuncture significantly increases the connectivity of the corticostriatum to other brain regions, an important brain circuit connection involved in rewards and motivation. In the same investigation, eight weeks of acupuncture treatments significantly decreased depression scores. Based on MRI results and clinical data, Guangzhou University researchers conclude that acupuncture regulates corticostriatal reward and motivation circuitry and improves patient outcomes for patients with depression. [1] 

The investigation examined an integrative medicine approach to care. All patients received fluoxetine, an antidepressant. However, one group received sham acupuncture and another received true acupuncture. The true acupuncture group demonstrated the aforementioned changes in the corticostriatal circuitry and clinical improvements as well. Sham acupuncture did not produce these changes.

MDD and its debilitating symptoms affect a large portion of the global population; MDD presents widespread economic, social, and personal challenges. Antidepressant medications for MDD are used to help stabilize patients but are often problematic due to adverse effects. The authors note that “accumulating evidence has indicated acupuncture combined with antidepressant medication is more effective than antidepressants alone, and is safe, well tolerated, and has an early onset of action.” [2] The addition of acupuncture to an antidepressant medication protocol increases efficacy and speeds the onset of clinical relief.

The researchers investigated acupuncture’s effects on brain networking changes; fMRI scans were used to measure corticostriatal resting-state functional connectivity (rsFC). The researchers mapped rsFC because it shows the patterns and timing of neuron activation in separate areas of the brain. Measuring rsFC allows researchers to reveal the function of a brain region and investigate how disparate parts of the brain are networked together to serve common mental processes.

The results confirm that acupuncture is effective at reducing self-reported depression symptoms compared with sham acupuncture. Additionally, the fMRI results document that acupuncture significantly increases rsFC between the inferior ventral striatum and medial prefrontal cortex, ventral rostral putamen and the amygdala/parahippocampus, and also the dorsal caudate and middle temporal gyrus. Also, acupuncture decreases rsFC between the right ventral rostral putamen and the right dorsolateral prefrontal cortex, right dorsal caudate, and the bilateral cerebellar tonsil. [3]

Increased connectivity of the striatum is important because it receives input from cortical areas activated during activities such as reward prediction and states of motivation. This brain circuitry is critical for an individual’s ability to learn appropriate actions that produce rewards and to have the motivation for selecting those actions. A core characteristic of patients with depression is anhedonia, the loss of interest in pleasurable activities and loss of ability to feel pleasure. The striatum of the brain (in the basal ganglia) is a critical area of the neurological reward circuit and modulates an individual’s ability to predict pleasure, reward, and mediate motivational states.

The researchers note that prior studies confirm that the pathophysiology of MDD is associated with corticostriatal reward circuitry. [4] In this study, investigators examine the effects of acupuncture combined with fluoxetine on the corticostriatal rsFC before and after both real and sham acupuncture treatments. The researchers conclude that true acupuncture achieves “the treatment effect by modulating the rsFC of corticostriatal reward circuits.” [5]

 Study Design
Patients with MDD were recruited through postings in the community. Forty-six female major depressive patients were included based on the following criteria:

  • ICD-10 criteria for depression
  • Ages 30–60
  • Self-Rating Depression Scale (SDS) score
  • Montgomery-Asberg Depression Rating Scale (MADRS) score
  • Normal cognitive functioning
  • Primary school education or higher
  • Right handed

Patients were excluded that did not meet the inclusion criteria or that had other conditions such as severe organ damage or psychosis. Pregnant or breastfeeding women were also excluded from the investigation.

Patients completed the Montgomery-Asberg Depression Rating Scale and Self-Rating Depression Scale to assess depression clinical scores before and after the eight week treatment period. In addition, participants had blood tests for liver function using aminotransferase (ALT) and aspartate aminotransferace (AST), and for kidney function using blood urea nitrogen (BUN) and creatinine tests (Cr).

All participants included in the study were given 20 mg of fluoxetine before being randomly assigned to verum (real acupuncture) or sham acupuncture groups. The researchers note that prior studies indicate that acupuncture treatment combined with antidepressant medications is more effective than antidepressant monotherapy. [6], [7], [8] The fMRI scans were taken before and after eight weeks of acupuncture treatments to map rsFC changes over the intervention time period.

 Acupuncture Protocol
Abdominal acupuncture was chosen for the style of treatment for several reasons. The authors note that research shows that abdominal acupuncture is effective for treatment of depression. They add that it is relatively painless and accepted by patients. Additionally, the rationale for this style includes that “CV8 (umbilicus) plays a crucial role in propelling and regulating the flow of Qi… thus, the acupoints around CV8 in the abdomen may regulate the flow of Qi more efficiently.” [9]

The acupuncture point prescription harmonizes the zang-fu organs, tonifies qi, and replenishes blood. The specific acupoints in the protocol are Zhongwan (CV12), Xiawan (CV10), Qihai (CV6), Guanyuan (CV4), Shangqu (KD17), Huaroumen (ST24), and Qipang (extra point).

Acupuncture needles (0.22 mm × 40 mm) were inserted to a depth of 15–20 mm and were retained for 20 minutes. Sham acupuncture was performed at the same acupoints, but plastic needle tubes absent the presence of any needles were tapped against the skin. The acupoints in both groups were covered for blinding purposes. Acupuncture was administered once a day for three days, and then once every 3 days for the rest of the 8-week intervention.

 Summary
The focus of the investigation was to examine the patterns of rsFC affected by acupuncture treatment. The fMRI imaging confirms that acupuncture increases connectivity of the corticostriatum to other brain regions and is associated with decreased depression symptoms. Specifically, acupuncture significantly increases rsFC of corticostriatal reward circuits and decreases rsFC of the striatal-cerebellar regions. The researchers conclude that acupuncture treatments exert their effective action by modulating the corticostriatal reward and motivation brain circuitry in patients with MDD. Patients interested in learning more about acupuncture treatments are recommended to contact a local acupuncturist.

 

References:
[1] Wang Z, Wang X, Liu J, Chen J, Liu X, Nie G, Jorgenson K, Sohn KC, Huang R, Liu M, Liu B, and Kong J. “Acupuncture treatment modulates the corticostriatal reward circuitry in major depressive disorder.” Journal of Psychiatric Research, 2017; 84:18–26.
[2] Ibid.
[3] Ibid.
[4] Bluhm R, Williamson P, Lanius R, Theberge J, Densmore M, Bartha R, Neufeld R, Osuch E. Resting state default-mode network connectivity in early depression using a seed region-of-interest analysis: decreased connectivity with caudate nucleus. Psychiatry Clin Neurosci. 2009; 63:754–761.
[5] Wang Z, Wang X, Liu J, Chen J, Liu X, Nie G, Jorgenson K, Sohn KC, Huang R, Liu M, Liu B, and Kong J. “Acupuncture treatment modulates the corticostriatal reward circuitry in major depressive disorder.” Journal of Psychiatric Research, 2017; 84:18–26.
[6] Naranjo CA, Tremblay LK, Busto UE. The role of the brain reward system in depression. Prog Neuropsychopharmacol Biol Psychiatry. 2001; 25:781–823.
[7] Pizzagalli DA, Holmes AJ, Dillon DG, Goetz EL, Birk JL, Bogdan R, Dougherty DD, Iosifescu DV, Rauch SL, Fava M. Reduced caudate and nucleus accumbens response to rewards in unmedicated individuals with major depressive disorder. Am J Psychiatry. 2009; 166:702–710.
[8] Chan YY, Lo WY, Yang SN, Chen YH, Lin JG. “The benefit of combined acupuncture and antidepressant medication for depression: A systematic review and meta-analysis.” J Affect Disord. 2015; 176:106–117.
[9] Wang Z, Wang X, Liu J, Chen J, Liu X, Nie G, Jorgenson K, Sohn KC, Huang R, Liu M, Liu B, and Kong J. “Acupuncture treatment modulates the corticostriatal reward circuitry in major depressive disorder.” Journal of Psychiatric Research, 2017; 84:18–26.
[10] Wang X, Wang Z, Liu J, Chen J, Liu X, Nie G, Byun J-S, Liang Y, Park J, Huang R. “Repeated acupuncture treatments modulate amygdala resting state functional connectivity of depressive patients.” NeuroImage: Clinical. 2016 In press.
[11] Zhang WJ, Yang XB, Zhong BL. “Combination of acupuncture and fluoxetine for depression: a randomized, double-blind, sham-controlled trial.” J Altern Complement Med. 2009; 15:837–844.