A brief overview of the analgesic and immunologic effects of acupuncture in domestic animals

Acupuncture and acupressure with improved cancer-related depression of retrospective studies

Introduction

Acupuncture and acupressure are widely used for treating cancer pain and depression and recognized as safe and effective by the international medical community. In this study, we systematically evaluated the efficacy, safety, and clinical significance of acupuncture and acupressure in treating cancer-related depression.

Methods

We searched MEDLINE, PubMed, Science Direct, Google Scholar, Web of Science and Embase and Chinese-language databases for randomized clinical trials (RCTs). To assess efficacy, rating scales administered by clinicians or experts were preferred, including the Hamilton Depression Rating Scale (HAMD), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), and Quality of Life Questionnaire-Core 30 (QLQ-C30) and the total effective rate after treatment. In all, Sixteen RCTs involving 1019 cancer patients were included in the Meta-analysis.

Results

Eleven (69%) of these studies reported the post-treatment total effective rate. Three hundred fifty-three patients received antidepressants; the total effective rate was 72.5%. Three hundred sixty-one patients underwent acupuncture and acupressure; the total effective rate was 90%. Meta-analysis results showed I² = 0%, no heterogeneity, (Z = 5.84, p < 0.00001); and combined OR = 3.55, (95% CI = 2.32 to 5.43).

Discussion

This study found that acupuncture and acupressure are as effective as medication in the treatment of cancer-related depression, provide a reliable basis for the clinical use of acupuncture to treat cancer-related depression, help promote nonpharmacological treatment for cancer-related complications. These approaches thus help reduce drug resistance and adverse reactions and improve patients' quality of life.

A randomized controlled clinical trial on the effect of acupuncture therapy in dairy cows affected by pyometra

Pyometra (PYO) is a reproductive disease characterized by the accumulation of purulent or mucopurulent material within the uterine lumen, in the presence of an active corpus luteum (CL). As the CL continues secreting progesterone, PYO would develop following endometritis. Due to prohibited use of artificial luteolytic hormones in US certified organic dairies, conventional therapies consisting of administration of prostaglandin F2α, are not applicable. The objective of this study was to evaluate the efficacy of two acupuncture procedures on the treatment of persistent CL in cows with PYO. We hypothesized that acupuncture would reduce CL diameter and serum progesterone (P4) concentrations, leading to regression of PYO. Holstein cows with PYO, at an USDA certified organic dairy farm in Northern Colorado, were enrolled in a randomized controlled clinical trial and assigned to 1 of 3 treatments: (1) control pyometra (CP; no treatment; n = 17); (2) electroacupuncture (EAP; n = 15); and (3) laser acupuncture (LAP; n = 15). Each cow received three 9-min (EAP) or 20-min (LAP) acupuncture sessions in alternate days. All study cows had blood samples collected for determination of serum progesterone concentration at d0, and at d2, d4, d11, d18, and d25 after first treatment. The ovaries were scanned by transrectal ultrasonography at -3d, d0, d2, d4, d11, and d18 to determine the diameter of the CL. The effect of treatment in the outcome variables was evaluated by ANOVA and by repeated measures analyses, accounting for baseline data (CL diameter and progesterone serum concentration). Average ± SE change in CL diameter from d0 to d18 were 0.94 ± 1.0 mm, 0 ± 1.0 mm, and - 0.33 ± 1.0 mm for CP, EAP, and LAP, respectively. The repeated measures analysis indicated no significant differences for CL diameter among groups. None of the study cows had serum progesterone values <1 ng/ml by the end of the monitoring period (d25) and average ± SE change from d0 to d25 were - 4.0 ± 1.97 ng/ml, -0.76 ± 2.1 ng/ml, and 3.24 ± 1.9 ng/ml for CP, EAP, and LAP, respectively. The repeated measures analysis indicated no significant differences for serum progesterone concentrations among groups. On farm cow records reviewed 150 d after treatment indicated that 2 cows in EAP and 1 cow in LAP conceived 38 d, 68 d, and 38 d, after treatment completion. In conclusion, acupuncture was not an effective treatment for persistent CL in cows with PYO, during the monitoring period.

Effects of acupuncture at Pericardium-6 and Stomach-36 on nausea, sedation and gastrointestinal motility in healthy dogs administered intravenous lidocaine infusions

The objectives of this study were to assess gastrointestinal transit times, sedation, and signs of nausea associated with intravenous lidocaine infusions in dogs following targeted acupuncture at Pericardium-6 (PC6) and Stomach-36 (ST36). In a randomized, blind crossover design, 6 healthy, adult Beagles were fed thirty 1.5 mm barium-impregnated polyethylene spheres (BIPS), then were subject to 30 minutes of: 1) no acupuncture, 2) bilateral targeted acupuncture at PC6 and ST36, or 3) bilateral non-target acupuncture at Lung-5 (LU5) and Bladder-55 (BL55). Lidocaine was immediately administered at 1 mg/kg intravenously followed by 50 μg/kg/min. BIPS were tracked radiographically; sedation and nausea were scored at baseline (Time 0) and for 11 hours during lidocaine infusions. Transit times and sedation and nausea scores were analyzed with a linear mixed-effects model; the number of BIPS at defined time points was analyzed with a piecewise linear mixed-effects model. All P values were two-sided and P < 0.05 was considered significant. Sedation and nausea scores did not differ between treatments at any time point (all P > 0.05). However, nausea scores in all groups were significantly greater at Times 5 through 7 and at Time 11 compared to Time 0 whereas sedation scores in all groups were significantly greater at Times 2 through 11 compared to Time 0 (all P < 0.05). The number of BIPs found out of the stomach, the number found in the large intestine, gastric emptying and gastrointestinal transit times did not differ between treatments (all P > 0.05). Acupuncture at PC6 and ST36 did not alleviate nausea and sedation associated with lidocaine infusions in clinically normal animals or affect gastric emptying and gastrointestinal transit.

Thermal antinociceptive, sedative and cardiovascular effects of Governing Vessel 1 dexmedetomidine pharmacopuncture in healthy cats

OBJECTIVE

To compare the antinociceptive, sedative and cardiovascular effects of dexmedetomidine pharmacopuncture at Governing Vessel 1 (GV 1) with dexmedetomidine intramuscular (IM) administration.

STUDY DESIGN

Randomized, masked crossover design.

ANIMALS

A group of eight healthy female cats.

METHODS

Cats were randomly administered either dexmedetomidine (0.005 mg kg^-1; Dex-IM) IM or at acupuncture point GV 1 (Dex-P) separated by 1 week. Prior to and up to 120 minutes posttreatment, skin temperature (ST), thermal threshold (TT), heart rate (HR), respiratory rate (f_R), sedation, muscle relaxation and auditory response scores were recorded. Parametric data were analyzed using a two-way repeated measures anova followed by Tukey's test for multiple comparisons. Nonparametric data were analyzed using a Friedman test followed by Dunn's multiple comparisons test, and Wilcoxon signed-rank test with Bonferroni correction for multiple comparisons. Significance was set at p ≤ 0.05.

RESULTS

There were no differences within or between treatments for ST, f_R and auditory response. TT was significantly higher at 30-90 minutes in Dex-P (p ≤ 0.0285) than baseline. TT was significantly higher at 60-90 minutes for Dex-P than for Dex-IM (p ≤ 0.0252). HR was significantly lower at 10-75 minutes in Dex-P (p ≤ 0.0378) and at 5-75 minutes in Dex-IM (p ≤ 0.0132) than baseline. Compared with baseline, sedation scores were higher at 25 minutes (p = 0.0327) and 30 minutes (p = 0.0327), and muscle relaxation scores were higher at 25 minutes (p = 0.0151) and 35 minutes (p = 0.0151) in Dex-P. There were no differences in HR, sedation and muscle relaxation scores between treatments.

CONCLUSIONS AND CLINICAL RELEVANCE

Dex-P increased thermal antinociception compared with Dex-IM at the same dose of dexmedetomidine in cats. This antinociceptive effect must be evaluated under clinical situations.

Gastrointestinal effects following acupuncture at Pericardium-6 and Stomach-36 in healthy dogs: a pilot study

OBJECTIVES

To quantify changes in gastric and intestinal emptying times in the conscious dog following gastrointestinal acupoint stimulation.

MATERIALS AND METHODS

In a randomised, blinded crossover study, six dogs were fed 30×1.5 mm barium-impregnated polyethylene spheres and underwent: (1) no acupuncture (Control); (2) stimulation of target points PC6 and ST36 (Target) and (3) stimulation of non-target points LU7 and BL55 (Sham). Abdominal radiographs were assessed immediately after feeding the spheres and every hour for 12 hours and their number in the stomach and large intestines was counted.

RESULTS

The number of barium-impregnated polyethylene spheres found distal to the stomach was less in the Target group compared to the Control and Sham groups between hours 2 and 4, but no differences between groups were seen for the remainder of the treatment period. The number of spheres found within the colon/rectum was less in the Target group compared to the Control and Sham groups between hours 4 and 6, and compared to the Sham group only at hour 7 but no differences between groups were seen after hour 8.

CLINICAL SIGNIFICANCE

Acupuncture targeted at the gastrointestinal tract of dogs was associated briefly with slowed gastric emptying and gastrointestinal transit time. This foundational study lays the groundwork for additional studies of acupuncture effects associated with altered physiologic states.

Identification and mapping of real acupoints in the anatomical topography of Boa constrictor

Acupuncture is a therapy of the traditional Chinese medicine technique, which over the years has been widespread in the West. Defined as a needle-point treatment technique (acupoints), exactly preconfigured in the body to produce a specific physiological reaction to restore the balance between the function of conflicting states and homeostasis, alternating states of energy and thus maintain the ideal organ and body organization. Thus, the objective of this study was to map and describe the main points of acupuncture in the species Boa constrictor , and their indications to promote the balance of this species. The unprecedented result of the mapping was the discovery of specific acupoints with individual location indications without distribution in specific meridians and dispersedly distributed in the body.

A pilot study of the effects of acupuncture treatment on objective and subjective gait parameters in horses

OBJECTIVES

To investigate whether acupuncture can alter gait in horses as assessed by objective and subjective parameters.

STUDY DESIGN

Prospective, randomized, singleblinded, crossover study.

ANIMALS

Eight adult horses.

METHODS

Horses were randomly assigned to a treatment (three acupuncture treatments in 8 days) or control group. Subjective and objective gait analyses were performed before and after each treatment and at 1, 3 and 7 days after the last treatment (time-points 1-9, respectively). Horses were assessed at the trot in a straight line on a hard surface and on the lunge on the left and right reins on a soft surface (conditions 1-3, respectively). After 12 weeks, groups were reversed. Objective gait analysis was performed using inertial sensors and subjective analysis by two board- certified surgeons who reviewed video-recordings. Each limb was assessed for lameness before and after treatment. Lameness and global scores were assigned using 4-point scales. Assessors were blinded to treatment status. The effects of treatment (yes/no), time (1-9) and horse under conditions 1 -3 were compared using a linear mixed-effects model and a generalized estimating equation.

RESULTS

Treatment decreased hip hike difference under all conditions [condition 1: control, 6.3 ± 6.4 mm versus treatment, -0.2 ± 6.4 mm (p = 0.007); condition 2: control, 9.7 ± 7.8 mm versus treatment, 2.8 ± 7.8 mm (p = 0.032); condition 3: control, 7.3 ± 6.3 mm versus treatment, -2.7 ± 6.4 mm (p = 0.003)]. Other parameters also improved significantly under conditions 1 and 3. Based on subjective gait analysis, treatment decreased lameness [odds ratio (OR) 0.51, 95% confidence interval (CI) 0.34-0.78; p = 0.002] but not global (OR 0.53, 95% CI 0.24-1.10; p = 0.12) scores.

CONCLUSIONS AND CLINICAL RELEVANCE

Acupuncture can change horses' gaits to a degree appreciable by objective and subjective analyses.

Electroacupuncture for thalidomide/bortezomib-induced peripheral neuropathy in multiple myeloma: a feasibility study

Background

This single-arm study evaluated feasibility, safety, and initial efficacy of electroacupuncture for thalidomide/bortezomib-induced peripheral neuropathy (PN) in cancer patients with multiple myeloma.

Methods

Patients with neuropathy ≥ grade 2 received 20 acupuncture treatments over 9 weeks.

Results

For the 19 evaluable patients, Functional Assessment of Cancer Therapy/Gynecological Oncology Group-Neurotoxicity (FACT/GOG/NTX) mean (SD) scores improved significantly between baseline and week 13 (20.8 [9.6] vs 13.2 [8.5], p = 0.0002). Moderate effect size differences began on week 4, with the largest effect size differences found at week 9 for FACT/GOG/NTX scores, worst pain in the last 24 hours, and pain severity (Cohen’s d = 1.43, 1.19, and 1.08, respectively) and continuing through week 13 (Cohen’s d = 0.86, 0.88, and 0.90, respectively). From baseline to week 13, additional significant improvements were seen as follows: postural stability (1.0 [0.6] vs 0.8 [0.4], p = 0.02); coin test (10.0 [7.4] vs 5.6 [1.9], p < 0.0001); button test (96.1 [144.4] vs 54.9 [47.3], p < 0.0001); and walking test (21.6 [10.0] vs 17.2 [7.7], p = 0.0003). No significant changes were seen with NCS.

Conclusions

Acupuncture may help patients experiencing thalidomide- or bortezomib-induced PN. Larger, randomized, clinical trials are needed.

Trial registration

ClinicalTrials.gov Identifier: NCT00891618.

Acupuncture for treatment of uncontrolled pain in cancer patients: a pragmatic pilot study

PURPOSE

Pain control is an ongoing challenge in the oncology setting. Prior to implementing a large randomized trial at our institution, we investigated the feasibility, safety, and initial efficacy of acupuncture for uncontrolled pain among cancer patients.

HYPOTHESES

Our hypotheses were that the acupuncture treatments provided would be ( : ) feasible, ( : ) safe, and ( : ) a beneficial adjunct to pain management.

STUDY DESIGN

This was a single arm, nonrandomized pragmatic pilot study.

METHODS

Participants experiencing pain ≥4 on a 0 to 10 numeric rating scale received a maximum of 10 treatments on an individualized basis. Recruitment, attrition, compliance, and adverse events (AEs) were assessed. Pain (Brief Pain Inventory-Short Form), quality of life (MD Anderson Symptom Inventory [MDASI]), and patient satisfaction were assessed at baseline and at the end of treatment.

RESULTS

Of 115 patients screened, 52 (45%) were eligible and agreed to participate. Eleven (21%) were lost to follow-up, leaving 41 who completed all study procedures. No AEs were reported. Mean pain SEVERIT: was 6.0 ± 1.3 at baseline and 3.8 ± 2.0 at follow-up ( : < .0001). Pain INTERFERENC: was 6.2 ± 2.3 at baseline and 4.3 ± 2.8 at follow-up ( : < .0011). On the MDASI, the mean symptom SEVERIT: was 4.6 ± 1.8 at baseline and 3.2 ± 1.9 at follow-up ( : < .0001), and mean symptom INTERFERENC: was 5.8 ± 2.4 at baseline and 4.1 ± 2.9 at follow-up ( : < .002). Prescribed pain medications decreased across the course of the study. Patient satisfaction was high: 87% reported that their expectations were met "very well" or "extremely well"; 90% said they were likely to participate again; 95% said they were likely to recommend acupuncture to others; and 90% reported they found the service to be "useful" or "very useful."

CONCLUSIONS

Acupuncture was feasible, safe, and a helpful treatment adjunct for cancer patients experiencing uncontrolled pain in this study. Randomized placebo-controlled trials are needed to confirm these results.

Systematic review of acupuncture in cancer care: a synthesis of the evidence

PURPOSE

Many cancer centers offer acupuncture services. To date, a comprehensive systematic review of acupuncture in cancer care has not been conducted. The purpose of this review was to evaluate the efficacy of acupuncture for symptom management in patients with cancer.

METHODS

Medline, Embase, CINAHL, Cochrane (all databases), Scopus, and PubMed were searched from inception through December 2011 for prospective randomized clinical trials (RCT) evaluating acupuncture for symptom management in cancer care. Only studies involving needle insertion into acupuncture points were included. No language limitations were applied. Studies were assessed for risk of bias (ROB) according to Cochrane criteria. Outcomes by symptom were designated as positive, negative, or unclear.

RESULTS

A total of 2,151 publications were screened. Of those, 41 RCTs involving eight symptoms (pain, nausea, hot flashes, fatigue, radiation-induced xerostomia, prolonged postoperative ileus, anxiety/mood disorders, and sleep disturbance) met all inclusion criteria. One positive trial of acupuncture for chemotherapy-induced nausea and vomiting had low ROB. Of the remaining studies, eight had unclear ROB (four positive, three negative, and one with unclear outcomes). Thirty-three studies had high ROB (19 positive, 11 negative, and three with both positive and negative outcomes depending on the symptom).

CONCLUSION

Acupuncture is an appropriate adjunctive treatment for chemotherapy-induced nausea/vomiting, but additional studies are needed. For other symptoms, efficacy remains undetermined owing to high ROB among studies. Future research should focus on standardizing comparison groups and treatment methods, be at least single-blinded, assess biologic mechanisms, have adequate statistical power, and involve multiple acupuncturists.

Effect of Acupuncture Treatment on the Immune Function Impairment Found in Anxious Women

It is presently accepted that emotional disturbances lead to immune system impairment, and that therefore their treatment could restore the immune response. Thus, the aim of the present work was to study the effect of an acupuncture treatment, designed specifically to relieve the emotional symptoms stemming from anxiety, on several functions (adherence, chemotaxis, phagocytosis, basal and stimulated superoxide anion levels, lymphocyte proliferation in response to phytohemagglutinin A (PHA) and natural killer (NK) activity) of leukocytes (neutrophils and lymphocytes) from anxious women. The acupuncture protocol consisted of manual needle stimulation of 19 acupoints, with each session lasting 30 min. It was performed on 34 female 30–60 year old patients, suffering from anxiety, as determined by the Beck Anxiety Inventory (BAI). Before and 72 hours after receiving the first acupuncture session, peripheral blood samples were drawn. In 12 patients, samples were also collected immediately after the first single acupuncture session and one month after the end of the whole acupuncture treatment, which consisted of 10 sessions during a year, until the complete remission of anxiety. Twenty healthy non-anxious women in the same age range were used as controls. The results showed that the most favorable effects of acupuncture on the immune functions appear 72 hours after the single session and persist one month after the end of the complete treatment. Impaired immune functions in anxious women (chemotaxis, phagocytosis, lymphoproliferation and NK activity) were significantly improved by acupuncture, and augmented immune parameters (superoxide anion levels and lymphoproliferation of the patient subgroup whose values had been too high) were significantly diminished. Acupuncture brought the above mentioned parameters to values closer to those of healthy controls, exerting a modulatory effect on the immune system.

Pain and analgesia in domestic animals

The biggest challenge to the use of analgesic agents in animals is the determination of the efficacy of these agents. In humans, the verbal communication of the alleviation of pain is fundamental to the effective use of analgesics. In animals, the lack of verbal communication not only confounds the diagnosis and characterisation of the experience of pain, but also challenges the evaluation of the analgesic therapy. As animals possess the same neuronal pathways and neurotransmitter receptors as humans, it seems reasonable to expect that their perceptions of painful stimuli will be similar, and this is a basis for the use of laboratory animals for screening of analgesics for human use. However, as the evaluation in the laboratory animal tests is based mainly on behavioural responses, and although some physiological responses do occur, it is often difficult to separate these from stress responses. The use of behavioural responses to evaluate analgesics in a range of species is complicated by the fact that different species show different behaviours to a similar pain stimulus, and different pain stimuli produce different pain responses in the same species. Thus behaviours may be species- and pain-specific and this can complicate analgesic evaluation. As most animals possess similar neuronal mechanisms to humans for pain perception, it is not surprising that the standard human pain control strategies can be applied to animals. For instance, local anaesthetics, opioids, non-steroidal anti-inflammatory drugs (NSAIDs), as well as other analgesics used in humans are all found to be effective for animal use. Differences in metabolism and distribution between various species, as well as financial considerations in larger animals can affect efficacy and thus limit their use. In addition, the use of any drug in a species that may be intended for human consumption will be limited by residue considerations. The treatment of pain in animals presents many challenges, but the increasing public concerns regarding animal welfare will ensure that studies into the nature and control of animal pain will continue to have a high profile.

Effects of electrostimulated acupuncture on ground reaction forces and pain scores in dogs with chronic elbow joint arthritis

OBJECTIVE

To determine whether use of electrostimuluated acupuncture (ESA) would result in significant improvements in ground reaction forces and lameness scores in dogs with chronic elbow joint osteoarthritis secondary to elbow joint dysplasia.

DESIGN

Randomized, controlled, crossover clinical trial.

ANIMALS

9 dogs with chronic forelimb lameness and radiographic evidence of elbow joint osteoarthritis.

PROCEDURES

All dogs had a 3-week control acclimation period during which gait analysis was performed weekly. Dogs then received ESA once weekly for 3 weeks followed by a sham treatment once weekly for 3 weeks or received the sham treatment followed by ESA. Gait analysis was repeated prior to each treatment, and owners were asked to provide pain scores by use of a visual analog scale method.

RESULTS

Treatment (control, acupuncture, or sham) did not have a significant effect on ground reaction forces for any limb. Owners of 8 of the 9 dogs were able to correctly guess the time period when ESA was delivered.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that ESA did not have any significant effects on severity of lameness, as determined by measurement of ground reaction forces, or severity of pain, as determined by visual analog scale pain scores, in dogs with chronic elbow joint osteoarthritis secondary to elbow joint dysplasia.

Pain management in cats--past, present and future. Part 1. The cat is unique

Cats are popular pets but until recently their perioperative and traumatic pain was seriously underestimated and under treated. There are several causes of this under treatment. First, it may be difficult to detect pain in cats, because they do not demonstrate overt pain-associated behaviour. Secondly, there are relatively few analgesic drugs with market authorization for cats. Thirdly, cats have an unfortunate reputation for toxicity from analgesic drugs, particularly opioid-induced mania and classical non steroidal anti inflammatory drug toxicity. Fourthly, cats are deficient in some metabolic pathways used to metabolise analgesic drugs in other species; this may lead to genuine toxicity or to lack of effect. Recently, understanding of feline behaviour and physiology has improved, leading to better clinical management of this enigmatic species. Behavioural methods are proving to be the best means of assessing pain, and knowledge of unique feline physiology has enabled rational treatment protocols to be developed specifically for cats.