Scalp electroacupuncture targeting the VTADA neurons to relieve negative emotions and promote the alleviation of chronic pain

Object

Chronic pain and negative emotions are often linked, and both can impact the reward circuit. The use of electroacupuncture (EA) has been found to regulate and improve these conditions. This study explores the potential mechanism of chronic pain relief by adding acupoints with emotional regulation effect to the basis of routine EA analgesia, to optimize the acupoint compatibility scheme of EA in the treatment of analgesia.

Method

For this study, 42 male Wistar rats were used. Recombinant adeno-associated viruses were used to label and regulate the activity of dopamine (DA) neurons. The rat model was established by complete Freund's adjuvant (CFA). Lower limb electroacupuncture (LEA) was applied to the ST36 and BL60 acupoints. In addition, LEA + scalp EA (SEA) was given using the GV20 and GV24+ acupoints besides ST36 and BL60. To evaluate the pain threshold, we measured 50% paw withdrawal thresholds and thermal paw withdrawal latencies. Negative emotions were evaluated through the open field test, marble-burying test, sucrose preference test, and forced swimming test. Moreover, the conditional place preference test was conducted to measure the reward behavior in response to pain relief. Immunofluorescence staining, Western blotting, and qPCR were used to detect the activity of the VTADA-NAc reward circuit.

Result

The injection of CFA significantly lowered the pain threshold. As the pain persisted, the anxiety and depression-like behaviors escalated while the response to reward reduced. Meanwhile, the VTADA-NAc pathway was suppressed with pain chronification. However, activating DA neurons in VTA attenuated the effects induced by CFA. LEA could relieve chronic pain, negative emotions, and reward disorders, while also activating the VTADA-NAc pathway. In addition, LEA + SEA exhibited a more pronounced effect compared with LEA alone. Nevertheless, chemogenetic inhibition of DA neurons decreased the efficacy of LEA + SEA in the treatment of chronic pain and associated comorbidities.

Conclusion

Adding SEA to conventional LEA effectively alleviates negative emotions and chronic pain, potentially due to the activation of the VTADA-NAc reward neural circuit. Thus, LEA + SEA is a more effective treatment for hyperalgesia and associated negative emotions compared with LEA alone.

Characteristics of Acupoint Selection and Therapeutic Effect Analysis of Acupuncture Treatment for Patients with Chronic Kidney Disease

OBJECTIVES

The therapeutic effect of acupuncture treatment on chronic kidney disease (CKD) was assessed, and the characteristics of acupoint selection in different CKD types were summarised.

METHODS

A total of 100 patients with CKD were enrolled in this retrospective cohort study, of whom 50 received acupuncture treatment for 12 weeks (acupuncture group) and 50 received routine treatment for 12 weeks (control group). Routine treatment included appropriate rest, low-salt and low-protein diet and correction of the disturbance in water, electrolyte and acid-base balance. Hypertensive patients received antihypertensive treatment, and patients with hyperuricaemia received uric acid lowering treatment. Acupuncture acupoints were selected in accordance with traditional Chinese medicine (TCM) theory. Baseline characteristics, therapeutic effects and adverse events were assessed, and kidney function indexes, urine albumin creatine ratios (UACRs) and estimated glomerular filtration rates (eGFRs) were compared at different time points (before acupuncture treatment, T1; Immediately after acupuncture treatment, T2; After 3 months of follow-up, T3).

RESULTS

The baseline data were slightly different between the groups (p > 0.05), specifically gender, age, duration time, TCM syndrome, CKD stage, systolic blood pressure (SBP), diastolic blood pressure (DBP), and cholesterol, triglyceride, low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). The acupuncture group presented better therapeutic effects than the control group (82.00% vs. 60.00%, p = 0.015). At T2 or T3, the value of UACR in both groups obviously decreased (p < 0.05), whereas the eGFRs markedly increased (p < 0.05). In addition, at T2 or T3, the UACRs were significantly lower in the acupuncture group than in the control group (p < 0.01), whereas an opposite result was obtained for eGFR (p < 0.05). The adverse event rate barely differed between the groups (8.00% vs. 6.00%, p = 0.695).

CONCLUSIONS

Acupuncture treatment can effectively treat CKD and can improve kidney function. This study provides a theoretical basis for clinical application.

[Acupoint selection for cancer pain: based on current evidence and Delphi method]

Based on literature research and Delphi expert consensus method, the important acupoints for cancer pain was summarized to provide evidence basis for the formulation of Clinical Practice Guide of Acupuncture in the Treatment of Cancer Pain. Through systematic search of Chinese and English databases, 28 clinical studies regarding acupuncture for cancer pain were included. The acupoint selection methods and high-frequency acupoints were summarized and analyzed. Based on this, a Delphi questionnaire was designed and two rounds of questionnaire survey on 30 experts in acupuncture and tumor related fields in China and abroad were conducted. As a result, it was suggested that the individualized acupoint selection should be adopted for acupuncture treatment of cancer pain, with Zusanli (ST 36), Hegu (LI 4), Taichong (LR 3), Sanyinjiao (SP 6), Yanglingquan (GB 34) and ashi points as the main acupoints. Combined with clinical research evidence and expert consensus, the important acupoints for cancer pain were identified. However, clinical acupoint selection still needed further research and refinement.

Optimal acupoint and session of acupuncture for patients with chronic prostatitis/chronic pelvic pain syndrome: a meta-analysis

Background

The study aims to perform a meta-analysis of published trials and evaluate the efficacy of acupuncture on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) by symptom score reduction, optimal acupuncture session, and most frequently used acupoints.

Methods

A literature search was performed for randomized controlled trials (RCTs) comparing efficacy of acupuncture with sham acupuncture or standard medication on CP/CPPS. The primary outcome was the reduction of National Institute of Health-Chronic Prostatitis Index (NIH-CPSI) total score and its subscales. The optimal acupuncture session to reach its clinical efficacy and most common compatibility rule of acupoints were also evaluated.

Results

Ten trials involving 770 participants were included. Meta-analysis showed compared with sham acupuncture, acupuncture yielded significant reduction in NIH-CPSI total score [weighted mean difference (WMD): 7.28, 95% confidence interval (95% CI): 5.69-8.86), and provided better pain relief (WMD: 3.57, 95% CI: 2.07-5.08), urinary symptoms improvement (WMD: 1.68, 95% CI: 1.13-2.22), and quality of life (QOL) (WMD: 2.38, 95% CI: 1.41-3.36). Compared with standard medication, acupuncture were more efficacious in reducing NIH-CPSI total score (WMD: 3.36, 95% CI: 1.27-5.45), also showed significant greater pain relief (WMD: 2.36, 95% CI: 1.67-3.06), marginal advantage in improving QOL (WMD: 0.98, 95% CI: 0.12-1.83) but no difference in reducing urinary symptom (WMD: -0.03, 95% CI: -1.30 to 1.24). Four acupuncture sessions were the minimum "dose" to reach clinical efficacy, and prolonged acupuncture sessions continuously improved urinary symptoms and QOL. The majority of acupoint selection strategies were based on the combination of any three acupoints from CV3, CV4, BL32, SP6, and SP9.

Conclusions

Acupuncture has promising efficacy for patients with CP/CPPS, especially category IIIB, in aspects of relieving pain and urinary symptoms and improving the QOL. Acupuncture may serve as a standard treatment option when available, and a tailored comprehensive treatment strategy for CP/CPPS is the future trend.

[Analysis of acupoint selection of plaster therapy in treatment of stable chronic obstructive pulmonary disease based on data mining]

This article analyze acupoint selection and characteristics of plaster therapy for stable chronic obstructive pulmonary di-sease(COPD) by data mining. The CNKI, VIP, CBM, WanFang, PubMed, EMbase, Cochrane Library were retrieved for collecting clinical studies of plaster therapy for stable COPD. After literature screening, a total of 46 systematic reviews were included. Frequency statistics, cluster analysis, and Apriori correlation analysis were used to analyze the pattern and characteristics of plaster therapy for stable COPD. The result showed that the main acupoints for stable COPD were BL13, Dingchuan, CV22, BL23 and BL20. The acupoints used are mainly concentrated on the chest and back. The most frequently used meridian is the bladder meridian. Analysis of the acupoints yielded 27 correlation rules. And cluster analysis grouped the high frequency acupoints into 5 categories. The results of the study showed that the current choice of acupoints is rather concentrated. &quot;Local acupuncture points&quot; and &quot;matching points with front and back&quot; were the main acupoint selection rules. The choice of acupuncture points reflected the traditional Chinese medicine treatment principle of strengthening healthy Qi to eliminate pathogenic factor, treating both manifestation and root cause of disease, and preventing measure taken after the occurrence of disease.

Acupoint selection for the treatment of dry eye: A systematic review and meta-analysis of randomized controlled trials

The effectiveness of acupuncture in the treatment of dry eye has been confirmed, but the association between acupoint selection and therapeutic effect has remained to be elucidated. In the present study, a systematic review and meta-analysis were performed to evaluate the effect of periocular acupoints and periocular acupoints plus body acupoints compared with AT for the treatment of dry eye disease (DED). The PubMed, Cochrane Library, Embase, Ovid, China National Knowledge Infrastructure and Chonqing VIP Information, Co., Ltd. databases were searched with entries until 10 July 2018 considered. Only randomized controlled trials (RCTs) were included. Meta-analyses were performed to compare the effects of acupuncture with those of conventional treatment (including AT or other non-acupuncture therapies). The primary outcomes, including tear break-up time (BUT), Schirmer's I test (SIT) result and Symptom scores were analyzed. Subgroup analysis was performed for periocular acupoints only and periocular acupoints plus body acupoints. A total of 12 studies comprising 900 participants were included. In the primary meta-analysis, a significant improvement in the BUT [n=1,209, weighted mean difference (WMD)=1.01, 95% CI: 0.56-1.84, P<0.00001], SIT result (n=1,107, WMD=1.98, 95% CI: 0.44-3.34, P<0.00001) and Symptom scores (n=402, WMD=-1.02, 95% CI: -1.33 to -0.72, P<0.00001) was obtained to evaluate the clinical efficacy of acupuncture and AT. Furthermore, periocular acupoints plus body acupoints were more effective in the treatment of DED. However, the total sample size of subjects with only periocular acupoints in the treatment of DED was too small to get any firm conclusions. Further large RCTs are warranted.

[The rules of acupoint selection of acupuncture for dry eye]

The rules of acupoint selection of acupuncture for dry eye in recent 10 years were summarized to provide reference for clinical treatment. The clinical researches regarding acupuncture for dry eye published from May 5, 2007 to December 1, 2017 were searched in CNKI, WANFANG and VIP database. The acupoint and meridian used and application frequency were analyzed to summarize the rules of acupoint selection. Totally, 52 related clinical papers were collected, involving 60 acupoints, 14 meridians and 5 extra point. The total frequency of acupoints was 541, which were mainly related with the bladder meridian, stomach meridian and gallbladder meridian. In conclusion, the rules of acupoint selection of acupuncture for dry eye highlighted meridians circulation, acupoint combination, and syndrome differentiation.

[Analysis on standardization of patient posture for acupuncture treatment]

The standardization of patient posture for acupuncture treatment was discussed. According to the opinions in Neijing (Inner Canon of Huangdi), combined with the clinical practice of acupuncture, it was believed that the patient posture for acupuncture treatment should be standardized based on Neijing. The standardized patient posture was the foundation of acupuncture, the need of blood flow and requirement of acupuncture technique. The combination of three elements was beneficial for the traveling of spirit-qi through meridian-acupoint, which could regulate balance of yin and yang to treat disease. In addition, the principles and methods of standardization of patient posture was proposed, and the important clinical significance of standardization of patient posture for acupuncture treatment was highlighted.

[Professor WANG Fuchun's experience in the acupoint selection of clinical treatment with acupuncture and moxibustion]

Professor WANG Fuchun's experience in the acupoint selection of clinical treatment with acupuncture and moxibustion was summarized. The main acupoints are selected by focusing on the chief symptoms of disease, the supplementary points are selected by differentiating the disorders. The acupoints are modified in terms of the changes of sickness. The effective acupoints are selected flexibly in accordance with the specific effects of points. The summary on the acupoint selection reflects professor WANG Fuchun's academic thoughts and clinical experience and effectively instructs the clinical practice of acupuncture and moxibustion.