Efficacy of Naprapathy in Brachial Plexus Injury: Protocol for a Randomized Clinical Trial

BACKGROUND

Clinical rehabilitation for brachial plexus injury is difficult in terms of chronic pain and dysfunction. Physiotherapy is considered a routine intervention for rehabilitation. Common physical therapy may require a variety of instruments. One approach that does not need instruments, but belongs to the field of complementary and alternative medicine, is naprapathy. Naprapathy, also called Tuina in China, has been applied in rehabilitation after brachial plexus injury for a long time. Naprapathy can relieve chronic neuropathic pain, promote local blood circulation, and improve body edema. Naprapathy can passively help improve motor functions in patients with peripheral nerve injury. However, the efficacy of naprapathy in improving rehabilitation after brachial plexus injury is unclear.

OBJECTIVE

This study aims to evaluate the additional value of naprapathy when combined with conventional physical therapy for the treatment of brachial plexus injury.

METHODS

This will be a single-center randomized controlled trial. A total of 116 eligible patients with brachial plexus injury will be randomly divided into an experimental group (naprapathy plus physical therapy group) or a control group (physical therapy group). The participants will be followed up for 4 weeks of treatment. Observation outcomes will include the visual analog scale score, upper limb index, electromyography findings, and adverse reactions, among others. The measuring points for outcomes will be the baseline and the completion of treatment. In addition, a quality control group independent from the research team will be set up to control the quality of the trial. Finally, the data will be analyzed using SPSS software (version 21.0; IBM Corp).

RESULTS

The study is recruiting participants. The first participant was enrolled in September 2021. As of January 2023, a total of 100 participants have been enrolled. The trial is expected to be completed by September 2023. The study protocol was approved by the Ethics Review Committee of Yue Yang Hospital affiliated with the Shanghai University of Traditional Chinese Medicine (2021-012).

CONCLUSIONS

One limitation of this trial is that we will be unable to achieve strict double-blinding because of the features of naprapathy. The trial aims to contribute reliable evidence for decision-making in naprapathy for treating brachial plexus injury.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2100043515; http://www.chictr.org.cn/showproj.aspx?proj=122154.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/46054.

Effects of heat-sensitive moxibustion combined with naprapathy and warming needle moxibustion combined with naprapathy in patients with periarthritis of shoulder

OBJECTIVE

To evaluate the effects of heat-sensitive moxibustion (HSM) combined with naprapathy and warming needle moxibustion (WNM) combined with naprapathy on shoulder function and serum levels of calcitonin gene-related peptide (CGRP), substance P (SP), tumor necrosis factor-α (TNF-α) and interleukin-2 (IL-2) in patients with periarthritis of shoulder (POS).

METHODS

From July 2017 to July 2020, sixty patients with POS admitted to our hospital were selected as the study subjects, and divided into HSM group (n=29) receiving HSM combined with naprapathy and WNM group receiving WNM combined with naprapathy (n=31). The changes in shoulder function, degrees of pain and serum levels of CGRP, SP, TNF-α and IL-2 were compared between the two groups.

RESULTS

After treatment, the scores of myodynamia, pain, range of motion (ROM) of shoulder joint and activities of daily living (ADLs) were improved in both groups (P<0.05), and the scores in HSM group were remarkably higher than those in WNM group (P<0.05). Visual analogue scale (VAS) scores after 3 courses of treatment were lower than those after 1 and 2 courses of treatment respectively (P<0.05), and the VAS scores in HSM group were markedly lower than those in WNM group after 1, 2, and 3 courses of treatment (P<0.05). After treatment, the serum levels of CGRP, SP, TNF-α and IL-2 were decreased in both groups (P<0.05), and the levels in HSM group were noticeably lower than those in WNM group (P<0.05).

CONCLUSION

HSM combined with naprapathy is superior to WNM combined with naprapathy in inhibition of inflammatory factors of pain and serum inflammatory factors, alleviating the pain and promoting the restoration of shoulder function in patients with POS.

Naprapathy attenuates neuropathic pain after brachial plexus injury

BACKGROUND

This study was to explore the potential mechanism of naprapathy in treating neuropathic pain (NP) after brachial plexus injury (BPI).

METHODS

Totally 72 rats were randomly divided into normal group, model control group, and naprapathy group (n=24 per group). A right upper-limb chronic NP model was established, and naprapathy was administered at C5-T1 Jiaji Points on 4th day after modeling. Naprapathy was performed for 15 min once daily with a frequency of 60 per minute. The treatment was applied for altogether 28 days. Cold pain threshold and mechanical pain threshold were measured 1 day before modeling, 3 days after modeling, and 7, 14, 21 and 28 days after naprapathy; 7, 14, 21 and 28 days after naprapathy, rats were killed and the β-endorphin expression and γ-aminobutyric acid (GABA) content were detected in the thalamus.

RESULTS

After 14-day treatment, there was significant difference of mechanical pain threshold between the naprapathy group and the normal group (P<0.05); after treatment for 21 and 28 days, there was no significant difference between the naprapathy group and the normal group (P>0.05); after 28-day naprapathy, there was significant difference of β-EP expression between the normal group and the naprapathy group (P<0.05), while the difference between model control group and naprapathy group was statistically significant (P<0.05). After 14-day treatment, there was significant difference of GABA content between the model control group and the naprapathy group (P<0.05). After 28-day treatment, significant difference was also found between the model control group and the naprapathy group (P<0.05).

CONCLUSIONS

After naprapathy, chronic NP is attenuated in rats with BPI, which might be ascribed to the upregulation of β-endorphin and GABA.