NTPDase1-ATP-P2Y2Rs axis in the sciatic nerve contributes to acupuncture at "Zusanli" (ST36)-induced analgesia in ankle arthritis rats

BACKGROUND

The efficacy of acupuncture at Zusanli (ST36) in alleviating lower-limb pain is widely acknowledged in clinical practice, while its underlying mechanism remains incompletely elucidated. Our previous research had revealed that the prompt analgesia induced by needling-ST36 was accompanied by expression alterations in certain exco-nucleotidases within the sciatic nerve. Building upon this finding, the current work focused on NTPDase1, the primary ecto-nucleotidase in the human body, which converts ATP into AMP.

METHODS

A 20-min acupuncture was administered unilaterally at the ST36 on rats with acute ankle arthritis. The pain thresholds of the injured hind paws were determined. Pharmacological interference was carried out by introducing the corresponding reagents to the sciatic nerve. ATP levels around the excised nerve were measured using a luciferase-luciferin assay. Live calcium imaging, utilizing the Fura 2-related-F340/F380 ratio, was conducted on Schwann cells in excised nerves and cultured rat SCs line, RSC96 cells.

RESULTS

The analgesic effect induced by needling-ST36 was impaired when preventing ATP degradation via inhibiting NTPDase1 activities with ARL67156 or Ticlopidine. Conversely, increasing NTPDase1 activities with Apyrase duplicated the acupuncture effect. Similarly, preventing the conversion of AMP to adenosine via suppression of NT5E with AMP-CP hindered the acupuncture effect. Unexpectedly, impeded ATP hydrolysis ability and diminished NTPDase1 expression were observed in the treated group. Agonism at P2Y2Rs with ATP, UTP, or INS365 resulted in anti-nociception. Contrarily, antagonism at P2Y2Rs with Suramin or AR-C 118925xx prevented acupuncture analgesia. Immunofluorescent labeling demonstrated that the treated rats expressed more P2Y2Rs that were predominant in Schwann cells. Suppression of Schwann cells by inhibiting ErbB receptors also prevented acupuncture analgesia. Finally, living imaging on the excised nerves or RSC96 cells showed that agonism at P2Y2Rs indeed led to [Ca2+]i rise.

CONCLUSION

These findings strongly suggest that the analgesic mechanism of needling-ST36 on the hypersensation in the lower limb partially relies on NTPDase1 activities in the sciatic nerve. In addition to facilitating adenosine signaling in conjunction with NT5E, most importantly, NTPDase1 may provide an appropriate low-level ATP milieu for the activation of P2Y2R in the sciatic nerve, particularly in Schwann cells.

Caffeine Impaired Acupuncture Analgesia in Inflammatory Pain by Blocking Adenosine A1 Receptor

Caffeine consumption inhibits acupuncture analgesic effects by blocking adenosine signaling. However, existing evidence remains controversial. Hence, this study aimed to examine the adenosine A1 receptor (A1R) role in moderate-dose caffeine-induced abolishing effect on acupuncture analgesia using A1R knockout mice (A1R-/-). We assessed the role of A1R in physiological sensory perception and its interaction with caffeine by measuring mechanical and thermal pain thresholds and administering A1R and adenosine 2A receptor antagonists in wild-type (WT) and A1R-/- mice. Formalin- and complete Freund's adjuvant (CFA)-induced inflammatory pain models were recruited to explore moderate-dose caffeine effect on pain perception and acupuncture analgesia in WT and A1R-/- mice. Moreover, a C-fiber reflex electromyogram in the biceps femoris was conducted to validate the role of A1R in the caffeine-induced blockade of acupuncture analgesia. We found that A1R was dispensable for physiological sensory perception and formalin- and CFA-induced hypersensitivity. However, genetic deletion of A1R impaired the antinociceptive effect of acupuncture in A1R-/- mice under physiological or inflammatory pain conditions. Acute moderate-dose caffeine administration induced mechanical and thermal hyperalgesia under physiological conditions but not in formalin- and CFA-induced inflammatory pain. Moreover, caffeine significantly inhibited electroacupuncture (EA) analgesia in physiological and inflammatory pain in WT mice, comparable to that of A1R antagonists. Conversely, A1R deletion impaired the EA analgesic effect and decreased the caffeine-induced inhibitory effect on EA analgesia in physiological conditions and inflammatory pain. Moderate-dose caffeine administration diminished the EA-induced antinociceptive effect by blocking A1R. Overall, our study suggested that caffeine consumption should be avoided during acupuncture treatment. PERSPECTIVE: Moderate-dose caffeine injection attenuated EA-induced antinociceptive effect in formalin- and CFA-induced inflammatory pain mice models by blocking A1R. This highlights the importance of monitoring caffeine intake during acupuncture treatment.

Understanding acupuncture anesthesia from a foreign perspective： reviewing Acupuncture Anesthesia in the People's Republic of China

"Acupuncture Anesthesia in the People's Republic of China： A Trip Report of the American Acupuncture Anesthesia Study Group" (Report for short) is the first extraterritorial systematic investigation and evaluation report in the history of acupuncture anesthesia in China. After Report was released to the public, it has not drawn much attention in China. At the moment when acupuncture anesthesia is extended to perioperative treatment, by reviewing the Report, the differences in understanding acupuncture anesthesia were analyzed from a foreign perspective. Report involves the clinical observation of surgery under acupuncture anesthesia, the analysis on the factors of acupuncture anesthesia in therapeutic effects and the relevant mechanisms, and the differences in the research methods and foci on the recognition of acupuncture anesthesia between China and foreign countries. In association with the development of acupuncture anesthesia during the past 65 years and the conclusion in Report, the paper briefly describes the development and perfection of acupuncture anesthesia, the historical verification to the conclusions in Report and the limitations in modern acupuncture anesthesia. It provides some inspiration for the development of acupuncture anesthesia, acupuncture-moxibustion medicine and life science in the future.

Advances in the study of endocannabinoid receptors in experimental acupuncture analgesia

The endocannabinoid system, an important biological network for maintaining and balancing various functions of the human body, is involved in many physiological functions such as pain, emotion, learning and memory, etc. Among which the endocannabinoid receptors ［including type I (CB1) and type II (CB2) receptors］ play an important role in the regulation of pain and have become an important target in the mechanism research of acupuncture analgesia. CB1 is mainly distributed in the central nervous system, including the spinal cord, cerebral cortex, amygdala, insular cortex, and basal ganglia, etc. CB2 is mainly distributed in peripheral immune tissues, such as spleen, bone, skin, etc. In the central and peripheral nervous systems, acupuncture can activate CB1 and CB2 receptors respectively, which is involved in the transmission of central nociceptive signals and related transmitters as well as the peri-pheral pro-nociceptive inflammatory response, thereby alleviating the nociceptive hypersensitivity in animal models. In this paper, we systematically summarize the roles of the above mechanisms in different types of animal models (inflammatory pain, neuropathological pain, visceral pain, etc.), so as to provide new ideas for the study of the underlying mechanisms of acupuncture analgesia.

Local analgesia of electroacupuncture is mediated by the recruitment of neutrophils and released β-endorphins

ABSTRACT

The efficacy of acupuncture in treating pain diseases has been recognized in clinical practice, and its mechanism of action has been a hot topic in academic acupuncture research. Previous basic research on acupuncture analgesia has focused mostly on the nervous system, with few studies addressing the immune system as a potential pathway of acupuncture analgesia. In this study, we investigated the effect of electroacupuncture (EA) on the β-endorphins (β-END) content, END-containing leukocyte type and number, sympathetic neurotransmitter norepinephrine (NE), and chemokine gene expression in inflamed tissues. To induce inflammatory pain, about 200 µL of complete Frester adjuvant (CFA) was injected into the unilateral medial femoral muscle of adult Wistar rats. Electroacupuncture treatment was performed for 3 days beginning on day 4 after CFA injection, with parameters of 2/100 Hz, 2 mA, and 30 minutes per treatment. The weight-bearing experiment and enzyme-linked immunosorbent assay showed that EA treatment significantly relieved spontaneous pain-like behaviors and increased the level of β-END in inflamed tissue. Injection of anti-END antibody in inflamed tissue blocked this analgesic effect. Flow cytometry and immunofluorescence staining revealed that the EA-induced increase in β-END was derived from opioid-containing ICAM-1 + /CD11b + immune cells in inflamed tissue. In addition, EA treatment increased the NE content and expression of β2 adrenergic receptor (ADR-β2) in inflammatory tissues and upregulated Cxcl1 and Cxcl6 gene expression levels. These findings provide new evidence for the peripheral analgesic effect of acupuncture treatment by recruiting β-END-containing ICAM-1 + /CD11b + immune cells and increasing the β-END content at the site of inflammation.

[Progress of the application research of modern acupuncture anesthesia in perioperative period of thoracic surgery]

Modern acupuncture anesthesia is the application of acupuncture-related therapies to optimize the perioperative management which is based on the combined acupuncture-medicine anesthesia technology, and building a perioperative acupuncture anesthesia accelerated rehabilitation system. Based on the thoracic surgery, this paper analyzes and summarizes the application effects of modern acupuncture anesthesia, focusing on preoperative anxiety relief and advanced analgesia； reduce the dosage of anesthetics, stable respiration and hemodynamics, anti-stress and organ protection during surgery； postoperative analgesia, prevention of nausea, vomiting and cognitive impairment, improvement of gastrointestinal function, prevention of cognitive impairment, and enhancement of immunity. It is anticipated that this review may provide a basis for the further promotion and application of modern acupuncture anesthesia in clinical practice.

The real-time detection of acupuncture-induced extracellular ATP mobilization in acupoints and exploration of its role in acupuncture analgesia

Our and in vitro studies had confirmed that mechanosensitive ATP release and accumulation in acupoints was elicited by acupuncture (AP), which might be a pivotal step for triggering AP analgesia. But to date, the dynamics of extracellular ATP (eATP) in the interstitial space during AP process was poorly known, mainly due to the low temporal resolution of the current detection approach. This study attempted to capture rapid eATP signals in vivo in the process of needling, and further explored the role of this eATP mobilization in initiating AP analgesic effect. Ipsilateral 20-min needling was applied on Zusanli acupoint (ST36) of complete Freund's adjuvant (CFA)-induced ankle arthritis rats. Pain thresholds were assessed in injured-side hindpaws. eATP in the interstitial space was microdialyzed and real-time quantified by luciferin-luciferase assay at 1-min interval with the aid of the microfluid chip. We revealed in behavioral tests that modulation of eATP levels in ST36 influenced AP analgesic effect on ankle arthritis. A transient eATP accumulation was induced by needling that started to mobilize at 4 min, climbed to the peak of 11.21 nM within 3.25 min and gradually recovered. Such AP-induced eATP mobilization was significantly impacted by ankle inflammation, needling depth, needle manipulation, and the presence of local ecto-nucleotidases. This work reveals that needling elicits a transient eATP mobilization in acupoints, which contributes to initiating AP analgesia. This study will help us better understand the peripheral mechanism of AP analgesia and guide clinicians to optimize the needle manipulations to improve AP efficacy.

Laser Acupuncture Analgesia on Postpartum Low Back Pain: A Prospective Randomized Controlled Study

BACKGROUND

Unresolved postpartum LBP may affect women...s physical and psychological health.

AIM

To investigate the analgesic effects of laser acupuncture therapy (LAT) for postpartum LBP.

METHOD

Postpartum women with LBP were recruited and randomly assigned to the intervention group or the control group from November 2017 to July 2018. The participants in the intervention group received LAT and standard care. The participants in the control group received only standard care. The primary outcome was the Visual Analogue Scale for LBP. Secondary outcomes were limitation of daily activities and physical activity; perceived stress scale; and salivary cortisol values.

RESULTS

In all, 106 participants were recruited and assigned to the intervention group or the control group. As compared with the control group, the participants in the LAT group had significantly lower intensity of LBP (mean ± SD: 1.21 ± 0.99 vs 3.25 ± 1.14; p < .001), limitations of daily activities (mean ± SD: 3.17 ± 2.09 vs 10.40 ± 4.72; p < .001) and physical activity (mean ± SD: 3.04 ± 2.17 vs 9.79 ± 4.71; p < .001), perceived stress (mean ± SD: 26.13 ± 3.97 vs 28.85 ± 4.26; p = .001), and salivary cortisol levels (mean ± SD: 0.194 ± 0.131 vs 0.280 ± 0.234; p = .02) post-intervention.

CONCLUSIONS

For postpartum LBP, LAT combined with standard care had greater analgesic efficacy, lower perceived stress, lower limitations of daily activities and physical activity, and lower salivary cortisol levels than standard care alone.

Combined acupuncture-medicine anesthesia used in thyroid surgery: A systematic review and meta-analysis

BACKGROUND

Combined acupuncture-medicine anesthesia (CAMA) is extensively used in thyroid surgery in China. We conducted a systematic review and meta-analysis to assess the efficacy and safety of CAMA.

METHODS

We searched the China National Knowledge Infrastructure (CNKI), VIP database, WanFang database, PubMed, EMBASE, and the Cochrane Library for relevant literature. The term of literature was published before April 18, 2020, and there were no restrictions on publication language, region, or publication year. The inclusion criteria included a randomized controlled trial (RCT) of acupuncture combined with cervical plexus anesthesia. We used RevMan5.3 software for data analysis. If the chi-square test showed no significant heterogeneity (P > .10, I2 < 50%), we used the fixed-effect model to calculate risk ratio (RR) and mean difference. Otherwise, the random-effects model was used.

RESULTS

Overall, 18 RCTs involving 1211 patients were included in the study. The anesthesia significant rate (ASR) in the transcutaneous electrical acupoint stimulation (TEAS) plus cervical plexus block anesthesia (CPBA) and electroacupuncture (EA) plus CPBA groups was significantly higher compared with the CPBA group (TEAS + CPBA: P < .001; EA + CPBA: P < .001). The pooled effect values of the intraoperative heart rate (HR) and mean arterial pressure (MAP) were significantly lower in both the TEAS + CPBA and EA + CPBA groups relative to the control group (HR: P = .05, P < .001; the MAP: P = .002, P < .001; respectively). Moreover, the postoperative adverse reaction was markedly lower in the experimental group than in the control group (RR = 0.30, P < .001), and there was no heterogeneity between the two groups (P = .71, I2 = 0%).

CONCLUSION

Combined acupuncture-medicine anesthesia significantly increases the anesthesia significance rate, reduces the intraoperative heart rate, and blood pressure, and reduces the incidence of postoperative adverse reactions. However, more high-quality future studies should be conducted to validate the efficacy and safety of acupuncture combined anesthesia further.

Mechanisms of acupuncture-electroacupuncture on inflammatory pain

Acupuncture, as a traditional treatment, has been extensively used in China for thousands of years. According to the World Health Organization (WHO), acupuncture is recommended for the treatment of 77 diseases. And 16 of these diseases are related to inflammatory pain. As a combination of traditional acupuncture and modern electrotherapy, electroacupuncture (EA) has satisfactory analgesic effects on various acute and chronic pain. Because of its good analgesic effects and no side effects, acupuncture has been widely accepted all over the world. Despite the increase in the number of studies, the mechanisms via which acupuncture exerts its analgesic effects have not been conclusively established. A literature review of related research is of great significance to elaborate on its mechanisms and to inform on further research directions. We elucidated on its mechanisms of action on inflammatory pain from two levels: peripheral and central. It includes the mechanisms of acupuncture in the periphery (immune cells and neurons, purinergic pathway, nociceptive ion channel, cannabinoid receptor and endogenous opioid peptide system) and central nervous system (TPRV1, glutamate and its receptors, glial cells, GABAergic interneurons and signaling molecules). In this review, we collected relevant recent studies to systematically explain the mechanisms of acupuncture in treating inflammatory pain, with a view to providing direction for future applications of acupuncture in inflammatory pain and promoting clinical development.

[Research progress of neuroendocrine mechanism of acupuncture for dyspnea]

The paper reviewed the relevant studies on dyspnea treated with acupuncture over the past 20 years, as well as the underlying neuroendocrine mechanism from the perspective of central and peripheral vagus nerves, neurotransmitter, respiratory muscle function and anti-depression-anxiety function. It revealed that the central response area was regulated by acupuncture in treatment of dyspnea, which is similar to the area affected in acupuncture analgesia. Additionally, acupuncture generates its therapeutic effects on dyspnea through promoting the release of endogenous opioid peptides and the regulation of autonomic nerve, amygdale and hypothalamic-pituitary-adrenal axis.

[New perspective of acupuncture analgesia: reward of chronic pain relief and related brain reward circuits]

Relief of the chronic pain, as the negative reinforcement of pain, is recognized as a reward and it activates related brain's reward circultries. Brian's reward circuits not only relate to rewards, but also participate in pain process. Currently, the reward effect of acupuncture on chronic pain relief and the mechanism of brain's reward circuits involved in acupuncture analgeisa have not been revealed adequately yet. This paper reviewed the conceptual features of analgesia reward and the new progression of brain's reward circuits and function, expounded the valuable clinical and scientific significance of the researches for the reward effect of acupuncture analgesia and related brain's reward circuits, proposed the ideas and suggestions on many questions in the study of reward effect of acupuncture analgesia and related brain's reward circuits, and then, determined the multi-dimensional characteristis and positive regulation of acupuncture analgesia. Focusing on the reward effect of acupuncture and related brain's reward circuits for chronic pain relief, the research on the regulatory effect of acupuncture analgesia will be conductive to deepen the understanding of acupuncture analgies in clinical practice and innovate a research concept of acupuncture analgeis. Eventually, a new approach can be provided to further elaborate neurobiolgical mechanism of acupuncture analgesia.

Predictors of Pain Reduction in Trials of Interventions for Aromatase Inhibitor-Associated Musculoskeletal Symptoms

Background

Almost one-half of aromatase inhibitor (AI)-treated breast cancer patients experience AI-associated musculoskeletal symptoms (AIMSS); 20%-30% discontinue treatment because of severe symptoms. We hypothesized that we could identify predictors of pain reduction in AIMSS intervention trials by combining data from previously conducted trials.

Methods

We pooled patient-level data from 3 randomized trials testing interventions (omega-3 fatty acids, acupuncture, and duloxetine) for AIMSS that had similar eligibility criteria and the same patient-reported outcome measures. Only patients with a baseline Brief Pain Inventory average pain score of at least 4 of 10 were included. The primary outcome examined was 2-point reduction in average pain from baseline to week 12. Variable cut-point selection and logistic regression were used. Risk models were built by summing the number of factors statistically significantly associated with pain reduction. Analyses were stratified by study and adjusted for treatment arm.

Results

For the 583 analyzed patients, the 4 factors statistically significantly associated with pain reduction were Functional Assessment of Cancer Therapy Functional Well-Being greater than 24 and Physical Well-Being greater than 14 (higher scores reflect better function), and Western Ontario and McMaster Universities Osteoarthritis Index less than 50 and Modified Score for the Assessment and Quantification of Chronic Rheumatoid Affections of the Hands less than 33 (lower scores reflect less pain). Patients with all 4 factors were greater than 6 times more likely to experience at least a 2-point pain reduction (odds ratio = 6.37, 95% confidence interval = 2.31 to 17.53, 2-sided P < .001); similar results were found for secondary 30% and 50% pain reduction endpoints.

Conclusions

Patients with AIMSS who have lower symptom and functional distress at study entry on AIMSS intervention trials are more likely to experience meaningful pain reduction. Baseline symptom and functional status should be considered as stratification factors in future interventional trials.

Effect of Acupuncture on Diabetic Neuropathy: A Narrative Review

Diabetic neuropathy, a major complication of diabetes mellitus, refers to a collection of clinically diverse disorders affecting the nervous system that may present with pain. Although the number of patients suffering from severe neuropathy is increasing, no optimal treatment method has been developed yet. Acupuncture is well known for its ability to reduce various kinds of pain, and a number of studies have also reported its effect on diabetes mellitus; however, its effect and underlying mechanism against diabetic neuropathy are not yet clearly understood. In this review, ten and five studies performed in humans and animals, respectively, were analyzed. All studies reported that acupuncture significantly relieved diabetic neuropathy. ST36, BL13, BL20, SP6, and SP9 were the most widely used acupoints. Five studies used electro-acupuncture, whereas other studies used manual acupuncture. Furthermore, the effect of acupuncture was shown to be mediated through the various molecules present in the peripheral nerves and spinal cord, such as P65, GPR78, and TRPV1. Five studies reported side effects, such as swelling, numbness, and nausea, but none were reported to be serious. Based on these results, we suggest that acupuncture should be considered as a treatment option for diabetic neuropathy.

The Role of Skin Mast Cells in Acupuncture Induced Analgesia in Animals: A Preclinical Systematic Review and Meta-analysis

While mast cells (MCs) are previously well-known as a pathological indicator of pain, their role in alleviating pain is recently emerged in acupuncture research. Thus, this study systematically reviews the role of MC in acupuncture analgesia. Animal studies on MC changes associated with the acupuncture analgesia were searched in PubMed and EMBASE. The MC number, degranulation ratio and pain threshold changes were collected as outcome measures for meta-analyses. Twenty studies were included with 13 suitable for meta-analysis, most with a moderate risk of bias. A significant MC degranulation after acupuncture was indicated in the normal and was significantly higher in the pain model. In the subgroup analysis by acupuncture type, manual (MA) and electrical (EA, each P < .00001) but not sham acupuncture had significant MC degranulation. Meta-regression revealed the linear proportionality between MC degranulation and acupuncture-induced analgesia (P < .001), which was found essential in MA (P < .00001), but not in EA (P = .45). MC mediators, such as adenosine and histamine, are involved in its mechanism. Taken together, skin MC is an essential factor for acupuncture-induced analgesia, which reveals a new aspect of MC as a pain alleviator. However, its molecular mechanism requires further study. PERSPECTIVE: This systematic review synthesizes data from studies that examined the contribution of skin MC in acupuncture analgesia. Current reports suggest a new role for skin MC and its mediators in pain alleviation and explain a peripheral mechanism of acupuncture analgesia, with suggesting the need of further studies to confirm these findings.

Acupuncture Anesthesia on American Bodies: Communism, Race, and the Cold War in the Making of "Legitimate" Medical Science

This article explores the brief American fascination with acupuncture anesthesia, a technique in which needling was used in place of, or in combination with, chemical anesthetics during surgery. In 1971, a series of American medical delegations began traveling to China to observe the procedure and gauge its viability. While some of these physicians were optimistic about the technique's therapeutic possibilities, others were antagonistic to its feasibility in an American context. Previous studies have explained the quick rise and rapid delegitimization of acupuncture anesthesia by invoking the professional interests of biomedical doctors. In contrast, this article rethinks the history of the procedure by casting it against the backdrop of the Cold War. In discussions about the legitimacy of the technique, assumptions about race, communist politics, and Cold War bipolarity were omnipresent, causing acupuncture anesthesia to become a synecdoche for the promises and perils of Chinese communism writ large.

Complementary and alternative therapies for post-caesarean pain

BACKGROUND

Pain after caesarean sections (CS) can affect the well-being of the mother and her ability with her newborn. Conventional pain-relieving strategies are often underused because of concerns about the adverse maternal and neonatal effects. Complementary alternative therapies (CAM) may offer an alternative for post-CS pain.

OBJECTIVES

To assess the effects of CAM for post-caesarean pain.

SEARCH METHODS

We searched Cochrane Pregnancy and Childbirth's Trials Register, LILACS, PEDro, CAMbase, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (6 September 2019), and checked the reference lists of retrieved articles.

SELECTION CRITERIA

Randomised controlled trials (RCTs), including quasi-RCTs and cluster-RCTs, comparing CAM, alone or associated with other forms of pain relief, versus other treatments or placebo or no treatment, for the treatment of post-CS pain.

DATA COLLECTION AND ANALYSIS

Two review authors independently performed study selection, extracted data, assessed risk of bias and assessed the certainty of evidence using GRADE.

MAIN RESULTS

We included 37 studies (3076 women) which investigated eight different CAM therapies for post-CS pain relief. There is substantial heterogeneity among the trials. We downgraded the certainty of evidence due to small numbers of women participating in the trials and to risk of bias related to lack of blinding and inadequate reporting of randomisation processes. None of the trials reported pain at six weeks after discharge. Primary outcomes were pain and adverse effects, reported per intervention below. Secondary outcomes included vital signs, rescue analgesic requirement at six weeks after discharge; all of which were poorly reported, not reported, or we are uncertain as to the effect Acupuncture or acupressure We are very uncertain if acupuncture or acupressure (versus no treatment) or acupuncture or acupressure plus analgesia (versus placebo plus analgesia) has any effect on pain because the quality of evidence is very low. Acupuncture or acupressure plus analgesia (versus analgesia) may reduce pain at 12 hours (standardised mean difference (SMD) -0.28, 95% confidence interval (CI) -0.64 to 0.07; 130 women; 2 studies; low-certainty evidence) and 24 hours (SMD -0.63, 95% CI -0.99 to -0.26; 2 studies; 130 women; low-certainty evidence). It is uncertain whether acupuncture or acupressure (versus no treatment) or acupuncture or acupressure plus analgesia (versus analgesia) has any effect on the risk of adverse effects because the quality of evidence is very low. Aromatherapy Aromatherapy plus analgesia may reduce pain when compared with placebo plus analgesia at 12 hours (mean difference (MD) -2.63 visual analogue scale (VAS), 95% CI -3.48 to -1.77; 3 studies; 360 women; low-certainty evidence) and 24 hours (MD -3.38 VAS, 95% CI -3.85 to -2.91; 1 study; 200 women; low-certainty evidence). We are uncertain if aromatherapy plus analgesia has any effect on adverse effects (anxiety) compared with placebo plus analgesia. Electromagnetic therapy Electromagnetic therapy may reduce pain compared with placebo plus analgesia at 12 hours (MD -8.00, 95% CI -11.65 to -4.35; 1 study; 72 women; low-certainty evidence) and 24 hours (MD -13.00 VAS, 95% CI -17.13 to -8.87; 1 study; 72 women; low-certainty evidence). Massage We identified six studies (651 women), five of which were quasi-RCTs, comparing massage (foot and hand) plus analgesia versus analgesia. All the evidence relating to pain, adverse effects (anxiety), vital signs and rescue analgesic requirement was very low-certainty. Music Music plus analgesia may reduce pain when compared with placebo plus analgesia at one hour (SMD -0.84, 95% CI -1.23 to -0.46; participants = 115; studies = 2; I2 = 0%; low-certainty evidence), 24 hours (MD -1.79, 95% CI -2.67 to -0.91; 1 study; 38 women; low-certainty evidence), and also when compared with analgesia at one hour (MD -2.11, 95% CI -3.11 to -1.10; 1 study; 38 women; low-certainty evidence) and at 24 hours (MD -2.69, 95% CI -3.67 to -1.70; 1 study; 38 women; low-certainty evidence). It is uncertain whether music plus analgesia has any effect on adverse effects (anxiety), when compared with placebo plus analgesia because the quality of evidence is very low. Reiki We are uncertain if Reiki plus analgesia compared with analgesia alone has any effect on pain, adverse effects, vital signs or rescue analgesic requirement because the quality of evidence is very low (one study, 90 women). Relaxation Relaxation may reduce pain compared with standard care at 24 hours (MD -0.53 VAS, 95% CI -1.05 to -0.01; 1 study; 60 women; low-certainty evidence). Transcutaneous electrical nerve stimulation TENS (versus no treatment) may reduce pain at one hour (MD -2.26, 95% CI -3.35 to -1.17; 1 study; 40 women; low-certainty evidence). TENS plus analgesia (versus placebo plus analgesia) may reduce pain compared with placebo plus analgesia at one hour (SMD -1.10 VAS, 95% CI -1.37 to -0.82; 3 studies; 238 women; low-certainty evidence) and at 24 hours (MD -0.70 VAS, 95% CI -0.87 to -0.53; 108 women; 1 study; low-certainty evidence). TENS plus analgesia (versus placebo plus analgesia) may reduce heart rate (MD -7.00 bpm, 95% CI -7.63 to -6.37; 108 women; 1 study; low-certainty evidence) and respiratory rate (MD -1.10 brpm, 95% CI -1.26 to -0.94; 108 women; 1 study; low-certainty evidence). We are uncertain if TENS plus analgesia (versus analgesia) has any effect on pain at six hours or 24 hours, or vital signs because the quality of evidence is very low (two studies, 92 women).

AUTHORS' CONCLUSIONS

Some CAM therapies may help reduce post-CS pain for up to 24 hours. The evidence on adverse events is too uncertain to make any judgements on safety and we have no evidence about the longer-term effects on pain. Since pain control is the most relevant outcome for post-CS women and their clinicians, it is important that future studies of CAM for post-CS pain measure pain as a primary outcome, preferably as the proportion of participants with at least moderate (30%) or substantial (50%) pain relief. Measuring pain as a dichotomous variable would improve the certainty of evidence and it is easy to understand for non-specialists. Future trials also need to be large enough to detect effects on clinical outcomes; measure other important outcomes as listed lin this review, and use validated scales.

Can insights from placebo and nocebo mechanisms studies improve the randomized controlled trial?

Background and aims The randomized controlled trial (RCT) is currently facing several challenges, one of these being that the placebo response appears to be increasing in RCTs, thereby making it difficult to demonstrate an effect of potentially new treatments over placebo. This problem has primarily been approached by predicting the magnitude of the placebo response via stable factors, such as demographic variables, and/or by developing complex designs aimed at reducing the placebo response in the hope that it will improve the test of the active treatment. Yet, the success of this approach has so far been limited. Methods A new approach toward improving the RCT is put forward based on placebo and nocebo mechanism studies, i.e. studies that investigate the mechanisms underlying placebo analgesia and nocebo hyperalgesia. In a series of meta-analyses the magnitude of placebo and nocebo effects were determined. Experimental studies across nociplastic and neuropathic pain conditions and across pharmacological and acupuncture treatments investigated psychological and neurobiological mechanisms underlying these effects. The obtained results were used to make approximations of expectations to see if that could predict the placebo response in RCTs and function as a new way of tapping into the placebo component of treatment effects. Results The magnitude of placebo and nocebo effects is large and highly variable. Placebo effects exist across chronic pain conditions with varying degrees of known etiology as well as across pharmacological and non-pharmacological treatments. Patients' perception of the treatment, the verbal suggestions given for pain relief, and the patients' expectations toward pain relief contribute to the magnitude of the placebo effect and to pain relief following placebo interventions. Also, unintentional unblinding and patients' perception of a treatment markedly influence the treatment outcome. By making approximations of expectations toward treatment effects it was possible to predict the magnitude of the placebo response in RCTs. Conclusions and implications The new approach of tapping into or directly asking patients about their perception and expectations toward a treatment, along with the account of the natural history of pain, has the potential to improve the information that can be obtained from RCTs. Thus, by interfacing insights from placebo and nocebo mechanism studies, it may be possible to enhance the information that can be obtained from RCTs and to account for a large part of the variability in the placebo component of the overall treatment effect. This approach has the potential to improve the scientific evaluation of treatments, as well as to illustrate how the effect of treatments can be optimized in clinical practice, which is the crux of evidence-based medicine.

Comparative Analgesia Between Acupuncture and Dipyrone in Odontalgia

The aim of this study was to assess whether the effectiveness of acupuncture is similar to the use of analgesics in the management of toothache. The research included 56 volunteers who were divided into 4 groups: Real Acupuncture group, Placebo Acupuncture group, Real Dipyrone group, and Placebo Dipyrone group. The interventions of the study were performed before the dental care. Inclusion criteria were toothache of pulpal origin with pain scale (Visual Analogue Scale) above 4, absence of medication for the pain, and aged over 18 years. The Real Acupuncture volunteers received a session of acupuncture using piercing needles, while volunteers from the Placebo Acupuncture group received an acupuncture session using non-piercing sham needles. Volunteers from the Real Dipyrone group received a dipyrone tablet and the Placebo Acupuncture group received a tablet with no active ingredient. Before any therapeutic intervention, we collected samples from the volunteers' saliva to analyze the salivary cortisol, the volunteers rated the intensity of their pain using VAS, and we measured their energy level by the Ryodoraku method. After 20 minutes of treatment, all the volunteers' analysis parameters were collected again. The Real Acupuncture group presented a greater reduction of VAS than the reduction obtained by the Real Dipyrone group (p<0.05). There was no statistically significant difference between the groups for the salivary cortisol and energy level variables. It can be concluded that acupuncture was more effective in reducing odontalgia than the dipyrone and that it can be an alternative for odontalgia management.

Influence of the quickness and duration of De Qi on the analgesic effect of acupuncture in primary dysmenorrhea patients with a cold and dampness stagnation pattern

OBJECTIVE

To investigate the influence of the quickness and duration of De Qi (or Qi arrival) on the analgesic effect of acupuncture in primary dysmenorrhea patients with a cold and dampness stagnation pattern.

METHODS

Sixty-eight patients were randomly assigned to the De Qi group (deep needling with thick needles and manipulation, n = 17) or the non-De Qi group (shallow needling with thin needles and no manipulation, n = 51). Both groups underwent needling at Sanyinjiao (SP 6) for 30 min. The visual analogue scale was used to measure the degree of menstrual pain, and the Acupuncture De Qi Clinical Assessment Scale was used to assess De Qi. Only data from patients who experienced actual De Qi were included in the analysis.

RESULTS

Thirty-nine patients experienced actual De Qi. Patients who experienced actual De Qi in the De Qi group (n = 14) felt De Qi more rapidly (P = 0.028) and for a longer duration (P = 0.04) than patients who experienced actual De Qi in the non-De Qi group (n = 25). Both groups showed a reduction in the visual analogue scale score for pain after treatment. The analgesic effect did not significantly differ between the two groups. The occurrence time of De Qi showed a significant negative correlation with pain reduction at 20 and 30 min after needle removal (P < 0.05). There was no correlation between the duration of De Qi and the therapeutic effect.

CONCLUSION

In primary dysmenorrhea patients with a cold and dampness stagnation pattern, quicker onset of De Qi when needling Sanyinjiao (SP 6) achieves a better analgesic outcome. However, a longer duration of De Qi does not affect the degree of analgesia. Compared with minimal acupuncture, active acupuncture stimulation achieves a more rapid onset and longer duration of De Qi.

[Open heart surgery under acupuncture ? Decrypting a program broadcast on France 2]

OBJECTIVES

To analyze a clip from the program ? Acupuncture, osteopathy, hypnosis: do complementary medicines have superpowers ? about acupuncture as an anesthetic for surgical procedures in China. To propose a rational explanation for the phenomena observed. To describe the processes leading a public service broadcasting channel to offer this type of content at prime time and the potential consequences in terms of public health.

METHOD

Analysis using critical thinking attitudes and skills, along with a bibliographical search of Medline, Google Scholar and Cochrane Library databases.

RESULTS

The information delivered in the television clip is ambiguous. It does not allow the viewer to form an informed opinion on the relevance of acupuncture as an anesthetic for surgical procedures. It is reasonable to assume that the clip shows surgery performed with undisclosed epidural anesthesia coupled with mild intravenous anesthesia, sometimes performed in other countries. What needs to be highlighted here is the overestimation of acupuncture added to the protocol. The media tend to exaggerate the risks and expected effects of the treatments they report on, which can lead patients to turn to unproven therapies.

CONCLUSION

Broadcasting such a clip at prime time underlines the urgent need for the public and all health professionals to be trained in sorting and critically analyzing health information.

Effectiveness of two different acupuncture strategies in patients with vulvodynia: Study protocol for a pilot pragmatic controlled trial

BACKGROUND

Vulvodynia, or vulvar pain, is a common condition in women; however, there are few evidence-based clinical trials evaluating nonpharmacological therapies for this condition. Acupuncture is one complementary and integrative medicine therapy used by some patients with vulvodynia. This study evaluates two different acupuncture strategies for the treatment of vulvodynia and aims to evaluate whether either of the acupuncture protocols reduces vulvar pain, pain duration or pain with intercourse. The study also examines how long the effect of acupuncture lasts in women with vulvodynia.

METHODS/DESIGN

The study is designed as a randomized controlled trial, focused on two acupuncture protocols. Fifty-one patients who have had vulvodynia for more than 3 months will be recruited. Among them, 34 patients will be randomized into Groups 1a and 1b; those who are unwilling to receive acupuncture will be recruited into the standard care group (Group 2). Patients in Group 1a will have acupuncture focused on the points in the pudendal nerve distribution area, while patients in Group 1b will receive acupuncture focused on traditional (distal) meridian points. Patients in Group 2 will receive routine conventional treatments, such as using pain medications, local injections and physical therapies or other nonsurgical procedures. Acupuncture will last 45 min per session, once or twice a week for 6 weeks. The primary outcome measurement will be objective pain intensity, using the cotton swab test. The secondary outcome measurement will be subjective patient self-reported pain intensity, which will be conducted before cotton swab test. Pain intensities will be measured by an 11-point Numeric Pain Rating Scale. Pain duration and pain score during intercourse are recorded. Local muscle tension, tenderness and trigger points (Ashi points) are also recorded. All measurements will be recorded at baseline (before the treatment), at the end of each week during treatment and at the end of the 6 weeks. Follow-up will be done 6 weeks following the last treatment.

DISCUSSION

Results of this trial will provide preliminary data on whether acupuncture provides better outcomes than nonacupuncture treatments, i.e., standard care, and whether acupuncture focused on the points in pudendal nerve distribution, near the pain area, has better results than traditional acupuncture focused on distal meridian points for vulvodynia.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT03481621. Register: March 29, 2018.

[Roles of CX3CR1 in mediation of post-incision induced mechanical pain hypersensitivity: Effects of acupuncture-combined anesthesia]

Post-incision pain often occurs after surgery and is emergent to be treated in clinic. It hinders the rehabilitation of patients and easily leads to various types of postoperative complications. Acupuncture-combined anesthesia (ACA) is the combination of traditional acupuncture and modern anesthesia, which means acupuncture is applied at acupoints with general anesthesia. It was testified that ACA strengthened the analgesic effect and reduced the occurrence of postoperative pain, but its mechanism was not clear. Numerous reports have shown that chemokine receptor CX3CR1 is involved in the development and progression of many pathological pains. The present study was aimed to reveal whether ACA played the analgesic roles in the post-incision pain by affecting CX3CR1. A model of toe incision pain was established in C57BL/6J mice. The pain threshold was detected by behavioral test, and the expression of CX3CR1 protein was detected by immunohistochemical method and Western blot. The results showed that the significant mechanical allodynia and thermal hyperalgesia were induced by paw incision in the mice. Mechanical allodynia was significantly suppressed by ACA, but thermal hyperalgesia was not changed. CX3CR1 was mainly expressed in microglia in the spinal cord dorsal horn, and its protein level was significantly increased at 3 d after incision compared with that of naïve C57BL/6J mice. ACA did not affect CX3CR1 protein expression at 3 d after incision in the toe incision model mice. Paw withdrawal threshold was significantly increased at 3 d after incision in CX3CR1 knockout (KO) mice compared with that in the C57BL/6J mice. But the analgesic effect of ACA was disappeared in CX3CR1 KO mice. Accordingly, it was also blocked when neutralizing antibody of CX3CR1 was intrathecally injected (i.t.) 1 h before ACA in the C57BL/6J mice. These results suggest that CX3CR1 in microglia is involved in post-incision pain and analgesia of ACA.

[Possible Living Factors Influencing the Efficacy of Acupuncture Analgesia Between Chinese and Western Populations:Caffeine]

It has been known for thousands of years that acupuncture can relieve pain. However, the efficacy of acupuncture analgesia (AA) now has to be reconsidered due to negative reports from western countries. In the present study, the possible correlation between caffeine and the difference in AA in China and western countries was determined using the following factors:1) caffeine and pain; 2) adenosine, adenosine receptor and caffeine; 3) AA and caffeine. As a non-selective antagonist of the adenosine receptor, caffeine at low doses can be used as an adjuvant analgesic, and can augment antinociception combined with other analgesics. Caffeine can act as an important neural modulator, and adenosine can produce antinociception when combined with the A₁ receptor located in spinal, supraspinal and peripheral tissue. A preclinical study demonstrated that caffeine at moderate doses could inhibit AA efficacy following plantar incision surgery in a mouse model. Caffeine is present in various foods, especially coffee, and approximately 85% of adults in western countries consume coffee regularly. Therefore, by reconsidering the correlation between caffeine, adenosine receptor and AA, and by determining the possible relationship between caffeine intake habits and AA efficacy, these findings will demonstrate the differences in AA between Chinese and western populations.

[New Trains of Thoughts About Acupuncture Analgesia-Acupuncture Analgesia Feb Involve Multi-dimensional Regulation of Pain]

With the development of pain study, researchers gradually recognized that pain is composed of three main dimensions, namely "sensory-discriminative" "affective-motivational" and "cognitive-evaluative" which influence each other and are also independent from each other. Pain study has shifted away from focusing on the single mode of nociception to the multi-dimensional mode of sensory-affection-cognition. It is held early in traditional Chinese medicine that "when there is a stoppage, there is a pain" and a worsening disease Feb induce depression, which has already shown a multi-dimensional recognition about pain. Acupuncture therapy has been considered to be an effective adjuvant approach for relieving pain. In the present paper, the authors introduced applicability of acupuncture analgesia by modulating the abovementioned multi-dimensions of pain from the following 4 aspects:1) multi-dimensions of pain and related brain regions; 2) recognitions of traditional Chinese medicine about pain; 3) development of researches on acupuncture analgesia, including a) balancing activities of endogenous analgesic and algogenic substances, and triggering intracellular mitogen-activated protein kinase (MAPK) signaling to reduce algesia, b) improving psychological symptoms of patients with depression, anxiety, insomnia, etc., c) modulating functional activities of some common brain regions (as hippocampus, anterior cingutate, frontal lobe of cerebral cortex, etc.) sharing both pain information and learning-memory processing. Hence, the authors hold that if the clinical study and application and experimental researches conducted on the underlying mechanisms of acupuncture analgesia extend towards the multi-dimensions of pain, a series of new concepts or thoughts will be brought out, thereby possibly opening a bright applicable prospect for acupuncture analgesia.

[Effect of Electroacupuncture Intervention on Expression of Synaptic Plasticity-related Molecules in Amygdala in Chronic Pain-negative Affection Rats]

OBJECTIVE

To observe the effect of electroacupuncture (EA) on expression of synaptic plasticity-related glutamate N-methyl-D-aspartate (NMDA) receptor subunit NR 1, gamma-aminobutyric acid (GABA) receptor subunits (Aβ 2, B 1), etc. in the amygdala in chronic neuropathic pain negative affection (CNPPNA) rats, so as to reveal its mechanism underlying pain relief.

METHODS

Male Wistar rats were randomized into normal control, CNPPNA model, EA, and anesthesia+EA (AEA)groups (n=14 in each group, 8 for quantitative RT-PCR and 6 for immunofluorescence staining). The CNPPNA model was established by ligation of the left sciatic nerve and repeated electrical stimulation of the hindpaw plantar skin in the pain-paired compartment. EA was applied to bilateral "Zusanli"(ST 36)and "Yanglingquan"(GB 34)for 30 min, once daily for 7 days.Thermal pain threshold (paw withdrawal latency, PWL)of the bilateral paws was measured by using a Tail-Flick Unit. The conditioned place aversion (CPA) was determined by using a CPA-paired compartment. The expression levels of GABAAβ 2, GABAB 1, NMDA receptor subunit NR 1, postsynaptic density-95 protein(PSD-95), Piccolo genes in the right amygdala area were determined using quantitative RT-PCR, and the immunoactivity of metabotropic glutamate receptor subunit 1 (mGluR 1) and GABAB 2 in the basolateral amygdala (BLA) nucleus was detected using immunofluorescence staining.

RESULTS

After modeling, PWL difference (PWLD) values of the model group were significantly increased (P<0.001),and the time spent in the CPA-paired compartment was considerably decreased compared with the control group (P<0.001).After EA intervention for 3 and 7 days, the PWLD levels of both EA and AEA groups were apparently decreased(P<0.05),and the time spent in the CPA-paired compartment was apparently increased in the EA and AEA groups(P<0.05),suggesting a pain relief and an improvement of the negative affection after EA intervention. Additionally, following EA, the apparently-decreased expression levels of GABAAβ 2,GABAB 1,PSD-95,Piccolo genes and the reduced numbers of GABAB 2 positive cells and NMDA-NR 1 mRNA as well as mGluR 1 positive fiber numbers were remarkably increased in the EA group (P<0.05, P<0.001).The expression levels of Piccolo gene, GABAB 2 and mGluR 1 positive cells/fiber numbers were apparently lower in the AEA group than in the EA group (P<0.001). No significant differences were found between the EA and AEA groups in the PWLD, time spent in the CPA-paired compartment, and the expression levels of NMDA-NR 1, GABAAβ 2, GABAB 1 and PSD-95 genes (P>0.05).

CONCLUSIONS

Repeated EA stimulation of ST 36-GB 34 has a role in relieving both sensory and affection dimensions of chronic pain in CNPPNA rats, which Feb be respectively related to its effects in up-regulating the expression of GABAAβ 2, GABAB 1, NMDA-NR 1, PSD-95 and Piccolo genes, and in promoting the expression of mGluR 1 and GABAB 2 proteins and Piccolo gene in the amygdala.

Immediate analgesic effect of needling acupoints (bilateral De Qi vs unilateral De Qi) on primary dysmenorrhea: a multi-center, randomized, controlled trail

OBJECTIVE

To analyze the effect of needling acupoints (bilateral vs unilateral) with De Qi using data collected from 501 primary dysmenorrhea (PD) patients participating in multi-center, randomized, controlled trail.

METHODS

De Qi was defined as at least one of the feelings in soreness, numbness, fullness or heaviness at the acupoints when stimulated with needles. The 501 patients were grouped in 3 groups in terms of De Qi or not De Qi in one side (unilateral) or both sides (bilateral) of the body: bilateral De Qi group, unilateral De Qi group, and non-De Qi group. The abdominal pains were measured using visual analog scale (VAS).

RESULTS

In 501 patients, 472 acquired De Qi at unilateral acupoints, 24 De Qi at bilateral acupoint, and 5 had no De Qi at any acupoint. The data of non-De Qi group was excluded as the sample was less than 5% of that in the bilateral De Qi group. There was significant difference in the VAS before and after treatment between unilateral and bilateral De Qi group (P < 0.01). After stratified by acupoints, for the patients needled at Sanyinjiao (SP 6) and Xuanzhong (GB 39), VAS scores in the bilateral De Qi group were larger than those in the unilateral De Qi group (P < 0.05).

CONCLUSION

Bilateral De Qi was possibly superior to unilateral De Qi in enhancing the immediate analgesic effect of needling the acupoints, but no statistical significance was observed on the patients of needling at non acupoint, which preliminarily suggested this immediate analgesic effect was perhaps along meridians.

[Development of Researches on Cytokine Mechanisms in Analgesia and Anti-inflammation in Acupuncture Therapy for Rheumatoid Arthritis]

Cytokines are closely related to the occurrence and development of rheumatoid arthritis(RA). Acupuncture exerts anti-inflammatory and analgesic effects via elevating anti-inflammatory cytokine level and reducing pro-inflammatory cytokine level and regulating Th 1/Th 2 balance, which reflects the dual directional regulatory effect of acupuncture. However, problems exist in the current researches, such as inadequate depth, limited breadth and not so up-to-date research focus. The mediocre research level and the phenomena of some contradictory results among studies also need being concerned. Therefore, progress may be attained if a holistic, dynamic and networked study is conducted on the influence of acupuncture on cytokines by combining the latest progress in the mechanisms of network of cytokines and neuroendocrine immune network, and high throughput cytokine capture assay. In this way, the mechanism of cytokines in multi-targets (such as local joints, peripheral blood circulation, central nervous system) involving the effects of acupuncture in improving RA will be known more.

[Involvement of Central Neuroglia Cells in Analgesic Effect of Electroacupuncture Therapy for Neuropathic Pain]

Neuropathic pain is one of the common chronic syndromes in clinical practice. It has been demonstrated that the chronic neuropathic pain and glial cells in the central nervous system are closely related to each other. When inducing analgesic effect in neuropathic pain, EA suppressed OX-42 labeled activation of microgliacytes in dorsal horns of the spinal cord, down-regulated release of nitric oxide (NO), expression of P 2 X₄ receptor, intracellular mitogen-activated protein kinase (MAPK), extracellular regulated protein kinases (ERK), proinflammatory cytokines IL-1 β, IL-6, TNF-α, interferon (IF)-γ and up-regulated neurotrophin-3 expression in neuropathic pain rats. In regard to spinal astrocytes, acupuncture suppressed peripheral nerve injury induced activation of GFAP-labeled astrocytes, down-regulated the expression levels of macrophage inflammatory proteins (MIP)-1, MIP-1 β, MIP-3 α, TNF-α mRNA and IL-1 β mRNA, etc. in the dorsal horns of the spinal cord. Up to now, the underlying me-chanisms of acupuncture in regulating activities of glia cells, and interaction between neurons and glia cells, and the related pathways in the peripheral and central systems remain unclear. The effects of some related protein and gene expressions involving in acupuncture analgesia need being confirmed by adopting different approaches.

[Analgesic and Sedative Effect of Acupuncture Combined with Medicine on Patients Undergiong Cardiac Surgery]

OBJECTIVE

To observe analgesic and sedative effect of acupuncture combined with medicine (ACM) on patients undergiong cardiac surgery.

METHODS

A total of 50 patients with cardiac surgery from January 2012 to October 2014 were randomly assigned to the conventional analgesia group (group A) and the ACM analgesia group (group B), 25 in each group. Patients in group A were subjected to analgesia and sedation by injecting dexmedetomidine, while patients in group B were subjected to analgesia and sedation by electro-acupuncture [EA, Shenting (GV24); Yintang (EX-HN3)] combined with injection of dexmedetomidine. Morphine hydrochloride injection was performed when analgesia and sedation effect was ineffective in the two groups. The indicators of patients at different time points in the two groups were observed, such as static and dynamic VAS scores, SAS scores, mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO2). The injection dosage of dexmedetomidine and morphine hydrochloride, analgesia satisfaction rate, sedation satisfaction rate, the incidences of adverse reactions during treatment such as bradycardia and low blood pressure, mechanical ventilation time, ICU time, and hospitalization expense were observed and recorded in the two groups.

RESULTS

There was no statistical difference in static and dynamic VAS scores, SAS score, MAP, HR and SpO2 between the two groups at different time points (P > 0.05). The injection dosage of dexmedetomidine and morphine hydrochloride was significantly reduced in group B than in group A (P < 0.05). The analgesia satisfaction rate of patients in group B was much higher than that in group A (P < 0.05). The incidence of bradycardia also obviously decreased more in group B than in group A (P < 0.05). There was no statistical difference in patients' sedation satisfaction rate, incidences of low blood pressure, delirium, vomiting; mechanical ventilation time, ICU time, or hospitalization expense between the two groups (P > 0.05).

CONCLUSION

The analgesia method of ACM could reduce the dosage of traditional analgesic drugs and the occurrence of partial adverse reactions.

[Improving the synergy of muscle movement is one of the important mechanisms in acupuncture analgesia]

The efficacy of acupuncture for pain diseases is significant, however, the unified understanding re garding mechanisms of acupuncture analgesia has not been fully reached. In this paper, it is believed that uncoordi nated muscle movement is one of the important causes for pain, while acupuncture could enhance the contact of nerve cells and improve the synergy of muscle movement, so as to achieve the aim of pain relief and even cure.

[Clinical observation on controlling antihypertension with the general anesthesia of TEAS and anesthetics in endoscopic endonasal surgery]

OBJECTIVE

To study whether the dose of controlling antihypertensive drug is reduced by transcutaneous electrical acupoint stimulation (TEAS) and the anesthetics, as well as the control of blood pressure (BP) and heart rate (HR) in endoscopic endonasal surgery with general anesthesia.

METHODS

Sixty patients for selective endoscopic endonasal surgery with general anesthetics and controlling antihypertension involved were selected and randomized into a TEAS group, a sham-TEAS group, 30 cases in each one. The electric pads were attached to bilateral Hegu (LI 4), Zusanli (ST 36), Sanyinjiao (SP 6) and Quchi (LI 11), stimulated with Hans-200 apparatus, 3 to 5 mA, 2 Hz/100 Hz in the TEAS group based on the patients' response to comfort. No electric stimulation was applied to the sham-TEAS group. The general anesthesia started after 30 min intervention and lasted till the end of surgery. The BP and HR were observed and recorded at the end of monitoring in operation room, 10 min after tranquilization (T0), 30 min after intervention (Tj, after induction~of general anestiesa (T2), 30 min after surgery start (T3), 60 min after surgery start (T4) and 30 min after extubation (T5). The doses of vecuronium bromide, propofol and nitroglycerin were recorded statistically in surgery, as well as the operative bleeding volume, the operative time, the resuscitation time and the visual analogue scale (VAS) score after resuscitation.

RESULTS

Compared with that at T0, the mean arterial pressure (MAP) at T2, T3, T4 and T5 in the TEAS group and at T3 and T4 in the sham-TEAS group was all reduced, indicating the significant difference (all P < 0.01). MAP at T2 and T5 in the TEAS group was lower than that in the sham-TEAS group (both P < 0.01). Compared, with that at T5, except at T2 in the TEAS group (P<0. 05), HR was not different significantly at the rest time points (all P > 0.05). HR was different at T2 to Ts in the sham-TEAS group statistically (all P < 0.01). The doses of vecuronium bromide, propofol and nitroglycerin, the operative bleeding volume, the operative time, the resuscitation time and VAS after resuscitation were not different significantly between the two groups (all P > 0.05).

CONCLUSION

The general anesthesia with TEAS and anesthetics involved for controlling antihypertension contributes to the control of BP and HR in the patients in endoscopic endonasal surgery. The impacts are not obvious on the doses of antihypertensive drug, the general anesthetics, the operative bleeding volume, the time of resuscitation and the postoperative analgesia.

[Electroacupuncture Intervention Combined with Anesthetics for Analgesia and Post-surgical Gastrointestinal Recovery in Pneumectomy Patients]

OBJECTIVE

To observe the effect of electroacupuncture (EA) stimulation of bilateral Taichong (LR 3), Yan-glingquan (GB 34), Waiguan (TE 5) and Chize (LU 5) on pain and post-surgical gastrointestinal reactions in patients undergoing pneumectomy.

METHODS

Sixty patients with pneumectomy were randomly divided into EA group (30 cases) and control group (30 cases). For patients of the EA group, EA stimulation (2 Hz, 3 - 5 mA) was applied to bilateral LR 3, GB 34, TE 5 and LU 5 once every 12 h in the following two days after the surgery. For patients of the control group, the filiform needles were just adhered to the abovementioned acupoints without electrical stimulation. In addition, patients of both groups were treated first with lower dose of anesthetics including Fentanyl (250 μg) + Flurbiprofen axetil (25 mg) + normal saline (i. v., 2 mL/h), and Sauteralgyl (muscular injection if necessary). The visual analogue scale (VAS) was used for measuring the patients' pain reaction at 24(th) h and 48(th) h after surgery. The contents of plasma β-endorphine (EP) and leu-enkephalin were assayed by ELISA, the times of vomiting and nausea, and the time of postoperative exhaust and defecation were recorded.

RESULTS

Compared with the control group, the VAS score at 48 h after surgery, and the dosage of the supplemented Sauteralgyl were evidently lower, and the time of both exhaust and defecation after surgery was significantly earlier, and the degree of nausea after surgery was obviously milder in patients of the EA group (P<0.05, P<0.01). Compared with 0 h post-operation, the β-endorphin and leu-enkephalin levels were significantly increased in the EA group (P<0.01). No significant difference was found between the control and EA groups in the vomiting rating (P>0.05).

CONCLUSION

EA intervention combined with anesthetics is effective in reducing the dosage of the supplemented Sauteralgyl and the degree of postoperative nausea, and in improving postoperative gastrointestinal functional recovery in patients undergoing pneumectomy.

[Clinical research of analgesic for labor with acupoint injection and electroacupuncture]

OBJECTIVE

To explore a safe and effective scheme of analgesic for labor.

METHODS

Eighty-four primiparas without contraindication of vaginal delivery were divided into an observation group and a control group, 42 cases in each one. In the observation group, the acupoint injection was given at Zusanli (ST 36) combined with electroacupuncture (EA) at Hegu (LI 4) and Sanyinjiao (SP 6) till the cervical opening at the end of first stage labor. In the control group, the routine respiratory instruction was applied. In 5 min, 10 min and 60 min of acupuncture (the same time points in the control group) as well as at the end of the first and second stage labor, the analgesic effect was assessed for the primiparas of the two groups. The labor stages, adverse reactions, postpartum hemorrhage, postpartum urine retention, newborn asphyxia rate and usage rate of oxytocin were compared between the two groups.

RESULTS

In the observation group, in 5 min, 10 min and 60 min of acupuncture as well as at the end of the first and second stages, the visual analogue scale (VAS) was lower apparently as compared with the control group at the corresponding time points (all P < 0.05). The differences in the time limit in the active period, the second and third stages were not significant between the two groups (all P > 0.05). The incidence of adverse reactions and the usage rate of oxytocin were lower than those in the control group [2.4% (1/42) vs 31.0% (13/42); 2.4% (1/42) vs 23.8% (10/42), both P < 0.05]. The differences in postpartum hemorrhage, postpartum urine retention and newborn asphyxia rate were not significant between the two groups (all P > 0.05).

CONCLUSION

The combination of acupoint injection and EA is the effective analgesic scheme for labor. This scheme effectively alleviates labor pain and has no maternal and child complications.

[Immediate analgesic effects of tendon acupuncture on soft tissue injury]

OBJECTIVE

To observe the immediate analgesic effect of tendon acupuncture on soft tissue injury in different sites.

METHODS

A total of 140 cases of soft tissue injury, involving 14 injury sites, were treated with tendon acupuncture. According to the principle of "considering pain as acupoint", based on injury sites, one to three tendon acupoints were selected in each tendon, which were treated with 1 to 5 times. Totally 676 times Of treatment was given. The visual analogue scale (VAS) was used to evaluate the immediate. analgesic effect before and after the treatment.

RESULTS

After the treatment, the score of VAS was significantly reduced (4. 20+ 1. 77 vs 2. 43 ± 1. 30, P<0. 001); regardless of the total number of treatment, the score of VAS after each acupuncture was obviously reduced compared with that before acupuncture (all P<0. 001); the score of VAS at each injury sites after treatment was significantly reduced compared with that before treatment (all P<0. 001).

CONCLUSION

There is an immediate analgesic effect of tendon acupuncture for different sites of soft tissue injury. Also, the effect has been shown in different frequencies of treatment.

[Anti-inflammatory and synovial-opioid system effects of electroacupuncture intervention on chronic pain in arthritic rats]

OBJECTIVE

To observe the analgesic effect of electroacupuncture (EA) on collagen-induced arthritis (CIA) rats and its regulating effect on inflammation reaction and the endogenous opioid system of synovial tissues. Methods A total of 30 healthy male Wistar rats were randomly divided into a control group, a model group and an EA group, 10 rats in each one. The chronic pain model of CIA rats was made by cattle type-II collagen in the model group and EA group. Rats in the EA group were treated with EA at "Zusanli" (ST 36) and "Kunlun" (BL 60) for 30 min from 16th day after model establishment, once a day for consecutive 10 days. Rats in the control group did not receive any treatment. Rats in the model group were treated with fixation as the EA group. Threshold of pain, arthritis index, paw swelling were measured before model establishment and 16 d, 20 d, 23 d and 25 d after model establishment. The levels of beta-endorphin (β-END), met-enkephalin (met-ENK), dynorphin A (Dyn A) were measured by radioimmunoassay; the mRNA expressions of mu opioid receptor (MOR), kappa opioid receptor (KOR) and delta opioid receptor (DOR) in synovial tissues of CIA rats were detected by I quantitative polymerase chain reaction (qPCR).

RESULTS

Compared with the control group, threshold of pain was reduced (all P<0. 01), arthritis index was increased (all P<0. 01) and paw swelling was increased (all P<0. 01) in the model group on the 16th day, 20th day, 23rd day, 25th day after model establishment. Compared with the model group, the threshold of pain was increased in the EA group (all P<0. 01), arthritis index and paw swelling were reduced (all P<0. 01) on the 23rd day and 25th day after model establishment. Compared with the control group, the level of Dyn A in synovial tissues of CIA rats was increased in the model group (P<0. 01); the mRNA expressions of MOR, KOR and DOR were down-regulated lower than 0. 5 fold of normal level. Compared with the model group, the level of β-END in synovial tissues of the knee joint was increased in the EA group (P<0. 05), and the mRNA expressions of MOR, KOR and DOR in synovial tissues of CIA rats were up-regulated more than 2 folds of normal level.

CONCLUSION

The intervention of EA on chronic pain of CIA rats is superior, which is likely to be related with effects of EA on anti-inflammation and up-regulation of synovial tissue β-END and MOR, KOR, DOR.

[FlU Zhonghua's clinical experience of Fu's subcutaneous needling for cervical spondylosis]

Professor FU Zhonghua's unique clinical experience of Fu's subcutaneous needling (FSN) for cervical spondylosis (CS) is discussed in this paper, which is analyzed from the aspects of recognition of CS pathogenesis, treatment mechanism of FSN, advantage indications of FSN for CS and examples of medical cases. Professor FU introduced the theory of myofascial trigger points (MTrP) into the field of the management of CS. The site of neck MTrP should be carefully examined, and FSN needles for single use are used to sweep the affected area or subcutaneous layer of adjacent upper limb. This method can rapidly improve ischemia and hypoxia state of the relevant muscles and prompt the self-recovery of neck muscles. During FSN treatment, reperfusion approach is recommended to adopt to improve the qi and blood circulation and recovery of neck function.

Acupuncture or low frequency infrared treatment for low back pain in Chinese patients: a discrete choice experiment

Acupuncture is a popular but controversial treatment option for low back pain. In China, it is practised as traditional Chinese medicine; other treatment strategies for low back pain are commonly practised as Western medicine. Research on patient preference for low back-pain treatment options has been mainly conducted in Western countries and is limited to a willingness-to-pay approach. A stated-preference, discrete choice experiment was conducted to determine Chinese patient preferences and trade-offs for acupuncture and low frequency infrared treatment in low back pain from September 2011 to August 2012 after approval from the Department of Scientific Research in the study settings. Eight-six adult outpatients who visited the 'traditional medicine department' at a traditional Chinese medicine hospital and the 'rehabilitation department' at a Western medicine hospital in Guangdong Province of China for chronic low back pain during study period participated in an interview survey. A questionnaire containing 10 scenarios (5 attributes in each scenario) was used to ask participants' preference for acupuncture, low frequency infrared treatment or neither option. Validated responses were analysed using a nested-logit model. The decision on whether to receive a therapy was not associated with the expected utility of receiving therapy, female gender and higher out-of-pocket payment significantly decreased chance to receive treatments. Of the utility of receiving either acupuncture or low frequency infrared treatment, the treatment sensation was the most important attribute as an indicator of treatment efficacy, followed by the maximum efficacy, maintenance duration and onset of efficacy, and the out-of-pocket payment. The willingness-to-pay for acupuncture and low frequency infrared treatment were about $618.6 and $592.4 USD per course respectively, demonstrated patients' demand of pain management. The treatment sensation was regarded as an indicator of treatment efficacy and the most important attribute for choosing acupuncture or low frequency infrared treatment. The high willingness-to-pay demonstrated patients' demand of pain management. However, there may be other factors influencing patients' preference to receive treatments.

[Analgesic effect of electroacupuncture on gastric ulcer rats with liver-depression syndrome]

OBJECTIVE

To explore the analgesic effect and action mechanism of electroacupuncture (EA) on gastric ulcer rats with liver-depression syndrome.

METHODS

Through open-field experimental method, 45 qualified SPF-grade male SD rats were selected and divided into a blank group, a model group and an EA group according to random number table method, 15 rats in each group. The model of gastric ulcer rats with liver-depression syndrome was established in the model group and the EA group by using chronic unpredictable stimulation combined with acetic acid burning method. Rats in the blank group did not receive intervention. Rats in the model group were treated with fixation and immobilization for 13 days. Rats in the EA group were treated with EA at "Liangqiu" (ST 34) and "Ganshu" (BL 18); EA voltage was 2 V; disperse-dense wave was selected with 4 Hz of disperse wave and 15 Hz of dense wave, and the intensity of EA was according to the slight vibration of local skin and; muscles; the needles were retained for 20 min, once a day for consecutive 6 days; there was an interval of 1 day' and the treatment was given for 2 weeks. The general condition, open-field experimental result and gastric ulcer index were observed; the western blotting method was applied to measure the expression of vanilloid receptor subtype 1 (VR1) in hypothalamus and gastric antral mucosal, and ELISA method was applied to test the expression of 5-hydroxytryptamine (5-HT) and norepinephrine (NE) in hippocampus.

RESULTS

After model establishment, the general behavior condition in the model group was inferior to that in the blank group, which was obviously improved after EA. The range of motion in the model group was less than that in the blank group (P<0.01) while that in the EA group was higher than that in the model group (P<0.01). The ulcer inhibition rate was. 54.95%, and the ulcer index in the EA group was lower than that in the model group (P<0.01). Compared with; the blank group, the expression of VR1 in hypothalamus and gastric antral mucosal in the model group was increased (P<0.05); compared with the model group, the expression of VR1 in the EA group was reduced (P<0.05). Compared with the blank group, the expression of 5-HT an NE in hippocampus in the model group was significantly reduced (both P<0.01); compared with the model group, the expression of 5-HT and NE in the EA group was increased (both P<0.01).

CONCLUSION

EA at "Liangqiu" (ST 34) and "Ganshu" (BL 18) has certain analgesic effect in gastric ulcer rats with liver-depression syndrome, which is likely to be related with lowering the contents of VR1 in hypothalamus and gastric antral mucosal and increasing the content of 5-HT and NE in hippocampus.

[Analgesic effect on primary dysmenorrheal treated with conventional and sham acupuncture at San-yinjiao (SP 6)]

OBJECTIVE

To observe the difference in the analgesic effect on primary dysmenorrheal between acupuncture and sham acupuncture at Sanyinjiao (SP 6) during menstrual pain and evaluate the impact of psychological effect on acupuncture analgesia.

METHODS

Sixty subjects were randomized into an acupuncture group and a sham acupuncture group, 30 cases in each one. The conventional acupuncture and sham acupuncture were applied to Sanyinjiao (SP 6) on bilateral sides when menstrual pain began to attack and needles were retained for 30 min each time. Three menstrual cycles were required. The visual analogue scale (VAS) was adopted to determine the scores before and 0. 5 h, 1 h, 3 h, 6 h and 12 h after acupuncture during menstrual pain in each cycle separately.

RESULTS

In the acupuncture group, VAS score at each time point after acupuncture was reduced as compared with that at the previous one during menstrual pain in each menstrual cycle, indicating the significant difference (all P<0. 05). In the sham acupuncture group, the scores in 6 h and 12 h of acupuncture were reduced as compared with the previous one, indicating the significant difference (all P<0. 05). After acupuncture, VAS score at each time point in the acupuncture group was lower than that in the sham acupuncture group (all P<0. 05).

CONCLUSION

The conventional acupuncture at Sanyinjiao (SP 6) achieves the significant analgesic effect on primary dysmenorrheal. The psychological placebo effect of sham acupuncture has no obvious impact on acupuncture analgesia.

[Clinical research of lung resection surgery with microinjection acupuncture and drug anesthesia instead of traditional acupuncture anesthesia]

OBJECTIVE

To explore the feasibility and safety on lung resection surgery with the combined method of microinjection acupuncture (MIA) and intravenous anesthesia instead of compound traditional acupuncture and drug anesthesia (ADA).

METHODS

Ninety cases of lung resection surgery were randomized into a general anesthesia group, a MIA group and a ADA group, 30 cases in each one. In the general anesthesia group, before surgery, the intramuscular injection of atropine 0. 5 mg was used; during surgery, the anesthesia induction was followed with intravenous injection of fentanyl citrate, propofol and rocuronium bromide and the dosage was increased accordingly; after surgery, the analgesia pump was applied. In the MIA group, on the basis of general anesthesia, before anesthesia induction, the acupoint catgut embedding was applied to Jiaji (EX-B 2) of T4 , T6 and T, , Feishui (BL 13), Xinshu (BL 15) and Geshu (BL 17) on the affected side and bilateral Quchi (LI 11) and Zusanli (ST 36); after surgery, the analgesia pump was applied. In the ADA group, on the basis of general anesthesia, before! anesthesia induction, electroacupuncture (EA) was applied to Hegu (LI 4), Neiguan (PC 6) , Houxi (SI 3) and Zhigou (TE 6) for 30 min; during surgery, EA and intravenous medication were combined at the same acupoints as those before surgery; after surgery, moxibustion and the analgesia pump were applied in combination for analgesia. In each group, the biological indices were monitored during surgery at 11 time points named T. (before anesthesia I induction), T1 (intubation in general anesthesia induction), T2 (skin incision), T3 (rib exposure in muscular incision) T. (chest open), T, (lung removal), T6 (drainage tube implantation), T7 (chest closure), T (muscular stitching), T, (skin stitching) and T0 (extubation). The actual dosage of anesthetics during surgery and the, dosage of fentanyl citrate in analgesia pump were quantified after surgery. Results (1) In the MIA group and ADA group, the increased dosage of fentanyl citrate was less than that in the general anesthesia group [(1. 23±0. 28) µg . kg-1 . h-1 vs (2. 4±0. 54µg. kg-1 . h-1, (1. 1±0. 38µg . kg-1 . h-1 vs (2. 4±0. 54µg. kg-1 . h-1 , both P<0. 05]. The increased dosage of propofol and rocuronium bromide was not different during surgery among the groups (all P>0. 05). (2) In the MIA group and ADA group, after surgery, the increased dosage of fentanyl citrate was less than that in the general anesthesia group [(11. 0±1. 04)µg/kg vs (15. 4±1. 52µg/kg, (11. 5±1. 38µg/kg vs (15. 4±1. 52µg/kg, both P<0. 05], reducing by 25% in comparison. (3) The differences in heart rate and blood pressure at 11 time points during surgery were not significant among the three groups (all P>0. 05).

CONCLUSION

n The combined method of MIA and intravenous anesthesia significantly reduces the dosage of intravenous anesthetics during and after lung resection surgery as compared with ADA, presenting the similar analgesic effect as simple intravenous medication and the good safety. The combined method of MIA and intravenous anesthesia is much

[Timeliness law on the immediate analgesia on acute migraine treated with electroacupuncture at shaoyang meridian points]

OBJECTIVE

To observe the differences in timely effectiveness of immediate analgesia on acute migraine between electroacupuncture (EA) at shaoyang meridian points and non-meridian points.

METHODS

The randomized controlled trial method was adopted. One hundred and ten cases of acute migraine were randomized into two groups. 55 cases in each one. In the observation group, EA was applied to Fengchi (GB 20), Waiguan (TE 5), etc. In the control group. EA was applied to non-meridian points. Only one treatment was given, and the nee dies were retained for 30 min in the two groups. Separately. at 10 time points, named before acupuncture, in 5 min, 10 min. 20 min and 30 min (at the moment of needle removal), 1 h, 2 h, 4 h, 6 h and 8 h after acupuncture, the pain intensity numerical rating scale (PI-NRS) was adopted to evaluate the pain severity and the adverse reac tion was recorded.

RESULTS

(1) The effective rate of imnmediate analgesia was 87. 3% (48/55) in the observation group. significantly higher than 52.7% (29/55) in the control group (P<0.01). (2) NRS of each group was re duced at each time point, from 5 min to 8 h after acupuncture (all P<0.01). (3) NRS score at 30 min after acu puncture in the control group was obviously lower than that in the observation group (P<0.05), but the scores in 2 h, 4 h, 6 h and 8 h after acupuncture in the observation group were lower apparently than those in the control group (all P<0. 01). The differences in the scores in 5 min, 10 min, 20 min and 1 h after acupuncture were not significant (all P>0. 05). (4) For the reducing amplitude of NRS score at the same time point after acupuncture, the results in 20 min, 30 min and 1 h in the control group were higher apparently than those in the observation group (all P<0. 05). But, in 2 h, 4 h, 6 h and 8 h, the results in the observation group were higher apparently than those in the control group (all F<0.05). The differences in 5 min and 10 min after acupuncture were not significant (both P>0. 05). (5) In 24 h after acupuncture, the recurrence rate of migraine was 12. 7% (7/55) in the observation group, which was lower obviously than 34. 5% (19/55) in the control group (P<0. 05). The adverse reaction was not found in the two groups.

CONCLUSION

EA at the shaoyang meridian points achieves the definite immediate analgesia effect on acute migraine and presents the time effectiveness of analgesia.

[Progress on pain control during the perioperative period of shoulder arthroscopy]

Successful pain management of perioperative shoulder arthroscopy may allow patients to go home earlier, improve the quality of life in perioperative period, and facilitate rehabilitation. A comprehensive method to perioperative pain control has three stages including preoperative, intraoperative and postoperative phase. Successful pain reduction should begin preoperatively because of an excellent communication between patient and physician, moreover, preoperative analgesia also should be administered. Intraoperative efforts should include local wound infiltration and the administration of anesthetic medication intra-articularly. Postoperative management should include oral analgesics, constant infusion devices, Patient Controlled Analgesia (PCA), sedative-hypnotic drug, continuous cryotherapy and vicarious treatment.

[Development of researches on acupuncture stimulation-induced regulatory effect under pathological state based on resting-state functional magnetic resonance technology]

Using keywords of "acupuncture, fMRI and resting state", authors of the present paper retrieved papers in both Chinese and English from CNKI and PubMed databases without time limitation. A total of 13 articles (11 for acupuncture and 2 for moxibustion) met the standards were subjected to analysis. Of the 13 papers, 6 involve acupuncture analgesia, 2 moxibustion analgesia, 3 mild cognitive impairment, one involves stroke, and the rest one is for depression. Research results of acupuncture analgesia revealed that the analgesic effect is closely related to its regulation on "pain matrix" brain regions and pain-related default mode network. In the studies, a single acupoint is often used, without acupoints-combined recipes. Therefore, it is highly recommended that researchers pay more attention to (OD studies on the underlying mechanism of moxibustion, and (improvement of design protocols targeting requirements of acupuncture clinical practice.

[Analysis and comparison of theories of circulation of blood and qi in both eastern and western ancient medicines]

In ancient Egypt, the theory of circulation of blood and qi was preliminarily established on the basis of cadaver dissection, gradually revised and improved following the progress of anatomy and physiology. However, the "Meridian Theory" of circulation of blood and qi in Chinese medicine had never been established on the basis of anatomical and physiological studies. Thus a suspicion was aroused, "whether the meridians really exist, or artificially assumed by imagination"? Therefore, in recent one half of a century, numerous scholars at home and abroad spent countless financial capacities and human power to study the essence of Meridians in order to find their material or substantial evidence, but with no breakthrough obtained. Nevertheless, in the 70th of the last century, studies on mechanisms of acupuncture analgesia and acupuncture anesthesia won an undoubtedly good result. Hence, the therapeutic effect of acupuncture on pain control was admitted by the "Consensus Statement on Acupuncture" at an international meeting held by NIH in Dec. 1997. Then the old Chinese acupuncture won an international acceptance and application. Therefore, the investigation of mechanism of acupuncture analgesia set up a positive model for future scientific researches on acupuncture mechanisms and essence of Meridians, as well as on other Chinese medical theories.

[Clinical observation on therapeutic effect of cupping combined with acupuncture stimulation at trigger points for lumbar myofascial pain syndrome]

OBJECTIVE

To observe the clinical effect of cupping combined with acupuncture stimulation of trigger points on lumbar myofascial pain syndrome (MPS).

METHODS

Sixty MPS patients were randomly divided into acupuncture + TDP group (n = 30), and cupping + acupuncture group (n = 30). Patients in the acupuncture + TDP group were treated by acupuncture stimulation of trigger points and local TDP irradiation, and patients of the cupping + acupuncture group treated by intensive cupping applied to the myofascial band and acupuncture stimulation of the locus according to the position of muscular tension band. The therapeutic effects were assessed according to the score of the McGill pain questionnaire composing of pain rating index (PRI), visual analogue scale (VAS) and present pain intensity (PPI) before, immediately and 1 month after the treatment.

RESULTS

After the treatment, the total effective rates of the acupuncture+ TDP and cupping + acupuncture groups were 83.3% (25/30) and 96.6% (29/30), respectively, without significant difference between the two groups (P > 0.05). One month's follow-up showed that the total effective rates of the acupuncture + TDP and cupping + acupuncture groups were 40.0% and 90.0% respectively, and the latter group was significantly better than the acupuncture + TDP group in the therapeutic effect (P < 0.05). The scores of PRI, VAS, PPI after the treatment were markedly decreased in both groups (P < 0.05). One month later, the scores of PRI, VAS and PPI in the cupping + acupuncture group were obviously lower than those of the acupuncture group (P < 0.05).

CONCLUSION

Both acupuncture stimulation of trigger points plus TDP and cupping plus acupuncture can effectively relieve pain in MPS patients, while the therapeutic effect of cupping plus acupuncture treatment lasts longer analgesic effect.

[Anesthetic effect of preemptive analgesia of frequency acupoint electrical stimulation on painless-induced abortion]

OBJECTIVE

To explore the anesthetic effect of preemptive analgesia of frequency acupoint electrical stimulation on painless-induced abortion as well as its effect on anesthetics dosage.

METHODS

Ninety cases of early pregnancy who selected painless-induced abortion were randomly divided into two groups, 45 cases in each group. Frequency acupoint electrical stimulation at Ciliao (BL 32) and Shenshu (BL 23), disperse-densewave, 2 Hz/100 Hz in frequency for 15 to 20 min, was applied in the group A, which was followed by intravenous anesthesia of propofol. The intravenous anesthesia of propofol was applied in the group B. The blood pressure (BP), heart rate (HR) and SpO2 before, during and after surgery, anesthetic effect and dosage, waking time and adverse events were observed in the two groups.

RESULTS

The BP and HR during and after the surgery in the group A were not statistically different from those before the surgery (all P > 0.05). The BP was reduced and HR was slowed down during the surgery in the group B, which was significantly different from those before the surgery as well as those in the group A (all P < 0.05). The dosage of propofol was (114. 3-+6. 1) mg in the group A. obviously less than (193.2 +/- 8.9) mg in the group B (P < 0.05). The waking time was (5.6 +/- 1.2) min in the group A, obviously less than (10.1 +/- 3.9) min in the group B (P < 0.05). As for anesthetic effect, the incidence of Grade I in the group A was more than the group B (P < 0.05). The adverse events, including nausea, vomiting and contractions pain in the group A were evidently less than those in the group B (all P < 0.05).

CONCLUSION

The preemptive analgesia of frequency acupoint electrical stimulation could significantly improve anesthetic effect of painless-induced abortion, reduce dosage of anesthetics, shorten waking time of surgery and guarantee the safety of surgery.