Effects of acupressure on lower limb blood flow for the treatment of peripheral arterial occlusive diseases

Effects of acupuncture and acupressure of the acupoint compared to the tendon on the blood circulation of human tendon in vivo

PURPOSE

The purpose of this study was to compare the effects of acupuncture and acupressure of acupoints on tendon blood circulation with those of both types of stimulation of tendon itself.

METHODS

Before, during (except for acupressure), and after acupuncture and acupressure of the tendon and acupoint, blood circulation of the Achilles tendon was measured using red laser lights.

RESULTS

The blood volume of the treated and non-treated tendons increased after acupuncture of the tendon (effect of time p = 0.030), whereas that tended to increase after acupuncture of the acupoint (effect of time p = 0.063). In addition, no significant difference in the increases in blood volume was found among the four conditions, i.e., after acupuncture stimulation of the tendon and acupoint for the treated and non-treated tendons (p = 0.492). The blood volume of the treated tendon significantly increased after acupressure of the tendon (effect of time p < 0.001), but not of the acupoint (effect of time p = 0.260), whereas that of the non-treated tendon did not change after acupressure of both the tendon and acupoint.

CONCLUSION

These results suggested that acupuncture of the tendon and acupoint acted centrally to enhance blood circulation of both the treated and non-treated tendons during the recovery period, whereas acupressure of the tendon locally increased blood circulation of the treated tendon only, but not the non-treated tendon and both the treated and non-treated tendons after acupressure of acupoint.

Acupuncture- and Intermittent Compression-Induced Changes in Blood Circulation of Tendon

Objective: The purpose of this study was to compare changes in blood circulation (blood volume and oxygen saturation [StO₂]) of tendon by acupuncture (insertion depth of the needle was 4 mm) and intermittent compression. Subjects: Thirteen healthy volunteers (12 males and 1 female; age: 26.9 ± 9.8 years) participated in this study. Methods: Before the treatments (10 min for acupuncture, 3 min for intermittent compression, and 10 min for control condition) and the recovery period (40 min), the blood volume (total hemoglobin [THb]) and StO₂ of treated and nontreated Achilles tendons were measured using red laser lights. Results: Regarding the acupuncture-induced changes in blood circulation of tendons, THb and StO₂ of the treated tendon suddenly increased during acupuncture with up-and-down manipulation, and those of the treated and nontreated tendons gradually increased after removal of the needle. The authors were not able to present the measured variables during intermittent compression, since obvious noises were observed. After acupuncture and intermittent compression, THb and StO₂ of the treated tendon remained high during the recovery period and those of the nontreated tendon gradually increased during the latter half of the recovery period. There were no differences in the mean changes of THb or StO₂ of the treated and nontreated tendons during the recovery period between acupuncture and intermittent compression. Under the control condition, no significant changes were noted in the measured variables. Conclusion: These results suggest that intermittent compression to the tendon brought about increases in tendon blood circulation similar to those induced by acupuncture.

Invasive and non-invasive acupuncture techniques for pain management in neonates: a systematic review

BACKGROUND

Neonatal pain is an extensive research field and there are many possibilities to treat pain in neonates. Acupuncture is one new and non-pharmacological option and a promising tool to reduce pain in neonates undergoing minor painful interventions during routine medical care.

OBJECTIVES

This review summarises trials of acupuncture for pain reduction in neonates undergoing painful interventions during routine medical care.

DATA SOURCE

MEDLINE, Embase, CINAHL, electronic clinical trials registry platforms and reference lists were systematically screened for trials from their dates of inception to February 2017 (English language database search).

STUDY SELECTION

Inclusion criteria were (1) preterm or term neonates, (2) acupuncture for painful medical interventions and (3) formal pain assessment as a primary or secondary study outcome. We included only randomised controlled trials.

DATA EXTRACTION

Data were extracted using a standardised protocol and individual risk of bias was assessed.

RESULTS

The literature search revealed a total of 12 196 records. After application of inclusion criteria, five studies were included in this review. Two studies demonstrated significant pain reduction, one found equal outcomes in comparison to standard care, and two showed significantly higher pain scores with acupuncture alone.

LIMITATIONS

The main limitation of the results is the heterogeneity across trials in acupuncture modality, acupuncture point selection, control groups and pain assessment (heterogeneity: I²=87%).

CONCLUSION

The results of this review suggest that acupuncture may have a positive pain-relieving effect in neonates. However, due to the low number of available high-quality trials and heterogeneity across the studies it is not possible to state clear recommendations.

Compression at Myofascial Trigger Point on Chronic Neck Pain Provides Pain Relief through the Prefrontal Cortex and Autonomic Nervous System: A Pilot Study

Compression at myofascial trigger points (MTrPs), known as “ischemic compression,” has been reported to provide immediate relief of musculoskeletal pain and reduce the sympathetic activity that exacerbates chronic pain. We conducted a pilot study to investigate the possible involvement of the prefrontal cortex in pain relief obtained by MTrP compression in the present study, and analyzed the relationships among prefrontal hemodynamic activity, activity of the autonomic nervous system, and subjective pain in patients with chronic neck pain, with and without MTrP compression. Twenty-one female subjects with chronic neck pain were randomly assigned to two groups: MTrP compression (n = 11) or Non-MTrP compression (n = 10). Compression for 30 s was conducted 4 times. During the experiment, prefrontal hemodynamic activity [changes in Oxy-hemoglobin (Hb), Deoxy-Hb, and Total-Hb concentrations] and autonomic activity based on heart rate variability (HRV) were monitored by using near infrared spectroscopy (NIRS) and electrocardiography (ECG), respectively. The results indicated that MTrP compression significantly reduced subjective pain compared with Non-MTrP compression. The spectral frequency-domain analyses of HRV indicated that a low frequency (LF) component of HRV was decreased, and a high frequency (HF) component of HRV was increased during MTrP compression, while LF/HF ratio was decreased during MTrP compression. In addition, prefrontal hemodynamic activity was significantly decreased during MTrP compression compared with Non-MTrP compression. Furthermore, changes in autonomic activity were significantly correlated with changes in subjective pain and prefrontal hemodynamic activity. Along with previous studies indicating a role for sympathetic activity in the exacerbation of chronic pain, the present results suggest that MTrP compression in the neck region alters the activity of the autonomic nervous system via the prefrontal cortex to reduce subjective pain.

The evidence for Shiatsu: a systematic review of Shiatsu and acupressure

Background

Shiatsu, similar to acupressure, uses finger pressure, manipulations and stretches, along Traditional Chinese Medicine meridians. Shiatsu is popular in Europe, but lacks reviews on its evidence-base.

Methods

Acupressure and Shiatsu clinical trials were identified using the MeSH term 'acupressure' in: EBM reviews; AMED; BNI; CINAHL; EMBASE; MEDLINE; PsycARTICLES; Science Direct; Blackwell Synergy; Ingenta Select; Wiley Interscience; Index to Theses and ZETOC. References of articles were checked. Inclusion criteria were Shiatsu or acupressure administered manually/bodily, published after January 1990. Two reviewers performed independent study selection and evaluation of study design and reporting, using standardised checklists (CONSORT, TREND, CASP and STRICTA).

Results

Searches identified 1714 publications. Final inclusions were 9 Shiatsu and 71 acupressure studies. A quarter were graded A (highest quality). Shiatsu studies comprised 1 RCT, three controlled non-randomised, one within-subjects, one observational and 3 uncontrolled studies investigating mental and physical health issues. Evidence was of insufficient quantity and quality. Acupressure studies included 2 meta-analyses, 6 systematic reviews and 39 RCTs. Strongest evidence was for pain (particularly dysmenorrhoea, lower back and labour), post-operative nausea and vomiting. Additionally quality evidence found improvements in sleep in institutionalised elderly. Variable/poor quality evidence existed for renal disease symptoms, dementia, stress, anxiety and respiratory conditions. Appraisal tools may be inappropriate for some study designs. Potential biases included focus on UK/USA databases, limited grey literature, and exclusion of qualitative and pre-1989 studies.

Conclusions

Evidence is improving in quantity, quality and reporting, but more research is needed, particularly for Shiatsu, where evidence is poor. Acupressure may be beneficial for pain, nausea and vomiting and sleep.

Differences in the microcirculatory effects of local skin surface contact pressure stimulation between acupoints and nonacupoints: possible relevance to acupressure

In the present study, laser Doppler measurement was used to quantitatively investigate the microcirculatory effects of contact pressure stimulation (PS) underneath the Hoku acupoint and its nearby nonacupoint, to improve the understanding of the mechanisms underlying acupressure therapy. A control group (no PS applied) and three experimental groups with different applied PS (group A, 60 mmHg on the Hoku acupoint; group B, 60 mmHg on a nearby nonacupoint; group C, 50 mmHg on a nearby nonacupoint) were studied. Each experiment involved recording data of a 20 min baseline and two periods of effects after stopping PS. The relative energy contribution (REC) in five frequency bands, as revealed by Morlet wavelet transformation, was calculated. At the pressed site, the average value of the laser Doppler flux signal was increased only in group A, and coefficient of variance of the amplitude sequence was only significantly decreased during measurement (M1: 0 to 20 min) in group B. The RECs of the myogenic-related band were significantly increased in groups A and C, whereas there were no significant changes found in group B. The improved microcirculatory blood-flow perfusion at Hoku may partly explain why acupressure can exert better therapeutic effects than PS applied to other sites. The laser Doppler spectra responses illustrated that the induced pressure-induced vasodilation can be attributed mainly to the myogenic response. Laser Doppler measurement and analysis therefore represent a noninvasive method of examining the microcirculatory efficacy of acupressure therapy.

Efficacy of the transfer function index using the pulse volume recording as a parameter to assess intermittent claudication

PURPOSE

The aim of this study was to elucidate whether the ankle brachial pressure index (ABPI) or transfer function index (TFI) was useful as an alternative parameter to the treadmill-walking test using near-infrared spectroscopy (NIRS) in evaluating muscle ischemia for patients with intermittent claudication (IC).

METHODS

In 155 claudicants, the treadmill-walking test using NIRS was performed to calculate the recovery ability index (=recovery time/walking time). The ABPI and TFI were measured at the calf (TFI(calf)) and ankle (TFI(ankle)) using pulse volume recording. The area under the curve (AUC) was calculated from the receiver operating characteristic (ROC) curve and cutoff value was determined using crossing point of the ROC curve with a diagonal line.

RESULTS

In the nondiabetics, AUCs were 77.3%, 80.0%, and 76.0% in the ABPI, TFI(calf), and TFI(ankle), respectively, which were not different significantly. In the diabetics, the AUC of TFI(calf) was 77.9%, which was different significantly from those of the other indices such as the ABPI or TFI(ankle) showing 66.2% or 68.1%. The cutoff value of ABPI indicating moderate or severe IC was 0.75 in the nondiabetics whereas that of TFI(calf) was 0.85 in the diabetics.

CONCLUSION

TFI(calf) was useful to distinguish moderate or severe IC from mild IC in diabetic patients even if the ABPI was sufficient in nondiabetic patients.

An Engineering Approach for Quantitative Analysis of the Lengthwise Strokes in Massage Therapies

Massage therapies are widely used for improving and restoring the function of human tissues. It is generally accepted that such therapies promote human health and well-being by several possible mechanisms, including increase in blood flow and parasympathetic activity, release of relaxation hormones, and inhibition of muscle tension, neuromuscular excitability, and stress hormones. Nonetheless, most of the purported beneficial/adverse effects of massage are based on anecdotal experiences, providing little insight on its effectiveness or the mechanisms underlying its usefulness. Furthermore, most studies to date have not quantitatively demonstrated the efficacy of massage on human health. This might be due to the lack of appropriate tools necessary for the application of quantitatively controlled loading and for the evaluation of the subsequent responses. To address this issue, we developed a device that applies compression in lengthwise strokes to the soft tissues of the New Zealand white rabbit, thereby mimicking the rubbing and effleurage techniques of massage. This device permits control of the magnitude and frequency of mechanical load applied to the rabbit’s hind limb for various durations. The measurement of tissue compliance and the viscoelastic properties as a function of loading parameters was also demonstrated. Findings of this study suggest that this device offers a quantitative analysis of the applied loads on the tissue to determine an optimal range of loading conditions required for the safe and effective use of massage therapies.