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Bang SK, Chang S, Seo SY, Kang SY, Cho SJ, Choi KH, Juping X, Kim HY, Ryu Y. Attenuation of immobilization stress-induced hypertension by temperature-controllable warm needle acupuncture in rats and the peripheral neural mechanisms. Front Neurol 2023; 14:1168012. [PMID: 37384285 PMCID: PMC10294230 DOI: 10.3389/fneur.2023.1168012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/26/2023] [Indexed: 06/30/2023] Open
Abstract
Introduction We and others have shown that electrical stimulation of the PC-6 acupoint over the wrist relieves hypertension by stimulating afferent sensory nerve fibers and activating the central endogenous opioid system. Warm needle acupuncture has long been utilized to treat various diseases in clinics. Methods Here, we developed a temperature-controllable warm needle acupuncture instrument (WAI) and investigated the peripheral mechanism underlying the effect of warm needle acupuncture at PC-6 on hypertension in a rat model of immobilization stress-induced hypertension. Results Stimulation with our newly developed WAI and traditional warm needle acupuncture attenuated hypertension development. Such effects were reproduced by capsaicin (a TRPV1 agonist) injection into PC-6 or WAI stimulation at 48°C. In contrast, PC-6 pretreatment with the TRPV1 antagonist capsazepine blocked the antihypertensive effect of WAI stimulation at PC-6. WAI stimulation at PC-6 increased the number of dorsal root ganglia double-stained with TRPV1 and CGRP. QX-314 and capsaicin perineural injection into the median nerve for chemical ablation of small afferent nerve fibers (C-fibers) prevented the antihypertensive effect of WAI stimulation at PC-6. Additionally, PC-6 pretreatment with RTX ablated the antihypertensive effect of WAI stimulation. Conclusion These findings suggest that warm needle acupuncture at PC-6 activates C-fiber of median nerve and the peripheral TRPV1 receptors to attenuate the development of immobilization stress-induced hypertension in rats.
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Affiliation(s)
- Se Kyun Bang
- Department of Korean Medicine Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Department of Korean convergence Medical Science, University of Science and Technology, Daejeon, Republic of Korea
| | - Suchan Chang
- Department of Physiology, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Su Yeon Seo
- Department of Korean Medicine Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Suk-Yun Kang
- Department of Korean Medicine Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Seong Jin Cho
- Department of Korean Medicine Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Kwang-Ho Choi
- Department of Korean Medicine Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Xing Juping
- Department of Physiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Young Kim
- Department of Physiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yeonhee Ryu
- Department of Korean Medicine Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Department of Korean convergence Medical Science, University of Science and Technology, Daejeon, Republic of Korea
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Liu J, Li Y, Li L, Luo X, Li N, Yang X, Zhang H, Liu Z, Kang D, Luo Y, Liu Y, Jia Y, Ren Y, Yao M, Wang Y, Chen J, Maiji M, Zou K, Zhao L, Liang F, Sun X. Effects of acupuncture at acupoints with lower versus higher pain threshold for knee osteoarthritis: a multicenter randomized controlled trial. Chin Med 2022; 17:67. [PMID: 35676697 PMCID: PMC9175460 DOI: 10.1186/s13020-022-00626-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/28/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The acupoint selections impact the effects of acupuncture, and preliminary evidence showed potential connection between pain threshold (PT) and acupuncture response. This study examined whether acupuncture at acupoints with lower PT versus higher PT would yield different effects in patients with knee osteoarthritis (KOA). METHODS In this multicenter randomized clinical trial, patients were randomly assigned (1:1:1) to receive acupuncture at acupoints with lower PT (LPT group), acupuncture at acupoints with higher PT (HPT group), and no acupuncture (waiting-list group). PT was measured with electronic von Frey detector. The primary outcome was the change in WOMAC total score from baseline to 16 weeks, and the secondary outcomes were SF-12 score, and active knee range of motion (ROM). Intention-to-treat analysis was conducted with linear mixed-effect model. RESULTS Among 666 randomized patients, 625 (93.84%) completed the study. From baseline to 16 weeks, patients in the LPT group versus HPT group had similar effects in reducing WOMAC total score (adjusted mean difference (MD) 2.21, 95% confidence interval (CI) -2.51 to 6.92, P = 0.36), while a greater reduction in WOMAC total score was observed in LPT group (-9.77, 95% CI -14.47 to -5.07, P < 0.001) and HPT group (-11.97, 95% CI -16.71 to -7.24, P < 0.001) compared with waiting-list group. There were no differences in SF-12 score and knee ROM between LPT versus HPT groups. CONCLUSION Our findings found that the effects of acupuncture at acupoints with lower versus higher PT were similar, both were effective for patients with KOA. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03299439. Registered 3 October 2017, https://clinicaltrials.gov/ct2/show/NCT03299439.
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Affiliation(s)
- Jiali Liu
- Chinese Evidence-Based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041 Sichuan China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, 610041 Sichuan China
| | - Ying Li
- Graduate School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075 Sichuan China
| | - Ling Li
- Chinese Evidence-Based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041 Sichuan China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, 610041 Sichuan China
| | - Xiaochao Luo
- Chinese Evidence-Based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041 Sichuan China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, 610041 Sichuan China
| | - Ning Li
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610041 China
| | - Xuguang Yang
- College of Acupuncture and Massage, Henan University of Traditional Chinese Medicine, Zhengzhou, 450008 China
| | - Hongxing Zhang
- Department of Acupuncture, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, 430022 China
| | - Zhibin Liu
- Chinese Evidence-Based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
| | - Deying Kang
- Chinese Evidence-Based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
| | - Yanan Luo
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075 Sichuan China
| | - Yanmei Liu
- Chinese Evidence-Based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041 Sichuan China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, 610041 Sichuan China
| | - Yulong Jia
- Chinese Evidence-Based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041 Sichuan China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, 610041 Sichuan China
| | - Yan Ren
- Chinese Evidence-Based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041 Sichuan China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, 610041 Sichuan China
| | - Minghong Yao
- Chinese Evidence-Based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041 Sichuan China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, 610041 Sichuan China
| | - Yuning Wang
- Chinese Evidence-Based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041 Sichuan China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, 610041 Sichuan China
| | - Jin Chen
- Chinese Evidence-Based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
| | - Mewujia Maiji
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610041 China
| | - Kang Zou
- Chinese Evidence-Based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041 Sichuan China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, 610041 Sichuan China
| | - Ling Zhao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075 Sichuan China
| | - Fanrong Liang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075 Sichuan China
| | - Xin Sun
- Chinese Evidence-Based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041 Sichuan China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, 610041 Sichuan China
- Evidence-Based Medicine Research Center, School of Basic Science, Jiangxi University of Traditional Chinese Medicine, Nanchang, 330004 Jiangxi China
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Effect of Acupuncture on Time-Dependent of Muscle Endurance in Female Elbow Joint: A Randomized Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:8052256. [PMID: 35186105 PMCID: PMC8849896 DOI: 10.1155/2022/8052256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 01/25/2022] [Indexed: 11/28/2022]
Abstract
Immediate characteristics of acupuncture have been confirmed by relevant studies; however, the current study on the time effect of acupuncture in improving upper limb forearm muscle endurance is still limited. The aims of this study are to explore: (1) whether real acupuncture (RA) can improve female forearm muscle endurance compared to sham acupuncture (SA) and (2) whether the changes in forearm muscle endurance after RA are time-dependent. Thirty-six healthy female students were recruited to participate in isokinetic tests of elbow flexion/extension (Flex/Ext) from maximum flexion to maximum extension as much as possible using an isokinetic dynamometer at a speed rate of 60°/sec. Participants in the RA group were stimulated at Quchi (LI11), Shousanli (LI10), Hegu (LI4), Xiaohai (SI8), Tianjing (SJ10), and Waiguan (SJ5) acupoints for 20 min, while the SA group needling was near at these acupoints. The values of the isokinetic parameters and surface electromyography (sEMG) signals were recorded before and after acupuncture. After RA, the isokinetic parameters values (average torque, work, power, and speed), the sEMG values at four major muscles, and the joint stiffness of elbow Flex/Ext were significantly increased (p < 0.05). The enhancement of forearm muscle endurance lasted approximately 7–21 min (from post1 to post3/post4), indicating that the effect of RA to improve elbow Flex/Ext muscle endurance is time-dependent. Therefore, this study found that RA can immediately improve the forearm muscle endurance of healthy women compared with SA, and this effect can last approximately 7–21 min until the acupuncture efficacy decreased or disappeared.
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Trento MMS, Moré AOO, Duarte ECW, Martins DF. Peripheral receptors and neuromediators involved in the antihyperalgesic effects of acupuncture: a state-of-the-art review. Pflugers Arch 2021; 473:573-593. [PMID: 33474636 DOI: 10.1007/s00424-020-02503-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/23/2020] [Accepted: 12/03/2020] [Indexed: 12/30/2022]
Abstract
The present study aims to describe state-of-the-art of preclinical studies that have investigated peripheral receptors and neuromediators involved in the antihyperalgesic effects of acupuncture. The PubMed, Scopus, and Web of Science databases were searched using the integrative review method. Preclinical articles that involved the study of peripheral receptors and neuromediators on the pain control effects of acupuncture in rats or mice were selected using a predefined search strategy. From this search, 456 articles were found, and 29 of them met the inclusion criteria of the study. The selected articles addressed the following peripheral receptors: opioid (n = 9), adenosine (n = 5), cannabinoid (n = 5), transient receptor potential vanilloid (TRPV) (n = 3), histamine (n = 2), adrenergic (n = 1), muscarinic (n = 1), corticotrophin-releasing factor (CRF) (n = 2), IL-1 (n = 1), and endothelin (n = 1) receptors. The peripheral neuromediators correlated with the peripheral pain control effect were as follows: opioid peptides (n = 4), adenosine (n = 3), histamine (n = 1), substance P (n = 1) calcitonin gene-related peptide (CGRP) (n = 1), anandamide (n = 1), nitric oxide (n = 1), and norepinephrine (n = 1). This review summarizes the methods used to investigate the peripheral effects of acupuncture and discusses the main findings on each family of receptors and neuromediators. Ten families of peripheral receptors and 8 types of neuromediators were correlated with the antihyperalgesic effects of acupuncture in preclinical studies. Considering the benefits of a better understanding of the role of peripheral receptors and neuromediators in the context pain management, the findings of the present study highlight the importance of deepening the exploration of the peripheral mechanisms of acupuncture.
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Affiliation(s)
| | - Ari Ojeda Ocampo Moré
- Integrative Medicine and Acupuncture Service, University Hospital, Federal University of Santa Catarina, R. Profa. Maria Flora Pausewang, s/n - Trindade, Florianópolis, Santa Catalina, CEP: 88036-800, Brazil.
| | | | - Daniel Fernandes Martins
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil.,Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
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Butts R, Dunning J, Serafino C. Dry needling strategies for musculoskeletal conditions: Do the number of needles and needle retention time matter? A narrative literature review. J Bodyw Mov Ther 2020; 26:353-363. [PMID: 33992269 DOI: 10.1016/j.jbmt.2020.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 09/28/2020] [Accepted: 12/01/2020] [Indexed: 01/16/2023]
Abstract
Acupuncture and dry needling are both minimally invasive procedures that use thin, filiform needles without injectate for the management of a variety of neuromusculoskeletal pain conditions. While the theoretical constructs underlying the use of acupuncture and dry needling are unique, both appear to have the ability to elicit biochemical, biomechanical, endocrinological and neurovascular changes associated with reductions in pain and disability. However, optimal treatment dosage has yet to be determined, and there is a lack of consistency in the literature on the number of needles that should be inserted and the needle retention time. Therefore, the purpose of this narrative review is to further explore the importance of these two variables. While trigger point dry needling advocates single needle insertions via repetitive, quick in-and-out pistoning, most acupuncture and dry needling clinical trials have incorporated multiple needles for five to 40 min. Notably and to date, using a single needle to repeatedly prick trigger points one at a time with fast-in and fast-out pistoning maneuvers has not yet been shown to produce significant and clinically meaningful long term improvements in pain and disability in a wide array of musculoskeletal conditions. Insertion of multiple needles for typically 20-30 min durations has been shown to produce larger treatment effect sizes and longer-lasting outcomes than brief, single-needle strategies. Moreover, the number of needles and needle retention time are two variables associated with treatment dosage and must be carefully matched with specific musculoskeletal conditions and the patient's goals.
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Affiliation(s)
- Raymond Butts
- Physical Therapist, Research Physical Therapy Specialists, Columbia, SC, USA; Coordinator, American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, USA.
| | - James Dunning
- Physical Therapist, Montgomery Osteopractic Physiotherapy & Acupuncture Clinic, Montgomery, AL, USA; Director, American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, USA
| | - Clint Serafino
- Physical Therapist, U.S. Armed Forces Europe, Kelley Barracks, Stuttgart, Germany; Senior Instructor, American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, USA
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