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Liu YY, Chien TW, Li CC. Effectiveness of Auricular Acupressure on Improving Pain and Heart Rate Variability in Patients After Cervical Spine Surgery. Holist Nurs Pract 2024:00004650-990000000-00044. [PMID: 39196649 DOI: 10.1097/hnp.0000000000000695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Abstract
Cervical spine surgery is a common neurosurgical procedure; however, postoperative pain remains a problem. This study aimed to examine the effectiveness of auricular acupressure, which is considered a noninvasive, convenient, and safe method for pain reduction and heart rate variability in patients after surgery. A total of 62 patients who underwent cervical spine surgery were randomly divided into experimental (32 patients) and control (30 patients) groups. Both groups received routine care, whereas the experimental group received auricular acupressure three times a day for four days. The Short-Form McGill Pain Questionnaire was administered, and heart rate variability measurements were obtained on the first, second, third, and fourth postoperative days. The results indicated that auricular acupressure was effective in reducing pain (P < .05) and improving heart rate variability (P < .05) in patients. Based on the findings, this study suggests that auricular acupressure can be used as a complementary treatment to reduce pain in patients after cervical spine surgery.
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Affiliation(s)
- Ying-Yin Liu
- Department of Nursing, Taipei Veterans General Hospital, Taipei City, Taiwan (Ms Liu); School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan (Dr Chien); and Department of Nursing, MacKay Medical College, New Taipei City, Taiwan (Dr Li)
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2
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Elliott T, Merlano Gomez M, Morris D, Wilson C, Pilitsis JG. A scoping review of mechanisms of auricular acupuncture for treatment of pain. Postgrad Med 2024; 136:255-265. [PMID: 38501597 DOI: 10.1080/00325481.2024.2333232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVES Auricular acupuncture (AA) is becoming increasingly common in primary care clinics, emergency departments and peri-operatively for pain relief. Over the last decade, since the last comprehensive reviews were published, the literature has expanded. In this scoping review, we seek to document the efficacy of AA in treating both acute and chronic pain, describe the mechanism of action of AA in treating pain, and discuss how AA has been integrated into Western medicine to date. METHODS The authors performed a MEDLINE search inclusive of articles from 1966 to June 2023 including articles written in English identifying literature. We included human studies when more than 3 patients were included. Three hundred and fourteen unique articles were identified and 152 were selected by title screen. After abstract review, 117 were chosen for full-text review. Following full-text review, 33 articles were excluded and 21 added from references, totaling 105 articles included in our scoping review. RESULTS AA reduces pain severity in patients with both acute and chronic pain. The best studies in the acute settings have occurred in the peri-operative setting where sham AA is employed, multiple sessions of AA are given, and medication dosing is carefully monitored. In these cases, AA reduced pain and post-operative medications. In patients with chronic pain, multiple sessions of AA resulted not only in pain relief but also in improvements in function and disability. Literature suggests that AA works through multiple mechanisms with the most compelling data coupled to the autonomic nervous system and neuroendocrine system. Curriculums designed to teach AA and aid in implementation have been published. CONCLUSION AA is an accessible, effective means of pain relief. AA is relatively straightforward to learn, and protocols and curriculums exist to teach healthcare professionals this valuable skill. Overcoming implementation barriers, including patient education, are essential next steps.
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Affiliation(s)
- Trish Elliott
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Maria Merlano Gomez
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Deborah Morris
- Department of Neurosurgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Candy Wilson
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, University of Arizona College of Medicine, Tucson, AZ, USA
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Su N, Cai P, Dou Z, Yin X, Xu H, He J, Li Z, Li C. Brain nuclei and neural circuits in neuropathic pain and brain modulation mechanisms of acupuncture: a review on animal-based experimental research. Front Neurosci 2023; 17:1243231. [PMID: 37712096 PMCID: PMC10498311 DOI: 10.3389/fnins.2023.1243231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
Neuropathic pain (NP) is known to be associated with abnormal changes in specific brain regions, but the complex neural network behind it is vast and complex and lacks a systematic summary. With the help of various animal models of NP, a literature search on NP brain regions and circuits revealed that the related brain nuclei included the periaqueductal gray (PAG), lateral habenula (LHb), medial prefrontal cortex (mPFC), and anterior cingulate cortex (ACC); the related brain circuits included the PAG-LHb and mPFC-ACC. Moreover, acupuncture and injurious information can affect different brain regions and influence brain functions via multiple aspects to play an analgesic role and improve synaptic plasticity by regulating the morphology and structure of brain synapses and the expression of synapse-related proteins; maintain the balance of excitatory and inhibitory neurons by regulating the secretion of glutamate, γ-aminobutyric acid, 5-hydroxytryptamine, and other neurotransmitters and receptors in the brain tissues; inhibit the overactivation of glial cells and reduce the release of pro-inflammatory mediators such as interleukins to reduce neuroinflammation in brain regions; maintain homeostasis of glucose metabolism and regulate the metabolic connections in the brain; and play a role in analgesia through the mediation of signaling pathways and signal transduction molecules. These factors help to deepen the understanding of NP brain circuits and the brain mechanisms of acupuncture analgesia.
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Affiliation(s)
- Na Su
- First Clinical Medicine College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Pingping Cai
- Department of Traditional Chinese Medicine, Shandong Provincial Hospital, Jinan, China
| | - Zhiqiang Dou
- College of Acupuncture and Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiaoxue Yin
- Department of Science and Education, Shandong Academy of Chinese Medicine, Jinan, China
| | - Hongmin Xu
- Department of Gynecology, Laiwu Hospital of Traditional Chinese, Jinan, China
| | - Jing He
- First Clinical Medicine College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhaofeng Li
- College of Acupuncture and Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, China
- International Office, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Changzhong Li
- Department of Obstetrics and Gynecology, Shenzhen Hospital, Peking University, Shenzhen, China
- Department of Gynecology, Shandong Provincial Hospital, Jinan, China
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Koukoulithras I, Alkhazi A, Gkampenis A, Stamouli A, Plexousakis M, Drousia G, Xanthi E, Roussos C, Kolokotsios S. A Systematic Review of the Interventions for Management of Pain in Patients After Spinal Cord Injury. Cureus 2023; 15:e42657. [PMID: 37644939 PMCID: PMC10461890 DOI: 10.7759/cureus.42657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/31/2023] Open
Abstract
Chronic pain is a very common problem in patients with spinal cord injury (SCI) as it affects 80% of these patients, which negatively affects their quality of life. Despite many advantages that exist in the management of any type of pain (neuropathic, nociceptive, mixed) in these patients, there is no cure, and the analgesic effect of some treatments is inadequate. This study aims to conduct an evidence-based systematic review regarding the various interventions used for the management of pain after SCI. The PubMed, Physiotherapy Evidence Database (PEDro), and Cochrane Library databases were searched from 1969 to 2023. The risk of bias was assessed using the PEDro scoring system. A total of 57 studies met the inclusion criteria and were included in this systematic review. Among the different interventions at present, 18 studies examined the role of oral medications, 11 studies examined the role of minimally invasive methods (injection and infusion), 16 studies investigated physiotherapy and alternative treatments, and 12 studies examined the role of repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and cranial electrotherapy stimulation (CES) in the management of pain in patients after SCI. Gabapentin and pregabalin are very effective in managing chronic neuropathic pain after SCI, and pregabalin also seems to reduce anxiety and sleep disturbances in the patients. It is noteworthy that lamotrigine, valproate, and carbamazepine do not have an analgesic effect, but mirogabalin is a novel and promising drug. Antidepressants (selective serotonin reuptake inhibitors and serotonin and noradrenaline reuptake inhibitors) did not reduce the pain of the patients, although some studies showed an efficacy of amitriptyline especially in depressed patients and tramadol should be considered short-term with caution. Also, tDCS and rTMS reduced pain. Moreover, botulinum toxin type A, lidocaine, ketamine, and intrathecal baclofen significantly reduced pain intensity, although the sample of the studies was small. Physiotherapy and alternative treatments seem to relieve pain, and transcutaneous electrical nerve stimulation had the greatest reduction of pain intensity. In conclusion, several pharmaceutical and non-pharmaceutical methods exist, which can reduce pain in patients after SCI. The type of intervention can be considered by the physician depending on the patients' preference, age, medical history, type of pain, and associated symptoms. However, more studies with greater samples and with better methodological quality should be conducted.
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Affiliation(s)
- Ioannis Koukoulithras
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, GRC
- Faculty of Medicine, University of Ioannina, Ioannina, GRC
| | - Abdulaziz Alkhazi
- Department of Neurosurgery, Mater Dei Hospital, Msida, MLT
- Faculty of Medicine, University of Malta, Imsida, MLT
| | - Athanasios Gkampenis
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, GRC
- Faculty of Medicine, University of Ioannina, Ioannina, GRC
| | - Alexandra Stamouli
- Department of Physical Therapy, University Hospital, University of West Attica, Athens, GRC
- Faculty of Medicine, National and Kapodistrian University of Athens, Athens, GRC
| | - Minas Plexousakis
- Department of Physical Therapy, University Hospital, University of West Attica, Athens, GRC
| | - Gianna Drousia
- Department of Physical Therapy, University Hospital, University of West Attica, Athens, GRC
| | - Eleana Xanthi
- Department of Physical Therapy, University Hospital, University of West Attica, Athens, GRC
| | - Charis Roussos
- Department of Physical Medicine and Rehabilitation, Mitera Hospital, Athens, GRC
| | - Spyridon Kolokotsios
- Department of Physical Therapy, University Hospital, University of West Attica, Athens, GRC
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Feng Z, Cui S, Yang H, Wang Y, Zhou X, Wong J, Lai L, Yang Z, Huang B, Zheng H, Xu M. Acupuncture for neuropathic pain: A meta-analysis of randomized control trials. Front Neurol 2023; 13:1076993. [PMID: 36698895 PMCID: PMC9868276 DOI: 10.3389/fneur.2022.1076993] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/09/2022] [Indexed: 01/10/2023] Open
Abstract
Background Neuropathic pain (NP) is expected to increase due to the high risk of global population aging. Acupuncture has a definite clinical effect on NP. Therefore, a systematic review and meta-analysis were conducted to evaluate the effect on pain intensity and safety of acupuncture in patients with NP. Methods An encompassing search of specific authoritative databases in English, from their inception to 2022, was performed. The databases were as follows: Scopus, Ovid EMBASE, Ovid Cochrane Database of Systematic Reviews, Ovid Cochrane Central Register of Controlled Trials, Ovid MEDLINE(R) and Epub Ahead of Print, In-Process and Other Non-Indexed Citations, and Daily. All the randomized controlled trials regarding the acupuncture treatment of NP will be included. Methodological quality assessment of the included trials was assessed based on the risk of bias from the Cochrane handbook. A meta-analysis was performed for the main outcomes. In addition, sensitivity analysis, subgroup analysis, and funnel plot were also carried out. Results A total of 16 studies with 1,021 patients with NP were evaluated in a systematic review. According to the results of the overall meta-analysis in eight RCTs with 338 participants, the acupuncture group was better than the control group in improving changes in pain intensity (SMD -0.59, 95% CI: -0.95 to -0.23, P = 0.001). In subgroup analysis, five trials indicated that acupuncture was more effective in improving changes in pain intensity than sham acupuncture (SMD -0.54, 95% CI: -0.95 to -0.13, P = 0.01), two trials evaluated the effect on changes in pain intensity in the comparison of acupuncture and conventional treatments, no significant difference existed (SMD -0.61, 95% CI: -1.83 to 0.61, P = 0.33), and one trial compared acupuncture with blank control evaluating the effect of changes in pain intensity with a significant difference. Eleven studies mentioned the safety conditions and acupuncture-induced AEs were mild and reversible. Both the sensitivity analysis and funnel plot analysis showed that the meta-analysis was stable and irreversible without publication bias. The GRADE was rated as "very low." Conclusion The acupuncture group had higher effectiveness than sham intervention or blank control for changes in pain intensity, but there is no significant difference between acupuncture and conventional treatments in treating NP. The acupuncture-induced adverse events were mild and reversible. However, the interpretation of our results should be performed cautiously due to the low methodological quality of selected publications. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022306461.
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Affiliation(s)
- Zitong Feng
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shaoyang Cui
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China,Department of Rehabilitation, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Huijun Yang
- Department of Rehabilitation, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Yixiao Wang
- Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Xuan Zhou
- Formula-Pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - John Wong
- School of Nursing, MGH Institute of Health Professions, Boston, MA, United States,Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, United States
| | - Liting Lai
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zeyu Yang
- Department of Rehabilitation, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Bingjing Huang
- Department of Rehabilitation, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Huiyan Zheng
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mingzhu Xu
- Shenzhen Hospital, Southern Medical University, Shenzhen, China,*Correspondence: Mingzhu Xu ✉
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Treating pain using acupuncture for nonacupuncturists. JAAPA 2023; 36:1-4. [PMID: 36573821 DOI: 10.1097/01.jaa.0000902880.99336.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
ABSTRACT Battlefield acupuncture is a specific auricular acupuncture protocol that can be performed by nonacupuncturists in military and civilian clinical settings. Battlefield acupuncture is purported to be efficacious in controlling pain, is quickly administered, and requires minimal postadministration observation. With very low risk and a negligible adverse reaction profile, this technique can be used as an alternative or complement to manage pain. More large randomized controlled trials are needed to compare acupuncture with standard therapy in military and civilian settings.
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Zhong P, Zeng H, Huang M, Chen L, Fu W. Combined acupuncture and moxibustion therapy for the treatment of neurogenic bladder and bowel dysfunction following traumatic spinal cord injury: A case report. Explore (NY) 2023; 19:136-140. [PMID: 34933828 DOI: 10.1016/j.explore.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/21/2021] [Indexed: 01/25/2023]
Abstract
Neurogenic bladder and bowel are two critical autonomic complications following traumatic spinal cord injury (TSCI). Chronic lower urinary tract and bowel dysfunctions can lead to secondary complications, drastically affect the quality of life and significantly increase the risk of hospital readmission and mortality. Other than symptomatic treatments, a few effective therapies are available. Combined acupuncture and moxibustion therapy has positive effects on improving nerve repair and functional recovery in the early phases following TSCI. However, whether it is effective for TSCI-related chronic urinary and bowel dysfunctions remains unknown. This report presents the case of a 26-year-old male patient who experienced neurogenic bladder and bowel dysfunction following TSCI due to an accidental fall from height for more than 10 months and visited our department for combined acupuncture and moxibustion therapy. After 48 treatment sessions, he regained voluntary urination and defecation to a large extent. Urodynamic testing showed recovered bladder compliance and improved detrusor contractility. Symptom assessment with the Qualiveen Short-Form and neurogenic bowel dysfunction scores demonstrated reduced symptom severity. This case suggests that combined acupuncture and moxibustion therapy might help to restore the physiological functions of the lower urinary and digestive tracts following TSCI and might be a promising alternative for the treatment of neurogenic bladder and bowel dysfunction in patients with TSCI.
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Affiliation(s)
- Ping Zhong
- Department of Acupuncture and Moxibustion, The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hai Zeng
- College of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Miaochun Huang
- Department of Emergency, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Ling Chen
- Department of Acupuncture and Moxibustion, The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenbin Fu
- Department of Acupuncture and Moxibustion, The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China; Innovative research team of acupuncture for depression and related disorders, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.
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Huang Y, He K, Fang D, Ni F, Qiu B, Liang K, Ma R. A bibliometric of research trends in acupuncture for spinal cord injury: Quantitative and qualitative analyses. Front Neurol 2022; 13:936744. [PMID: 36188361 PMCID: PMC9521612 DOI: 10.3389/fneur.2022.936744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Spinal cord injury (SCI) is a severe disease of the central nervous system with a very high disability rate that seriously affects the daily life of patients. Acupuncture is one of the rehabilitation therapies that has shown significant efficacy in treating post-SCI complications such as motor disorders, neuropathic pain, and neurogenic bladder. Current studies have focused on the effectiveness and mechanisms of acupuncture for SCI, but no studies are available to analyze the bibliometrics of publications related to this area. Methods Publications related to acupuncture for SCI were retrieved from the Web of Science Core Collection for quantitative and qualitative analyses. The quantitative analysis was unfolded in the following six main areas: annual publications, countries, institutions, authors, sources, and keywords. The qualitative analysis section screened out publications with high annual citation rates and categorized them according to the study content. Results There were 213 relevant publications, more than half of which were journal articles. The number of publications showed a fluctuating upward trend. China and the United States were hub countries for related publications and had extensive cooperation with other countries. The most relevant author was Yuanshan Zeng from Sun Yat-sen University, China. The efficacy and mechanism of acupuncture for neuropathic pain after SCI was the first research hotspot in this field, and electroacupuncture was the most widely used technique. In the past 5 years, the mechanism of acupuncture to improve the local microenvironment of SCI and promote nerve regeneration had become a new research trend. At the same time, acupuncture had been gradually applied to various complications after SCI and in veterinary medicine. Conclusion The findings suggest that research on acupuncture for SCI is still flourishing, and more research on electroacupuncture for promoting nerve repair and regeneration after SCI will be available in the future.
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Affiliation(s)
- Yi Huang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
| | - Kelin He
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, China
| | - Dandan Fang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
| | - Fengjia Ni
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
| | - Bei Qiu
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
| | - Kang Liang
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, China
| | - Ruijie Ma
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, China
- *Correspondence: Ruijie Ma
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Almeida C, Monteiro-Soares M, Fernandes Â. Should Non-Pharmacological and Non-Surgical Interventions be Used to Manage Neuropathic Pain in Adults With Spinal Cord Injury? - A Systematic Review. THE JOURNAL OF PAIN 2022; 23:1510-1529. [PMID: 35417793 DOI: 10.1016/j.jpain.2022.03.239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/15/2022] [Accepted: 03/12/2022] [Indexed: 06/14/2023]
Abstract
Spinal Cord Injury (SCI) results in a permanent or temporary alteration of the motor, sensory and/or autonomic functions, frequently leading to neuropathic pain. To deal with this comorbidity, several non-pharmacological and non-surgical (NP-NS) interventions have been developed. However, their efficacy is still uncertain. The aim of this study was to systematically synthetize the available evidence assessing the efficacy of NP-NS interventions for treating neuropathic pain in people with SCI. Thus, an electronic search was conducted in five databases (Pubmed, Scopus, Cochrane Central, Web of Science and EBSCO) and trials registry databases, in addition to a manual search strategy to retrieve additional records. The review included randomized controlled trials with adults with SCI, in any stage of the condition. Data on the efficacy of the interventions was narratively synthetized. Once the research was completed, of 4853 identified references, 24 were included with a total of 653 participants with SCI and neuropathic pain, mostly male and with paraplegia. These studies investigated the effect of 13 types of NP-NS interventions with different protocols and methodological limitations. Seven different assessment scales were analyzed, with neuropathic pain being the primary outcome in 21 studies. Such high heterogeneity impaired the conduction of meta-analysis for any of the interventions. Although promising results were found regarding analgesic effect of NP-NS on neuropathic pain in people with SCI, it is not yet possible to safely state that these interventions are in fact effective. Further studies with homogeneous protocols and methodological quality are still needed. PERSPECTIVE: This article presents a review of existing studies on the effectiveness of NP-NS interventions in neuropathic pain in SCI. This synthesis could potentially alert and motivate clinicians to develop studies on this topic, so that interventions can be objectively evaluated and recommendations for an evidence-based practice be created.
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Affiliation(s)
- Carlos Almeida
- North Rehabilitation Center, V.N.Gaia/Espinho Hospital Center, EPE, Vila Nova de Gaia, Portugal; Polytechnic Institute of Porto, School of Health - ESS-P. PORTO, Scientific Area of Occupational Therapy, Porto, Portugal.
| | - Matilde Monteiro-Soares
- MEDCIDS - Departamento de Medicina da Comunidade Informação e Decisão em Saúde; Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal; Escola Superior de Saúde da Cruz Vermelha Portuguesa, Lisbon, Portugal
| | - Ângela Fernandes
- CIR - Center for Rehabilitation Research at Polytechnic Institute of Porto, School of Health - ESS-P. PORTO, Porto, Portugal
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10
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He K, Hu R, Huang Y, Qiu B, Chen Q, Ma R. Effects of Acupuncture on Neuropathic Pain Induced by Spinal Cord Injury: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:6297484. [PMID: 36034938 PMCID: PMC9417762 DOI: 10.1155/2022/6297484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 06/13/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022]
Abstract
Introduction Neuropathic pain is a commonly seen symptom and one of the most intractable comorbidities following spinal cord injury (SCI). Acupuncture has been widely used for neuropathic pain after SCI in clinical settings. There is no systematic review or meta-analysis evaluating the efficacy of acupuncture in the treatment of SCI-induced neuropathic pain. Thus, this study aimed to conduct a systematic review and meta-analysis to assess the efficacy of acupuncture on SCI-induced neuropathic pain. Methods Seven databases were comprehensively searched, including PubMed, the Cochrane Library, the Web of Science, the China National Knowledge Infrastructure (CNKI), the Chinese Biomedical Literature Service System (SinoMed), the Wanfang Database, and the Chinese Scientific Journals Database (VIP) from their inception to 30 September 2021. Two independent reviewers evaluated the eligibility of the data retrieved based on the pre-established eligibility criteria and assessed the methodological quality of the included studies using the Cochrane Risk of Bias Tool. The outcome indexes in this study included the visual analogue scale, the numeric rating scale, the present pain intensity, and the pain region index. Sensitivity and subgroup analyses were also performed to specifically evaluate the intervention effects. In addition, publication bias was analyzed. Results Six randomized controlled trials (145 participants in the experimental groups and 141 participants in the control groups) were identified that evaluated the application of acupuncture for neuropathic pain after SCI and were included in this study. The results of our study revealed that acupuncture had a positive effect on the pain severity (standardized mean difference (SMD): -1.40, 95% confidence interval (CI): -2.23; -0.57), the present pain intensity (MD = -0.61, 95% CIs = -0.98; -0.23), and the pain region index (MD = -3.04, 95% CI = -3.98; -2.11). In addition, sensitivity analyses showed that these results were robust and stable. Subgroup analyses indicated that electroacupuncture (EA) had better effects on SCI-induced neuropathic pain. However, a publication bias was observed. Conclusion Available evidence appears to suggest that acupuncture may have a role in SCI-induced neuropathic pain management, but this remains to be determined.
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Affiliation(s)
- Kelin He
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, Zhejiang, China
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Rong Hu
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, Zhejiang, China
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yi Huang
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, Zhejiang, China
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Bei Qiu
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qinqin Chen
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Ruijie Ma
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, Zhejiang, China
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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11
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Marks SK, Rodriguez NA, Shah A, Garcia AN, Ritter L, Pierce AN. Clinical Review of Neuromusculoskeletal Complementary and Alternative Approaches for the Treatment of Chronic Pelvic Pain Syndrome. Cureus 2022; 14:e27077. [PMID: 35989846 PMCID: PMC9388957 DOI: 10.7759/cureus.27077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/17/2022] Open
Abstract
Chronic pelvic pain syndrome (CPPS) is a functional pain disorder characterized by ongoing pain in the apparent absence of clinically identifiable causes. The prevalence of functional pain disorders demonstrates the importance of adequate management of ongoing symptomatology, but due to the uncertain etiology and myriad patient presentation phenotypes, reliable treatment options are difficult to implement. New interventions involving non-pharmacological approaches to pain management have been investigated across a spectrum of clinical and pre-clinical studies. Given that conservative care such as exercise, counseling, and musculoskeletal therapy is widely recommended as first-line treatment for CPPS, an updated review of these and related methodologies are needed. Familiarizing physicians and the public with the newest evidence for complementary and alternative medicine (CAM) and other conservative care treatments will assist with the promotion of evidence-based practices in a safe and reliable manner. This review aimed to summarize the current evidence and proposed mechanisms for non-pharmacological treatment specific to CAM and management of chronic pelvic pain centered on neuromusculoskeletal focused intervention such as acupuncture, auriculotherapy, manipulation, manual therapy, myofascial release, and phototherapy. The discussion suggests that reported improvements in pelvic pain or related symptomatology may be attributed to changes in the peripheral inflammasome and somatic origins of peripheral sensitization. Robustness of the included clinical studies is discussed throughout the review, and attention is paid to delineating inclusion criteria of formally diagnosed CPPS compared to general pelvic or abdominal pain. Overall, this review consolidates the current state of evidence regarding the utilization of non-traditional interventions using CAM techniques for the management of chronic pelvic pain and recommends a future direction for the field.
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Jiang K, Sun Y, Chen X. Mechanism Underlying Acupuncture Therapy in Spinal Cord Injury: A Narrative Overview of Preclinical Studies. Front Pharmacol 2022; 13:875103. [PMID: 35462893 PMCID: PMC9021644 DOI: 10.3389/fphar.2022.875103] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/14/2022] [Indexed: 12/29/2022] Open
Abstract
Spinal cord injury (SCI) results from various pathogenic factors that destroy the normal structure and function of the spinal cord, subsequently causing sensory, motor, and autonomic nerve dysfunction. SCI is one of the most common causes of disability and death globally. It leads to severe physical and mental injury to patients and causes a substantial economic burden on families and the society. The pathological changes and underlying mechanisms within SCI involve oxidative stress, apoptosis, inflammation, etc. As a traditional therapy, acupuncture has a positive effect promoting the recovery of SCI. Acupuncture-induced neuroprotection includes several mechanisms such as reducing oxidative stress, inhibiting the inflammatory response and neuronal apoptosis, alleviating glial scar formation, promoting neural stem cell differentiation, and improving microcirculation within the injured area. Therefore, the recent studies exploring the mechanism of acupuncture therapy in SCI will help provide a theoretical basis for applying acupuncture and seeking a better treatment target and acupuncture approach for SCI patients.
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Affiliation(s)
- Kunpeng Jiang
- Department of Hand and Foot Surgery, Zhejiang Rongjun Hospital, Jiaxing, China
| | - Yulin Sun
- Department of Neurosurgery, Zhejiang Rongjun Hospital, Jiaxing, China
| | - Xinle Chen
- Department of Neurosurgery, Zhejiang Rongjun Hospital, Jiaxing, China
- *Correspondence: Xinle Chen,
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Effect of Specific Acupuncture Therapy Combined with Rehabilitation Training on Incomplete Spinal Cord Injury: A Randomized Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2021:5671998. [PMID: 34987595 PMCID: PMC8720606 DOI: 10.1155/2021/5671998] [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: 08/12/2021] [Accepted: 12/02/2021] [Indexed: 02/05/2023]
Abstract
Acupuncture therapies were used to treat spinal cord injury (SCI) and its complications. To assess the effect of a specific acupuncture therapy combined with rehabilitation training for inpatients with incomplete SCI, we conducted an assessor-blinded, randomized controlled clinical trial in the Department of Rehabilitation Medicine Center in West China Hospital, Sichuan University. Seventy-two participants diagnosed with incomplete SCI were randomly assigned into 3 groups of 24 patients each, with data collection completed in December, 2019. Participants were randomly assigned (1 : 1 : 1) to 3 groups to receive treatment for 4 weeks, 5 times/week of acupuncture for Continuous Acupuncture Treatment (CAT) group, 3 times/week for Intermittent Acupuncture Treatment (IAT) group, and no acupuncture for Control group; all 3 groups received routine rehabilitation training. The primary outcome was the change of American Spinal Injury Association (ASIA) motor score from baseline to week 4. Secondary outcomes included sensory score, Modified Barthel Index (MBI). At week 4, CAT group had a higher motor score and MBI score increase than the control group (mean difference 10.52, 17.36; p < 0.001, p < 0.01, respectively). CAT group had more increase in motor score and MBI than IAT group (mean difference 5.55, 14.77; p < 0.05, p < 0.05, respectively). But the difference among groups in the increase of sensory score was not statistically significant. Acupuncture resulted in a higher motor score and MBI after 4 weeks. And the dosage of 5/week led to more improvement in motor score and MBI than that of 3/week. The results suggested that a dosage of 5/week of acupuncture is safe and more effective for SCI than 3/week. But further research is needed to determine the best intervention dosage, long-term efficacy, and underlying mechanism. This trial is registered with ChiCTR1900021530.
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14
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The CanPain SCI clinical practice guidelines for rehabilitation management of neuropathic pain after spinal cord injury: 2021 update. Spinal Cord 2022; 60:548-566. [PMID: 35124700 PMCID: PMC9209331 DOI: 10.1038/s41393-021-00744-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 12/23/2022]
Abstract
STUDY DESIGN Clinical practice guidelines. OBJECTIVES The objective was to update the 2016 version of the Canadian clinical practice guidelines for the management of neuropathic pain in people with spinal cord injury (SCI). SETTING The guidelines are relevant for inpatient, outpatient and community SCI rehabilitation settings in Canada. METHODS The guidelines were updated in accordance with the Appraisal of Guidelines for Research and Evaluation II tool. A Steering Committee and Working Group reviewed the relevant evidence on neuropathic pain management (encompassing screening and diagnosis, treatment and models of care) after SCI. The quality of evidence was scored using Grading of Recommendations Assessment, Development and Evaluation (GRADE). A consensus process was followed to achieve agreement on recommendations and clinical considerations. RESULTS The working group identified and reviewed 46 additional relevant articles published since the last version of the guidelines. The panel agreed on 3 new screening and diagnosis recommendations and 8 new treatment recommendations. Two key changes to these treatment recommendations included the introduction of general treatment principles and a new treatment recommendation classification system. No new recommendations to model of care were made. CONCLUSIONS The CanPainSCI recommendations for the management of neuropathic pain after SCI should be used to inform practice.
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Huang L, Xu G, He J, Tian H, Zhou Z, Huang F, Liu Y, Sun M, Liang F. Bibliometric Analysis of Functional Magnetic Resonance Imaging Studies on Acupuncture Analgesia Over the Past 20 Years. J Pain Res 2021; 14:3773-3789. [PMID: 34916843 PMCID: PMC8670890 DOI: 10.2147/jpr.s340961] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background Researches on the central mechanisms of acupuncture analgesia have been widely conducted worldwide. However, there is no bibliometric analysis of functional magnetic resonance imaging (fMRI) studies on acupuncture analgesia. This study visualized the current status, hot spots and frontiers of fMRI studies on acupuncture analgesia in the past 20 years to provide a theoretical basis for its clinical application. Methods All publications were obtained from Science Citation Index-Expanded (SCI-E) of Web of Science (WOS). We used CiteSpace to analyze publications, journals, cited journals, authors, cited authors, institutions, countries, references, and keywords. We also analyzed collaborative network maps and co-occurrence network maps. Results We retrieved a total of 797 articles. Regarding the volume of publications, the total number of annual publications showed a fluctuating but overall increasing trend. Evidence-based Complementary and Alternative Medicine (21 articles) was the most productive journal, and Pain (225 articles) was the most cited journal. The most productive author was Qin W (16 articles), and the most co-cited author was Hui KKS (111). The most prolific institution and country were Massachusetts General Hospital (34 articles) and USA (212 articles). “Pain” was the top-ranked for keyword frequency and centrality. “Functional connectivity” was the frontier hotspot for 2018–2021. Conclusion First, fMRI researches on acupuncture analgesia involved several countries (regions) and institutions, mainly located in the USA, China and Korea, and most of them were universities. In addition, the USA was a major contributor in this field. Second, in terms of disciplinary distribution, the literatures were mainly from clinical neurology, neuroscience, and radiology nuclear medicine medical imaging. Third, the keyword co-occurrence analysis showed that the hot keywords included pain, fMRI, and lower back pain. Fourth, through keyword clustering analysis, the hot disease was found to be lower back pain, and the hot contents were acupuncture specificity and frequency specificity. Fifth, a timeline analysis of the references identified that chronic low back pain and specificity will remain a hot topic for future research.
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Affiliation(s)
- Liuyang Huang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Guixing Xu
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Jiamei He
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Hao Tian
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Zhuo Zhou
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Fengyuan Huang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Yilin Liu
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Mingsheng Sun
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Fanrong Liang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine/Clinical Research Center for Acupuncture and Moxibustion in Sichuan Province, Chengdu, Sichuan, People's Republic of China
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16
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Castañeda G, Romero S, Mudra S, Gingrich T, Levy C. Provider Perceptions of Battlefield Acupuncture in a Major Veterans Health Administration Facility. Med Acupunct 2021; 33:159-168. [PMID: 33912274 DOI: 10.1089/acu.2020.1459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To assess provider perceptions regarding battlefield acupuncture (BFA) and integrative medicine at a single Veterans Health Administration facility. Materials and Methods: A total of 87 allopathic and osteopathic providers trained to provide BFA were invited to participate in a self-report web-based questionnaire assessing provider BFA perceptions and practice. Mixed methodology was used to analyze closed- and open-ended survey responses. Results: Sixty-six providers completed the survey. On average, most providers reported 3-4 BFA treatments per patient (43.2%) and 1-2 weeks of pain relief per treatment (51.4%). A positive correlation was found between post-BFA complementary and alternative medicine (CAM) attitude and (1) average total patients treated with BFA (r b = 0.41, n = 37, P = 0.01) and (2) percentage of patients treated experiencing meaningful pain relief (r = 0.47, n = 35, P = 0.003). A positive shift in CAM attitudes was observed [F(1, 59) = 25.5, P < 0.001, η p 2 = 0.302]. An overworked schedule was the most salient theme across open-ended questions addressing barriers to practice. Provider BFA attitude comments largely encompassed positive views about BFA treatment utility and effectiveness. Conclusions: Our findings provide preliminary evidence that exposure to BFA training and experience practicing BFA can positively affect provider CAM attitudes. Qualitative findings point to positive provider attitudes and beliefs regarding BFA treatment utility and effectiveness for pain management. BFA is an alternative treatment for pain management that many Veterans Affairs providers deem useful and effective, particularly after exposure to BFA training and as more BFA-related practice is attained.
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Affiliation(s)
- Gail Castañeda
- Veterans Rural Health Resource Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Sergio Romero
- Veterans Rural Health Resource Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Stephen Mudra
- North Florida/South Georgia Veteran's Health System, Gainesville, FL, USA
| | - Ted Gingrich
- North Florida/South Georgia Veteran's Health System, Gainesville, FL, USA
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Charles Levy
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
- North Florida/South Georgia Veteran's Health System, Gainesville, FL, USA
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Abstract
This study evaluated both randomized and nonrandomized trials of battlefield acupuncture for the treatment of both acute and chronic pain. Studies published between May 2016 and November 2019 were found through PubMed, the Cochrane Library, or Scopus, concerned with the treatment of pain using auricular acupuncture in accordance with battlefield acupuncture protocol. Search terms were battlefield acupuncture AND pain or auricular acupuncture AND pain. Case reports, literature reviews, meta-analyses, and expert opinions were not included. Bias risk was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. We found 12 studies with a combined sample size of 12,326. All five of the included nonrandomized trials reported positive outcomes, while five of seven of the included randomized trials reached statistical significance in their primary outcome. Six of the randomized trials were considered to have a high risk of bias resulting from the lack of blinding. The one randomized trial with moderate bias risk was a positive study. No severe adverse events were reported. Clinicians may consider battlefield acupuncture as a safe treatment for pain while the evidence base grows; however, we conclude that widespread adoption of battlefield acupuncture will require further high-quality studies drawing from diverse settings and patient populations. In addition, future studies should attempt to achieve blinding.
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Affiliation(s)
- Frank J Salamone
- From the Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven; the Department of Medicine, VA Connecticut Healthcare System, West Haven; and the Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Daniel G Federman
- From the Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven; the Department of Medicine, VA Connecticut Healthcare System, West Haven; and the Department of Medicine, Yale University School of Medicine, New Haven, CT
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18
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Yang J, Ganesh R, Wu Q, Li L, Ogletree SP, Del Fabro AS, Wahner-Roedler DL, Xiong D, Bauer BA, Chon TY. Battlefield Acupuncture for Adult Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2020; 49:25-40. [PMID: 33375924 DOI: 10.1142/s0192415x21500026] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pain is a major public health problem, causing heavy social and economic burdens to patients and society while consuming tremendous medical resources at the same time. Thus, there is a critical need to find low-cost, efficacious, and therapeutic approaches to help manage pain. While acupuncture is increasingly recognized as a promising pain-relieving method, less is known about a specific form of auricular acupuncture known as Battlefield Acupuncture (BFA). The BFA technique involves the sequential placement of semi-permanent, single-use, French ASP[Formula: see text] golden needles to five specific acupoints in one or both ears, where they are left in place for 3-4 days or longer [Niemtzow, R.C., Battlefield acupuncture. Med. Acupunct. 19: 225-228, 2007]. The BFA needles (more accurately described as tiny conical darts) pierce the ear in designated locations in a particular order [Levy, C.E., N. Casler and D.B. FitzGerald. Battlefield acupuncture: an emerging method for easing pain. Am. J. Phys. Med. Rehabil. 97: e18-e19, 2018.]. (Figs. 4 and 5) It was developed by Dr. Richard C. Niemtzow in 2001, as a subgroup form of an auricular acupuncture technique based on the somatotopic arrangement of an inverted fetus pattern on the external ear [Romoli, M. Ear acupuncture: historical abstract-differences of ear cartography between the east and the west. Dtsch. Z. Akupunkt. 53: 24-33, 2010.]. Currently, BFA is widely used in the US military, but to our knowledge, there is no review which comprehensively synthesizes the current publications surrounding pain management. This review aims to investigate the effects and safety of BFA in adults with pain. Electronic databases were searched for randomized controlled trials (RCTs) published in English evaluating efficacy and safety of BFA in adults with pain, from database inception to September 6, 2019. The primary outcome was pain intensity change, and the secondary outcome was safety. Nine RCTs were included in this review, and five trials involving 344 participants were analyzed quantitatively. Compared with no intervention, usual care, sham BFA, and delayed BFA interventions, BFA had no significant improvement in the pain intensity felt by adults suffering from pain. Few adverse effects (AEs) were reported with BFA therapy, but they were mild and transitory. BFA is a safe, rapid, and easily learned acupuncture technique, mainly used in acute pain management, but no significant efficacy was found in adult individuals with pain, compared with the control groups. Given the poor methodological quality of the included studies, high-quality RCTs with rigorous evaluation methods are needed in the future.
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Affiliation(s)
- Juan Yang
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States of America.,Department of Pain Medicine, Shenzhen Nanshan People's Hospital, Guangdong, Medical University, Shenzhen, Guangdong 518052, P. R. China
| | - Ravindra Ganesh
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Qinglong Wu
- College of Acupuncture and Rehabilitation, Guangzhou University of Traditional, Chinese Medicine, Guangzhou, Guangdong 510006, P. R. China
| | - Langping Li
- Department of Anesthesiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong, University School of Medicine, Shanghai 200020, P. R. China
| | - Sandra P Ogletree
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Anna S Del Fabro
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, United States of America
| | | | - Donglin Xiong
- Department of Pain Medicine, Shenzhen Nanshan People's Hospital, Guangdong, Medical University, Shenzhen, Guangdong 518052, P. R. China
| | - Brent A Bauer
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Tony Y Chon
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
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Yu J, Tu M, Shi Y, Liu Y, He X, Qiu F, Xu Y, Sun R, Jiang Y, Fang J. Acupuncture therapy for treating postherpetic neuralgia: A protocol for an overview of systematic reviews and meta-analysis. Medicine (Baltimore) 2020; 99:e23283. [PMID: 33217857 PMCID: PMC7676539 DOI: 10.1097/md.0000000000023283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/22/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Postherpetic neuralgia (PHN) is the most common complication and sequela of herpes zoster (HZ) that greatly affects the life and emotional experience of patients. Acupuncture therapy has been confirmed as an effective and safe treatment for PHN. Several systematic reviews (SRs) and meta-analysis (MAs) have reported the evidence of acupuncture therapy for treating PHN. However, the evidence has not been systematically synthesized. This overview aims to synthesize and assess the reliability of evidence generated from these SRs and MAs of acupuncture therapy for PHN. METHODS We will conduct a systematic search of the China Biology Medicine (CBM), VIP database, Wangfang database, China National Knowledge Infrastructure (CNKI), Pubmed, Cochrane Library, Excerpt Medical Database (Embase), and Web of Science to identify eligible SRs and MAs, from their inception to October 31, 2020. We will use Assessment of Multiple Systematic Reviews-2 (AMSTAR2) for methodological quality assessment, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for report quality assessment, Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) for the quality of evidence assessment, and ROBIS for the bias assessment. Our reviewers will conduct systematic reviews, qualification evaluation, data extraction, methodological quality, and evidence quality screening in pairs. The outcomes include pain intensity, Quality of life (QoL), Hamilton Anxiety Scale (HAMA), Global impression, and adverse events. All the extracted data will be provided in tabular form to summarize characteristics of each review. The evidence will be a narrative synthesis of the type and content of the intervention and the results reported. RESULTS The results of this study will be published in a peer-reviewed journal. CONCLUSIONS This overview will provide comprehensive evidence of acupuncture therapy for patients with PHN. ETHICS AND DISSEMINATION This review will not involve private information of participants, so the ethical approval will not be required. The results will be disseminated in a peer-reviewed journal or conference presentation. Important protocol modifications will be updated on PROSPERO. PROSPERO REGISTRATION NUMBER CRD42020178738.
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Affiliation(s)
- Jie Yu
- Department of Acupuncture and Massage, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine
- Department of Neurobiology and Acupuncture Research, the Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, China
| | - Mingqi Tu
- Department of Neurobiology and Acupuncture Research, the Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, China
| | - Yan Shi
- Department of Acupuncture and Massage, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine
| | - Yingjun Liu
- Department of Neurobiology and Acupuncture Research, the Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, China
| | - Xiaofen He
- Department of Neurobiology and Acupuncture Research, the Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, China
| | - Fanghui Qiu
- Department of Acupuncture and Massage, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine
| | - Yunyun Xu
- Department of Neurobiology and Acupuncture Research, the Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, China
| | - Ruohan Sun
- Department of Neurobiology and Acupuncture Research, the Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, China
| | - Yongliang Jiang
- Department of Neurobiology and Acupuncture Research, the Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, China
| | - Jianqiao Fang
- Department of Neurobiology and Acupuncture Research, the Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, China
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21
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Microglia TREM2: A Potential Role in the Mechanism of Action of Electroacupuncture in an Alzheimer's Disease Animal Model. Neural Plast 2020; 2020:8867547. [PMID: 32952550 PMCID: PMC7487106 DOI: 10.1155/2020/8867547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/29/2020] [Accepted: 08/18/2020] [Indexed: 12/31/2022] Open
Abstract
Alzheimer's disease (AD) is one of the most serious public health concerns facing the world. Its characteristic feature is neuroinflammation due to microglial activation. Electroacupuncture is one of the therapies employed to improve the condition of patients with AD, although its mechanism of action is still to be determined. Triggering receptor expressed on myeloid cells 2 (TREM2) is a microglia-specific receptor that is involved in regulating neuroinflammation in AD. In this study, we applied senescence-accelerated mouse-prone 8 mice as the AD animal model, used the Morris water maze, and applied hematoxylin and eosin staining, immunofluorescence double staining, and Western blotting, to explore the effects and potential mechanisms of action of electroacupuncture. In summary, this study suggested that electroacupuncture treatment could improve the learning and memory abilities (p < 0.05) and protect neurons. These effects result from acupuncture could upregulate TREM2 expression in the hippocampus (p < 0.01), which was essential for the anti-inflammatory effects in the AD animal model. However, further studies are needed to conclusively demonstrate the mechanism of action of electroacupuncture in AD.
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22
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Zhang Y, Liang Z, Li S, Yang L, Guo T, Xu Y, Yang J, Xu Q, Zhang Q, Zhao J, Li C, Liu X. Fire needle plus cupping for acute herpes zoster: study protocol for a randomized controlled trial. Trials 2020; 21:701. [PMID: 32762718 PMCID: PMC7409425 DOI: 10.1186/s13063-020-04599-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/12/2020] [Indexed: 01/09/2023] Open
Abstract
Background Acute herpes zoster (AHZ) is a common skin disease caused by invasion of the varicella zoster virus into the ganglia and skin, and the severe pain is the most complaint, which can seriously disturb the normal life of patients. Fire needle plus cupping is a special acupuncture treatment, which is widely used to treat AHZ for its better analgesic effect in China although it has not been fully verified by rigorous randomized controlled trial (RCT). Methods/design To test the effect, a three-arm randomized parallel controlled trial protocol has been designed. A total of 105 AHZ patients suffering pain will be randomly divided into three groups in an equal proportion. The interventions are fire needle plus cupping (FC) in group A, famciclovir plus gabapentin (FG) in group B, and fire needle plus cupping plus famciclovir (FCF) in group C. The length for the trial is set for a week time frame. Precisely speaking, the A group (FC) is to carry out 1 treatment per day for the total of 7 treatment sessions within 1 week period. On the other hand, the B group (FG) will take drugs orally three times a day within the trial 1 week. Meanwhile, with its combination element, the C group (FCF) is due to undertake both treatments and drugs as prescribed for A and B groups within the trial week. As an intra-trial arrangement, analgesic medication will be carefully administered for temporary pain release if the sudden intolerable pain appeared. For the primary outcome, this study is due to apply visual analogue scale to identify pain intensity relief. As the secondary outcomes are concerned, this study is aiming to focus on the issues related to changes in substance P and beta-endorphin concentrations in peripheral plasma, as well as those issues of analgesic needs, side effects, symptoms, and physical signs including pain classification, local itching, burning sensation, fever, local lymphadenopathy, skin lesion area, blisters, herpes clusters, vesicular traits, ulcers, and pimples; all these are taken into account for evaluation. For the final stage, the participants are to be followed up for postherpetic neuralgia. Discussion The results of this trial aim to provide sufficient evidence on FC treatment over both FG and FCF treatments. It will then give a credible alternative treatment to cut down acute pain and to cure AHZ infection. Trial registration Chinese Clinical Trial Registry ChiCTR1800015372. Registered on 28 March 2018.
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Affiliation(s)
- Ying Zhang
- The Six Affiliated Hospital of Kunming Medical University, Yuxi, 653100, China
| | - Zuohui Liang
- The Six Affiliated Hospital of Kunming Medical University, Yuxi, 653100, China
| | - Shihua Li
- The Six Affiliated Hospital of Kunming Medical University, Yuxi, 653100, China
| | - Ling Yang
- The Six Affiliated Hospital of Kunming Medical University, Yuxi, 653100, China
| | - Taipin Guo
- School of Acupuncture-Moxibustion and Tuina and Rehabilitation, Yunnan University of Chinese Medicine, Kunming, 650500, China.
| | - Yan Xu
- The Third People's Hospital of Yunnan Province, Kunming, 650011, China
| | - Juanjuan Yang
- The Six Affiliated Hospital of Kunming Medical University, Yuxi, 653100, China
| | - Qiannan Xu
- The Six Affiliated Hospital of Kunming Medical University, Yuxi, 653100, China
| | - Qing Zhang
- The Six Affiliated Hospital of Kunming Medical University, Yuxi, 653100, China
| | - Jian Zhao
- The Six Affiliated Hospital of Kunming Medical University, Yuxi, 653100, China
| | - Cailian Li
- The Six Affiliated Hospital of Kunming Medical University, Yuxi, 653100, China
| | - Xiuhong Liu
- The Six Affiliated Hospital of Kunming Medical University, Yuxi, 653100, China.
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Zheng Y, Zhou Y, Wu Q, Yue J, Ying X, Li S, Lou X, Yang G, Tu W, Zhou K, Jiang S. Effect of electroacupuncture on the expression of P2 × 4, GABAA γ 2 and long-term potentiation in spinal cord of rats with neuropathic pain. Brain Res Bull 2020; 162:1-10. [PMID: 32428626 DOI: 10.1016/j.brainresbull.2020.04.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/10/2020] [Accepted: 04/27/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To observe the impacts of electroacupuncture (EA) stimulation at "Zusanli and Kunlun Points" on spinal dorsal horn microglia activation in L5 spinal nerve ligation (SNL) rats and BNDF, P2 × 4 and GABAAγ2, and the changes in spinal dorsal horn synaptic plasticity in model rats. METHODS Adult male SD rats (180-220 g) were selected and randomly divided into 6 groups, including the sham group, the SNL group, the SNL + EA group, the SNL+5-BDBD group, the SNL + EA + 5-BDBD group and the SNL + FEA group. The changes in the Iba-1, BDNF, P2 × 4 and GABAAγ2 in the spinal cord of rats were observed by Western blotting, immunofluorescence, RT-PCR and other techniques; the long-term changes in the potential after the excitatory synapse of the spinal dorsal horn in rats were observed by in vivo electrophysiological technique. RESULTS After 7 days of intervention, the fluorescence intensity (FI) of P2 × 4 and Iba-1 in the SNL + EA group was lower than that in the SNL group and higher than that in the sham group(P < 0.01), but the FI of GABAAγ2 was higher than that in the SNL group(P < 0.01); the expression of Iba-1, BDNF and P2 × 4 proteins in the SNL + EA group, the SNL+5-BDBD group and the SNL + EA + 5-BDBD group was significantly lower than that in the SNL + FEA group(P < 0.05), but the expression of GABAAγ2 protein was higher (P < 0.05); after treatment with EA, the expression levels of Iba-1 mRNA and P2 × 4 mRNA in the SNL + EA group were lower than those in the SNL group(P < 0.01), but the expression levels of GABAAγ2 mRNA were higher (P < 0.01). Meanwhile, long-term potentiation changes could not be induced in the SNL + EA group. CONCLUSION The EA stimulation at "Zusanli" and "Kunlun" points can improve the pain threshold of rats with neuropathic pain (NP), inhibit the excitatory postsynaptic potential (EPSP), and weaken the excitatory transmission efficiency between synapses during NP.
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Affiliation(s)
- Yuyin Zheng
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Integrative & Optimized Medicine Research center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ye Zhou
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Integrative & Optimized Medicine Research center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qiaoyun Wu
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Integrative & Optimized Medicine Research center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jingjing Yue
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Integrative & Optimized Medicine Research center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinwang Ying
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Integrative & Optimized Medicine Research center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Sisi Li
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Integrative & Optimized Medicine Research center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinfa Lou
- Integrative & Optimized Medicine Research center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Guanhu Yang
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Integrative & Optimized Medicine Research center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wenzhan Tu
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Integrative & Optimized Medicine Research center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Kecheng Zhou
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Integrative & Optimized Medicine Research center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Songhe Jiang
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Integrative & Optimized Medicine Research center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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24
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Moisset X, Bouhassira D, Avez Couturier J, Alchaar H, Conradi S, Delmotte MH, Lanteri-Minet M, Lefaucheur JP, Mick G, Piano V, Pickering G, Piquet E, Regis C, Salvat E, Attal N. Pharmacological and non-pharmacological treatments for neuropathic pain: Systematic review and French recommendations. Rev Neurol (Paris) 2020; 176:325-352. [PMID: 32276788 DOI: 10.1016/j.neurol.2020.01.361] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 01/07/2020] [Indexed: 02/08/2023]
Abstract
Neuropathic pain remains a significant unmet medical need. Several recommendations have recently been proposed concerning pharmacotherapy, neurostimulation techniques and interventional management, but no comprehensive guideline encompassing all these treatments has yet been issued. We performed a systematic review of pharmacotherapy, neurostimulation, surgery, psychotherapies and other types of therapy for peripheral or central neuropathic pain, based on studies published in peer-reviewed journals before January 2018. The main inclusion criteria were chronic neuropathic pain for at least three months, a randomized controlled methodology, at least three weeks of follow-up, at least 10 patients per group, and a double-blind design for drug therapy. Based on the GRADE system, we provide weak-to-strong recommendations for use and proposal as a first-line treatment for SNRIs (duloxetine and venlafaxine), gabapentin and tricyclic antidepressants and, for topical lidocaine and transcutaneous electrical nerve stimulation specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a second-line treatment for pregabalin, tramadol, combination therapy (antidepressant combined with gabapentinoids), and for high-concentration capsaicin patches and botulinum toxin A specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a third-line treatment for high-frequency rTMS of the motor cortex, spinal cord stimulation (failed back surgery syndrome and painful diabetic polyneuropathy) and strong opioids (in the absence of an alternative). Psychotherapy (cognitive behavioral therapy and mindfulness) is recommended as a second-line therapy, as an add-on to other therapies. An algorithm encompassing all the recommended treatments is proposed.
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Affiliation(s)
- X Moisset
- Université Clermont Auvergne, Inserm, Neuro-Dol, 63000 Clermont-Ferrand, France; CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France.
| | - D Bouhassira
- INSERM U987, CETD, Ambroise-Paré Hospital, AP-HP, Boulogne-Billancourt, France; Université Versailles - Saint-Quentin-en-Yvelines, Versailles, France
| | - J Avez Couturier
- Service de Neuropédiatrie, Consultation Douleur Enfant, CIC-IT 1403, CHU de Lille, Lille, France
| | - H Alchaar
- 73, boulevard de Cimiez, Nice, France
| | - S Conradi
- CETD, CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | - M H Delmotte
- GHU, Paris site Ste-Anne, Structure Douleurs, 1, rue Cabanis, Paris 14, France
| | - M Lanteri-Minet
- Université Clermont Auvergne, Inserm, Neuro-Dol, 63000 Clermont-Ferrand, France; Département d'Évaluation et Traitement de la Douleur, Centre Hospitalier Universitaire (CHU) de Nice, Fédération Hospitalo-Universitaire InovPain, Université Côte d'Azur, Nice, France
| | - J P Lefaucheur
- EA 4391, Faculté de Médecine, Université Paris Est Créteil, Créteil, France; Service de Physiologie, Explorations Fonctionnelles, Hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, Créteil, France
| | - G Mick
- Centre d'Évaluation et Traitement de la Douleur du Voironnais, Centre Hospitalier de Voiron, Laboratoire P2S, Université de Lyon, Lyon, France
| | - V Piano
- Centre Hospitalier de Draguignan, Service Algologie 4(e), route de Montferrat, 83007 Draguignan cedex, France
| | - G Pickering
- Université Clermont Auvergne, Inserm, Neuro-Dol, 63000 Clermont-Ferrand, France; Clinical Pharmacology Department, CPC/CIC Inserm 1405, University Hospital CHU, Clermont-Ferrand, France
| | - E Piquet
- Département d'Évaluation et Traitement de la Douleur, Centre Hospitalier Universitaire (CHU) de Nice, Fédération Hospitalo-Universitaire InovPain, Université Côte d'Azur, Nice, France
| | - C Regis
- CETD, CHU Montpellier, Montpellier, France
| | - E Salvat
- Centre d'Évaluation et de Traitement de la Douleur, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France
| | - N Attal
- INSERM U987, CETD, Ambroise-Paré Hospital, AP-HP, Boulogne-Billancourt, France; Université Versailles - Saint-Quentin-en-Yvelines, Versailles, France
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25
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Kwon CY, Lee B, Leem J, Chung SY, Kim JW. Korean medicine treatments including blood stasis-removing therapy and auriculotherapy for persistent headache after traumatic brain injury: A case report. Explore (NY) 2019; 15:419-424. [PMID: 31262688 DOI: 10.1016/j.explore.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 05/27/2019] [Accepted: 06/06/2019] [Indexed: 01/07/2023]
Abstract
Headache after traumatic brain injury (TBI) is a common symptom which includes moderate-to-severe pain more than 5 years after the injury and severely limits the quality of life. Some guidelines have indicated that there are several cases where headaches do not respond adequately to conventional therapies. Therefore, effective alternative approaches are needed. In this case report, we present a 74-year-old woman, who had persistent headache attributed to traumatic injury to the head and subjective cognitive impairment. By using the Korean Medical (KM) treatment blood stasis-removing therapy using Dangguixu-san and auriculotherapy, her headache improved markedly. Improvements in the cognitive function and hemorrhage were also observed. This case report suggests that KM treatments using Dangguixu-san and auriculotherapy may be an alternative therapeutic approach for headache after TBI.
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Affiliation(s)
- Chan-Young Kwon
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul 02453, Republic of Korea; Yanggu Public Health Center, Gangwon-do 24522, Republic of Korea.
| | - Boram Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea.
| | - Jungtae Leem
- Chung-Yeon Central Institute, Gwangju 61165, Republic of Korea.
| | - Sun-Young Chung
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul 02453, Republic of Korea; Department of Oriental Neuropsychiatry, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea.
| | - Jong Woo Kim
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul 02453, Republic of Korea; Department of Oriental Neuropsychiatry, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea.
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26
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Stillman M, Graves D, New PW, Bryce T, Alexander M. Survey on current treatments for pain after spinal cord damage. Spinal Cord Ser Cases 2019; 5:14. [PMID: 30729038 PMCID: PMC6363782 DOI: 10.1038/s41394-019-0160-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/14/2019] [Accepted: 01/24/2019] [Indexed: 11/08/2022] Open
Abstract
Study design An online questionnaire. Objectives To assess the international spinal cord medicine and rehabilitation community's utilization of pharmacological and non-pharmacological treatments for spinal cord damage (SCD)-related pain and to determine whether approaches to SCD-related pain differ between developed and less developed nations. Setting An international collaboration of authors. Methods An on-line survey querying availability and utilization of a number of approaches to SCD-related pain was developed, distributed, and made available for 6 months. Responses were analyzed for the entire cohort and according to participants' descriptions of their home nations' economies. Results A total of 153 responses were submitted, mostly from developed nations. Nearly three quarters of subjects reported offering their patients with SCD narcotics; only 13% reported offering their patients with SCD medical cannabis. Subjects from developing countries were more likely than those from developed countries to prescribe buprenorphine (20.0% vs 15.6%; p = 0.001) and less likely to prescribe medical cannabis (0% vs 15.6%; p = 0.001) and acupuncture (4.0% vs 23.4%; p = 0.02). Conclusions Most spinal cord medicine clinicians employ a multimodal approach to pain. There are significant differences in utilization of pharmacologic and non-pharmacologic approach to SCD-related pain between clinicians from more and less developed countries.
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Affiliation(s)
- Michael Stillman
- Internal Medicine and Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, 1100 Walnut Street, Suite 601, Philadelphia, PA 19107 USA
| | - Daniel Graves
- Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA USA
| | - Peter W. New
- Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, Caulfield, Caulfield, VIC Australia
- Epworth-Monash Rehabilitation Medicine Unit, Monash University, Melbourne, VIC Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - Thomas Bryce
- Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Marcalee Alexander
- Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL USA
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27
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Xu J, Cheng S, Jiao Z, Zhao Z, Cai Z, Su N, Liu B, Zhou Z, Li Y. Fire Needle Acupuncture Regulates Wnt/ERK Multiple Pathways to Promote Neural Stem Cells to Differentiate into Neurons in Rats with Spinal Cord Injury. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2019; 18:245-255. [PMID: 30714534 PMCID: PMC6806613 DOI: 10.2174/1871527318666190204111701] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/03/2018] [Accepted: 01/15/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND & OBJECTIVE NSCs therapy is considered one of the most potential methods for spinal cord injury (SCI). METHODS We build the SCI model rats to investigate the therapeutic effect of fire needle acupuncture in improving the locomotor function of SCI rats and its possible mechanism. BBB scale was used for the motor ability of rats. The expression of Nestin, NSE, Gal-C, and GFAP was detected by immunohistochemistry. Wnt, GSK3β, β-catenin, ERK1/2, CyclinD1, and ngn1 were detected by western blot and PCR. The BBB score of both model group (1.20±0.94, 3.12±0.67, 5.34±1.57, 7.12±1.49) and fire needle group (1.70±0.58, 4.50±1.63, 7.53±2.41, 9.24±0.63) gradually increased after SCI. Furthermore, at d10 and d14, the fire needle group showed a significantly high score compared with that in model group at the same time (P<0.05). Fire needle increased Nestin, NSE, and Gal-C expression inhibited GFAP expression after SCI. Also, fire needle could up-regulate Wnt3a, GSK3β, β-catenin, and ngn1, and down-regulate ERK1/2, cyclinD1 gene and protein expression. CONCLUSION In conclusion, fire needle could improve lower limb locomotor function of SCI rats. Also, fire needles could promote endogenous NSCs proliferation differentiating into neurons, and the mechanism might be mediated by promoting the activation of Wnt/β-catenin and inhibiting the overexpression of ERK.
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Affiliation(s)
| | | | | | | | | | | | | | - Zhen Zhou
- Address correspondence to these authors at the Tianjin Gongan Hospital, No. 78 Nanjing Road, Heping District, Tianjin, China; Phone/Fax: +86-022-23142735; ; The Second Hospital Affiliated to Tianjin University of Traditional Chinese Medicine, NO. 69 Zengchan Road, Hebei District, Tianjin, China; E-mail:
| | - Yan Li
- Address correspondence to these authors at the Tianjin Gongan Hospital, No. 78 Nanjing Road, Heping District, Tianjin, China; Phone/Fax: +86-022-23142735; ; The Second Hospital Affiliated to Tianjin University of Traditional Chinese Medicine, NO. 69 Zengchan Road, Hebei District, Tianjin, China; E-mail:
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Liang Y, Gu Y, Shi R, Li G, Chen Y, Huang LYM. Electroacupuncture downregulates P2X3 receptor expression in dorsal root ganglia of the spinal nerve-ligated rat. Mol Pain 2019; 15:1744806919847810. [PMID: 30983496 PMCID: PMC6537063 DOI: 10.1177/1744806919847810] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 03/30/2019] [Accepted: 03/31/2019] [Indexed: 12/18/2022] Open
Abstract
Electroacupuncture has been shown to effectively reduce chronic pain in patients with nerve injury. The underlying mechanisms are not well understood. Accumulated evidence suggests that purinergic P2X3 receptors (P2X3Rs) in dorsal root ganglion neurons play a major role in mediating chronic pain associated with nerve injury. The aim of this study is to determine if electroacupuncture stimulation alters P2X3R activity in dorsal root ganglia to produce analgesia under neuropathic pain condition. Peripheral neuropathy was produced by ligation of the left lumbar 5 (L5) spinal nerve in rats. Low-frequency (2 Hz) electrical stimulation was applied to ipsilateral ST36 and BL60 acupoints in rats. The P2X3R agonist (α,β-meATP)-induced flinch responses were reduced after electroacupuncture treatment. Western analyses showed that P2X3R expression was upregulated in nerve-uninjured lumbar 4 (L4) dorsal root ganglion neurons ipsilateral to the spinal nerve ligation. Electroacupuncture-stimulation reversed the upregulation. In nerve-injured L5 dorsal root ganglia, P2X3R expression was substantially reduced. Electroacupuncture had no effect on the reduction. We also determined the injury state of P2X3R expressing dorsal root ganglion neurons using the neuronal injury marker, activating transcription factor 3 (ATF3). Immunohistochemical assay showed that in L4 dorsal root ganglia, almost all P2X3Rs were expressed in uninjured (ATF3-) neurons. Spinal nerve ligation increased the expression of P2X3Rs. Electroacupuncture reduced the increase in P2X3R expression without affecting the percentage of ATF + neurons. In ipsilateral L5 dorsal root ganglion neurons, spinal nerve ligation reduced the percentage of P2X3R + neurons and markedly increased the percentage of ATF3 + cells. Almost all of P2X3Rs were expressed in damaged (ATF3+) neurons. Electroacupuncture had no effect on spinal nerve ligation-induced changes in the percentage of P2X3R or percentage of ATF3 + cells in L5 dorsal root ganglia. These observations led us to conclude that electroacupuncture effectively reduces injury-induced chronic pain by selectively reducing the expression of P2X3Rs in nerve-uninjured L4 dorsal root ganglion neurons.
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Affiliation(s)
- Yi Liang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Neuroscience, Cell Biology and Anatomy, University of Texas Medical Branch, Galveston, TX, USA
| | - Yanping Gu
- Department of Neuroscience, Cell Biology and Anatomy, University of Texas Medical Branch, Galveston, TX, USA
| | - Renyi Shi
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Guangwen Li
- Department of Neuroscience, Cell Biology and Anatomy, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong Chen
- Department of Neuroscience, Cell Biology and Anatomy, University of Texas Medical Branch, Galveston, TX, USA
| | - Li-Yen Mae Huang
- Department of Neuroscience, Cell Biology and Anatomy, University of Texas Medical Branch, Galveston, TX, USA
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29
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Federman DG, Radhakrishnan K, Gabriel L, Poulin LM, Kravetz JD. Group Battlefield Acupuncture in Primary Care for Veterans with Pain. South Med J 2018; 111:619-624. [DOI: 10.14423/smj.0000000000000877] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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30
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Chen FC, Shao HL, Han FL. A pilot study of neuromuscular electrical stimulation for neuropathic pain caused by spinal cord injury. Medicine (Baltimore) 2018; 97:e11658. [PMID: 30075553 PMCID: PMC6081201 DOI: 10.1097/md.0000000000011658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This pilot study retrospectively investigated the feasible effect and safety of neuromuscular electrical stimulation (NMES) for the management of neuropathic pain (NPP) caused by spinal cord injury (SCI).A total of 54 patient cases with NPP after SCI were included. Of these, 27 cases underwent carbamazepine plus NMES treatment, and were assigned to an NMES group; while the other 27 cases received carbamazepine only, and were assigned to a control group. The primary outcome of pain intensity was measured by numerical rating scale (NRS). The secondary outcome of quality of life was measured by the Short Form 36 (SF-36) Scale. Furthermore, adverse events were also documented in this study. All outcomes were measured and analyzed before and after 3-month treatment.After 3-month treatment, the cases in the NMES group neither reduced the pain intensity of NPP, measured by the NRS (P > .05), nor improved the quality of life, measured by the SF-36 (P > .05), compared with cases in the control group. Moreover, both groups had similar adverse events.The results of this study showed that NMES might be not efficacious for NPP caused by SCI after 3 months treatment with quite low intervention dose.
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Affiliation(s)
| | | | - Feng-li Han
- Department of Neurology, The Fourth People's Hospital of Shaanxi, Xi’an, Shaanxi, China
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31
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Niemtzow R, Baxter J, Gallagher RM, Pock A, Calabria K, Drake D, Galloway K, Walter J, Petri R, Piazza T, Burns S, Hofmann L, Biery J, Buckenmaier C. Building Capacity for Complementary and Integrative Medicine Through a Large, Cross-Agency, Acupuncture Training Program: Lessons Learned from a Military Health System and Veterans Health Administration Joint Initiative Project. Mil Med 2018; 183:e486-e493. [DOI: 10.1093/milmed/usy028] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/06/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Richard Niemtzow
- United States Air Force Acupuncture and Integrative Medical Center, Joint Base Andrews, 1060W Perimeter Road, Joint Base Andrews, MD
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - John Baxter
- Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, 1060W Perimeter Road, Joint Base Andrews, MD
| | - Rollin M Gallagher
- Penn Pain Medicine Center, University of Pennsylvania, 1840 South Street, Tuttleman Center, Philadelphia, PA
| | - Arnyce Pock
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Kathryn Calabria
- Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, 1060W Perimeter Road, Joint Base Andrews, MD
| | - David Drake
- Hunger Holmes McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA
- Virginia Commonwealth University, 907 Floyd Avenue, Richmond, VA
| | - Kevin Galloway
- Defense and Veterans Center for Integrative Pain Management, 11300 Rockville Pike, Suite 709, Rockville, MD
| | - Joan Walter
- Samueli Institute, 1150 Kersey Road, Silver Spring, MD
| | - Richard Petri
- William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX
| | - Thomas Piazza
- Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, 1060W Perimeter Road, Joint Base Andrews, MD
| | - Stephen Burns
- Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, 1060W Perimeter Road, Joint Base Andrews, MD
| | - Lew Hofmann
- Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, 1060W Perimeter Road, Joint Base Andrews, MD
| | - John Biery
- Naval Branch Health Clinic, 450 Turner Street, Pensacola, FL
| | - Chester Buckenmaier
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
- Defense and Veterans Center for Integrative Pain Management, 11300 Rockville Pike, Suite 709, Rockville, MD
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