Mechanism of acupuncture on neuromodulation in the gut--a review

Efficacy of Traditional Acupuncture Compared to Biofeedback Therapy in Fecal Incontinence: A Randomized Controlled Trial

BACKGROUND

Fecal incontinence has a devastating impact on quality of life and imposes a substantial socioeconomic burden. Best medical therapy, including biofeedback therapy, improves mild symptoms with minimal impact on moderate to severe symptoms. Surgical management for incontinence carries a degree of morbidity, resulting in low uptake and acceptability. Although acupuncture is common practice in Singapore for numerous medical conditions, its role in fecal incontinence is relatively novel. In our local context, however, acupuncture is accessible, inexpensive, and potentially well accepted as a treatment strategy.

OBJECTIVE

To determine the effectiveness of traditional Chinese medicine acupuncture, compared to biofeedback therapy, in the treatment of fecal incontinence. The secondary aim is to investigate the differences in quality of life after treatment.

DESIGN

Randomized controlled trial.

SETTING

Prospective, single-institution study.

PATIENTS

Patients with 2 or more episodes of fecal incontinence per week or St. Mark's incontinence score of 5 or higher were recruited. Patients were randomly assigned into biofeedback therapy, which included 3 sessions over 10 weeks, or 30 sessions of acupuncture over 10 weeks.

MAIN OUTCOME MEASURES

Incontinence episodes, St. Mark's score, and fecal incontinence quality-of-life scale.

RESULTS

Eighty-five patients were randomly assigned to biofeedback therapy (n = 46) or acupuncture (n = 39). Demographics and baseline clinical characteristics were not different ( p > 0.05). Overall median incontinence episodes were reduced in both, with the acupuncture arm reporting significantly fewer episodes at week 15 ( p < 0.001). Acupuncture also improved quality of life, with improvement in lifestyle, coping, depression, and embarrassment at week 15 ( p < 0.05). Although the St. Mark's score was significantly reduced in both arms at week 15 ( p < 0.001), the acupuncture arm's score was significantly lower ( p = 0.002).

LIMITATIONS

Longer follow-up is required.

CONCLUSIONS

Acupuncture is clinically effective and improves the quality of life in patients with fecal incontinence. See Video Abstract .

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov : NCT04276350.

EFICACIA DE LA ACUPUNTURA TRADICIONAL COMPARADA CON LA TERAPIA DE BIORRETROALIMENTACIN EN LA INCONTINENCIA FECAL UN ENSAYO CONTROLADO ALEATORIO

ANTECEDENTES:La incontinencia fecal tiene un impacto devastador en la calidad de vida e impone una carga socioeconómica sustancial. La mejor terapia médica, incluida la terapia de biorretroalimentación, mejora los síntomas leves, con un impacto mínimo sobre los síntomas moderados a graves. El tratamiento quirúrgico de la incontinencia conlleva un grado de morbilidad que resulta en una baja aceptación y aceptabilidad. Si bien la acupuntura es una práctica común en Singapur para numerosas afecciones médicas, su papel en la incontinencia fecal es relativamente novedoso. Sin embargo, en nuestro contexto local, la acupuntura es accesible, económica y potencialmente bien aceptada como estrategia de tratamiento.OBJETIVO:Determinar la efectividad de la acupuntura de la Medicina Tradicional China, en comparación con la terapia de biorretroalimentación en el tratamiento de la incontinencia fecal. El objetivo secundario es investigar las diferencias en la calidad de vida después del tratamiento.DISEÑO:Ensayo controlado aleatorio.AJUSTE:Estudio prospectivo de una sola institución.PACIENTES:Se reclutaron pacientes con >2 episodios de incontinencia fecal/semana o una puntuación de incontinencia de St. Mark's >5. Los pacientes fueron asignados aleatoriamente a una terapia de biorretroalimentación que incluyó 3 sesiones durante 10 semanas o 30 sesiones de acupuntura durante 10 semanas.PRINCIPALES MEDIDAS DE RESULTADO:Episodios de incontinencia, puntuación de St. Mark's y escala de calidad de vida de incontinencia fecal.RESULTADOS:Ochenta y cinco pacientes fueron asignados aleatoriamente a terapia de biorretroalimentación (n = 46) o acupuntura (n = 39). Las características demográficas y clínicas iniciales no fueron diferentes ( p > 0,05). La mediana general de episodios de incontinencia se redujo en ambos, y el grupo de acupuntura informó significativamente menos en la semana 15 ( p <0,001). La acupuntura también mejoró la calidad de vida, con mejoras en el estilo de vida, el afrontamiento, la depresión y la vergüenza en la semana 15 ( p <0,05). Mientras que la puntuación de St Mark se redujo significativamente en ambos brazos en la semana 15 ( p < 0,001), la puntuación del brazo de acupuntura fue significativamente menor (p = 0,002).LIMITACIONES:Se requiere un seguimiento más prolongado.CONCLUSIONES:La acupuntura es clínicamente efectiva y mejora la calidad de vida en pacientes con incontinencia fecal. (Traducción-Dr Yolanda Colorado ).

Effects of Laser Acupuncture on Metabolic Functions of Sedentary People: A Double-Blind Randomized Clinical Trial

Background: Laser acupuncture regulates energy flow and restores body fluid metabolism. Objective: To evaluate the effects of the laser acupuncture protocol (LAP) on hepatic and renal metabolism in sedentary people. Methods: Longitudinal, double-blind, and randomized clinical trial with 29 participants, adults, both sexes, sedentary, without pre-existing metabolic diseases, subdivided into control and laser groups. Based on the STandards for Reporting Interventions in Clinical Trials of Acupuncture 2010 guidelines, 10 laser applications (660 nm ±10 nm wavelength, 100 mW power. The irradiation tip has a diameter of 5 mm, which corresponds to an area of 0.19 cm2, totaling a power density of 0.52 W/cm2 and considering the irradiation time of 90 s, the energy density applied was 47.3 J/cm2) were performed on the acupoints of metabolic functions (LR3, SP6, ST36, and LI4) and blood samples were collected for fasting glycemia, lipid profile (HDL, LDL, total cholesterol, and triglycerides), liver function (AST/GOT and ALT/GPT), and renal function (serum creatinine and urea). A repeated measures analysis of variance (ANOVA) with Bonferroni corrected post hoc comparisons was applied to compare statistical differences between groups and times, adopting p < 0.05 as the null hypothesis. Results: The laser stimulated changes in serum lipid profile values and renal and hepatic functions. There was a significant (p = 0.014) reduction in LDL ("bad" cholesterol) from 105.75 ± 32.83 pre- to 84.32 ± 18.38 mg/dL postintervention, associated with cardioprotective function. Positive significant (p = 0.035) impacts were also observed in the reduction of creatinine (0.86 ± 0.12 mg/dL to 0.75 ± 0.12 mg/dL) and the enzyme AST/GOT (33.73 ± 12.95 U/L to 20.80 ± 4.99 U/L, p = 0.002). Conclusion: LAP applied to basal metabolism acupoints promoted positive metabolic changes in the lipid profile (LDL), and in main markers of the liver (AST/GOT) and kidney (creatinine) functions, contributing to risk control of cardiovascular diseases.

Acupuncture for constipation in Parkinson's disease: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Parkinson's disease (PD) is the second most common neurological disease worldwide, and there is a potential interaction between PD and constipation. PD constipation often causes significant trouble for patients and seriously affects their quality of life. Acupuncture is widely used for treating constipation and has been clinically proven. However, it is unclear whether the current evidence is sufficient to support acupuncture to improve PD constipation.

METHODS

We searched the Cochrane Central Register of Controlled Trials, Embase, PubMed, Web of Science, China National Knowledge Infrastructure, Wan Fang Data Knowledge Service Platform, and Chinese Scientific Journal Database (VIP database) for randomized controlled trials from inception through July 1, 2023. Randomized controlled trials (RCTs) included acupuncture, sham acupuncture, and medication for PD constipation. Stata 16.0 software and Cochrane RoB2.0 were used for data processing and migration risk analysis.

RESULTS

The 11 studies included a total of 960 patients. The results showed that acupuncture or acupuncture combined with conventional treatment seemed to have advantages in improving complete spontaneous bowel movements (WMD: 1.49, 95% CI: 0.86, 2.11; P < .00001), Patient-Assessment of Constipation Quality of Life questionnaire (WMD: -11.83, 95% CI: -15.67, -7.99; P < .00001), the chronic constipation severity scale (CCS) (SMD: -0.99, 95% CI: -1.40, -0.58; P < .01), and c(RRP) (WMD: 2.13, 95% CI: 0.44, 3.82; P < .05).

CONCLUSION

The present results show that compared with conventional treatment, acupuncture combined with conventional treatment seems to increase the number of spontaneous defecations in PD patients, improve quality of life, increase rectal resting pressure, and alleviate the severity of chronic constipation. Thus, acupuncture has the potential to treat PD constipation. However, due to the study's limitations, higher-quality RCTs are needed for verification.

Neural circuit mechanisms of acupuncture effect: where are we now?

Recently, there has been increasing attention on the impact of acupuncture on the dysregulated neural circuits in different disease. This has led to new understandings of how acupuncture works. This review presents a comprehensive analysis of research that have examined the impact of acupuncture on abnormal neural circuits associated with pain, anxiety, Parkinson's disease, addiction disorders, cognitive problems, and gastrointestinal disorders. These studies have shown that acupuncture's therapeutic effects are mediated by specific brain areas and neurons involved in neural circuit mechanisms, emphasising its wide-ranging influence. The positive impacts of acupuncture can be ascribed to its ability to modify the functioning of neurocircuits in various physiological conditions. Nevertheless, contemporary studies on acupuncture neural circuits frequently overlook the comprehensive circuit mechanism including the periphery, central nervous system, and target organ. Additionally, the scope of diseases studied is restricted. Future study should focus on broadening the range of diseases studied and exploring the neural circuit mechanisms of these diseases in depth in order to enhance our understanding of acupuncture's neurobiological impacts.

Objectivization study of acupuncture Deqi and brain modulation mechanisms: a review

Deqi is an important prerequisite for acupuncture to achieve optimal efficacy. Chinese medicine has long been concerned with the relationship between Deqi and the clinical efficacy of acupuncture. However, the underlying mechanisms of Deqi are complex and there is a lack of systematic summaries of objective quantitative studies of Deqi. Acupuncture Deqi can achieve the purpose of treating diseases by regulating the interaction of local and neighboring acupoints, brain centers, and target organs. At local and neighboring acupoints, Deqi can change their tissue structure, temperature, blood perfusion, energy metabolism, and electrophysiological indicators. At the central brain level, Deqi can activate the brain regions of the thalamus, parahippocampal gyrus, postcentral gyrus, insular, middle temporal gyrus, cingulate gyrus, etc. It also has extensive effects on the limbic-paralimbic-neocortical-network and default mode network. The brain mechanisms of Deqi vary depending on the acupuncture techniques and points chosen. In addition, Deqi 's mechanism of action involves correcting abnormalities in target organs. The mechanisms of acupuncture Deqi are multi-targeted and multi-layered. The biological mechanisms of Deqi are closely related to brain centers. This study will help to explore the mechanism of Deqi from a local-central-target-organ perspective and provide information for future clinical decision-making.

Noninvasive electrical neuromodulation for gastrointestinal motility disorders

INTRODUCTION

Gastrointestinal motility disorders are highly prevalent without satisfactory treatment. noninvasive electrical neuromodulation is an emerging therapy for treating various gastrointestinal motility disorders.

AREAS COVERED

In this review, several emerging noninvasive neuromodulation methods are introduced, including transcutaneous auricular vagal nerve stimulation, percutaneous auricular vagal nerve stimulation, transcutaneous cervical vagal nerve stimulation, transcutaneous electrical acustimulation, transabdominal interference stimulation, tibial nerve stimulation, and translumbosacral neuromodulation therapy. Their clinical applications in the most common gastrointestinal motility are discussed, including gastroesophageal reflux disease, functional dyspepsia, gastroparesis, functional constipation, irritable bowel syndrome, and fecal incontinence. PubMed database was searched from 1995 to June 2023 for relevant articles in English.

EXPERT OPINION

Noninvasive neuromodulation is effective and safe in improving both gastrointestinal symptoms and dysmotility; it can be used when pharmacotherapy is ineffective. Future directions include refining the methodology, improving device development and understanding mechanisms of action.

Infertility clinics and acupuncture: a qualitative web-based study

The increasing demand for fertility treatments has led to the rise of private clinics offering complementary and alternative medicine (CAM) treatments. The most frequently offered CAM infertility treatment is acupuncture. However, there is no good evidence to support the effectiveness of acupuncture in treating infertility. This study evaluates the scope of information provided by CAM fertility clinics in the UK. A content analysis was conducted on 200 websites of CAM fertility clinics in the UK that offer acupuncture as a treatment for infertility. Of the 48 clinics that met the eligibility criteria, the majority of the websites did not provide sufficient information on the efficacy, risks and success rates of acupuncture for infertility. This has the potential to infringe on patient autonomy, provide false hope and reduce the chances of pregnancy ever being achieved as fertility declines during the time course of ineffective acupuncture treatment.

The efficacy and neural mechanism of acupuncture therapy in the treatment of visceral hypersensitivity in irritable bowel syndrome

Irritable Bowel Syndrome (IBS) is a complex functional gastrointestinal disorder primarily characterized by chronic abdominal pain, bloating, and altered bowel habits. Chronic abdominal pain caused by visceral Hypersensitivity (VH) is the main reason why patients with IBS seek medication. Significant research effort has been devoted to the efficacy of acupuncture as a non-drug alternative therapy for visceral-hyperalgesia-induced IBS. Herein, we examined the central and peripheral analgesic mechanisms of acupuncture in IBS treatment. Acupuncture can improve inflammation and relieve pain by reducing 5-hydroxytryptamine and 5-HT3A receptor expression and increasing 5-HT4 receptor expression in peripheral intestinal sensory endings. Moreover, acupuncture can also activate the transient receptor potential vanillin 1 channel, block the activity of intestinal glial cells, and reduce the secretion of local pain-related neurotransmitters, thereby weakening peripheral sensitization. Moreover, by inhibiting the activation of N-methyl-D-aspartate receptor ion channels in the dorsal horn of the spinal cord and anterior cingulate cortex or releasing opioids, acupuncture can block excessive stimulation of abnormal pain signals in the brain and spinal cord. It can also stimulate glial cells (through the P2X7 and prokinetic protein pathways) to block VH pain perception and cognition. Furthermore, acupuncture can regulate the emotional components of IBS by targeting hypothalamic-pituitary-adrenal axis-related hormones and neurotransmitters via relevant brain nuclei, hence improving the IBS-induced VH response. These findings provide a scientific basis for acupuncture as an effective clinical adjuvant therapy for IBS pain.

Acupuncture for Parkinson's disease-related constipation: current evidence and perspectives

Parkinson's disease-related constipation (PDC) is commonly associated with impaired dopamine transmission and gastrointestinal dysfunction. Current pharmacological treatments have limited efficacy and potential side effects. Acupuncture has shown promise as an alternative or adjunct therapy by modulating the brain-gut axis, gastrointestinal hormones, and autonomic function. Preliminary randomized trials have shown that acupuncture significantly improves constipation symptoms, bowel movements, and comfort compared to sham or drug treatments and is well-tolerated. The mechanisms of action may involve regulating the gut microbiota and mucosal immunity to improve dysbiosis and gastrointestinal motility. However, more rigorous studies are required to optimize acupuncture protocols and determine long-term efficacy and safety. In summary, acupuncture shows promise as an adjunct therapy for PDC, but further research is needed to confirm its efficacy and safety.

Transcutaneous Electrical Nerve Stimulation (TENS) for Opioid-Induced Constipation in Palliative Care: A Systematic Review and Network Meta-Analysis

Background

Opioid-induced constipation (OIC) has become increasingly prevalent with the rise of prescription opioid use, particularly in patients with advanced illnesses. Existing literature suggests that transcutaneous electrical nerve stimulation (TENS) could be applied to treat cancer pain and reduce OIC incidence. However, there need to be more systematic review studies on the effectiveness of TENS in treating OIC.

Objective

In order to fill the gap of TENS in treating OIC in current knowledge, we have conducted a systematic review and network meta-analysis.

Methods

The comprehensive computer retrieval PubMed, Embase, Cochrane, China National Knowledge Infrastructure (CNKI), Chinese Biomedical (CBM), and Wanfang Database were used to collect literature for relevant studies of TENS treatment of OIC, in accordance with the standard of literature filtering, data extraction, and quality evaluation. The data were meta-analysed using ReviewManager 5.3 software recommended by Cochrane.

Results

A total of 180 pieces of literature were yielded through original search. Based on the inclusion and exclusion criteria, a total of 9 articles were included in this study. Our analysis of seven studies has revealed that TENS (28.18%) significantly reduces the incidence rate of OIC compared to control (52.45%) (I ² = 57%, P=0.03; OR = 0.66 (95% CI, 0.53 to 0.82), Z = 3.70, P < 0.01). The results of two studies indicated that TENS significantly improved the quality of life compared to the control group (i.e., treatment-as-usual only) (I ² = 80%, P=0.03; OR = -1.91; 95% CI, -2.54 to -1.29, Z = 6.00, P < 0.01).

Conclusion

The administration of TENS therapy holds the potential to mitigate the occurrence of OIC and augment the quality of life for individuals suffering from cancer. Particularly, TENS therapy proves to be appropriate for propagation within community and domestic environments. Nevertheless, advanced clinical randomized controlled trials of superior quality are necessary to authenticate the comprehensive clinical efficiency and safety of this therapy. Further investigation is indispensable to comprehend its mechanism in greater detail and establish the optimum therapeutic strategy.

A bibliometric analysis of 100 top-cited journal articles related to acupuncture regulation of the autonomic nervous system

Purpose

Research on the effects of acupuncture on autonomic function has been conducted for several decades, and a few notable studies have emerged in recent years. This study used bibliometric analysis to assess 100 top-cited articles to characterize the current status and research trends over the last three decades.

Methods

The 100 top-cited publications were identified from the Web of Science Core Collection database. The bibliometrix package in R was used for quantitative and qualitative analyses of the publication patterns and the country/region, institution, and author contributions. VOSviewer was used to construct networks based on co-citation analysis of the journals and the keyword co-occurrence.

Results

The 100 top-cited articles were identified with a total of 8,123 citations (range: 37-345). The majority of the articles came from the USA (n = 42), followed by Japan (n = 14) and mainland China (n = 13). Articles from the USA exhibited the largest number of citations (3,582 citations), followed by articles from Japan (1,189 citations), then articles from mainland China (755 citations). Neurosciences/Neurology was the most studied research area (n = 41). The Autonomic Neuroscience: Basic and Clinical published the largest number of papers (n = 14), while Brain Research received the largest number of citations (205 citations). Longhurst JC was the most productive author (10 publications), and Sato A was first among the cited authors (87 citations). The most frequently cited articles that focused on gastrointestinal, cardiovascular, or gynecologic responses to acupuncture regulation of the autonomic nervous system first appeared in the 1990s, peaked in the 2000s, then decreased after 2010. Publication of articles focused on the anti-inflammatory effects of acupuncture associated with autonomic function demonstrated an increasing trend over the last three decades.

Conclusion

From the initial studies focusing on the autonomic mechanism of visceral responses to acupuncture, researchers concentrated on exploring the autonomic mechanism of acupuncture in the control of systemic inflammation. Non-invasive electrical methods that activate somato-autonomic reflexes are current translational directions in clinical practice. Additional investigation of the underlying neuroanatomical basis of somato-autonomic reflexes also is needed.

Effects of Electroacupuncture on Opioid-Induced Constipation in Patients With Cancer: Study Protocol for a Multicenter Randomized Controlled Trial

Background

Opioid-induced constipation (OIC) is one of the most prevalent adverse events associated with cancer patients who receive opioid analgesics for moderate to severe pain. Acupuncture may be an effective treatment for OIC. We designed this trial to assess the efficacy and safety of electroacupuncture for OIC in cancer patients.

Methods

This is a multicenter, sham-controlled, parallel-group, subject- and assessor-blinded randomized trial. A total of 100 cancer patients with OIC will be randomly assigned to either the electroacupuncture group or the sham electroacupuncture group at a ratio of 1:1. Patients in each group will receive a total of 24-session treatment over 8 weeks, three sessions a week and 30 min each session. Thereafter, patients will be followed up for another 8 weeks. The primary outcome will be the proportion of responders, defined as a patient who has ≥3 spontaneous bowel movements (SBMs)/wk and ≥ increase of 1 SBM from baseline simultaneously for at least 6 out of 8 weeks of the treatment period. The secondary outcomes will include the mean weekly SBMs and complete spontaneous bowel movements, the mean Bristol Stool Form Scale score for stool consistency, the mean score for straining of SBM, the total and subscale scores of Patient Assessment of Constipation-Symptom questionnaires, and the total and subscale scores of Patient Assessment of Constipation-Quality of Life questionnaire. Patients' global assessment of treatment effectiveness, patients' expectation toward the effectiveness of acupuncture and safety of acupuncture will also be assessed. All efficacy analyses will be performed in the intention-to-treat population.

Discussion

To improve the adherence to intervention protocols, the majority of the participants will be recruited from an inpatient setting. The results will help to determine the clinical effects and safety of electroacupuncture for the treatment of OIC among patients with cancer.

Clinical Trial Registration

www.ClinicalTrials.gov, identifier: NCT03797586, registered on 4 January 2019, https://clinicaltrials.gov/ct2/show/NCT03797586.

Potential Mechanisms of Acupuncture for Functional Dyspepsia Based on Pathophysiology

Functional dyspepsia (FD), a common disorder of gastrointestinal function, originated from the gastroduodenum. Although the therapeutic effect of acupuncture has been investigated by various high-quality randomized controlled trials, the potential mechanisms showed obvious heterogeneity. This review summarized the potential mechanisms of acupuncture on FD in order to guide for future laboratory and clinical studies. Here, we argued that the primary cause of FD was gastroduodenal low-grade inflammation and acid exposure, which impaired mucosal integrity, caused brain-gut axis dysfunction, and impaired brain network connectivity, all of which generated various symptom patterns. Overall the clinical studies indicated that acupuncture was a promising treatment to alleviate symptoms in FD patients, whose efficacy was influenced by acupoints and individual variance. Mechanistically, studies with animal models of FD and patients have shown that acupuncture, a non-invasive strategy for nerve stimulation, may have the potential to control intestinal inflammation and suppress acid-secretion via different somatic autonomic reflex pathways, regulate the brain-gut axis through intestinal microbiota, and has the potential to ameliorate FD-symptoms. The cumulative evidence demonstrated that acupuncture is a promising treatment to alleviate symptoms of FD patients.

The Anti-Inflammatory Actions and Mechanisms of Acupuncture from Acupoint to Target Organs via Neuro-Immune Regulation

Inflammation plays a significant role in the occurrence and development of multiple diseases. This study comprehensively reviews and presents literature from the last five years, showing that acupuncture indeed exerts strong anti-inflammatory effects in multiple biological systems, namely, the immune, digestive, respiratory, nervous, locomotory, circulatory, endocrine, and genitourinary systems. It is well known that localized acupuncture-mediated anti-inflammatory effects involve the regulation of multiple populations and functions of immune cells, including macrophages, granulocytes, mast cells, and T cells. In acupuncture stimulation, macrophages transform from the M1 to the M2 phenotype and the negative TLR4 regulator PPARγ is activated to inhibit the intracellular TLR/MyD88 and NOD signaling pathways. The downstream IκBα/NF-κB and P38 MAPK pathways are subsequently inhibited by acupuncture, followed by suppressed production of inflammasome and proinflammatory mediators. Acupuncture also modulates the balance of helper T cell populations. Furthermore, it inhibits oxidative stress by enhancing SOD activity via the Nrf2/HO-1 pathway and eliminates the generation of oxygen free radicals, thereby preventing inflammatory cell infiltration. The anti-inflammatory effects of acupuncture on different biological systems are also specific to individual organ microenvironments. As part of its anti-inflammatory action, acupuncture deforms connective tissue and upregulates the secretion of various molecules in acupoints, further activating the NF-κB, MAPK, and ERK pathways in mast cells, fibroblasts, keratinocytes, and monocytes/macrophages. The somatic afferents present in acupuncture-activated acupoints also convey sensory signals to the spinal cord, brainstem, and hypothalamic neurons. Upon information integration in the brain, acupuncture further stimulates multiple neuro-immune pathways, including the cholinergic anti-inflammatory, vagus-adrenal medulla-dopamine, and sympathetic pathways, as well as the hypothalamus-pituitary-adrenal axis, ultimately acting immune cells via the release of crucial neurotransmitters and hormones. This review provides a scientific and reliable basis and viewpoints for the clinical application of acupuncture in various inflammatory conditions.

The Role of Traditional Acupuncture in Low Anterior Resection Syndrome Treatment: A Pilot Study

BACKGROUND

There is limited evidence on the efficacy of acupuncture in bowel dysfunction treatment.

OBJECTIVE

The aim of this pilot study was to investigate the potential value of acupuncture in the treatment of low anterior resection syndrome.

DESIGN

This was an open-design pilot study.

SETTINGS

This was a single-center study.

PATIENTS

Nine (5 female) patients with major low anterior resection syndrome were included.

INTERVENTIONS

All patients underwent acupuncture by a trained specialist once a week for 10 weeks.

MAIN OUTCOME MEASURES

Bowel function was assessed by using the low anterior resection syndrome score and the Memorial Sloan-Kettering Cancer Center bowel function instrument before the procedure, just after finishing the course of acupuncture, and 6 months after the treatment.

RESULTS

The average age was 56.44 (50-65; SD ±5.4). Median age was 56 years. At the end of the procedure, all patients reported significant improvement in low anterior resection syndrome symptoms: the average low anterior resection syndrome score before acupuncture was 39 (±2.7), after acupuncture it was 30.3 (±10.6), and 6 months after acupuncture it was 7.22 (±10.244; p < 0.000). The average Memorial Sloan-Kettering Cancer Center bowel function instrument score before acupuncture was 55.33 (±11.55), after the procedure it was 60 (±14.97), and 6 months later it was 70.22 (±12.2; p < 0.000).

LIMITATIONS

The small sample size and the fact that this is a single-center nonblinded study are limitations of this work.

CONCLUSIONS

Acupuncture may be effective in low anterior resection syndrome treatment and needs further evaluation. The procedure is safe and feasible. See Video Abstract at http://links.lww.com/DCR/B700.

REGISTRATION

ClinicalTrials.gov: NCT03916549.

EL PAPEL DE LA ACUPUNTURA TRADICIONAL EN EL TRATAMIENTO DEL SNDROME DE RESECCIN ANTERIOR BAJA UN ESTUDIO PILOTO

ANTECEDENTES:Existe evidencia limitada sobre la eficacia de la acupuntura para el tratamiento de la disfunción intestinal.OBJETIVO:El objetivo de este estudio piloto fue investigar el valor potencial de la acupuntura en el tratamiento del síndrome de resección anterior baja.DISEÑO:Este fue un estudio piloto de diseño abiertoAJUSTES:Este fue un estudio en un solo centroPACIENTES:Fueron incluidos nueve pacientes con síndrome de resección anterior baja (muy sintomáticos), cinco de ellos eran mujeresINTERVENCIONES:Todos los pacientes fueron tratados con acupuntura, una vez a la semana durante diez semanas por un especialista capacitado.PRINCIPALES MEDIDAS DE RESULTADO:La función intestinal fue evaluada, antes del procedimiento, justo al finalizar el ciclo de acupuntura y a los seis meses, utilizando la puntuación (score) para el síndrome de resección anterior baja y el instrumento de función intestinal del Memorial Sloan-Kettering Cancer Center.RESULTADOS:La edad media fue 56,44 (50 - 65) (DE ± 5,4). Edad mediana 56 años. Al final del procedimiento, todos los pacientes manifestaron una mejoría significativa de los síntomas del síndrome de resección anterior baja: La puntuación promedio del síndrome de resección anterior baja antes de la acupuntura fue 39 (± 2,7), después de - 30,3 (± 10,6) y 6 meses después de 7,22 (± 10,244) (p <0,000). El puntaje promedio del instrumento de función intestinal del Memorial Sloan-Kettering Cancer Center antes de la acupuntura fue 55.33 (± 11.55), después del procedimiento 60 (± 14.97) y 6 meses después 70.22 (± 12.2) (p <0,000).LIMITACIONES:Tamaño de muestra pequeño, estudio no cegado en un solo centro.CONCLUSIONES:La acupuntura puede ser eficaz en el tratamiento del síndrome de resección anterior baja, pero es necesario continuar evaluando su utilidad. El procedimiento es seguro y factible. Consulte Video Resumen en http://links.lww.com/DCR/B700.

The Temporal Dynamics of EEG Microstate Reveals the Neuromodulation Effect of Acupuncture With Deqi

The electroencephalography (EEG) microstate has recently emerged as a new whole-brain mapping tool for studying the temporal dynamics of the human brain. Meanwhile, the neuromodulation effect of external stimulation on the human brain is of increasing interest to neuroscientists. Acupuncture, which originated in ancient China, is recognized as an external neuromodulation method with therapeutic effects. Effective acupuncture could elicit the deqi effect, which is a combination of multiple sensations. However, whether the EEG microstate could be used to reveal the neuromodulation effect of acupuncture with deqi remains largely unclear. In this study, multichannel EEG data were recorded from 16 healthy subjects during acupuncture manipulation, as well as during pre- and post-manipulation tactile controls and pre- and post-acupuncture rest controls. As the basic acupuncture unit for regulating the central nervous system, the Hegu acupoint was used in this study, and each subject’s acupuncture deqi behavior scores were collected. To reveal the neuroimaging evidence of acupuncture with deqi, EEG microstate analysis was conducted to obtain the microstate maps and microstate parameters for different conditions. Furthermore, Pearson’s correlation was analyzed to investigate the correlation relationship between microstate parameters and deqi behavioral scores. Results showed that: (1) compared with tactile controls, acupuncture manipulation caused significantly increased deqi behavioral scores. (2) Acupuncture manipulation significantly increased the duration, occurrence, and contribution parameters of microstate C, whereas it decreased those parameters of microstate D. (3) Microstate C’s duration parameter showed a significantly positive correlation with acupuncture deqi behavior scores. (4) Acupuncture manipulation significantly increased the transition probabilities with microstate C as node, whereas it reduced the transition probabilities with microstate D as node. (5) Microstate B→C’s transition probability also showed a significantly positive correlation with acupuncture deqi behavior scores. Taken together, the temporal dynamic feature of EEG microstate could be used as objective neuroimaging evidence to reveal the neuromodulation effect of acupuncture with deqi.

Transcutaneous electrical acupoint stimulation combined with electroacupuncture for rapid recovery of patients after laparotomy for gastrointestinal surgery: a study protocol for a randomised controlled trial

INTRODUCTION

Abdominal surgery is associated with common complications, including decreased or poor appetite, abdominal distension, abdominal pain caused by decreased or absent gastrointestinal motility, anal arrest with flatus and defecation, and nausea and vomiting resulting from the use of anaesthetics and opioid analgesics. These complications seriously affect postoperative recovery, prolong hospital stay and aggravate patient burden. This study aims to investigate for the first time the efficacy of transcutaneous electrical acupoint stimulation (TEAS) combined with electroacupuncture (EA) therapy for rapid recovery after laparotomy for gastrointestinal surgery. There have been no clinical studies of this combination therapy.

METHODS AND ANALYSIS

This will be a prospective, single-centre, three-arm, randomised controlled trial. A total of 480 patients undergoing abdominal surgery will be stratified according to surgery type (ie, gastric or colorectal procedure) and randomised into three groups; namely, the EA, TEAS +EA and control groups. The control group will receive enhanced recovery after surgery (ERAS)-standardised perioperative management, including preoperative education, optimising the anaesthesia scheme, avoiding intraoperative hypothermia, restrictive fluid infusion and reducing surgical trauma. The EA group will receive EA stimulation at LI4, PC6, ST36, ST37 and ST39 based on the ERAS-standardised perioperative management. Moreover, the TEAS +EA group will receive ERAS-standardised perioperative management; EA stimulation at the LI4, PC6, ST36, ST37 and ST39; and TEAS stimulation at ST21 and SP15. The primary outcome will be the GI-2 (composite outcome of time to first defaecation and time to tolerance of a solid diet). Secondary outcomes will include the time of first passage of flatus, time to first defaecation, time to tolerance of a solid diet, time to first ambulation, hospital duration from operation to discharge, pain and nausea vomiting scores on the Visual Analogue Scale, medication use, incidence of postoperative complications and evaluation of treatment modality acceptability. All statistical analyses will be performed based on the intention-to-treat principle.

ETHICS AND DISSEMINATION

Ethics approval has been granted by the Ethics Committee on Biomedical Research, West China Hospital of Sichuan University (approval number: 2021; number 52). The results are expected to be published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ChiCTR2100045646.

Acupuncture With deqi Modulates the Hemodynamic Response and Functional Connectivity of the Prefrontal-Motor Cortical Network

As a world intangible cultural heritage, acupuncture is considered an essential modality of complementary and alternative therapy to Western medicine. Despite acupuncture’s long history and public acceptance, how the cortical network is modulated by acupuncture remains largely unclear. Moreover, as the basic acupuncture unit for regulating the central nervous system, how the cortical network is modulated during acupuncture at the Hegu acupoint is mostly unclear. Here, multi-channel functional near-infrared spectroscopy (fNIRS) data were recorded from twenty healthy subjects for acupuncture manipulation, pre- and post-manipulation tactile controls, and pre- and post-acupuncture rest controls. Results showed that: (1) acupuncture manipulation caused significantly increased acupuncture behavioral deqi performance compared with tactile controls. (2) The bilateral prefrontal cortex (PFC) and motor cortex were significantly inhibited during acupuncture manipulation than controls, which was evidenced by the decreased power of oxygenated hemoglobin (HbO) concentration. (3) The bilateral PFC’s hemodynamic responses showed a positive correlation trend with acupuncture behavioral performance. (4) The network connections with bilateral PFC as nodes showed significantly increased functional connectivity during acupuncture manipulation compared with controls. (5) Meanwhile, the network’s efficiency was improved by acupuncture manipulation, evidenced by the increased global efficiency and decreased shortest path length. Taken together, these results reveal that a cooperative PFC-Motor functional network could be modulated by acupuncture manipulation at the Hegu acupoint. This study provides neuroimaging evidence that explains acupuncture’s neuromodulation effects on the cortical network.

Transcutaneous electrical acupoint stimulation applied in lower limbs decreases the incidence of paralytic ileus after colorectal surgery: A multicenter randomized controlled trial

BACKGROUND

Postoperative paralytic ileus prolongs hospitalization duration, increases medical expenses, and is even associated with postoperative mortality; however, effective prevention of postoperative paralytic ileus is not yet available. This trial aimed to assess the preventative effectiveness of transcutaneous electrical acupoint stimulation applied in the lower limbs on postoperative paralytic ileus incidence after colorectal surgery.

METHODS

After ethics approval and written informed consent, 610 patients from 10 hospitals who were scheduled for colorectal surgery between May 2018 and September 2019 were enrolled. Patients were randomly allocated into the transcutaneous electrical acupoint stimulation (stimulated on bilateral Zusanli, Shangjuxu, and Sanyinjiao acupoints in lower limbs for 30 minutes each time, total 4 times) or sham (without currents delivered) group with 1:1 ratio. The primary outcome was postoperative paralytic ileus incidence, defined as no flatus for >72 hours after surgery.

RESULTS

Compared to the sham treatment, transcutaneous electrical acupoint stimulation lowered the postoperative paralytic ileus incidence by 8.7% (32.3% vs 41.0%, P = .026) and decreased the risk of postoperative paralytic ileus by 32% (OR, 0.68; P = .029). Transcutaneous electrical acupoint stimulation also shortened the recovery time to flatus, defecation, normal diet, and bowel sounds. Transcutaneous electrical acupoint stimulation treatment significantly increased median serum acetylcholine by 55% (P = .007) and interleukin-10 by 88% (P < .001), but decreased interleukin-6 by 47% (P < .001) and inducible nitric oxide synthase by 42% (P = .002) at 72 hours postoperatively.

CONCLUSION

Transcutaneous electrical acupoint stimulation attenuated the postoperative paralytic ileus incidence and enhanced gastrointestinal functional recovery, which may be associated with increasing parasympathetic nerve tone and its anti-inflammatory actions.

Pilot Study of Acupuncture's Antispasmodic Effect on Upper Gastrointestinal Tract during Endoscopic Submucosal Dissection for Early Gastric Cancer: Controlled Clinical Trial

A prospective study was conducted in patients with early-stage gastric cancer to determine the efficacy and safety of acupuncture stimulation as an antispasmodic compared with conventional medication during the procedure of endoscopic submucosal dissection (ESD) of the upper gastrointestinal tract. This study was a prospective single blinded quasi-randomized controlled trial. Seventy-three patients who were scheduled to undergo ESD for gastric cancer at Aizu Medical Center between 19 February 2016 and 30 June 2016 were assessed for eligibility for the study. Sixty out of 73 patients were included in the study and assigned into two intervention groups: medication group (MG) and acupuncture group (AG). Ease of the procedure was evaluated using modified NIWA classification (MNC) by endoscopist considering the frequency and amplitude of the upper gastrointestinal peristalsis. For the statistical analysis, Mann-Whitney test was used to compare the differences of MNC values (baseline and end of procedure) between two groups. The difference of MNC found in the AG (-2.00 (-3.0 to -2.0)) was significantly greater than that in the MG (-1.00 (-2.0 to -1.0), p < 0.0001, Mann-Whitney test). We consider that acupuncture to the abdomen could be an alternative antispasmodic method during upper gastrointestinal endoscopic procedure.

Acupuncture and Related Therapies for the Treatment of Gastrointestinal Diseases

Gastrointestinal diseases are very common worldwide. Patients with gastroesophageal reflux disease, functional dyspepsia, irritable bowel syndrome, and inflammatory bowel diseases frequently recur to complementary medicine, including acupuncture, likely because of the recurrence of symptoms and the sometimes lack of efficacy of conventional treatments. Acupuncture is a medical practice used in Asian country with benefits for thousands years. In the last decades, growing attention has been given to acupuncture also in Western countries and many studies have investigated the role of acupuncture in gastroenterology. This review provided an overview of the effectiveness and potential mechanisms of action of acupuncture for the treatment of gastrointestinal diseases.

The Role of Traditional Acupuncture in Patients with Fecal Incontinence-Mini-Review

OBJECTIVE

Fecal incontinence affects up to 15% of the general population, with higher rates of incidence among women and the elderly. Acupuncture is an old practice of Traditional Chinese Medicine that might be used to treat fecal incontinence. The aim of this mini review was to assess the effect of acupuncture for fecal incontinence.

MATERIALS AND METHODS

Cochrane Library, Web of Science, Embase, PubMed, and CENTRAL electronic databases were searched until August 2020. The following keywords were used: acupuncture, electroacupuncture, moxibustion, fecal incontinence, diarrhea, irritable bowel syndrome, and bowel dysfunction. In addition, references were searched. Five studies (two randomized controlled trials), out of 52,249 predefined publications after an electronic database search, were included into the review.

RESULTS

Overall, 143 patients were included. All studies report significant improvements in continence, although they all apply different acupuncture regimens. Randomized controlled trials show significant differences in experimental groups treated with acupuncture in improving continence. Significant improvement in quality of life scores was reported. In addition, improvement in fecal continence remained significantly improved after 18 months of follow-up.

CONCLUSION

Acupuncture is a promising treatment alternative for fecal incontinence. Based on small, low-quality studies, it might be a safe, inexpensive, and efficient method. However, more high-quality studies are needed in order to apply this treatment technique routinely.

Sensory Stimulation of Oxytocin Release Is Associated With Stress Management and Maternal Care

It has been shown that various types of stress initiate different physiological and neuroendocrine disorders. Oxytocin (OT) is mainly produced in the supraoptic nucleus (SON) and paraventricular nucleus (PVN) of the hypothalamus. Hypothalamic OT has antistress effects and attenuates the hypothalamic–pituitary–adrenal (HPA) axis. One mechanism behind the antistress effects of OT is mediated through the inhibition from GABA_A receptors on corticotropin-releasing factor (CRF) expression at the PVN. Various manual therapies such as acupuncture, transcutaneous electrical nerve stimulation (TENS), and massage initiate the stimulation of somatosensory neurons of the body. It is well-known that TENS simulates OT expression, while it inhibits CRF expression at the PVN following chronic stress loading in rodents. Upregulation of OT expression at the hypothalamus is activated by the somatosensory stimulation, which is mediated via the spinothalamic pathway (the connection between the spinal cord and hypothalamus). Thus, somatosensory stimulation is beneficial in treating stress-associated symptoms. Hypothalamic OT is associated with the social behaviors, including maternal care and affiliation. Childhood neglect and/or child abuse are severely responsible for deleterious long-term effects on the cognitive/social activity and behavioral development. At parturition, a profound amount of OT is released into the systemic circulation in response to vaginal and cervical stimulation caused by the body of fetus, which induces the onset of maternal behavior. Peridural anesthesia effectively impairs the sensitivity to vaginal and cervical stimulation at parturition. OT levels in cerebrospinal fluid is significantly reduced following peridural anesthesia. The vaginal delivery mothers had significantly more OT pulses than the caesarian section (CS) mothers. Due to low levels of endogenous OT, maternal behavior could be interrupted by epidural anesthesia and CS at parturition because of the reduction of the usual sensory input from the genitalia.

Acupuncture for Adults with Diarrhea-Predominant Irritable Bowel Syndrome or Functional Diarrhea: A Systematic Review and Meta-Analysis

Objective. To evaluate the clinical effectiveness and safety of acupuncture therapy in the treatment of diarrhea-predominant irritable bowel syndrome (IBS-D) or functional diarrhea (FD) in adults. Method. Five electronic databases-PubMed, EMBASE, CNKI, VIP, and Wanfang-were searched, respectively, until June 8, 2020. The literature of clinical randomized controlled trials of acupuncture for the treatment of IBS-D or FD in adults were collected. Meta-analysis was conducted by Using Stata 16.0 software, the quality of the included studies was assessed by the RevMan ROB summary and graph, and the results were graded by GRADE. Result. Thirty-one studies with 3234 patients were included. Most of the studies were evaluated as low risk of bias related to selection bias, attrition bias, and reporting bias. Nevertheless, seven studies showed the high risk of bias due to incomplete outcome data. GRADE's assessments were either moderate certainty or low certainty. Compared with loperamide, acupuncture showed more effectiveness in weekly defecation (SMD = -0.29, 95% CI [-0.49, -0.08]), but no significant improvement in the result of the Bristol stool form (SMD = -0.28, 95% CI [-0.68, 0.12]). In terms of the drop-off rate, although the acupuncture group was higher than the bacillus licheniformis plus beanxit group (RR = 2.57, 95% CI [0.24, 27.65]), loperamide group (RR = 1.11, 95% CI [0.57, 2.15]), and trimebutine maleate group (RR = 1.19, 95% CI [0.31, 4.53]), respectively, it was lower than the dicetel group (RR = 0.83, 95% CI [0.56, 1.23]) and affected the overall trend (RR = 0.93, 95% CI [0.67, 1.29]). Besides, acupuncture produced more significant effect than dicetel related to the total symptom score (SMD = -1.17, 95% CI [-1.42, -0.93]), IBS quality of life (SMD = 2.37, 95% CI [1.94, 2.80]), recurrence rate (RR = 0.43, 95% CI [0.28, 0.66]), and IBS Symptom Severity Scale (SMD = -0.75, 95% CI [-1.04, -0.47]). Compared to dicetel (RR = 1.25, 95% CI [1.18, 1.32]) and trimebutine maleate (RR = 1.35, 95% CI [1.13, 1.61]), acupuncture also showed more effective at total efficiency. The more adverse effect occurred in the acupuncture group when comparing with the dicetel group (RR = 11.86, 95% CI [1.58, 89.07]) and loperamide group (RR = 4.42, 95% CI [0.57, 33.97]), but most of the adverse reactions were mild hypodermic hemorrhage. Conclusion. Acupuncture treatment can improve the clinical effectiveness of IBS-D or FD, with great safety, but the above conclusions need to be further verified through the higher quality of evidence.

Acupuncture for metabolic syndrome: systematic review and meta-analysis

BACKGROUND

Metabolic syndrome (MetS) is a cluster of conditions associated with an increased risk of cardiovascular disease and diabetes mellitus. Acupuncture may have benefits in the treatment of MetS. This systematic review with meta-analysis aimed to determine the effectiveness and safety of acupuncture therapy in the treatment of MetS.

METHODS

Large-sample randomized controlled trials (RCTs) of acupuncture treatment for MetS were extracted from multiple Chinese and English databases and analyzed using meta-analysis to evaluate the efficacy/effectiveness of acupuncture with respect to various MetS indices in comparison with control treatments including conventional medications (CMs) and lifestyle intervention (LI), together and separately.

RESULTS

A total of 13 RCTs were identified with 423 subjects undergoing acupuncture regimens and 411 receiving control interventions. Active acupuncture yielded better outcomes than sham acupuncture with respect to improving multiple MetS indices. Acupuncture monotherapy had similar effectiveness in controlling triglyceride levels and high-density lipoprotein levels compared to CMs. The overall effects of adjunctive acupuncture were markedly greater than those of controls (CMs + LI, CMs, and LI) with respect to waist circumference with a mean difference of -5.11 cm (Z = 4.57, p < 0.001) and body mass index with a mean difference of -2.54 (Z = 5.38, p <0.001), and improvements were observed in most hyperlipidemia indices and fasting blood glucose. An evidence-based acupuncture regimen was identified as a future treatment strategy for MetS.

CONCLUSION

Acupuncture is beneficial in the treatment of MetS and could serve as an alternative therapy for MetS-associated conditions. Larger-scale RCTs are needed to confirm the efficacy/effectiveness of our recommended evidence-based acupuncture regimen in MetS.

Treatment expectations seem to affect bowel health when using acupuncture during radiotherapy for cancer: Secondary outcomes from a clinical randomized sham-controlled trial

OBJECTIVE

To investigate if frequent stools ("diarrhoea"), infrequent stools ("constipation"), capacity in daily activities and Quality of Life (QoL) differed between patients treated with verum or sham acupuncture, and if patients with more positive treatment expectations differed regarding frequent stools and infrequent stools from patients with less positive treatment expectations.

METHODS

In this randomized sham controlled trial, 200 patients received verum traditional penetrating acupuncture or sham acupuncture using a telescopic non-penetrating sham-needle 2-3 times a week during abdominal-pelvic radiotherapy (12 needling sessions during median 5 radiotherapy weeks). The patients registered stool frequency once a week, and registered capacity in daily activities and QoL at the start and end of radiotherapy, and at a one-month follow-up.

RESULTS

In the verum acupuncture group, 29 of 96 answering patients (30 %) experienced frequent stools and 7 (7 %) experienced infrequent stools at least one week of radiotherapy. In the sham acupuncture group, 21 of 97 (22 %) experienced frequent stools (p = 0.175) and 10 (10 %) experienced infrequent stools (p = 0.613). Patients with low treatment expectancy were more likely than other patients to experience frequent stools (60 % versus 26 %, p = 0.014) but not to experience infrequent stools (25 % versus 12 %, p = 0.334).

CONCLUSION

Penetrating acupuncture was not effective for frequent stools or for infrequent stools and did not improve capacity in daily activities or QoL in patients undergoing pelvic-abdominal irradiation for cancer more than non-penetrating acupuncture. Since patients with low acupuncture treatment expectations were more likely to experience frequent stools compared to other patients, non-specific treatment effects warrant further studies.

Postfundoplication retching: Strategies for management

BACKGROUND

Retching is a common symptom in children following antireflux surgery, particularly in those with neurodisability. There is now a strong body of evidence that implicates retching as a major cause of wrap breakdown. Retching is not a symptom of gastroesophageal reflux disease; it is a component of the emetic reflex. In addition to causing wrap breakdown, it is indicative of the presence of nausea. It is a highly aversive experience and warrants treatment in its own right.

METHODS

A framework was constructed for the management of postoperative retching, with strategies targeting different components of the emetic reflex. The impact of differing antireflux procedures upon retching was also considered.

CONCLUSIONS

Once treatable underlying causes have been excluded, the approach includes modifications to feeds and feeding regimens, antiemetics and motility agents. Neuromodulation and other, novel, therapies may prove beneficial in future. Children at risk of postoperative retching may be identified before any antireflux surgery is performed. Fundoplication is inappropriate in these children because it does not treat their symptoms, which are not because of gastroesophageal reflux, and may make them worse. They are also at risk of wrap disruption. Alternative strategies for symptom management should be employed, and fundoplication should be avoided.

LEVEL OF EVIDENCE

II-V.

Electroacupuncture: A New Approach for Improved Postoperative Sleep Quality After General Anesthesia

General anesthesia produces a state of drug-induced unconsciousness that is controlled by the extent and duration of administered agents. Whether inhalation or intravenous in formulation, such agents may interfere with normal sleep-wake cycles, impairing postoperative sleep quality and creating complications. Electroacupuncture is a new approach widely applied in clinical practice during recent years. This particular technology helps regulate neurotransmitter concentrations in the brain, lowering norepinephrine and dopamine levels to improve sleep quality. It also alleviates surgical pain that degrades postoperative sleep quality after general anesthesia by downregulating immune activity (SP, NK-1, and COX-1) and upregulating serotonin receptor (5-HT1AR, 5-HT2AR) and endocannabinoid expression levels. However, large-scale, multicenter studies are still needed to determine the optimal duration, frequency, and timing of electroacupuncture for such use.

Veterinary acutherapy in management of musculoskeletal disorders: An eye-opener to the developing countries' veterinarians

Traditional Chinese medicine practitioners believed that the maintenance of the health status of any individual or animal is by the harmonious flow of Chi (life force) along a pathway known as the meridian. Interruption or blockage of Chi brings about disorders, pain, and diseases. Acutherapy, therefore, aims at correcting the interruption or blockage of the harmonious flow of Chi along the meridian to restore the healthy condition of the body system. This correction could be accomplished by either acupuncture or acupressure, and are both collectively referred to as acutherapy. This form of therapy has been used in both humans and animals for several decades. It is, however, just gaining popularity in the treatment of humans and is still not yet in practice among veterinarians for animal patients in most developing countries like Nigeria. This review, therefore, is aimed at exposing veterinarians from the developing countries to the general application of acutherapy with emphasis on the musculoskeletal system and associated pain where it is most applied. It is highly recommended that the universities, where Veterinary Medicine is studied in developing countries, should endeavor to train their veterinary surgeons in this area and see to how acutherapy can be included in the curriculum.

Electroacupuncture ameliorates corticotrophin-releasing factor-induced jejunal dysmotility in a rat model of stress

BACKGROUND

Central injection of corticotrophin-releasing factor (CRF) mimics the effect of stress on gastrointestinal (GI) responses, including inhibition of GI motility. This study was designed to explore the effects of electroacupuncture (EA) on disordered jejunal motility in a rat model of stress induced by intracisternal (IC) injection of CRF.

METHODS

A stress model was established by IC injection of CRF in Sprague-Dawley rats. GI motility was evaluated by assessing gastric emptying (GE), gastrointestinal transit (GIT) and jejunal motility in vivo. EA was performed at ST36. The functional roles of CRF receptor subtype 1 and subtype 2 (CRFr1 and CRFr2) were examined by IC administration of the corresponding selective CRF antagonists. Protein expression of CRFr1 and CRFr2 in the hypothalamus and jejunum was detected by Western blotting.

RESULTS

IC injection of CRF significantly inhibited GE, GIT and jejunal motility. EA treatment remarkably improved the disturbed GI motility. Intriguingly, the disordered jejunal motility induced by central CRF was abolished by IC injection of a selective CRFr2 antagonist, indicating the essential role of central CRFr2 in mediating the stress-induced jejunal motor disorder. EA at ST36 decreased central and peripheral expression of CRFr2, which might be one of the potential mechanisms underlying the beneficial effect of EA on jejunal dysmotility in this rat model of stress.

CONCLUSION

This study suggested that EA at ST36 could ameliorate disordered jejunal motility induced by stress, and that this might be associated with the down-regulation of CRFr2.

Enhanced spinal neuronal responses as a mechanism for increased number and size of active acupoints in visceral hyperalgesia

Acupuncture has been used to treat a variety of illness and involves the insertion and manipulation of needles into specific points on the body (termed “acupoints”). It has been suggested that acupoints are not merely discrete, static points, but can be dynamically changed according to the pathological state of internal organs. We investigated in a rat model of mustard oil (MO)-induced visceral hyperalgesia whether the number and size of acupoints were modified according to the severity of the colonic pain, and whether the changes were associated with enhanced activity of the spinal dorsal horn. In MO-treated rats, acupoints showing neurogenic inflammation (termed “neurogenic spots” or Neuro-Sps) were found both bilaterally and unilaterally on the leg. The number and size of these acupoints increased along with increasing doses of MO. Electroacupuncture of the acupoints generated analgesic effects on MO-induced visceral hypersensitivity. The MO-treated rats showed an increase in c-Fos expression in spinal dorsal horn neurons and displayed increased evoked activity and a prolonged after-discharge in spinal wide dynamic response (WDR) neurons in response to colorectal distension. Increased number and size of neurogenic inflammatory acupoints following MO treatment were reduced by inhibiting AMPA and NMDA receptors in the spinal cord. Our findings suggest that acupoints demonstrate increased number and size along with severity of visceral pain, which may be associated with enhanced neuronal responses in spinal dorsal horn neurons.

Neuromechanism of acupuncture regulating gastrointestinal motility

Acupuncture has been used in China for thousands of years and has become more widely accepted by doctors and patients around the world. A large number of clinical studies and animal experiments have confirmed that acupuncture has a benign adjustment effect on gastrointestinal (GI) movement; however, the mechanism of this effect is unclear, especially in terms of neural mechanisms, and there are still many areas that require further exploration. This article reviews the recent data on the neural mechanism of acupuncture on GI movements. We summarize the neural mechanism of acupuncture on GI movement from four aspects: acupuncture signal transmission, the sympathetic and parasympathetic nervous system, the enteric nervous system, and the central nervous system.

Exploring traditional acupuncture point selection patterns for pain control: data mining of randomised controlled clinical trials

BACKGROUND

The underlying principles of traditional acupuncture point selection for pain control are complex. Analysis of acupuncture treatments from clinical studies may provide us with a potential rule when selecting traditional acupuncture points (hereafter abbreviated as "points") in treatment protocols for pain control. The aim of this study was to investigate which points were most commonly used to treat pain in randomised controlled clinical trials (RCTs).

METHODS

We searched acupuncture treatment regimens in RCTs included in the Cochrane Database of Systematic Reviews for pain management. We analysed information on point selection (more than 10 RCTs included) from seven eligible systematic reviews on pain control. The frequency of the points used was calculated and visualised using a human body template.

RESULTS

The points most commonly used across diseases were SP6, ST36, LI4 and LR3. However, the most frequently used points varied across individual conditions. For example, the most frequently used points to treat migraine were GB20, LR3, GV20, Taiyang, LI4 and TE5, while the most frequently used points to manage dysmenorrhoea were SP6, CV4, SP8, LR3 and BL32. Both regional and distal points were used for pain management with acupuncture.

CONCLUSIONS

Our findings suggest that local and segmental/extra-segmental neuromodulation appear to be the most common phenomena for pain control in acupuncture research. Analysis of information on point selection using a data-driven approach may unveil the hidden patterns of traditional acupuncture point utilisation in clinical practice.

Effects of electroacupuncture on stress-induced gastric dysrhythmia and mechanisms involving autonomic and central nervous systems in functional dyspepsia

Electroacupuncture (EA) is widely used as an effective method to treat stress-related disorders. However, its mechanisms remain largely unknown. The aim of this study was to investigate the effects and mechanisms of EA on gastric slow wave (GSW) dysrhythmia and c-Fos expression in the nucleus of the solitary tract (NTS) induced by stress in a rodent model of functional dyspepsia (FD). Rats in the neonatal stage were treated using intragastric iodoacetamide. Eight weeks later, the rats were implanted with electrodes in the stomach for the measurement of GSW and electrodes into accupoints ST36 for EA. Autonomic functions were assessed by spectral analysis of heart rate variability. Rats were placed for 30 min in a cylindrical plastic tube for acute restraint stress. The involvement of a central afferent pathway was assessed by measuring c-Fos-immunoreactive cells in the NTS. 1) EA normalized restraint stress-induced impairment of GSW in FD rats. 2) EA significantly increased vagal activity (P = 0.002) and improved sympathovagal balance (P = 0.004) under stress in FD rats. 3) In FD rats under restraint stress, plasma norepinephrine concentration was increased substantially (P < 0.01), which was suppressed with EA. 4) The EA group showed increased c-Fos-positive cell counts in the NTS compared with the sham EA group (P < 0.05) in FD rats. Acute restraint stress induces gastric dysrhythmia in a rodent model of FD. EA at ST36 improves GSW under stress in FD rats mediated via the central and autonomic pathways, involving the NTS and vagal efferent pathway.

Effect of acupuncture on hormone level in patients with gastrointestinal dysfunction after general anesthesia: A study protocol for a randomized controlled trial

BACKGROUND

Postoperative gastrointestinal dysfunction (PGD) refers to one of the common postoperative complications. Acupuncture can facilitate the recovery of PGD, whereas no therapeutic schedule of acupuncture has been internationally recognized for treating PGD. In the present study, a scientific trial protocol has been proposed to verify the feasibility of acupuncture in treating gastrointestinal dysfunction after laparoscopic cholecystectomy under general anesthesia. We conduct this protocol to investigate whether acupuncture recovery gastrointestinal dysfunction by influencing the expression of gastrointestinal hormone.

METHOD

The present study refers to a randomized, evaluator blinded, controlled, multi-center clinical trial; it was designed complying with the Consolidated Standards of Reporting Trials (CONSORT 2010) as well as the Standard for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA). The subjects will be taken from the inpatients having undergone laparoscopic surgery of Mianyang Affiliated Hospital of Chengdu University of traditional Chinese medicine, Mianyang Third Hospital and Mianyang Anzhou Hospital. Based on the random number yielded using SPSS 25.0 software, the qualified subjects will be randomly classified to the experimental group and the control group. Therapies will be performed 30 min once after operation, the experimental group will be treated with acupuncture, while the control group will receive intravenous injection of granisetron. The major outcome will be the time to first flatus, and the secondary outcomes will include the time to first defecation, abdominal pain, dosage of analgesia pump, abdominal distention, nausea, vomiting, gastrointestinal hormone, as well as mental state. The efficacy and safety of acupuncture will be also assessed following the principle of Good Clinical Practice (GCP).

DISCUSS

A standardized and scientific clinical trial is conducted to assess the efficacy and safety of acupuncture for gastrointestinal dysfunction after laparoscopic cholecystectomy under general anesthesia. The aim is to objectively evidence and improves the clinical practice of acupoint prescription, as an attempt to promote the clinical application of this technology.

Acupoint selection for the treatment of dry eye: A systematic review and meta-analysis of randomized controlled trials

The effectiveness of acupuncture in the treatment of dry eye has been confirmed, but the association between acupoint selection and therapeutic effect has remained to be elucidated. In the present study, a systematic review and meta-analysis were performed to evaluate the effect of periocular acupoints and periocular acupoints plus body acupoints compared with AT for the treatment of dry eye disease (DED). The PubMed, Cochrane Library, Embase, Ovid, China National Knowledge Infrastructure and Chonqing VIP Information, Co., Ltd. databases were searched with entries until 10 July 2018 considered. Only randomized controlled trials (RCTs) were included. Meta-analyses were performed to compare the effects of acupuncture with those of conventional treatment (including AT or other non-acupuncture therapies). The primary outcomes, including tear break-up time (BUT), Schirmer's I test (SIT) result and Symptom scores were analyzed. Subgroup analysis was performed for periocular acupoints only and periocular acupoints plus body acupoints. A total of 12 studies comprising 900 participants were included. In the primary meta-analysis, a significant improvement in the BUT [n=1,209, weighted mean difference (WMD)=1.01, 95% CI: 0.56-1.84, P<0.00001], SIT result (n=1,107, WMD=1.98, 95% CI: 0.44-3.34, P<0.00001) and Symptom scores (n=402, WMD=-1.02, 95% CI: -1.33 to -0.72, P<0.00001) was obtained to evaluate the clinical efficacy of acupuncture and AT. Furthermore, periocular acupoints plus body acupoints were more effective in the treatment of DED. However, the total sample size of subjects with only periocular acupoints in the treatment of DED was too small to get any firm conclusions. Further large RCTs are warranted.

Effects of Transcutaneous Electrical Acupoint Stimulation on the Postoperative Sleep Quality and Pain of Patients After Video-Assisted Thoracoscopic Surgery: A Prospective, Randomized Controlled Trial

OBJECTIVE

Postoperative sleep disturbances have serious adverse effects on postoperative outcomes. Our paper aimed to observe the effect of using transcutaneous electrical acupoint stimulation (TEAS) on sleep quality and complications after surgery in patients undergoing selective video-assisted thoracoscopic surgery.

PATIENTS AND METHODS

Eighty-five patients were divided into the TEAS group or the control group randomly. Thirty minutes of TEAS treatment was performed on TEAS group at the following time points: the first night before surgery, at the end of surgery, and before sleeping on the second and third nights after surgery. The Portable Sleep Monitor (PSM) was performed to determine the sleep quality of the two nights before the operation (Sleep preop 2 and Sleep preop 1) and the first and third night after surgery (Sleep POD 1 and Sleep POD 3). The visual analog scale (VAS) was performed to evaluate pain scores after surgery and the Athens Insomnia Scale (AIS) was used for evaluating subjective sleep quality.

RESULTS

Participants in the TEAS group had a lower AIS score and higher sleep efficiency at each time point except Sleep preop 2. Participants in the TEAS group showed significantly higher proportion of each sleep stage during Sleep-preop 1, Sleep POD 1, and Sleep POD 3. Patients in the TEAS group had significantly lower VAS scores at 2, 4, and 6 h during the first 24 h after surgery. The incidence of nausea and vomiting and dizziness in the control group was statistically higher than in the TEAS group.

CONCLUSION

Patients usually have sleep disturbances after video-assisted thoracoscopic surgery, such as decreased distribution of each sleep stage, lower sleep efficiency, and higher AIS score. Undergoing TEAS treatment perioperatively can improve sleep quality, and effectively promote the postoperative analgesic effect and alleviate postoperative complications.

The Status of the Acupuncture Mechanism Study Based on PET/PET-CT Technique: Design and Quality Control

PET/PET-CT is an important technique to investigate the central mechanism of acupuncture in vivo. This article collected original research papers with keywords of "Acupuncture," "PET," "PET/CT," and "Positron emission tomography" in PubMed and CNKI databases from January 2003 to December 2018. As a result, a total of 43 articles were included. Based on the literature analyses, we found that (1) reasonable arrangement of the operation process and the choice of appropriate acupuncture intervention time is conducive to a better interpretation of acupuncture-PET/PET-CT mechanism and (2) the selection of participants, sample size, acupuncture intervention, and experimental conditions would affect study results. Therefore, effective quality control is an important way to ensure the repeatability of research results.

Physiological impact of nanoporous acupuncture needles: Laser Doppler perfusion imaging in healthy volunteers

BACKGROUND

Recently, porous acupuncture (PA), which is anodized to increase its surface area for higher stimulation intensity, was developed and showed significantly improved therapeutic effects with more comfort as compared with original acupuncture (OA) in vivo. However, the impact of PA on the change of local blood flow as well as its efficacy and acceptability has not yet been confirmed in a clinical trial. In a randomized, controlled crossover clinical trial, we investigated the effects of PA on the change in local blood flow using laser Doppler perfusion imaging and considered the sensation of pain intensity and discomfort severity using a visual analogue scale (VAS) to explore its physiological impact and the possibility of PA in clinical use.

METHODS

Twenty-one healthy participants were randomly treated with PA or OA on one side of Zusanli (ST36) and each participant served as his or her own control. Baseline local blood flow and galvanic skin response (GSR) were obtained for 5 min and acupuncture interventions were subsequently performed. Next, local blood flow and GSR were subsequently obtained for 10 min after insertion, 10 min after manipulation, and 5 min after the withdrawal of acupuncture. At the end of the experiment, participants were asked to indicate the sensation of pain intensity at each session of insertion, retention, manipulation, and withdrawal as well as the overall pain intensity and discomfort severity.

RESULTS

PA significantly increased the local blood flow as compared with OA and there was no significant difference in GSR between patients treated with PA versus OA in each phase of insertion and manipulation. No significant difference in pain intensity or discomfort severity was found during manipulation, retention, or withdrawal of acupuncture.

CONCLUSIONS

These results indicate that PA increases local blood flow, which can be closely related to the observed enhanced performance, without any associated discomfort or pain, suggesting its applicability in clinical practice.

Fascial neuromodulation: an emerging concept linking acupuncture, fasciology, osteopathy and neuroscience

According to Traditional Chinese Medicine “acupuncture is believed to restore the balance between Yin and Yang” and this can be understood in the Western medicine terminology as a “modulation of the equilibrium between parasympathetic and sympathetic activity”. The vast majority of studies concerning the mechanisms of action of acupuncture have been conducted on its influence on pain, and it has been proposed that acupuncture may indirectly relieve chronic pain by its effects on autonomic nervous system function. Several studies have shown that acupuncture recruits brain networks involved in the integration of multiple other brain functions: for example, the limbic-paralimbic-neocortical network, which plays a major role in modulating the affective dimensions of pain processing and the integration of emotional, sensorimotor, autonomic and immunological functions. It has been recently proposed that mechanical signaling through the connective tissue, along with transmission of the matrix deformation through the fascial system network, can explain the therapeutic effect of acupuncture. This model of acupunture, which involves the transduction of mechanical signals through the connective planes and produces a secondary involvement of neurophysiological mechanism, appears to fit very closely to the ancient model. It is also compatible with the proposed neurophysiological explanation. Furthermore, it appears to be fruitful also in manual therapy approaches. Drawing on the basis of the “Fascial network hypothesis of meridians”, in which there is an overlap between the channels network described by Traditional Chinese Medicine and the newly-defined fascial system, I propose an intervention through a combination of acupoints that have been selected due to their relationship between “extraordinary acupuncture channels”, the myofascial sequences described by Stecco, and the emotional and adaptive function as contemplated by a psychosomatic model used in posturology. This intervention is aimed at treating both stress and postural imbalance.

Repeated transcutaneous electrical nerve stimulation of nonspecific acupoints of the upper body attenuates stress-induced visceral hypersensitivity in rats

Irritable bowel syndrome (IBS) is a common stress-related gastrointestinal disorder and visceral hypersensitivity (VH) is characteristically found in IBS patients. Transcutaneous electrical nerve stimulation (TENS) applied to certain acupoints has been shown to benefit IBS patients. Here, we investigated whether nonspecific acupoint is involved in the efficacy of TENS treatment for IBS. Twenty-five male rats were randomly assigned to four experimental groups and one sham-control group. The four experimental groups were defined as TENS-RR, TENS-RL, TENS-LR, and TENS-LL based on the location of the two TENS patches [right (R) or left (L)]. The former and latter letter pairs indicate that the patch locations were the upper chest and upper back, respectively. The heterotypic intermittent stress (HIS) protocol was performed for 16 days. VH was assessed by electromyography to evaluate response to rectal distention (RD). Modulated medium-frequency TENS, sweep range 1-10 Hz, amplitude slightly above the supra motor threshold, was applied 30 min per day followed by RD every second day for the final 7 days of the 16-day HIS period. VH was induced after the rats had been subjected to HIS for 10 days. A significant reduction of VH was observed only in the TENS-LL group compared with that in the sham-control group. These data suggest that repeated TENS treatment can alleviate stress-induced VH in rats. Further, whether TENS patches are attached to the left or right side of the body, which are nonspecific acupoints for gastrointestinal functions, may be an important factor in the treatment of stress-associated gastrointestinal symptoms.

Mechanism of Electroacupuncture on Postoperative Ileus Induced by Surgical Stress in Rats

Objectives: Acupuncture has been used for treating gastrointestinal (GI) disorders such as postoperative nausea and vomiting. Electroacupuncture (EA) accelerates GI transit following surgery and ameliorates postoperative ileus (POI) to restore colonic transit (CT); however, the mechanisms of this EA-induced restoration remain unclear. The aims of this study were to show CT following surgery and the effects of EA at ST 36 on POI induced by surgical stress (SS) in 45 conscious, male Sprague-Dawley rats. Materials and Methods: An operation was performed in each rat, setting a cannula into the cecum to connect the proximal colon to inject markers. On the day after surgery, 20 metal radiopaque markers were administered to the proximal colon of each rat. These markers were visible throughout the GI tract on soft X-ray immediately after administration and up to 240 minutes afterward. The rats were divided into 5 groups with 9 rats in each group: (1) SS; (2) 5 days post surgery (POST-5D); (3) SS + phentolamine; (4) EA alone; and (5) EA + atropine. The EA was performed at ST 36 for 20 minutes at a frequency of 10 Hz and agents were administered in the appropriate groups before markers were administered and measurements were taken. Measurements were performed the day after surgery except in the POST 5-D group. CT was calculated by the geometric center on the images showing the CT for each rat. Results: CT after surgery was delayed significantly and phentolamine accelerated CT. EA restored CT following surgery and atropine abolished the effect of EA on CT. Conclusions: The current study demonstrated that surgery induced a delay in CT through the sympathetic pathway via α-adrenoreceptors; CT was restored by EA. These results suggest that EA can be used to treat POI through mediation of the autonomic nervous system.

Effect of Electroacupuncture at Different Acupoints on the Expression of NMDA Receptors in ACC and Colon in IBS Rats

Objective

To observe the effects of electroacupuncture (EA) at different acupoints on the expression of N-methyl-D-aspartate receptor (NMDA receptor ) and behaviors in irritable bowel syndrome (IBS) rats.

Methods

Wistar rats were randomly divided into blank control group (blank group, n=10) and model preparation group (n=50); experimental rat model of IBS was established by the “neonatal maternal separation and acetic acid enema” combined with “colorectal distension stimulation” method. A total of 50 IBS rats were randomly assigned to five groups of 10 each: model group, Yintang (GV29) group, Neiguan (PC6) group, Tianshu (ST25) group, and Zusanli (ST36) group. Rats in four treatment groups, aged 9 weeks old, were treated with EA by HANS with a sparse-dense wave with a frequency of 2/100 Hz, current of 0.1-0.3mA, and 20 min/stimulation, every other day for a total of 5 sessions. After treatment, the abdominal visceral sensitivity was evaluated by abdominal withdrawal reflex (AWR), and the psychological and emotional behavior of rats were evaluated by the open-field test (OFT). The expression of NMDA receptors in anterior cingulate cortex (ACC) was detected by Quantitative Real-time PCR, and the positive expression of NMDA receptors in colon was detected by immunohistochemistry.

Results

The IBS rat's abdomen is more sensitive and irritable; NR1, NR2A, and NR2B in ACC and NR1 and NR2B in colon of rats significantly increased in the model group versus the normal group (P<0.01) and were inhibited in all treatment groups (P<0.01, P<0.05). Additionally, NR2A and NR2B in ACC reduced more in GV29 group (P<0.01) than in other treatment groups (P all<0.05) compared with the model group. The expression of NR2B in colon was significantly inhibited in ST36 group (P<0.01) and inhibited in GV29 group and ST25 group (P all <0.05) compared with the model group. And the expression of NR2B in colon was more inhibited in ST36 group than in PC6 group (P<0.01).

Conclusions

EA at different acupoints could obviously relieve abdominal pain and abnormal behaviors in IBS rats in different degrees of effects. The effect of abdominal pain-relief, from greatest to least, is ST25, ST36, GV29, and PC6, while the effect of relieving abnormal behaviors caused by IBS, from greatest to least, is GV29, PC6, ST36, and ST25. There are significant differences in the expressions of NMDA receptors in ACC and colon among different acupoints. This difference should be related to the location distribution and indications of acupoints.

Non-invasive High Frequency Median Nerve Stimulation Effectively Suppresses Olfactory Intensity Perception in Healthy Males

Median nerve stimulation (MNS) had been performed in the existing literature to alleviate symptoms of nausea and vomiting. The observed facilitative effects are thought to be mediated by the vagal pathways, particularly the vagus nerve (VN) brainstem nuclei of the dorsal motor nucleus of vagus and nucleus tractus solitarius (DMV-NTS). Sense of smell is one of the major sensory modalities for inducing vomiting and nausea as a primary defense against potentially harmful intake of material. This study aimed to test effects of non-invasive, high and low frequency MNS on human olfactory functioning, with supplementary exploration of the orbitofrontal cortex (OFC) using near-infrared spectroscopy (NIRS). Twenty healthy, male, adults performed supra-threshold odor intensity tests (labeled magnitude scale, LMS) for four food-related odorant samples (presented in three different concentrations) before and after receiving high-, low frequency MNS and placebo (no stimulation), while cortical activities in the OFC was monitored by the NIRS. Data of the NIRS and LMS test of separate stimulation parameters were statistically analyzed using mixed-model analysis of variance (ANOVA). Only the high frequency MNS showed effects for suppressing the intensity perception of the moderate concentration of Amyl Acetate (p:0.042) and strong concentration of Isovaleric Acid (p:0.004) and 1-Octen-3-ol (p:0.006). These behavioral changes were coupled with significant changes in the NIRS recordings of the left (p:0.000) and right (p:0.003) hemispheric orbitofrontal cortices. This is the first study that applied non-invasive, high frequency MNS to suppress the supra-threshold odor ratings of specific concentrations of odors. The vagal networks are potential relays of MNS to influence OFC. Results from the current article implore further research into non-invasive, high frequency MNS in the investigation of its modulatory effects on olfactory function, given its potential to be used for ameliorating nausea and malnutrition associated with various health conditions.

Inhibition of electroacupuncture on nociceptive responses of dorsal horn neurons evoked by noxious colorectal distention in an intensity-dependent manner

Background

The transmission of visceral nociception can be inhibited by electroacupuncture (EA) at the spinal level. However, relationships between current intensity and EA-induced analgesia are still lacking. This study compares the effects of different intensities of EA at local acupoints and heterotopic acupoints on nociceptive responses of spinal wide dynamic range (WDR) neurons induced by noxious colorectal distension (CRD).

Materials and methods

Experiments were conducted on 40 Sprague Dawley rats anesthetized with 10% urethane. Discharges of WDR neurons in the L1–L3 segments of the dorsal horn of the spinal cord were recorded extracellularly by glass micropipettes. Different intensities of EA (0.5, 1, 2, 4, 6, and 8 mA, 0.5 ms, 2 Hz) were applied to contralateral “Zusanli” (ST 36) or “Neiguan” (PC 6), with either the same or different segmental innervation of the colon.

Results

In local acupoints, the increased discharges of WDR neurons evoked by CRD were significantly inhibited by EA at 0.5–8 mA. A positive relationship between current intensity and the inhibiting rate was observed within 0.5–4 mA, but the inhibiting rate reached a plateau when EA exceeded 4 mA. In heterotopic acupoints, the increased discharges of WDR neurons evoked by CRD were significantly inhibited by EA at 2–8 mA. A positive relationship between current intensity and the inhibiting rate was observed within 2–6 mA. Further increase in the current beyond 6 mA also resulted in a plateau effect.

Conclusion

Within a certain range, the nociceptive responses of dorsal horn neurons induced by CRD could be inhibited by EA in an intensity-dependent manner.

Electroacupuncture via chronically implanted electrodes improves gastric dysmotility mediated by autonomic-cholinergic mechanisms in a rodent model of functional dyspepsia

BACKGROUND

Electroacupuncture (EA) has been shown to be effective in reducing symptoms in patients with functional dyspepsia (FD). However, its mechanisms remain largely unknown. The aim of this study was to investigate mechanisms of the prokinetic effects of EA in a rodent model of FD.

METHODS

A FD model was established by neonatal treatment of iodoacetamide (IA). Eight weeks later, the rats were implanted with electrodes in the stomach for the measurement of gastric slow waves (GSW) and electrodes into acupoints ST36 for EA. Autonomic functions were assessed by the spectral analysis of heart rate variability.

KEY RESULTS

(i) The IA-treated rats ("FD" rats) showed increased dysrhythmia in both fasting and fed states (P < .01) as well as during rectal distention (P < .02). EA reduced the percentage of dysrhythmia (P < .05 for both fasting and fed) and normalized RD-induced impairment in GSW in "FD" rats. Atropine blocked the effect of EA on GSW. (ii) "FD" rats showed delayed gastric emptying (P = .001 vs control) that was accelerated with EA (P = .01, vs sham-EA). (iii) "FD" rats showed increased plasma norepinephrine (P = .006, vs control) that was suppressed with EA (P = .003) and reduced vagal activity that was improved with EA.

CONCLUSIONS AND INFERENCES

Gastric motility (GSW and GE) is impaired in rats treated with IA, possibly attributed to impaired autonomic functions. EA improves GSW and accelerates GE mediated via the autonomic and cholinergic mechanisms.

Electroacupuncture treatments for gut motility disorders

Functional gastrointestinal (GI) diseases are common and there are patients who are refractory to medical therapies as not all treatments work in all patients. Consequently, a large number of patients with functional GI diseases use complementary and alternative medicine, such as acupuncture or electroacupuncture (EA). In this issue, Zheng et al. reported interesting results of a multi-center placebo-controlled clinical study on the use of EA for treating refractory functional dyspepsia; another study reported a multi-center clinical trial on EA for chronic functional constipation; Liang et al. studied mechanisms of EA involving enteric nervous system and neurotransmitters in treating constipation in rats. While controversial reports are available in the literature, EA with appropriate methodologies as shown in these recent studies is believed to be effective in treating certain functional GI diseases. In this mini-review, a number of clinical studies, including those included in this issue on the use of EA for treating gastro-esophageal reflux, functional dyspepsia, irritable bowel syndrome, and constipation are reviewed. Some critically important issues, such as the choice of stimulation parameters for EA, the administration frequency of the therapy, and the appropriate choice of placebo for clinical research are also discussed. Mechanisms of action involved in the therapeutic effects of EA for gut dysmotility and future research directions are also presented.