Electroacupuncture elevates blood cortisol levels in naive horses; sham treatment has no effect

Effects of acupuncture on hypothalamic-pituitary-adrenal axis: Current status and future perspectives

The hypothalamic-pituitary-adrenal (HPA) axis is a critical component of the neuroendocrine system, playing a central role in regulating the body's stress response and modulating various physiological processes. Dysregulation of HPA axis function disrupts the neuroendocrine equilibrium, resulting in impaired physiological functions. Acupuncture is recognized as a non-pharmacological type of therapy which has been confirmed to play an important role in modulating the HPA axis and thus favorably targets diseases with abnormal activation of the HPA axis. With numerous studies reporting the promising efficacy of acupuncture for neuroendocrine disorders, a comprehensive review in terms of the underlying molecular mechanism for acupuncture, especially in regulating the HPA axis, is currently in need. This review fills the need and summarizes recent breakthroughs, from the basic principles and the pathological changes of HPA axis dysfunction, to the molecular mechanisms by which acupuncture regulates the HPA axis. These mechanisms include the modulation of multiple neurotransmitters and their receptors, neuropeptides and their receptors, and microRNAs in the paraventricular nucleus, hippocampus, amygdala and pituitary gland, which alleviate the hyperfunctioning of the HPA axis. This review comprehensively summarizes the mechanism of acupuncture in regulating HPA axis dysfunction for the first time, providing new targets and prospects for further exploration of acupuncture. Please cite this article as: Zheng JY, Zhu J, Wang Y, Tian ZZ. Effects of acupuncture on hypothalamic-pituitary-adrenal axis: Current status and future perspectives. J Integr Med. 2024; 22(4): 446-459.

Neuromodulating Influence of Two Electroacupuncture Treatments on Heart Rate Variability, Stress, and Vagal Activity

Introduction: Although the clinical use of electro-acupuncture is widespread, the neuromodulating influence of various applied frequencies is not well established. Objectives: Heart rate variability (HRV), stress and parasympathetic recovery are closely related to health, longevity and vitality in humans. This study was undertaken to determine the influence of different electro-therapy frequencies on various autonomic nervous system markers when applied to a Battlefield Acupuncture Protocol (BFA). Design: A detailed comparison of autonomic nervous system (ANS) response to low frequency (LF) 2.5 Hz electro-acupuncture and mid-frequency (MF) 15 Hz electro-acupuncture applied by point stimulation to acupuncture points was undertaken on 2 groups of 12 patients. Interventions: Both LFEA and MFEA were applied to Battlefield Acupuncture protocol, consisting of five (5) key acupuncture ear (auricular) points that isolate the autonomic nervous system (ANS) and central nervous system's role in the chronic/acute pain cycle. Evaluations entailed an advanced status of autonomic nervous system (ANS) function through Electro-Cardiogram (ECG) baseline markers reflecting: sympathetic stress (SI); parasympathetic vagal tone (high frequency [HF]) and heart rate variability (HRV = total power). All were repeated subsequent to electro-therapy using 2 separate electro-modalities of low-frequency (2.5 Hz) electro-acupuncture (LFEA) and Mid-Frequency (15 Hz) electro-acupuncture (MFEA). All 24 patients received one (1) elector-acupuncture session. Results: The autonomic nervous system response to LFEA (2.5 Hz) reflected a statistically significant pre-post improvement in three of the markers collected: heart rate variability (HRV) improved by 61% [p = 0.002]; sympathetic stress (SI) reduced 42% [p = 0.002]; and parasympathetic vagal tone (HF) increased 56% [p = 0.017]. In contrast, MFEA (15 Hz) showed positive but non-significant changes in outcomes in all nervous system markers. Conclusions: The autonomic nervous system response with LFEA showed a measurable reduction in sympathetic stress with subsequent improvement in vagal tone, and HRV. This positive sympathetic nervous system deactivation from LFEA application shown in this study could have a major impact on other pathologies related to human health and longevity. Further cohort studies are warranted to determine the validity of these outcomes.

Acupuncture Points Have Subjective (Needing Sensation) and Objective (Serum Cortisol Increase) Specificity

This randomised, controlled trial was to determine if blinded subjects are able to discriminate between needle stimulation at traditional acupuncture points and sham points, based on the appreciation of needling sensation (de qi); and if needling at traditional points is related to the objective parameter of serum cortisol increase. Manual acupuncture at traditional and sham points was applied to 20 healthy male students in a single-blind crossover design. Needle sensation (de qi) was reported as significantly stronger with traditional needling than with sham acupuncture. Needling at traditional acupuncture points moderately, but significantly, increased serum cortisol values at 5, 25 and 45 minutes after cessation of stimulation. Needle sensation did not correlate with serum cortisol levels. Experience of pain did not show a difference between traditional and sham needling, nor did it correlate with serum cortisol levels. We conclude that acupuncture points show subjective (needling sensation) and objective (serum cortisol increase) specificity.

Acupuncture in the treatment of hand paresis in chronic and acute stroke patients - improvement observed in all cases

This study reports the effect of acupuncture on the treatment of hand paresis in stroke patients who had no other proximal arm or leg paresis following stroke. The location of the area of infarction on a chronic CT scan was analysed in all cases.

Eight chronic stroke patients were treated with acupuncture beginning after six months to eight years following stroke; and three acute stroke patients were treated with acupuncture beginning after two months following stroke. Patients received 20 or 40 acupuncture treatments over a two- or three-month period. All patients had good response defined as improvement on at least four of six hand tests after 20 or 40 acupuncture treatments. Among the eight chronic cases, significant improvement was observed in timed hand dexterity tests, as well as pinch and grip strength tests. Most of the improvement was sustained for at least two months after the completion of acupuncture treatments. All patients had lesion in only half, or less than half of the motor pathway areas on CT scan.

Results suggest that acupuncture may be an additional beneficial treatment modality for stroke patients with hand paresis, even when started as late as five to eight years following stroke. The CT scan findings and results from this study support those from our previous acupuncture research with stroke patients where good response was observed in patients with lesion in less than half of the motor pathway areas and in patients with only mild/moderate hemiparesis. More controlled research with a larger number of patients appears warranted.

The benefit of combined acupuncture and antidepressant medication for depression: A systematic review and meta-analysis

Acupuncture, one of the most popular complementary therapies, is best known for its ability to provide pain relief. Accumulating evidence suggests that acupuncture may also be beneficial in depression, although its effectiveness remains uncertain in this condition. We conducted a meta-analysis of randomized trials in which the effects of acupuncture combined with antidepressant medications were compared with those of antidepressant medications alone in adults with a diagnosed depressive disorder. Thirteen randomized controlled trials involving 1046 subjects were included in the meta-analysis. Our results confirmed that the pooled standardized mean difference of the 'endpoint scores of the 17-item Hamilton rating scale for depression' was -3.74 (95% CI, -4.77 to -2.70, p<0.001) in week 1 and -2.52 (95% CI, -4.12 to -0.92; p<0.01) in week 6, indicating a significant difference in favor of acupuncture combined with selective serotonin reuptake inhibitors (SSRIs). Moreover, therapeutic response rates were statistically significantly different between the two groups (risk ratio [RR], 1.23; 95% CI, 1.10 to 1.39; p<0.001; I(2)=68%) in favor of the combined treatment group. This systematic review and meta-analysis suggest that acupuncture combined with antidepressant medication is effective, has an early onset of action, safe and well-tolerated over the first 6-week treatment period. Moreover, this treatment combination appears to result in greater therapeutic efficacy than SSRI therapy alone. More high-quality randomized clinical trials are needed to evaluate the clinical benefit and long-term effectiveness of acupuncture in the treatment of depression.

Successful practice of electroacupuncture analgesia in equine surgery

Electroacupuncture analgesia was used for surgery in horses and donkeys. A KWD-808 electrical stimulator was used to incrementally induce a dense, dispersed wave output at frequencies from 20 to 55 Hz, which was maintained at a frequency of 55 Hz, and to change the amplitude of the wave to the best grading number for the suggested operation in each animal. Induction of analgesia lasted for 20-30 minutes, and the effect of analgesia was maintained for 20-45 minutes depending on the type of surgery performed. The exhibited clinical signs, physical examination data, and the responses of all animals were used for evaluating the periods of analgesia. Although the majority of the cases (95%) had no response to strong surgical pain, they experienced significant increases in heart rates and respiratory rates during induction. The lack of pain, relaxed surgical procedures, reduced intraoperative bleeding, and improved healing without complications were all definite benefits of using electroacupuncture analgesia in surgery. Thus, this study has provided surgical evidence supporting the effectiveness of electroacupuncture analgesia, as well as confirming its reliability, in the field of equine anesthesia and surgery.

Imaging-guided hyperstimulation analgesia in low back pain

Low back pain in patients with myofascial pain syndrome is characterized by painful active myofascial trigger points (ATPs) in muscles. This article reviews a novel, noninvasive modality that combines simultaneous imaging and treatment, thus taking advantage of the electrodermal information available from imaged ATPs to deliver localized neurostimulation, to stimulate peripheral nerve endings (Aδ fibers) and in turn, to release endogenous endorphins. "Hyperstimulation analgesia" with localized, intense, low-rate electrical pulses applied to painful ATPs was found to be effective in 95% patients with chronic nonspecific low back pain, in a clinical validation study.

Is acupuncture "stimulation" a misnomer? A case for using the term "blockade"

BACKGROUND

The term used most frequently in the literature to describe acupuncture's effects is "stimulation" which may be used to describe either (or both) the direct stimulus applied to a needle as well as putative stimulation of the nervous system, despite little published evidence describing what is actually being stimulated. In contrast, recent published work has suggested that acupuncture may, in fact be inhibitory at a peripheral level, acting by blocking neural transmission.

DISCUSSION

The suggestion that acupuncture exerts its effects through peripheral neural blockade is supported by recent evidence explaining related techniques including low level laser and capsaicin at acupoints. It also explains acupuncture's effect on painful and non-painful conditions and both Eastern and Western concepts of acupuncture. There is a need for additional work to elucidate acupuncture's mechanism of action, and the suggestion that it acts through neural blockade should prompt further research in this direction.

SUMMARY

If the term "blockade" were applied to acupuncture, this would, likely, be expected to promote this minimally invasive technique, and, potentially, bring it into mainstream clinical practice for pain management as well as other therapeutic applications.

Complementary and integrative treatments: expanding the continuum of care

This article is an introduction to the concepts of complementary, alternative, and integrative medicine. It discusses the scope and prevalence of complementary and integrative medicine (CIM) use among otolaryngology patients. Specific types of CIM are characterized in the context of their origins, philosophic and historical bases, scientific evidence, and applicability to the practice of otolaryngology. The author's intent is to provide a framework for discussing CIM with patients and integrating it into treatment paradigms in an evidence-based manner.

A novel image-guided, automatic, high-intensity neurostimulation device for the treatment of nonspecific low back pain

Purpose. The current pilot study investigates the effectiveness of a novel device in the management of chronic low back pain (LBP). This device is able to automatically measure skin impedance in a selected body area and, immediately afterwards, to stimulate multiple points that are targeted according to differentiation in their electrical properties (peripheral nerve ends-milinated A δ fibers) with high-intensity electrical stimulation. Materials and Methods. Nineteen outpatients were included in the study, 15 females (79%) and 4 men (21%), mean age 52.1 ± 10.8 years, all diagnosed with nonspecific chronic LBP. The protocol consisted of 6 treatment sessions, 2-4 days apart. Each session included a <1 minute automatic impedance screening, followed by a 20-minute treatment of lowest impedance points according to proprietary algorithms. Outcome Measures. The primary outcome measure consisted of changes in pain intensity as measured on a 100 mm pain visual analogue scale (VAS) obtained at enrollment, before and 2 hours after each treatment. Secondary outcome measures were the Oswestry Disability Index (ODI) and lumbar flexion range of motion (ROM) obtained at baseline and each week during treatment. Results. The mean ± SD baseline VAS score for all participants was 61 ± 14. There were no significant changes in VAS scores between enrollment and before the first treatment (55 ± 16; P = .102). During treatment, VAS scores decreased significantly compared with baseline scores by 39 ± 17 mm (P < .001). Notably, VAS scores of all the patients, except for one, decreased by more than 20 mm after the fourth treatment, thus showing marked improvement in 95% of enrolled patients. ODI decreased throughout the entire treatment period, with significant changes from baseline already at the first week (P = .001). Lumbar flexion ROM showed a mean increase of 2.1 cm during treatment, but was not statistically significant. Conclusion. The results of the current pilot study show that treatment with this novel device produced a clinically significant reduction in back pain in 95% of patients after four treatment sessions. The decrease both in pain and perceived disability, combined with the improvement in ROM, support further investigation of the use of this therapy in the treatment of LBP.

Clinical and endocrinological changes after electro-acupuncture treatment in patients with osteoarthritis of the knee

Neurobiological mechanisms invoking the release of endogenous opioids and depression of stress hormone release are believed to be the basis of acupuncture analgesia. This study compared plasma beta-endorphin and cortisol levels with self assessment scores of intensity of pain, before and after 10 days of electro-acupuncture treatment in patients suffering from chronic pain as a result of osteoarthritis knees. Forty patients of either sex over 40 years with primary osteoarthritis knee were recruited into a single-blinded, sham-controlled study. For electro-acupuncture group the points were selected according to the Traditional Chinese Medicine Meridian Theory. In the sham group needles were inserted at random points away from true acupoints and no current was passed. Both groups were treated for 10 days with one session every day lasting for 20-25min. Pre- and post-treatment Western Ontario and McMaster Universities (WOMAC) index of osteoarthritis knee and Visual Analogue Scale (VAS) for pain were recorded and blood samples were taken for the measurement of plasma cortisol and beta-endorphin levels. Following electro-acupuncture treatment there was a significant improvement in WOMAC index and VAS (p=0.001), a significant rise in plasma beta-endorphin (p=0.001), and a significant fall in plasma cortisol (p=0.016). In conclusion electro-acupuncture resulted in an improvement in pain, stiffness and disability. Of clinical importance is that an improvement in objective measures of pain and stress/pain associated biomarkers was shown above that of a sham treatment; hence demonstrating acupuncture associated physiological changes beyond that of the placebo effects.

Electroacupuncture analgesia in dogs: is there a difference between uni- and bi-lateral stimulation?

OBJECTIVE

To compare the analgesic effect of uni- and bi-lateral electroacupuncture (EA) in response to thermal and mechanical nociceptive stimuli and to investigate the cardiorespiratory, endocrine, and behavioral changes in dogs submitted to EA.

STUDY DESIGN

Prospective, randomized cross-over experimental study.

ANIMALS

Eight adult, clinically healthy, cross-breed dogs, weighing 13 +/- 4 kg.

METHODS

Dogs underwent electrostimulation at false acupoints (T-false); bilateral EA at acupoints, stomach 36, gall bladder 34 and spleen 6 (T-EA/bil); unilateral EA at the same points (T-EA/uni) or were untreated (T-control). All animals received acepromazine (0.05 mg kg(-1)) IV; and heart rate, pulse oximetry, indirect arterial blood pressure, respiratory rate, Pe'CO(2), rectal temperature, and plasma cortisol concentration were measured before, during, and after EA. Analgesia was tested using thoracic and abdominal cutaneous thermal and mechanical stimuli, and an interdigital thermal stimulus. Behavior was classified as calm or restless. Analysis of variance for repeated measures followed by Tukey's test was used for analysis of the data.

RESULTS

There were no cardiorespiratory differences among the treatments. The cutaneous pain threshold was higher after EA, compared with false points. The latency period was shorter and analgesia was more intense in T-EA/bil than T-EA/uni, when both were compared with T-false and T-control. Six out of eight animals treated with EA were calm during treatment, and 5/8 and 4/8 of the T-false and T-control animals, respectively, were restless. Latency to interdigital thermal stimulation increased in T-EA/bil compared with the others. There was no difference in plasma cortisol concentrations among the treatments.

CONCLUSIONS

Bilateral EA produced a shorter latency period, a greater intensity, and longer duration of analgesia than unilateral stimulation, without stimulating a stress response.

CLINICAL RELEVANCE

Bilateral EA produces a better analgesic effect than unilateral EA.

The acute effect of acupuncture on 20-km cycling performance

OBJECTIVE

To examine acupuncture's effect on cycling performance.

DESIGN

This was a prospective, single-blind, patient as own control (repeated measures), crossover design. Subjects underwent 3 tests a week, riding a stationary bike for 20-km as fast as able. Before each test, they received acupuncture (test A), "sham" acupuncture (test B), and no intervention (control, test C) once each in a random order.

SETTING

University of Alberta, Faculty of Rehabilitation Medicine.

PARTICIPANTS

20 male cyclists (age, 18 to 30 years) were recruited via convenience sampling of students and general public. Athletic ability was assessed through a questionnaire and modified Par-Q.

INTERVENTIONS

Acupuncture, sham acupuncture, and no intervention in random order with each subject before each test. Acupuncture points were chosen on the basis of Traditional Chinese Medicine and administered immediately before cycling. Sham was shallow needling of known acupoints.

MAIN OUTCOME MEASUREMENTS

The outcome measures of each of the tests were time to completion, VAS for lower extremity/exercise-induced pain, Borg rating of perceived exertion (RPE), and blood lactate concentrations, recorded immediately following each test.

RESULTS

Mean times to Test A, B, and C completion were 36.19 +/- 5.23, 37.03 +/- 5.66, and 37.48 +/- 6.00 minutes, respectively, P = 0.76. Mean RPE scores after tests A, B, and C were 17.65 +/- 0.67, 16.95 +/- 0.99, and 16.85 +/- 0.88, respectively, P = 0.0088. Mean VAS scores after tests A, B, and C were 7.72 +/- 0.86, 7.94 +/- 0.78, and 8.08 +/- 0.69, respectively, P = 0.76.

CONCLUSIONS

The only statistically significant finding was that acupuncture gave higher RPE scores compared to the other tests. The clinical significance was that the higher RPE scores gave lower time and VAS scores.

The effect of 2 Hz and 100 Hz electrical stimulation of acupoint on ankle sprain in rats

The electrical stimulation of acupoint (ESA) releases several endogenous neuropeptides, which play important roles in management of pain and inflammation. ESA with low and high frequencies has been shown to release different neuropepides, suggesting its various therapeutic effects. Pain and edema are major problems for ankle sprain. However, there have been few reports on the effects of ESA for ankle sprain. We aimed to investigate that ESA can reduce pain and edema resulting from ankle sprain, and whether there is a difference in therapeutic effects between low and high frequency ESA. To induce ankle sprain in Sprague-Dawley rats, the ankle of right hindpaw was overextended in direction of simultaneous inversion and plantar flexion. Stepping force and edema in the paw of the sprained ankle were measured by electronic balance and plethysmometer, respectively. In both 2 and 100 Hz ESA groups, stepping force was increased significantly in similar degrees (p<0.05). Only 2 Hz ESA produced the significant rapid decrease in ankle edema. This study demonstrates that ESA of 2 Hz and 100 Hz shows comparable analgesic effects, but only 2 Hz ESA can facilitate the reduction of edema caused by ankle sprain.

A systematic review of randomized controlled trials of acupuncture in the treatment of depression

BACKGROUND

Acupuncture has become a popular complementary and alternative treatment approach. This review examined the randomized controlled trials (RCTs) examining the effects of acupuncture treatment of depression.

METHODS

RCTs of the treatment of depression with acupuncture were located using MEDLINE, Allied and Complementary Medicine and the Cochrane Central Register of Controlled Trials. The methodology of RCTs was assessed using the Jadad criteria, and elements of research design, i.e., randomization, blinding, assessment of attrition rates, were quantified for systematic comparisons among studies.

RESULTS

Among the 9 RCTs examined, five were deemed to be of low quality based upon Jadad criteria. The odds ratios derived from comparing acupuncture with control conditions within the RCTs suggests some evidence for the utility of acupuncture in depression. General trends suggest that acupuncture modalities were as effective as antidepressants employed for treatment of depression in the limited studies available for comparison. However, placebo acupuncture treatment was often no different from intended verum acupuncture.

LIMITATIONS

The RCTs extracted were limited by small sample sizes, imprecise enrollment criteria, problems with randomization, blinding, brief duration of study and lack of longitudinal follow-up.

CONCLUSIONS

Despite the findings that the odds ratios of existing literature suggest a role for acupuncture in the treatment of depression, the evidence thus far is inconclusive. However, efforts are being made to standardize complementary approaches to treat depression, and further systematized research into their use is warranted.

Acupuncture: role in comprehensive cancer care--a primer for the oncologist and review of the literature

In recent studies, patients have reported an increased use of complementary and alternative medicine (CAM). Acupuncture is a popular complementary therapy for patients with cancer. This article will provide current cancer treatment providers with information on acupuncture as well as the research conducted on cancer symptoms and side effects of cancer treatments. Antiemetic studies are the most prevalent and contain the most promising results. Several studies have found that acupuncture significantly reduces the number of emesis (vomiting) episodes for patients receiving chemotherapy. While studies on pain control vary due to the heterogeneity of pain, there are few studies investigating pain caused from cancer and the removal of cancerous tumors. These studies, while promising, provide basic results that need further investigation for more definitive results. Although relatively few studies have been done on anxiety and depression, several researchers have found acupuncture to be just as effective as or more effective than antidepressants for patients without cancer. Studies on breathlessness, while small, have shown acupuncture to have a significant positive effect on chronic obstructive pulmonary disease, breathlessness associated with end-stage cancer, and asthma. Researchers studying xerostomic individuals who have received salivary gland irradiation found significant positive results in salivary flow rates compared to baseline. Patients with hot flashes due to hormonal imbalance may benefit from the use of acupuncture. A recent pilot study showed improvement of chronic postchemotherapy fatigue following acupuncture treatments. Many individuals with cancer have turned to acupuncture because their symptoms persisted with conventional treatments or as an alternative or complement to their ongoing treatments. Despite the immense popularity in the community, few large randomized trials have been conducted to determine the effects acupuncture has on cancer symptoms and side effects of treatments. A majority of the current studies have shown beneficial effects that warrant further investigation with large trial sizes.

Electroacupuncture Attenuates Inflammation in a Rat Model

BACKGROUND

Acupuncture has traditionally been used in China and is being increasingly applied in Western countries to treat a variety of conditions, including inflammatory disease. However, clinical trials investigating the effectiveness of the anti-inflammatory effects of acupuncture have yielded inconsistent results, and the underlying mechanisms of acupuncture-produced anti-inflammation are unclear.

OBJECTIVE

To evaluate the effectiveness of electroacupuncture (EA) on inflammation in a rat model.

MATERIALS AND METHODS

Four experiments were conducted on male Sprague-Dawley rats (n = 8-9 per group). Inflammation was induced by injecting complete Freund's adjuvant (CFA) subcutaneously into the plantar surface of one hind paw of the rat. Experiment 1: To determine the effect of EA (10 and 100 Hz) versus sham treatment on inflammation. Experiment 2: To investigate the involvement of the adrenal glands on the effect of EA treatment using adrenalectomized (ADX) rats. Experiment 3: To determine the effects of EA on plasma levels of corticosterone. Experiment 4: To determine the effects of EA treatment versus immobilization on such stress indicators as heart rate and blood pressure.

RESULTS

At 10 Hz EA significantly reduced CFA-induced hind paw edema. The effect was partially blocked in the ADX rats. EA significantly increased plasma levels of corticosterone but produced no noticeable signs of stress.

CONCLUSION

At 10 Hz but not 100 Hz, EA suppresses inflammation by activating the hypothalamus-pituitary-adrenal axis (HPA) and the nervous system.

A parametric study of electroacupuncture on persistent hyperalgesia and Fos protein expression in rats

We previously reported the anti-hyperalgesia of electroacupuncture (EA) on persistent inflammatory pain in an unrestrained, unsedated, and conscious rat model. Using this model, induced by injecting complete Freund's adjuvant (CFA) into one hind paw, we systematically evaluated the anti-hyperalgesia of EA stimulation parameters (frequency, intensity, treatment duration, and pulse width). We assessed hyperalgesia by paw withdrawal latency (PWL) to a noxious thermal stimulus and found that 10- and 100-Hz EA frequencies at a current intensity of 3 mA produced the greatest anti-hyperalgesia, when compared to other parameters. Both frequencies significantly increased PWL in the early phases of hyperalgesia (2.5 and 24 h; p < 0.05), and 10 Hz EA also significantly increased PWL in later phases (5 to 7 days; p < 0.05). A sufficient but tolerable intensity of 3 mA was more effective than lower intensities (1-2 mA). A 20-min treatment produced better anti-hyperalgesia than longer and shorter (10 and 30 min) treatments. Acupoint specificity study demonstrated that GB30 produced significant EA anti-hyperalgesia, while Waiguan (TE5) and sham points, an abdominal point and a point at the opposite aspect of GB30, did not. The spinal Fos protein expression study demonstrated that the optimal EA selectively suppressed Fos expression in superficial laminae (I/II) and activated it in deeper laminae (III/IV) of the spinal dorsal horn. The results suggest that the EA anti-hyperalgesia is parameter-dependent and point-specific, and they provide important information for designing further clinical acupuncture research on persistent inflammatory pain.

Acupuncture in the treatment of psychogenic erectile dysfunction: first results of a prospective randomized placebo-controlled study

In a prospective study, we investigated the potentially curative effect of acupuncture in patients with psychogenic erectile dysfunction (pED). A total of 22 patients with pED were randomized into two groups. They were either treated with acupuncture specific against ED (treatment group) or acupuncture specific against headache (placebo group). Nonresponders of the placebo group were crossed over to the treatment group. Prior to acupuncture, serum sexual hormone levels, IIEF score, nocturnal penile tumescence testing for three nights (Rigiscan) and the erectile response to 50 mg sildenafil were evaluated. Out of 21 patients, 20 completed the study, including 10 patients after crossover. A satisfactory response was achieved in 68.4% of the treatment group and in 9% of the placebo group (P=0.0017). Another 21.05% of the patients had improved erections, that is, sufficient rigidity under simultaneous treatment with 50 gm sildenafil. The results of our pilot study indicate that acupuncture can be an effective treatment option in more than two-thirds of patients with psychogenic erectile dysfunction.

Acupuncture mechanisms for clinically relevant long-term effects--reconsideration and a hypothesis

From the author's direct involvement in clinical research, the conclusion has been drawn that clinically relevant long-term pain relieving effects of acupuncture (>6 months) can be seen in a proportion of patients with nociceptive pain. The mechanisms behind such effects are considered in this paper. From the existing experimental data some important conclusions can be drawn: 1. Much of the animal research only represents short-term hypoalgesia probably induced by the mechanisms behind stress-induced analgesia (SIA) and the activation of diffuse noxious inhibitory control (DNIC). 2. Almost all experimental acupuncture research has been performed with electro-acupuncture (EA) even though therapeutic acupuncture is mostly gentle manual acupuncture (MA). 3. Most of the experimental human acupuncture pain threshold (PT) research shows only fast and very short-term hypoalgesia, and, importantly, PT elevation in humans does not predict the clinical outcome. 4. The effects of acupuncture may be divided into two main components--acupuncture analgesia and therapeutic acupuncture. A hypothesis on the mechanisms of therapeutic acupuncture will include: 1. Peripheral events that might improve tissue healing and give rise to local pain relief through axon reflexes, the release of neuropeptides with trophic effects, dichotomising nerve fibres and local endorphins. 2. Spinal mechanisms, for example, gate-control, long-term depression, propriospinal inhibition and the balance between long-term depression and long-term potentiation. 3. Supraspinal mechanisms through the descending pain inhibitory system, DNIC, the sympathetic nervous system and the HPA-axis. Is oxytocin also involved in the long-term effects? 4. Cortical, psychological, "placebo" mechanisms from counselling, reassurance and anxiety reduction.

Dexamethasone and stress-induced analgesia

Analgesia induced in rats by cold-water swim stress and measured by the tail-flick and hot-plate methods was significantly antagonized after IP pretreatment for 3 days with 8 mg/kg dexamethasone. The analgesia developed by the cold-water swim stressor was also attenuated by 1 mg/kg naloxone. These results suggest that the corticosteroids may have a role in modulating stress-induced analgesia and that the adrenal-pituitary axis modulates the endogenous opiate system. These conclusions are based on recent reports that indicate the release of the opiate-like peptide beta-endorphin and adrenocorticotropin (ACTH) from the pituitary are increased by acute stress and inhibited by administration of the synthetic glucocorticoid dexamethasone.

Blood pressure response to acupuncture in a population at risk for autonomic dysreflexia

OBJECTIVE

To determine whether acupuncture can lead to autonomic dysreflexia (AD) when used to treat chronic pain in individuals with spinal cord injury (SCI).

DESIGN

Acupuncture analgesia study.

SETTING

Medical rehabilitation research center.

PARTICIPANTS

Fifteen participants with post-SCI chronic pain who were at risk for AD (ie, SCI at or above T8).

INTERVENTIONS

Half-hour acupuncture treatment sessions twice a week for 7.5 weeks, for a total of 15 treatments. Acupuncture needles were inserted both above and below the patient's spinal lesion level. Blood pressure (BP) was measured before and after acupuncture treatments.

MAIN OUTCOME MEASURES

Systolic BP (SBP) and diastolic BP (DBP). Participants monitored for signs and symptoms of AD.

RESULTS

On average, SBP and DBP remained stable across all 15 treatment sessions. None of the participants experienced any symptoms of AD. However, examination of individuals' BP readings indicated acute elevations (20 mmHg or higher) in SBP for 3 of the 15 participants.

CONCLUSIONS

Although none of the 15 participants who were at risk for developing AD developed symptoms consistent with this diagnosis, 3 displayed an acute elevation in SBP, suggesting a pattern of imminent AD. Comorbid hypertension appeared to contribute to the elevation in 1 patient. Therefore, careful monitoring of patients with SCI or hypertension during acupuncture treatments is advisable.

Influence of transcutaneous electrical nerve stimulation on pain, range of motion, and serum cortisol concentration in females experiencing delayed onset muscle soreness

beta-Endorphin (BEP) has been implicated in the analgesic response to transcutaneous electrical nerve stimulation (TENS). The anterior pituitary gland is a source of beta-endorphin which shares the prohormone proopiomelanocortin (POMC) with adrenocorticotropin (ACTH). Current theory proposes that the stimulation-induced breakdown of POMC results in ACTH release with a subsequent elevation in blood cortisol levels. The purpose of this study was to determine the potential application and mechanism of TENS as an anti-inflammatory agent. Eight female subjects received low frequency, 300 musec pulse width TENS at four sites associated with relief of upper arm pain once when pain free and again while experiencing delayed onset muscle soreness (DOMS) of the elbow flexor muscle group. Blood samples were withdrawn 15 and 1 minute before and 1, 20, and 40 minutes after treatment. Serum was analyzed for cortisol by radioimmunoassay. TENS treatment failed to elevate serum cortisol concentration, but there was a significant reduction in perception of pain (p < 0.05) and an improvement in range of elbow extension (p < 0.05) when subjects were treated for DOMS. These results suggest that the anterior pituitary is not a source of BEP in TENS-induced analgesia. J Orthop Sports Phys Ther 1989;11(3):100-103.

Acupuncture for rheumatoid arthritis: an analysis of the literature

Despite the claims that acupuncture is beneficial in the treatment of stages I and II rheumatoid arthritis (RA), few satisfactory double-blind controlled studies exist. A review of the world literature showed eight studies examining the efficacy of acupuncture in RA. Five studies claim that acupuncture treatments give significant pain relief. Two studies claim that there is no significant difference between real and placebo acupuncture in RA. One study claims that acupuncture has antiinflammatory effects. Analysis of problems related to study design demonstrates that methodological flaws invalidate in varying degrees the broad spectrum of conclusions. The need for a more effective therapeutic armamentarium in the treatment of RA makes it imperative that satisfactory trials of acupuncture for RA be conducted in the future.

Acupuncture and bronchial asthma

Seventeen patients with stable bronchial asthma were randomly assigned to receive either correct acupuncture or placebo acupuncture. The study lasted 11 weeks and consisted of a pre-therapy, therapy, and post-therapy period. The patients received 10 treatments during a 5-week period. The effect of therapy on pulmonary function was assessed daily by the patients at home. Morning and evening peak expiratory flow rate, number of puffs beta 2-agonist aerosol needed, as well as subjective symptoms of asthma were recorded in a diary. The correctly treated group improved significantly throughout the study. Also, compared with the placebo group, a significant improvement was found in all assessed parameters 2 weeks after beginning therapy. Hereafter, no differences could be shown.

Plasma cortisol and beta-endorphin in horses subjected to electro-acupuncture for cutaneous analgesia

Electro-acupuncture (EA) treatment of horses to induce cutaneous analgesia also increased plasma concentrations of beta-endorphin (beta-EP) and cortisol. The magnitude of these increases did not relate consistently to the degree of EA-induced analgesia. Respiration and heart rates were also markedly increased during EA treatment. Intact female horses had higher packed cell volume and plasma beta-EP as well as lower plasma total protein than castrated male horses. Plasma cortisol, heart rate, and respiration rate did not differ significantly between sexes. None of the parameters measured before or during EA treatment provided an explanation for the differential cutaneous analgesia which depended on sex of subject and locus of stimulation as reported elsewhere.