Minimal immunoreactive plasma beta-endorphin and decrease of cortisol at standard analgesia or different acupuncture techniques

BACKGROUND AND OBJECTIVE

Acupuncture has been claimed to be associated with activation of the endogenous antinociceptive system. The analgesic effects of acupuncture have been ascribed to beta-endorphin interacting with opioid receptors. However, firstly, the release of beta-endorphin into the blood has been proven to be induced by stress, i.e. under dysphoric conditions, and, secondly, if released under stress, beta-endorphin has been shown not to be analgesic. Our aim was to test whether beta-endorphin immunoreactive material is released into the cardiovascular compartment during acupuncture comparing the most frequently used types of acupuncture with standard pain treatment under apparently low stress conditions.

METHODS

This prospective study included 15 male patients suffering from chronic low back pain. beta-Endorphin immunoreactive material and cortisol were measured in the plasma of patients who underwent, in random order, therapy according to a standard pain treatment, traditional Chinese acupuncture, sham acupuncture, electro acupuncture and electro acupuncture at non-acupuncture points before, at and after the treatment. Statistical analysis was performed using two-way ANOVA with repeated measures.

RESULTS

A decrease in plasma cortisol concentration measured over the five treatment protocols was highly significant (P < 0.001). The beta-endorphin immunoreactive material concentrations in plasma were minimal at all times and in all treatment conditions. The influence of treatments by various acupuncture procedures on cortisol and beta-endorphin immunoreactive material plasma concentrations over the three time points was not significantly different.

CONCLUSIONS

beta-endorphin immunoreactive material in blood is not released by any type of acupuncture as tested under low stress conditions.

[Pain treatment tomorrow]

In the last few years global understanding of pain has improved due to current molecular biological studies. The identification of a large number of different proteins is an essential part of future therapies, since they, as enzymes, receptors or ion channels, are specific relays in the nociceptive system and therefore have key functions in pharmacotherapeutic therapy. Nature itself supplies a variety of substances which are of therapeutic value, some of which are already in scientific trial. In contrast, even today not all available pain therapy measures are in use in Germany, at least not in all areas. Especially the treatment of children is not state of the art. Thus a further increase of chronic pain patients is to be expected in the future. This development has to be stopped, not only for ethical reasons, but also to prove the economical value of adequate pain therapy. Qualified treatment of acute pain within well defined limits can help to avoid chronification and further costs. This will be the decisive argument with which to mobilize the necessary funds for the development of the pain treatment of the future.