An update on acupuncture point injection

This overview reports the global research advances in acupuncture point injection in the last 5 years. Acupuncture point injection can be applied to a wide range of curable diseases, predominantly those involving pain, but it has poor clinical evidence. Progress has been attained in the mechanism research on acupuncture point injection, but further studies remain necessary. With the reported adverse effects of acupuncture point injection, the need to standardize its clinical procedure has become urgent.

Bee venom injection significantly reduces nociceptive behavior in the mouse formalin test via capsaicin-insensitive afferents

Peripheral bee venom (BV) administration produces 2 contrasting effects, nociception and antinociception. This study was designed to evaluate whether the initial nociceptive effect induced by BV injection into the Zusanli acupoint is involved in producing the more prolonged antinociceptive effect observed in the mouse formalin test, and whether capsaicin-sensitive primary afferents are involved in these effects. BV injection into the Zusanli point increased spinal Fos expression but not spontaneous nociceptive behavior. BV pretreatment 10 minutes before intraplantar formalin injection dose-dependently attenuated nociceptive behavior associated with the second phase of the formalin test. The destruction of capsaicin-sensitive primary afferents by resiniferatoxin (RTX) pretreatment selectively decreased BV-induced spinal Fos expression but did not affect BV-induced antinociception. Furthermore, BV injection increased Fos expression in tyrosine hydroxylase immunoreactive neurons in the locus caeruleus, and this expression was unaltered by RTX pretreatment. Finally, BV's antinociception was blocked by intrathecal injection of 10 microg idazoxan, and this effect was not modified by RTX pretreatment. These findings suggest that subcutaneous BV stimulation of the Zusanli point activates central catecholaminergic neurons via capsaicin-insensitive afferent fibers without induction of nociceptive behavior. This in turn leads to the activation of spinal alpha2-adrenoceptors, which ultimately reduces formalin-evoked nociceptive behaviors.

PERSPECTIVE

This study demonstrates that BV acupuncture produces a significant antinociception without nociceptive behavior in rodents, which is mediated by capsaicin-insensitive afferents and involves activation of central adrenergic circuits. These results further suggest that BV stimulation into this acupuncture point might be a valuable alternative to traditional electrical or mechanical acupoint stimulation.

Advancing acupuncture research

Since the early 1970s, acupuncture has been the subject of multiple animal experiments and randomized clinical trials. Our understanding of acupuncture from both the clinical and mechanistic perspectives has, as a result, grown tremendously. Yet the final word on acupuncture as a therapy remains mixed, largely due to the contradictory nature of the evidence. With some exception, what clinical conditions would benefit and how acupuncture physiologically operates remains unclear. The impediment to progress is found in three disjunctions in acupuncture research: (1) the biomedical need to standardize treatments creates uncertainty about whether we are studying acupuncture appropriately; (2) the variability in acupuncture styles creates ambiguity about whether we are studying the right style; and (3) the discrepancy between animal and human studies creates questions about whether we truly understand the underlying mechanism responsible for acupuncture's therapeutic effect. We propose that these disjunctions are best addressed with the use of "manualized" protocols in clinical trials that are linked with mechanistic studies. Through this approach, we can create a healthy dialogue between the medical and acupuncture communities and recognize the unique physiologic properties that may be found in each acupuncture style. To illustrate how this proposal may fundamentally change acupuncture research, we present diabetic neuropathy as a particularly interesting model because of its complex heterogeneous pathophysiology.

Different central manifestations in response to electroacupuncture at analgesic and nonanalgesic acupoints in rats: a manganese-enhanced functional magnetic resonance imaging study

Acupuncture analgesia is an important issue in veterinary medicine. This study was designed to elucidate central modulation effects in response to electroacupuncture (EA) at different acupoints. Manganese-enhanced functional magnetic resonance imaging was performed in Sprague-Dawley rats after sham acupuncture, sham EA, or true EA at somatic acupoints. The acupoints were divided into 3 groups: group 1, analgesic acupoints commonly used for pain relief, such as Hegu (LI 4); group 2, nonanalgesic acupoints rarely used for analgesic effect such as Neiguan (PC 6); and group 3, acupoints occasionally used for analgesia, such as Zusanli (ST 36). Image acquisition was performed on a 1.5-T superconductive clinical scanner with a circular polarized extremity coil. The results showed that there was no neural activation caused by EA at a true acupoint with shallow needling and no electric current (sham acupuncture). When EA at a true acupoint was applied with true needling but no electric current (sham EA), there was only a slight increase in brain activity at the hypothalamus; when EA was applied at a true acupoint with true needling and an electric current (true EA), the primary response at the hypothalamus was enhanced. Also, there was a tendency for the early activation of pain-modulation areas to be prominent after EA at analgesic acupoints as compared with nonanalgesic acupoints. In conclusion, understanding the linkage between peripheral acupoint stimulation and central neural pathways provides not only an evidence-based approach for veterinary acupuncture but also a useful guide for clinical applications of acupuncture.

Effect of acupuncture on knee function in advanced osteoarthritis of the knee: a prospective, non-randomised controlled study

We report a prospective controlled trial, comparing acupuncture with no treatment, in patients with advanced osteoarthritis of the knee awaiting total knee replacement. Knee function was assessed at the beginning of study and at the end of two months, using four parameters: HSS score, time to walk 50 metres, time to climb 20 steps, and degree of pain. Acupuncture was given at four local points around the knee and at one distal point. The acupuncture group improved in all parameters, whereas the control group deteriorated, a finding that was highly statistically significant (p < 0.0002). Further randomised-controlled trials with longer follow-up are required to confirm these findings.

Single-use acupuncture needles: scanning electron-microscopy of needle-tips

Unselected, disposable acupuncture needles from various manufacturers and retail suppliers were taken from a pool of donated and bought samples. Three needles of each type were prepared for electron-microscopy. The needle tips were inspected at two magnifications (x39.37 and x612.5): 52 electron-micrographs were taken of 31 individual needles from 11 different types. No needle-tip looked perfect and significant faults were seen in most; some appeared seriously deformed. The faults noted were: scratch marks along or across the needle, metallic scuff, lumps and irregularities in the needle surface, needle-tip stubbed or malformed, and needle point off-centre. An additional test made was to wipe a number of needles firmly on white paper tissue. Some left grey lines, and these were regarded as evidence of metallic or oily residue from the needle surface which could have been deposited in the patient. These unexpected findings, in a variety of popularly used needles from well-respected suppliers, suggest that most manufacturers need to reassess their quality control procedures.

Clinical applications of acupuncture in anesthesia practice

The most widely successful use of acupuncture in Western medicine has been in the treatment of chronic and intractable pain syndromes. Thus, it is especially important for the nurse anesthetist who is the practice of chronic pain management to be familiar with this treatment choice. This article provides the nurse anesthetist with basic information about the practice of acupuncture, the patient who may ask for acupuncture, application of segmental acupuncture techniques, and legislative and licensure issues.

Acupuncture in the management of pain of musculoskeletal and neurologic origin

Acupuncture has been used as therapeutic treatment for the health of the Chinese people for more than 3000 years; it is a system for diagnosing and treating disease using fine needles inserted into specific points of the body. Acupuncture can treat a wide variety of conditions. This article discusses the use of acupuncture in the management of pain of musculoskeletal and neurologic origin, with a focus on pain in spinal cord injuries.

The analgesic effect of acupuncture in chronic tennis elbow pain

The immediate analgesic effect of a single non-segmental acupuncture stimulation treatment on chronic tennis elbow pain was studied in a placebo-controlled single-blind trial completed by 48 patients. Before and after treatment, all patients were examined physically by an unbiased independent examiner. Eleven-point box scales were used [13] for pain measurement. Patients in the verum group were treated at non-segmental distal points (homolateral leg) for elbow pain following Chinese acupuncture rules, whereas patients in the placebo group were treated with placebo acupuncture avoiding penetration of the skin with an acupuncture needle. Overall reduction in the pain score was 55.8% (S = 2.95) in the verum group and 15% (S = 2.77) in the placebo group. After one treatment 19 out of 24 patients in the verum group (79.2%) reported pain relief of at least 50% (placebo group: six patients out of 24). The average duration of analgesia after one treatment was 20.2 h in the verum group (S = 21.54) and 1.4 h (S = 3.50) in the placebo group. The results are statistically significant (P < 0.01); they show that non-segmental verum acupuncture has an intrinsic analgesic effect in the clinical treatment of tennis elbow pain which exceeds that of placebo acupuncture.

Acupuncture and the nervous system

Acupuncture is based on neuroanatomy and neurophysiology. At each acupuncture point, there are peripheral nerves and terminals. Acupuncture will be useful for further understanding of the nervous system. A conceptual view of acupuncture's physiology is presented.

Morphine analgesia mediated by activation of the acupuncture-analgesia-producing system

Analgesia caused by intraperitoneal 0.5 mg/kg morphine (MA) in rats is equivalent to acupuncture analgesia (AA) caused by low frequency stimulation of the tibial muscle (Tsusanli acupuncture point). Analgesia equivalent to both AA and MA was produced by intrathecal application of 0.05 microgram morphine. This analgesia exhibits individual variation in effectiveness which is parallel to those of both AA and MA, and disappears after 250 mg/kg intraperitoneal D-phenylalanine. Analgesia that persisted after termination of acupuncture stimulation was not affected, maximally developed MA and AA were both partially antagonized, and the initial development of AA and MA were completely antagonized by intrathecal application of 0.2 microgram naloxone. Analgesia caused by intrathecal 0.05 microgram morphine was abolished by bilateral lesion of the anterolateral tract (ALT) of the spinal cord and that caused by acupuncture stimulation was abolished by contra-lateral lesion. Analgesia caused by larger doses (0.1-0.2 microgram) of intrathecal morphine was not abolished, but persisted after ALT lesion, unilateral lesion of the dorsal periaqueductal central gray (D-PAG), or hypophysectomy. Potentials were evoked by acupuncture stimulation in the bilateral D-PAG. Analgesia produced by D-PAG stimulation was not affected by ALT lesion nor by intrathecal naloxone, but was abolished by lesion of the dorsolateral funiculus. These results imply two types of morphine action in the spinal cord to produce analgesia: activation of the ascending AA pathway; and direct inhibition of pain message in the spinal cord. They also show that the AA producing pathway ascends contralaterally in the ALT and then bilaterally in the D-PAG.

Traditional acupuncture increases the content of beta-endorphin in immune cells and influences mitogen induced proliferation

We measured beta-endorphin concentrations in peripheral blood mononuclear cells and mitogen-induced T-lymphocyte proliferation in patient who underwent treatment with traditional acupuncture. Traditional acupuncture increased both the concentrations of the opioid in the immune cells and lymphocyte proliferation. Our data are consistent with the hypothesis that traditional acupuncture modulates immune responses in man.

A comparative study of diazepam and acupuncture in patients with osteoarthritis pain: a placebo controlled study

Forty-four patients with chronic cervical osteoarthritis took part in this study. Patients were treated with acupuncture, sham-acupuncture, diazepam or placebo-diazepam in randomized order. Pain was rated on visual analogue scales before, during, and after treatment. Two scales were separately used to rate the intensity (sensory component) and the unpleasantness (affective component) of pain. The results analyzed from these trials show that diazepam, placebo-diazepam, acupuncture and sham-acupuncture have a more pronounced effect on the affective than on the sensory component of pain. Acupuncture was significantly more effective than placebo-diazepam (p less than 0.05), but not significantly more effective than diazepam or sham-acupuncture.

The attenuation effect of chlorpromazine on electro-acupuncture analgesia: involvement of dopamine system

The effect of chlorpromazine (CPZ) (0.1 or 0.5 mg/kg, iv) on electroacupuncture analgesia (EAA) was examined by using potassium dolorimetry in rabbits. CPZ itself induced hyperanalgesia, whereas it attenuated EAA in terms of maximal increase of pain threshold as well as EAA after effect. Therefore, CPZ is not a good candidate for enhancing EAA in clinics. Monoamines and their metabolites in cerebrospinal fluid (CSF) of the rabbits were detected by high pressure liquid chromatography coupled to electrochemical detector (HPLC-ECD) method. It was revealed that CPZ enhanced DOPAC and HVA contents in CSF in both the presence and absence of electroacupuncture. CPZ attenuated EAA with elevations of DOPAC and HVA concentration in CSF. There was a positive correlation between the increases of DOPAC and HVA contents in CSF and attenuation effect of CPZ on EAA. These results suggested that activation of dopamine system be unfavorable for EAA.