Medical Acupuncture

Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture.

Figure 7

Figure 7
Schematic summarizing CTS response to acupuncture therapy. 
(A) While distal acupuncture at the leg can modulate median nerve function via indirect S1 interhemispheric neuroregulatory pathways, local acupuncture can modulate median nerve function at the wrist via both indirect (e.g. S1 influences on the central autonomic control of local vasa nervorum) and direct pathways (e.g. direct axon reflex mediated control of local vasa nervorum).
(B) Our results demonstrate that electro-acupuncture can produce improvement in symptoms, median nerve function, and S1 neuroplasticity, with objective changes following therapy (median nerve function, functional S1 neuroplasticity) directly predicting long-term symptom improvement.

Abstract

Carpal tunnel syndrome is the most common entrapment neuropathy, affecting the median nerve at the wrist. Acupuncture is a minimally-invasive and conservative therapeutic option, and while rooted in a complex practice ritual, acupuncture overlaps significantly with many conventional peripherally-focused neuromodulatory therapies. However, the neurophysiological mechanisms by which acupuncture impacts accepted subjective/psychological and objective/physiological outcomes are not well understood.

Eligible patients (n = 80, 65 female, age: 49.3 ± 8.6 years) were enrolled and randomized into three intervention arms: (i) verum electro-acupuncture ‘local’ to the more affected hand; (ii) verum electro-acupuncture at ‘distal’ body sites, near the ankle contralesional to the more affected hand; and (iii) local sham electro-acupuncture using non-penetrating placebo needles.

Acupuncture therapy was provided for 16 sessions over 8 weeks.

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Boston Carpal Tunnel Syndrome Questionnaire assessed pain and paraesthesia symptoms at baseline, following therapy and at 3-month follow-up.

Nerve conduction studies assessing median nerve sensory latency and brain imaging data were acquired at baseline and following therapy. Functional magnetic resonance imaging assessed somatotopy in the primary somatosensory cortex using vibrotactile stimulation over three digits (2, 3 and 5).

While all three acupuncture interventions reduced symptom severity, verum (local and distal) acupuncture was superior to sham in producing improvements in neurophysiological outcomes, both local to the wrist (i.e. median sensory nerve conduction latency) and in the brain (i.e. digit 2/3 cortical separation distance).

Moreover, greater improvement in second/third interdigit cortical separation distance following verum acupuncture predicted sustained improvements in symptom severity at 3-month follow-up. We further explored potential differential mechanisms of local versus distal acupuncture using diffusion tensor imaging of white matter microstructure adjacent to the primary somatosensory cortex. Compared to healthy adults (n = 34, 28 female, 49.7 ± 9.9 years old), patients with carpal tunnel syndrome demonstrated increased fractional anisotropy in several regions and, for these regions we found that improvement in median nerve latency was associated with reduction of fractional anisotropy near (i) contralesional hand area following verum, but not sham, acupuncture; (ii) ipsilesional hand area following local, but not distal or sham, acupuncture; and (iii) ipsilesional leg area following distal, but not local or sham, acupuncture.

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As these primary somatosensory cortex subregions are distinctly targeted by local versus distal acupuncture electrostimulation, acupuncture at local versus distal sites may improve median nerve function at the wrist by somatotopically distinct neuroplasticity in the primary somatosensory cortex following therapy.

Our study further suggests that improvements in primary somatosensory cortex somatotopy can predict long-term clinical outcomes for carpal tunnel syndrome.

 

Brain. 2017 Apr 1;140(4):914-927. doi: 10.1093/brain/awx015.

Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture.

 

 

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Medical Acupuncture

Acupuncture Effect and Central Autonomic Regulation

“Acupuncture has clinical efficacy on various autonomic nerve-related disorders, such as cardiovascular diseases, epilepsy, anxiety and nervousness, circadian rhythm disorders, polycystic ovary syndrome (PCOS) and subfertility. An increasing number of studies have demonstrated that acupuncture can control autonomic nerve system (ANS) functions including blood pressure, pupil size, skin conductance, skin temperature, muscle sympathetic nerve activities, heart rate and/or pulse rate, and heart rate variability. Emerging evidence indicates that acupuncture treatment not only activates distinct brain regions in different kinds of diseases caused by imbalance between the sympathetic and parasympathetic activities, but also modulates adaptive neurotransmitter in related brain regions to alleviate autonomic response. This review focused on the central mechanism of acupuncture in modulating various autonomic responses, which might provide neurobiological foundations for acupuncture effects.”

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Figure 1
Acupuncture autonomic regulation mechanism. Blue indicates the area involved in acupuncture parasympathetic regulation. Orange indicates the area involved in acupuncture sympathetic regulation.

 

Acupuncture Effect and Central Autonomic Regulation

Published online 2013 May 26. doi:  10.1155/2013/267959

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