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

Neurophysiological Basis of Acupuncture-induced Analgesia—An Updated Review

This article presents an up-to-date review of the various neurophysiologic mechanisms that have been proposed to produce acupuncture-induced analgesia.

Figure 4. Schematic diagram of the best explanation of the physiologic basis of acupuncture-induced analgesia.

Blue arrows = activation; red arrows = inhibition. 5-HT = 5-hydroxytryptamine; DNIC = diffuse noxious inhibitory control; LTD = long-term depression; LTP = long-term potentiation.

 

Neurophysiological Basis of Acupuncture-induced Analgesia—An Updated Review

Journal of Acupuncture and Meridian Studies

Volume 5, Issue 6, December 2012, Pages 261-270

 

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Medical Acupuncture

Critical roles of TRPV2 channels, histamine H1 and adenosine A1 receptors in the initiation of acupoint signals for acupuncture analgesia

The mast cell is the central structure of acupoints and is activated by acupuncture through TRPV2 channels. The mast cell transduces the mechanical stimuli to acupuncture signal by activating either H1 or A1 receptors, therefore triggering the acupuncture effect in the subject.

Figure 3

Critical roles of TRPV2 channels, histamine H1 and adenosine A1 receptors in the initiation of acupoint signals for acupuncture analgesia

Scientific Reports, volume 8, Article number: 6523 (2018)

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Medical Acupuncture

Electroacupuncture for Painful Diabetic Peripheral Neuropathy

The participants in the EA group received EA treatment with a mixed current of 2 Hz/120 Hz at 12 acupuncture points (bilateral Zusanli [ST36], Xuanzhong [GB39], Yinlingquan [SP9], Sanyinjiao [SP6], Taichong [LR3], and Zulinqi [GB41]) twice per week for 8 weeks. Depending on the sites of pain, the additional acupuncture point Bafeng (EX-LE10) was available.

Electroacupuncture for Painful Diabetic Peripheral Neuropathy A Multicenter Randomized Assessor Blinded Controlled Trial

“To our knowledge, this is the first multicenter randomized controlled trial to evaluate the effectiveness and safety of EA treatment for the management in PDN. One limitation is that neither a placebo nor sham EA was used as an active control; therefore, the possibility of a placebo effect was not excluded. In conclusion, the results of this study
demonstrate that EA treatment is effective for reducing pain and improving sleep disturbance and quality of life in PDN. In addition, EA treatment was well tolerated and safe during this study. These findings suggest that EA treatment may be recommended as a nonpharmacological treatment for pain reduction in PDN.”

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Integrative Cancer Care, Medical Acupuncture

Acupuncture as a Therapeutic Treatment for Cancer Pain

ACUPUNCTURE FOR CANCER PAIN: THE CLINICAL EVIDENCE

A Comparative Literature Review in 2017 found a potentially positive effect of acupuncture in treating cancer pain.3 The review included two systematic reviews, the older of which was unable to draw firm conclusions due to small sample sizes and clinical differences in the patients being treated. The more recent review included 36 trials and over 2200 randomised patients. They found a moderate effect size of acupuncture on cancer-related pain, and concluded that “acupuncture is effective in relieving cancer-related pain, particularly malignancy-related and surgery-induced pain.”4

Although this review did not report on risks arising from treatment with acupuncture, elsewhere studies have indicated that acupuncture is a feasible and safe treatment56 and may successfully be used to treat cancer patients for symptom management due to the low risks associated with its use.7

HOW ACUPUNCTURE TREATS CANCER PAIN: BIOLOGICAL MECHANISMS

Acupuncture’s mechanisms for treating cancer pain are thought to be similar to those for treating other painful conditions, whether the pain is categorised as acute or chronic.

These mechanisms have been researched extensively for over 60 years, and while there is still much left to learn about acupuncture mechanisms and the human body in general, the neural pathways from acupuncture point stimulation to the spinal cord and then to the deactivation of the pain centres in the brain have been mapped.89Acupuncture has been demonstrated to activate a number of the body’s own opioids as well as improve the brain’s sensitivity to opioids.10 A number of other biochemicals involved in pain reduction have been found to be released and regulated by acupuncture stimulation, including ATP, adenosine, GABA and substance P.11 Acupuncture has also been demonstrated to reduce activity in the parts of the brain associated with the perception of pain and increase activity in brain areas associated with improved self-regulation.12

 

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Acupuncture as a Therapeutic Treatment for Cancer Pain

Mairi Caughey, BSc and Mel Hopper Koppelman, DAc, MSc, MSc

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Integrative Cancer Care, Medical Acupuncture

Understanding the Benefits of Acupuncture Treatment for Cancer Pain Management

  • Two types of pain caused by cancer treatment in which several acupuncture studies have been conducted are: (1) aromatase inhibitor–associated arthralgia (AIAA) and aromatase inhibitor–associated musculoskeletal symptoms (AIMSS) and (2) chemotherapy-induced peripheral neuropathy (CIPN).
  • There is a moderate amount of evidence supporting the analgesic effect of acupuncture. In selected patients, acupuncture can be a useful addition to a comprehensive pain management plan.
  • Acupuncture is generally safe when performed by properly trained practitioners. There are specific safety precautions for cancer patients.
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