Welcome to my blog, discover acupuncture with Dr Maggie Ju

Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Many year research and clinical experiences. This blog is for information only.

Wednesday, 28 February 2018

Infertility caused by tube blockage, how can acupuncture help?

The role of fallopian tube is in reproduction

The fallopian tube is a part of the women’s reproductive system. It plays an essential role in gamete transport, fertilization and the early development of the embryo. The tube contains inner lining and smooth muscle wall. In the inner lining there are two major cell types are the ciliated and secretory cells. The fallopian tube goes through cyclical changes responding to estrogen and progesterone levels. The ciliated cells are low in height during the menstrual periods of the cycle, increasing during the follicular phase to reach their maximal height in the periovulatory period. Around the time of ovulation, the secretory cells reach peak activity. In the luteal phase, both cell types reduce in height.

Fallopian tubes are very important for normal fertility. They play a key role in picking up eggs and transporting eggs, sperm and embryo. When an egg is release, it takes about 8 hours to reach the site within fallopian tube. The fallopian tubes are the places where eggs are fertilised and embryo is accommodated there for 72 hours. Once progesterone dominance begins lumen opens and the embryo is transported to the uterus. Fallopian tubes are vulnerable to infection and surgical damage. This may affect tube function and cause infertility. If the tubes are blocked, this will cause infertility. Falllopian tube obstructions are the most common cause of female infertility, accounting for 30%-40% of cases.

Fallopian tube spasm, tubal infertility and acupuncture

As mentioned above, the fallopian tube is essential on sperm, egg and embryo transport and embryo development and it is very important for women who desire to get pregnant naturally. In IVF procedure, the fallopian tube is circumvented. The fallopian tube is not a concrete tunnel. The tube wall is flexible and consisted of smooth muscles which are responding to monthly cyclic hormone changes. Sometimes the tube can be obstructed by debris in the tube and tube muscle spasm. Women with tube spasm will find it difficult to get pregnant.

Fallopian tube smooth muscle contraction is induced by sympathetic nerves. Acupuncture reduces sympathetic activity and relaxes tube muscles and the debris in the tube is flushed away by the tubal fluids. This makes the obstructed tube reopen. In this case, pregnancy occurs quickly after acupuncture treatment.

Pelvic infection is a major cause of tubal infertility. Tubal damage by infection can be caused by sexually transmitted diseases, for example Chlamydia trachomatis accounts for half of the cases of acute inflammatory pelvic infections in developed countries. Tubal damage can also occur after miscarriage, termination of pregnancy, puerperal sepsis, or insertion of an intrauterine contraceptive device. Endometriosis associated adhesions is likely cause tubal distortion. Previous laparotomy is a risk factor for tubal infertility. In addition, ectopic pregnancy and uterine fibroids can also damage the tubes.

Acupuncture help to reduce inflammation; as a result, it releases tube spasms, reduces scar tissue contraction and helps inflammation absorption and helps healing process. There were a few case reports in Chinese that tubal infertility with acupuncture treatment, pregnancy rate was up to 72%.

References

R.A.Lyons et al (2006)Human Reproduction Update, 12: 363–372
Papaioannou S Hum Rreprod (2004) 19:481-5

Tuesday, 27 February 2018

Suffer from tailbone pain, acupuncture can help

Tailbone or coccyx is the lowest part of the spine and it is the triangular bony structure and consists of three to five different bones that fused together by joints and ligaments. It is surrounded by many tendons and ligaments. If the tailbone area becomes inflamed, it can cause tailbone pain or coccydynia. Soft tissue injury such as tendons and ligaments surrounding tailbone is the common cause of tailbone pain. The main symptom is pain and tenderness around the tip of the tailbone the area just above the buttocks. It is dull and achy most of the time, with occasional sharp pains. The pain is often worsened by sitting down, moving from sitting tostanding, standing for long periods, having sex and going for a poo. It may affect sleep and other daily activities. The pain can radiate to legs, buttocks and hips. Tailbone pain is often caused by an injury, such as sitting for a long time or bike rides, but it may have unknown causes. Vaginal birth in women sometimes is the cause of tailbone pain. The coccyx or pelvic bones injury is a risk factor and obesity is also a risk factor for getting tailbone pain. Secondary tailbone pain includes sciatica, infection such as shingles of the buttocks, sacroiliitis, and fractured bone. The major symptoms are pain and local tenderness at the tailbone. This can lead to difficulty sitting or leaning against the buttocks. Along with the pain with sitting, there is typical tenderness at the tailbone area.

Acupuncture can reduce tailbone pain effectively. Acupuncture points used in the treatment is very important. Recently a study compared two different acupuncture methods with different acupuncture points to treat sacroiliac joint injury which presents low back pain. In one group, 9 Ashi points were used and in another group as a control Huantiao (GB 30), Zhibian (BL 54) and Weizhong (BL 40), etc were used. Treatment durations and frequencies are the same. Two courses with each course containing 10 treatments were given. After the two courses of treatments, the pain scale and function recovery were found in the both groups, but the group with Ashi points had better effects. From this example, we can see acupuncture points selected are very important to achieve the best treatment results.

References

Grgic V Lijec Viesn (2012) 134:49-55

Gataullin IG and Samitov Osh Khirurgiia (Mosk) (1989) 2:64-6

Jordan J et al Clin Evid (Online) (2011) pii:118

Shan YL Zhongguo Zhen Jiu (2011) 31:987-90



Thursday, 22 February 2018

To get rid of the wrinkles, acupuncture can help

Facial expression muscles contracting create lines on the face, such as smiling, frowning, and squinting and so on. These lines will disappear when the muscles are relaxed. If these muscles are constantly contracting, the wrinkles will stay. With age, skin cells change as well to contribute to the wrinkle formation. For example, with age the skin loses its ability to hold on moisture, makes less oil and has less ability to repair any damage. This all contributes to the wrinkle formation in some stages. Exposure to the sun too much damages the skin. This leads to wrinkles. Acupuncture can relax facial expression muscles and get rid of the wrinkles. Acupuncture can improve circulation on the face and help skin repairing.

To get rid of wrinkles on the forehead, acupuncture can help

The frontalis muscle (frontal belly) is the muscle on the forehead. It is a thin, quadrilateral form. There is a pair of them. There are no bony attachments. The medial fibers are going downwards and connected with the muscle fibers below which includes the Procerus; the corrugator and the orbicularis oculi. They attach to the skin of eyebrow. Its lateral fibers also mix with the latter muscle over the zygomatic process of the frontal bone. The muscle fibers move up and join the galea aponeurotica (tough fiber layer on the head).

The frontalis muscles lift eyebrows when looking up and wrinkle the forehead by pulling the scalp back. The antagonist muscle is orbicularis oculi muscle.

Acupuncture relaxes this muscle to get rid of the wrinkles on the forehead.

To get rid of crow feet wrinkles, acupuncture can help

The orbicularis oculi muscle is the ring like muscle surrounding the eye. It originates from the nasal part of the bone and goes all the way laterally surrounding the border of the orbit forming a broad and thin layer. It spread over the eyelids, temple and down to the cheek. The orbital orbicularis is the orbital portion of the muscle. It forms a complete circle without interruption. The upper part blends in with the frontalis and corrugators muscles. Palpebral orbicularis is the palpebral portion of the muscles responsible for the involuntary eye blink. Contraction of this muscle causes the eye to close or blink. The orbital portion can be consciously controlled. The antagonist of this muscle is the levator palpebrae superioris muscle. It raises the upper eyelid and exposes the front of the bulb of the eye. Contraction of the muscle also causes the wrinkles at the out corner of the eye which are called crow feet. For example, as under the sun, the skin of the forehead, temple, and cheek is drawn toward the medial angle of the orbit, and the eyelids are firmly closed. The skin is folded especially radiating from the lateral angle of the eyelids.

Acupuncture relaxes this muscle to get rid of the crow feet wrinkle.

In addition, the orbital and palpebral portions can work independent of each other, as in the furrowing of the brows by contraction of the orbital to reduce glare while keeping the eyes open by virtue of the relaxation of the palpebral.

Muscles on the cheek and wrinkles on the face

There are four muscles on the cheek: They are lying in the cheek from middle to lateral, from cheek bone to the upper lip: They are the levator labii superioris alaeque nasi, the levator labii superioris muscle, the zygomaticus minor, the zygomaticus major. They form the nasolabial groove, from the side of the nose to the upper lip. This line is deepened in expressions of sadness. These muscles draw the angle of the mouth upward and backward in smiling. These muscles’s contraction creates tension on the cheek, deep nasolabial groove, and gummy smile. Acupuncture relaxes these muscles and release the tension of the face and soften the nasolabial groove and gummy smile.

Muscles surrounding the mouth and wrinkles and sagging skin

There are a few groups of muscles around the mouth.

The orbicularis oris muscle is the muscle encircling the mouth and it lies between the skin and the mucous membranes of the lips. Contraction of this muscle closes and wrinkles the lips.

The risorius muscle draws the angle of the mouth outward when laughing.

A few muscles below the mouth draw the corner of the mouth down.

The depressor anguli oris is a muscle that originates from the mandible and inserts on angles of the mouth to depress the angle of the mouth.

The depressor labii inferioris muscle is a muscle of the face that draws the lower lip down and slightly laterally

The mentalis muscle elevates and protrudes the lower lip and wrinkles the skin of the chin.

The platysma muscle is a broad sheet of muscle originated from the the fascia covering the upper parts of the pectoralis major and deltoid going upwards to lower cheek and blend in with the muscle around the mouth. It draws the lower lip and corner of the mouth outward and downward.

Muscles lift up the upper lip. Muscles in the cheek involves in lifting upper lip. These muscles include the levator labii superioris alaeque nasi, the levator labii superioris muscle, the zygomaticus minor, the zygomaticus major. They all end in upper lip. .

The tension and contraction of these muscles wrinkle the lips, chin, create lines around the mouth and chin.

Acupuncture can release the tension of the muscles and get rid of the wrinkles.

Procerus muscles and corrugators and wrinkles on the face

The procerus muscle arises from the nasal bone and inserts into the skin over the lower part of the forehead between the two eyebrows. Its fibers blend in with those of the frontalis muscles. Its contraction pulls the skin between the eyebrows downwards creating horizontal wrinkle between the eyes.

The corrugators supercilli muscle is a small muscle at the medial end of the eyebrow. It originates from the medial end of the superciliary arch and its fibers pass upward and laterally and end at the deep surface of the skin above the middle of the orbital arch. It is beneath the frontalis muscle and above the orbicularis oculi muscle. Contraction of this muscle draws the eyebrow downward and medially producing the deep vertical wrinkles between the eyebrows. It is known as frowning muscle.

Acupuncture can relax these muscles and reduce the related wrinkles.

Tuesday, 20 February 2018

How much acupuncture treatment is adequate?

How much acupuncture treatment is adequate? This is the most frequently asked question from patients. This is a good question, but it is difficult to get accurate answers.

The effect depends on the points chosen by the acupuncturists

If you go to see different acupuncturists, you would probably notice that different acupuncturists do acupuncture differently. Many different styles of acupuncture practice exist. Acupuncture is so individualized and there is no agreement on the optimal acupuncture treatment for any particular condition. Birkeflet O et al did a research about the agreement of acupuncture diagnosis and treatment in 30 infertile and 24 previously pregnant women. These women were examined for traditional Chinese medicine (TCM) patterns by two acupuncturists who would independently decide on the TCM patterns and the prescription of acupuncture points. They found that 39 different TCM patterns and 36 different acupuncture points were used. Poor to no agreement was found for the choice of acupuncture points. On one hand this makes acupuncture unique; on the other hand this makes it difficult to be recognised. Some research trials failed to distinguish the differences between acupuncture treatment and sham controlled treatment because of the generalization of acupuncture and inadequate treatment received. There was review by Errington-Evans N on effect of acupuncture for anxiety. They found that there was enormous variety regarding the points used, number of points used in a session, duration of sessions, frequency of treatment and duration of treatment programme; all of these makes conclusion difficult. White A et al analysed 47 acupuncture trials to evaluate the adequacy of acupuncture treatment which leads to reliable conclusion. They recommend the concept of dose of acupuncture treatment. Different doses may be required for different conditions and adequate dose is established by clinical experiences or basic research studies. They found that out of 47 reviews only 6 met the criteria of adequacy of the acupuncture treatment.

The effect also depends on the individual body’s response to the acupuncture treatment

Why different people have different sensitivity to acupuncture?

Acupuncture is used to treat variety of conditions worldwide. This is a safe intervention and effective treatment for many people, but different people have different sensitivity to acupuncture. Everyone is different, but why is that? Researchers found a scientific explanation for this. Li LM et al in China studied effect of acupuncture stimulation of Zusanli (ST36) on cerebral regional difference in healthy subjects with different acupuncture analgesia sensitivity using MRI techniques. There are 45 healthy subjects with different sensitivity to acupuncture. These people were divided into three groups: insensitive group, normal group and sensitive group. The pressure pain threshold (PPT) of the Zusanli ST 36 region before and after acupuncture stimulation at the point was assessed. And two weeks later after acupuncture stimulation, resting-state fMRI images were obtained using MRI scan to assess the cerebral regional homogeneity (ReHo). They found that there was significant increase in PPT levels in the normal and sensitive groups after acupuncture at ST36 point, while there was no change in insensitive group. In normal group there was a significant increase of ReHo in the regions including left brainstem, the right cerebellum posterior, right parahippocampa gyrus, right fusiform gyrus, left angular gyrus, temperal lobe and the left frontal lobe; and a significant decrease of ReHo in the regions including the occipital lobes and the right superior temperal gyrus after acupuncture at ST36. In sensitive group a marked increase of ReHo was found in the regions includig the left brainstem, bilateral cerebellum posterior lobes, left inferior temporal gyrus, basal ganglia, the left insular lobe, anterior cingutate, frontal lobe, inferior parietal lobule and the right supplementary motor area; decrease ReHo was found in the regions including the bilateral occipital lobes, fusiform gyrus, posterior central gyrus, the right posterior cingutate, the left temporal lobe and the left paracentral lobule. While in the insensitive group, only a significant decrease of ReHo was found in the regions including the left fusiform gyrus, left inferior temporal gyrus, bilateral postcentral gyrus, and left anterior central gyrus. So brain constitution associated needling sensation may be an important factor for acupuncture analgesia effect. Brain react differently in different people which is responsible for different sensitivity to acupuncture.

Acupuncture response is not associated with needle sensations

Needles stimulate nerves at acupuncture points and have been used to treat illness. During the application of needling, people are experiencing different sensations. There was a study that investigated the sensations of the transcutaneous electrical nerve stimulation over acupuncture points (acu-TENS) and the changes of the sensations related to changes in autonomic nervous system activity. There were 36 healthy subjects who were in three groups experimental group which was given acu-TENS on right LI4 and LI11points, control group which was given acu-TENS to bilateral kneecaps, or placebo group (sham acupuncture on right LI4 and LI11 points). There were significantly physiological changes in experimental group and control groups which were given acupuncture at different sites. There was no physiological change in placebo group which was not given active acupuncture. There was significant difference between the groups. There was no association between sensation intensity and physiological responses in any groups. From this study, we can see that even if people experience different sensation during acupuncture, they all have physiological responses to the needling.

Acupuncture dosage comprise two components: the numbers of points selected in a single treatment and total number of the treatments that patients received. It is possible for patients to have beneficial effects from a couple of treatments together with a couple of points selected for stimulation, but this is rather more exceptional than general. The nature and duration of the condition is a very significant determining factor that how many treatments are effective. Acute conditions of short duration in younger patients are most likely to respond to small dosage of acupuncture. On the contrary, chronic conditions of long term duration need larger dosages of acupuncture.

How many sessions of acupuncture are needed for lower back pain?

During the past 40 years, acupuncture, a therapeutic technique of oriental medicine, has become more and more popular, evolving into one of the most utilized forms of complementary integrative medicine interventions in the United States. More than 10 million acupuncture treatments are administered annually in the United States alone. Its rise in popularity, particularly in the West, can be attributed in part to its effectiveness for pain relief and in part to the fact that scientific studies have begun to prove its efficacy.

Non-specific low back pain is the most common application of acupuncture. It is listed in NICE guidelines in the UK. A course of acupuncture needling comprising up to a maximum of 10 sessions may be offered for non specific back pain over a period of up to 12 weeks. In some cases with long history of lower back pain, much more sessions are needed to completely live in pain free life.

What clinical evidences used for NICE guidalines for low back pain treatment with acupuncture?

Five studies were included to support the application of acupuncture: 4 RCTs and 1 systematic review on acupuncture. In these trials patients received 6 x 30min over 6 weeks in one, 20 x 30min over 12 weeks in another, 8 x 30min over 4 weeks in the third trial and 12 x 30min (3 times a week) in the fourth one.

For example, One randomised controlled trial recruited patients through their GPs (a total of 16 GP practices were involved which included 39 GPs) (Thomas, K. J., MacPherson, H., Ratcliffe, J. et al , 2005). Patients included had to be between age 18-65 and had nonspecific low back pain for 4-52 weeks. They also had to have been assessed by their GP to check that primary care management was suitable. A total of 289 patients were identified and approached to join the study, of these 241 accepted and met the criteria. 160 were allocated to receive acupuncture and 81 were allocated to receive usual care, however, 1 patient from each group dropped out, 159 actually received acupuncture (146 were followed up at 3 months, 147 at 12 months and 123 and 24 months) and 80 received usual care (71 were followed up at 3 months, 68 at 12 months and 59 and 24 months). Participants in the acupuncture group received 10 individualised acupuncture treatments over 3 months from one of 6 qualified acupuncturists. The usual care group received 10 NHS treatment sessions according the GPs assessment of the patients clinical need; this was a mixture of interventions, including drugs and recommended back exercises. Half the group also received physiotherapy or manipulation during the first three months. Both groups also received adjunctive care which included massage and advice on diet, rest and exercise. The results showed that acupuncture does give a greater long-term benefit compared to usual care. Acupuncture was significantly more effective in reducing pain at 24 months than usual care. The study also showed that traditional acupuncture care delivered in a primary care setting was safe and acceptable to patients with non-specific low back pain.

Can the effect of acupuncture stay?

People who have acupuncture treatment always like to know that how long the effect of acupuncture stays. A new research has shown that this effect can last very long time. This research used a large individual patient dataset from high quality randomised trials of acupuncture for chronic pain. The available individual patient dataset included 29 trials and 17,922 patients. The chronic pain conditions included musculoskeletal pain (low back, neck and shoulder), osteoarthritis of the knee and headache/migraine. In trials comparing a course of acupuncture to no acupuncture control (wait-list, usual care, etc), the result suggests that about 90% of the benefit of acupuncture relative to controls would be sustained at 12 months. The effects of a course of acupuncture treatment for patients with chronic pain do not appear to decrease importantly over 12 months. Longer term outcomes of acupuncture need further research to measure.


References

White A et al Acupunct Med (2008) 26:111-20

Errington-Evans N CNS Neurosci Ther (2012) 18:277-84

Birkeflet O et al Acupunct Med (2011) 29:51-7

Anderson B and Rosenthal L. Complement Ther Clin Pract (2013) 19:1-5

http://www.nice.org.uk/guidance/cg88/resources/cg88-low-back-pain-full-guideline3

Shi Y et al Evid Based Complement Alternat Med (2015) 2015:210120. doi: 10.1155/2015/210120. Epub 2015 Jun 16.

Guo L et al Biomed Mater Eng 2014 24 1063-9 doi:10.3233/BME-130904

Yu DT et al Acupunct Med 2013 Nov 1.doi10.1136/acupmed-2013-010428

Li LM et al Zhen Ci Yan Jiu (2013) 38:306-13

Monday, 19 February 2018

Acupuncture beyond Ying and Yang, Qi and meridians. Acupuncture alters brain activities

What do you know about the brain?

The brain is the central control organ in the body and is protected by the skull bones of the head. Though the brain function is not fully understood, it is known that it controls the activities of the body including processing, integrating and coordinating the information it receives from the sense organs and takes action accordingly, such as send signal to the body to react. Sensory nervous system is involved in receiving and processing sensory information, such as the skin is a sensory organ and senses touch, pressure, pain vibration and temperature. Motor system controls muscle function and body movement. Emotion and cognition are a part of the brain function. The brain is a big energy consumer and it receives 20% of total body oxygen and energy consumption and 25% of total body glucose utilization. The brain mostly uses glucose for energy, and deprivation of glucose causes loss of consciousness. Sleep can reduce brain oxygen and energy consumption and help restore brain energy supply.

Acupuncture has been accepted globally. Acupuncture stimulates the brain releasing endorphins which is essential in acupuncture analgesic effect.

Acupuncture altered brain activity and releases low back pain

Functional magnetic resonance imaging (fMRI) is a new technology that is used to study brain. Pain stimulus could induce extensive activations in the limbic system [anterior cingulated cortex (ACC), periaqueductal gray (PAG), prefrontal cortex] and somatosensory system (thalamus, primary somatosensory cortex (S1), secondary somatosensory cortex (S2), posterior parietal cortices, insula, supplementary motor area, striatum, and cerebellum) areas as well as the pain matrix (S1, S2, insular, frontal lobe and parietal lobe). The pain matrix showed a strong relationship with pain, which plays an important role in the conduction and communication of pain. This can be seen changes on fMRI. Low back pain (LBP) is one of the most common clinical syndromes and affects 80–85% of people at some point in their life. Most LBP is nonspecific which does not have a definitive cause.

In a recent study, an experimental acute LBP model and fMRI was used to study the neural mechanisms of acupuncture analgesia. All LBP subjects first underwent two resting state fMRI scans at baseline and during a painful episode and then underwent two additional fMRI scans, once during acupuncture stimulation (ACUP) and once during sham stimulation, at the BL40 acupoint. They found that acupuncture induced more deactivations and fewer activations in the brain. Acupuncture can alter brain activity and this contributes to mechanism of analgesia of acupuncture to LBP.

Acupuncture altered brain network function

There was a study about acupuncture stimulating brain functional network. This study was based on sample entropy of electroencephalograph (EEG) under magnetic stimulation at PC6 acupoint which is on your forearm and near your wrist. Magnetic stimulation at acupuncture point is a new method for studying the theory of acupuncture. It helps to investigate brain network and understand how brain works. This study was trying to provide evidence for the mechanism of acupuncture which is a part of traditional Chinese medicine. The magnetic stimulation of PC6 acupoint was performed and EEG signals were recorded. By analysing the results they found the brain network topology was changed after acupuncture at PC6 acupoint, the connection of the network is increased, the efficiency of information transmission is improved and the small-world proper is strengthened through stimulation the PC6 acupoint.

Acupuncture at different acupoints may alter brain activities in different area.

Recent acupuncture research study the effect of acupuncture on brain activity using functional magnetic resonance imaging (MRI). Wang W et al used electro-acupuncture to stimulate the cerebral activated areas. They compared the altered activation areas of the acupuncture point LI4 on the right hand with some non acupuncture points on the face. There were 6 people in the LI4 group and 5 in the facial nonacupoint group. MRI ws performed before and after acupuncture. They found that activation or deactivation was found the multiple cerebral areas in both groups. In the LI4 group, activation was found in the areas including medline nuclear group thalamus, left supra marginal gyrus, left supra temporal gyrus, right precuneous lobe, bilateral temporal pole, left precentral gyrus and left cerebellum; deactivation areas include bilateral hippocampus, parahippocampal gyrus, amygdale body area, rostral side/audal side of ingulate gyrus, prefrontal lobe and occipital lobe as well as left infratemporal gyrus. In the control group, the activation and deactivation areas were different from LI4. They concluded that the deactivation area by LI4 was a similar area distribution of pain area in the brain and closely related to the anatomic structure of limbic system which is possibly related to pain relief. Activation of left anterior gyrus by LI4 represents the movement of facial muscles and activation of cerebellum is possibly related to effect of LI4 in treating facial palsy and facial muscle spasm.

Fang JL et al compared the effects of electroacupuncture at acupoints ST36 and CV4 using MRI in 21 healthy volunteers. The similar deactivation effects in the anterior cingulated and medial prefrontal cortices were induced by acupuncture at ST36 or CV4 acupoint. The functional brain network was significantly changed after acupuncture. The instant postacupuncture effects were mainly found in the ventral medial prefrontal cortex and ventral anterior cingulated cortex in the limbic-paralimbic-neocortical network and the effects were stronger at ST36 than that CV4.

Facial acupuncture increases brain blood flow

A new research studies the effect of facial acupuncture on brain blood flow. In this study brain blood flow and heart rate were measured before and after acupuncture treatment. The result has shown that brain blood flow was significantly greater in the brain more specifically in the prefrontal cortex in the acupuncture group. Heart rate was reduced.

References

Han js Neurosci (2004) 36:258-61

Kim S et al Evid Based Complement Alternat Med (2016) 9874207. doi: 10.1155/2016/9874207. Epub 2016 Jun 14.

Li XM et al Zhen Ci Yan Jiu (2013) 38:297-300

Wang W et al Chin J Integr Med (2007) 13:10-6

Fang JL et al Zhen Ci Yan Jiu (2012) 37:46-52

Yan G et al Evid Based Complement Alternat Med 2013: 2013:429703

Guo L et al Biomed Mater Eng. 2013 23(0):S1115-S1121

Hsiu H et al Microvasc Res (2013) Jun 24

An Y et al Med Devices (Aucl) (2014) 7:17-21

Waki H et al Acupunct Med (2017) Aug 1. pii: acupmed-2016-011247. doi: 10.1136/acupmed-2016-011247. [Epub ahead of print]

Sunday, 18 February 2018

Acupuncture beyond Ying and Yang, Qi and meridians. Acupuncture increases blood circulation.

One of the mechanisms of acupuncture effect is increasing blood circulation

Acupuncture is originated from China 2500 thousand years ago and the theory is based on the meridians and energy (Qi) flow through the body. Recent scientific research on acupuncture provided evidence of the mechanisms of acupuncture. In 1950s Chinese government began to invest in research on acupuncture. The interest in acupuncture is increased not only for medical professionals all over the world, but also for researchers. They would like to know how the needles work. Since 70’s, acupuncture becomes more and more popular in US and European countries. In 1971, a report in the New York Times inspired American doctors to China to study analgesia effect of acupuncture. In 1990s there was a remarkable increase in acupuncture research. The publications of acupuncture research continue to increase. Acupuncture has received an enormous boost in the last few years. In 50 years the achievements of acupuncture research is extraordinary. The National Institute of Health consensus conference in 1997 recognised acupuncture (and by extension Traditional Chinese Medicine) as a legitimate branch of scientific medicine. Acupuncture seems very likely to be accepted and incorporated into Western medicine. Acupuncture becomes popular than ever.

Acupuncture increases local blood flow.

Regulating blood flow both centrally and peripherally are important in contributing mechanism of acupuncture.

Recently a study investigated the changes of local blood flow in response to acupuncture stimulation. In this study eight random controlled trials involved 205 participants were included. In most of the selected studies, acupuncture was performed at points located distal to the elbows and knees such as LI4, ST36, and PC6, whereas one study simultaneously used several acupoints on the extremities. In one study the GB21 acupoint on the posterior region of the shoulder was stimulated with an acupuncture needle. All eight studies selected for the present review observed acupuncture-induced changes in blood flow in the skin, whereas three studies observed changes in blood flow in the muscle. Four reported significant increases in blood flow following acupuncture compared with control, whereas one other study observed reductions in microcirculation immediately after acupuncture needling. The studies that assessed patients with either fibromyalgia or trapezius myalgia found significant increases in blood flow in the skin and muscle. Additionally, the degree and duration of increases in microcirculation varied depending on the condition of the subjects and the manipulation technique.

Another study about effect of acupuncture in peripheral tissue perfusion has been done on two healthy subjects. Acupuncture was performed on two acupoints (LI4 and SI3) which are in the hands three treatments within 1 week. Local blood perfusion on the hands was measured before and after acupuncture treatments. The result has shown that the blood perfusion rates of the hands were noticeably increased immediately after acupuncture at the first treatment in both cases. At the third treatment the increased blood perfusion was seen in one case, not the other one.

Hsiu H et al studied the microcirculatory blood flow response following acupuncture stimulation using beat to beat laser Doppler flowmetry (LDF) which could provides important information on the circulatory regulatory activities. Changes in the arterial pulse transmission or the opening condition of arteriolar opening might change the fluctuation pattern of the microcirculatory blood supply. They measured LDF signals to study the microcirculatory blood flow response at the needled site particularly at Hegu LI4 acupuncture point) after acupuncture stimulation. They selected 29 male healthy volunteers to measure microcirculatory blood flow after acupuncture stimulation. The measurements were at three times: before acupuncture stimulation, immediately after acupuncture stimulation and about 1 hour after acupuncture stimulation. They found that acupuncture not only improves local blood supply and but also regulates microciculatory blood flow by altering microcirculatory blood supply parameters. Their findings could help to identify the mechanism underlying the effects of acupuncture stimulation.

Acupuncture increases blood perfusion around the acupoints.

Researchers are using modern techniques to study the mechanisms of acupuncture to explain the phenomenon from modern science aspect. Li XM et al studied influence of different acupuncture manipulations at Zusanli (ST36) on skin microcirculation blood perfusion in healthy subjects. They measured local blood perfusion at ST 36 acupuncture points after acupuncture stimulation at 1min, 5 min, 10, 15min, 20 min, 25 min and 30 min. They also compared blood perfusion levels of microcirculation around the acupoints among the different manipulation techniques. They found that microcirculation around the selected acupoint was significantly increased from 1-10 min following simple needle insertion, from 5 -30 min after uniform reinforcing-reducing manipulation, from 1-30 min after reinforcing manipulation, and from 1-25 min following reducing manipulation respectively. The reinforcing manipulation was superior to other techniques. From this study we can see acupuncture increases local blood perfusion in normal subjects. The reinforcing manipulation had better effect.

Acupuncture dilates blood vessels

Research has shown that there were more of nerve fibers/trunks, blood vessels, hair follicles, and sweat glands as well as density of the gap junction in the acupuncture points. Recent research has shown that nitric oxide (NO) level is elevated in the acupoints and is associated with an enhanced expression of NO synthase endowed with transient receptor potential vanilloid type-1. This suggests that acupuncture induces NO-mediated vasodilatation, which increases local blood flow and allows for a flush of algesic or sensitizing substances, leading to pain relief.

Microcirculation and water retention

Microcirculation is the blood flow in the small blood vessels which spread out in organ tissues. These blood vessels include arterioles, capillaries and venules. The main functions of the microcirculation are the delivery of oxygen and nutrients to the tissues and the removal of CO2 from the tissues. It also regulates blood flow and tissue perfusion. Microcirculation responds to inflammation which is related to swelling. Capillaries are a sector of the microcirculation where gas and fluid exchange take place. About 7% of the blood in the capillaries is continuously exchanges with the fluid outside of the blood vessels. If there is problem with microcirculation, such as compression of the part of the body, the microcirculation is likely to be disturbed and water retention occurs. Acupuncture stimulates the nerve ending and relaxes blood vessels and skeletal muscles, it improves microcirculation and relieves water retention.

Acupuncture helps lymphatic circulation

The lymphatic system is a part of the circulatory system and it also involves immune function of the body as a part of the immune system. It consists of a network of lymphatic vessels which carries lymph-a clear fluid in the body which formed from tissue fluids known as interstitial fluid from the tissues. It carries large amount of lymphocytes and other white blood cells which play a role in the immune function. Its main function is to help tissue fluid circulation. The lymph capillaries absorb the interstitial fluid from the tissues and lymph vessels conduct the fluids to the blood vessels. As a part of the defence system, it also contains waste products and cellular debris together with bacteria and proteins etc which are toxic to the body.

The lymphatic system is responsible for maintaining the balance of the body fluids. Its network of capillaries and collecting lymphatic vessels work to efficiently drain and transport the fluid, along with proteins and antigens, back to the circulatory system. The lymphatic system is not closed system and the vessel walls are not as strong as blood vessels. If the circulation is blocked for various reasons, e.g. there is tension on the body, the transportation is disturbed and the fluids cannot be drained properly causing water retention. Also the toxins could remain in the body longer than they should be causing toxic to the body.

Acupuncture can help lymphatic circulation, improve water retention and help get rid of toxins of the body.

References

Kim S et al Evid Based Complement Alternat Med (2016) 9874207. doi: 10.1155/2016/9874207. Epub 2016 Jun 14.

Li XM et al Zhen Ci Yan Jiu (2013) 38:297-300

Wang W et al Chin J Integr Med (2007) 13:10-6

Fang JL et al Zhen Ci Yan Jiu (2012) 37:46-52

Yan G et al Evid Based Complement Alternat Med 2013: 2013:429703

Guo L et al Biomed Mater Eng. 2013 23(0):S1115-S1121

Hsiu H et al Microvasc Res (2013) Jun 24

An Y et al Med Devices (Aucl) (2014) 7:17-21

Ma SX Chin JIntegr Med (2017) 23:812-815

Sunday, 11 February 2018

Suffer from nerve pain? Acupuncture can help.

Acupuncture improves nerve pain

The nervous system is involved in all body functions. There are three types of nerves: autonomic nerves, motor nerves and sensory nerves. Autonomic nerves are involved in internal organs activities such as heart rate, blood pressure, breathing, digestion and reproduction etc; motors nerves control the skeletal muscles and involved in the body motion; sensory nerves transmit signals to the brain and let feel pain and other sensations. These nerves can be damaged by many conditions, such as virus infections, tumors, and autoimmune disorders. The symptoms of nerve damage vary greatly depending on the location and type of the nerves affected. Nerve pain is a common symptom of sensory nerve damage. Other symptoms involved in sensory nerves are sensitivity, numbness, tingling, burning and problems with positional awareness. The location of pain depends on which sensory nerves are involved.

Acupuncture can help to improve nerve pain. For example, there were many researches showing that acupuncture helped trigeminal nerve pain, sciatic nerve pain, pudendal nerve pain and other peripheral nerve pain etc. Below are examples for acupuncture treatments for nerve pain.

Pudendal neuralgia with acupuncture treatment

Pudendal neuralgia was first described in 1987. It is a severely painful and disabling neuropathic condition, affecting both men and women. This leads to a burning, tingling, or itching sensation in the clitoris/penis, vulva/scrotum, perineum, and rectum, especially when sitting. Symptoms are frequently on one side, however, in patients presenting with both sides, there is often a more affected side. The pain could be present in the lower abdomen, posterior thigh, and lower back. Another common symptom is the sensation of a foreign body in the vagina, perineum or rectum. Defecation and urination can also be painful. Urinary or fecal incontinence may develop from decreased sphincter tone if motor function is affected.

Acupuncture can help to reduce the pain.

Acupuncture for trigeminal neuralgia

The acupuncture that you get could be very different, if you see different acupuncturists. For example, a study analysed acupuncture points used for trigeminal neuralgia. In this study 180 papers were included and in these papers 148 acupuncture points were used and were distributed in 14 meridians. The most frequent used points are Hegu (LI 4), Xiaguan (ST 7), Fengchi (GB 20) and trigger points. Other points included crossing points, yuan-primary points and five-shu points. They were widely used, accounting for 65. 9%. As for the branch of trigeminal nerve, the top-3 selected acupoints were Yangbai (GB 14), Yuyao (EX-HN 4), Cuanzhu (BL 2) in the first branch, Sibai (ST 2), Quanlian (SI 18), Yingxiang (LI 20) in the second branch, Jiache (ST 6), Xiaguan (ST 7), Dicang (ST 4) in the third branch. It can be seen that right points need to be chosen to get best effects.

Acupuncture is effective for sciatica

Sciatica is a syndrome involving sciatic nerve root impingement or inflammation. The main symptoms include unilateral leg pain radiating to the foot or toes that is greater than low back pain and often associated with burning pain, numbness, and weakness of the leg; pain is increased on straight leg raising and the symptoms limited to one nerve root. Sciatica may be sudden in onset and may subsequently persist for days, weeks, even years. Acupuncture can help release sciatic nerve pain. This is suggested by recent research. A review studied 11 trials involved a total of 962 participants. The analysis suggested that acupuncture is effective for sciatica and the effect is better than pain killers. Their conclusion is that the use of acupuncture may more effectively relieve leg pain/lumbago and improve overall assessment of sciatica when compared with NSAID (ibuprofen, meloxicam, and diclofenac) treatment.

Acupuncture treatment for acute shingles

Herpes zoster known as shingles, is caused by varicella-zoster virus which affects nerve and the skin around it. This virus is also causes chickenpox which is primary infection. It remains dormant in the dorsal root ganglion after primary infection (causing chickenpox). It affects the sensory ganglia and their area of innervation. This is one of the most painful conditions with pain and rashes in the distribution of the affected nerve. Antiviral drugs are used to limit the damage of the nerve by the virus. Corticosteroids may be used to reduce inflammation. Various painkillers are used to reduce pain. Ursini et al from Pescara General Hospital in Italy studied acupuncture for the treatment of severe acute pain in shingles using randomized trial. They compared the efficacy of acupuncture in controlling intense or very intense pain in patients with shingles with standard pharmacological treatments. The treatments were given for 4 weeks for either acupuncture or painkillers. They found that both interventions (acupuncture and painkillers were largely effective. There were no significant differences observed in response rates, pain reduction, post-herpetic neuralgia after 3 months and pain after one year follow-up. No severe unwanted effects occurred on both interventions. Acupuncture is a potential intervention for treating acute severe pain in singles.

Acupuncture for chronic pain from shingles

Most people have chickenpox in childhood. When the illness has gone, the virus remains dormant in the nervous system being watched by the immune system. Once one’s immune system is compromised, the virus can be reactivated and cause shingles. Shingles is one of the most painful conditions. There is no cure for shingles and it can be unpleasant. In most case, the painful rash lasts 7-10 day and takes 2-4 weeks to fully heal. However about 25% of patients have pain lasting for more than one year. Unresolved pain can lead decreased quality of life, such as mood change, sleep disruption and depression etc. Hui F et al from University of Toronto studied three weeks complementary and alternative medicine including acupuncture to treat shingles related pain. The participants had a mean age of 69.8 years and had shingles related pain for a median of 4.8 months. Acupuncture points for acupuncture group were LI4, Liv 3 and ST36. After three weeks treatment, they found that pain score was significantly reduced in treatment groups. The pain reduction was maintained at 9 weeks after the treatment finished and one–two year follow-up.

Li et al studied 80 cases of shingles which were divided into two groups, acupuncture group and medication group. They found that the therapeutic effect of electroacupuncture was significantly superior to that of medication. After 10 treatments visual analogous scale (VAS) scores for of both groups reduced significantly. Both the VAS score and the crust formation time of EA group were significantly lower than those of medication group.

References

Tao S et al Zhongguo Zhen Jiu (2016) 36:207-11

Hui F et al Altern Med Rev (2012) 17:57-68

Ursini T et al BMC Complement Altern Med (2011) 11:46

Li X et al Zhen Ci Yan Jiu (2009) 34:125-7

Qin Z et al Evid Based Complement Alternat Med (2015):425108. doi: 10.1155/2015/425108. Epub 2015 Oct 21.

Friday, 9 February 2018

Having constant pain? Acupuncture can help.

Acupuncture for chronic pain relief

Chronic pain is any pain lasting more than 12 weeks. Chronic pain may arise from an initial injury, such as a back sprain or often there may be no clear causes. Chronic pain compromises people’s quality of life greatly and is one of the difficult conditions to treat. There is no test that can measure and locate pain with precision. Chronic pain may occur in a variety of locations in the body and for many different reasons, it is important to identify the causes and symptoms and locate the pain origin and get the pain treated.

Chronic pain can be mild or severe, episodic or continuous. Pain signals constantly stimulate nervous system for months or years. This can make great impact on a person’s physically and emotionally. The most common chronic pain is from headaches, joint pain, back pain, shoulder pain, pelvic pain, neck pain and pain from any injuries. The symptoms of chronic pain mainly are pain from mild to severe that does not go away. It can be shooting, burning, aching or electrical; or feeling discomfort, soreness, tightness or stiffness.

Chronic pain is closely related to emotions. Anxiety, stress, depression, anger and fatigue make the pain worse. These negative feelings may increase the level of substances that amplify sensations of pain, causing a vicious cycle of pain. The pain can suppress the immune system causing other symptoms.

Apart from the pain, there could be other symptoms including fatigue, sleeplessness, frequently having cold, changes in mood such as depression irritated anxiety and stress. Chronic pain may limit a person’s movements, which can reduce flexibility, strength, and energy.

Pain is a very personal and subjective experience. There is no test that can measure and locate pain with precision. Finding tender points can help locate the source of the pain.

Acupuncture is an effective treatment method for chronic pain. Acupuncture is a treatment derived from ancient Chinese medicine, it becomes popular worldwide. In the UK it is used in many NHS general practices, as well as the majority of pain clinics and hospices. The application of acupuncture in Western medicine is based on proper medical diagnosis and scientific evidence. The theory is that acupuncture can stimulate nerves under the skin and in muscle tissue. This results in the body producing pain-relieving substances, such as endorphins. It is likely these substances are responsible for any beneficial effects seen with acupuncture.

Acupuncture is recommended by the National Institute for Health and Care Excellence (NICE) as a treatment option for chronic lower back pain, chronic tension-type headaches and migraines. This recommendation by NICE is on the basis of scientific evidence. Acupuncture treatment for neck pain is also recognised as effective one.

Acupuncture is an effective treatment for chronic pain conditions

Acupuncture is well accepted to treat chronic pain conditions. A survey by MG Tan et al from Singapore studied the use of CAM in chronic pain patients in Singapore. They found that 84% of patients used CAM at some point of their life. 30% of patients used CAM for other reasons instead of chronic pain. 35% of patients used for both pain and non pain conditions. Acupuncture was the most utilised which is 49%, followed by Chinese herbs (18%), Tui Na (17%) and massage (16%). Many patients were on more than one form of the CAM. 72% patients thought that CAM helped with their pain. 26% patients used CAM because conventional medicine did not work. 38% thought it was safer and had fewer side effects. 24% of patients thought it was cheaper. 85% of patients were satisfied. Many patients did not discuss the use of CAM with their doctor, mainly because they thought that CAM is more natural and safe.

Acupuncture has little side effects and well tolerated. A survey from people accepted acupuncture treatment has shown that 46% said acupuncture helped greatly, 26% said it helped in some degree and 28% said there was little help. Research showed that lower back pain is the most common reason for visiting acupuncturists. Usage of acupuncture has increased enormously in recent 10 years.

Recently, Mao et al reviewed clinical research of a few chronic pain condition treatments with acupuncture including lower back pain, knee pain, neck pain and headache. Low back pain is the most common reason for visits to acupuncturists. Recent 10 years, using high quality randomized controlled trials study acupuncture has increased enormously. Most of them have shown that acupuncture treatment is effective to lower back pain and it is better than no treatment or equivalent to other conventional treatments. The situation of knee pain with acupuncture treatment is pretty similar to lower back pain which is acupuncture is better than no treatment. For neck pain treatment with acupuncture some controlled trials suggested that acupuncture is better than or equivalent to physiotherapy. Some study suggested that acupuncture is better than massage and dry needling in motion-related neck pain. In a study on headache, it showed that acupuncture reduced headache frequency and severity, and at the same time it also improves headache related quality of life. There is a review about acupuncture for chronic pain by Vickers AJ et al just published in Arch Intern Med (2012). They analysed 29 clinical randomized controlled trials involving in 17922 patients to investigate the effect of acupuncture for 4 chronic pain conditions: back and neck pain, osteoarthritis, chronic headache and shoulder pain. In the primary analysis, including all eligible trials, acupuncture was superior for both sham and no acupuncture control for each pain condition. After exclusion of an outlying set of trials that strongly favoured acupuncture, the effect sizes were similar across pain conditions analysed. Patients receiving acupuncture had less pain. They concluded that acupuncture is effective for the treatment of chronic pain and it is more than a placebo. Acupuncture is clearly a treatment option.

It becomes general knowledge that acupuncture releases pain effectively. However the effectiveness of acupuncture for pain relief is still coming up for debate and there are always some clinical trials showing lack of effect compared with control. What is the reason for this? Macpherson et al analysed clinical trials involving patients with headache and migraine, osteoarthritis, and back, neck and shoulder pain. There were many different types of controls used in the trials including sham controls such as non-needle sham, penetrating sham needles and non-penetrating sham needles and non sham control such as non-specified routine care and protocol-guided care. They analysed the impact of choice of control on effect of acupuncture. They found that acupuncture was significantly superior to all categories of control group. For trials that used penetrating needles for sham control, acupuncture had smaller effect sizes than for trials with non-penetrating sham or sham control without needles. Large effects of acupuncture were seen after exclusion of outlying studies. In trials with non-sham controls, larger effect sizes associated with acupuncture vs. non-specified routine care than vs. protocol-guided care. From this study it can be seen that acupuncture is significantly superior to control irrespective of the subtype of control. Penetrating needles can have positive effects which should be avoided as a control in the study.

Recently a study analysed 29 clinical trials involved in 17922 patients with chronic pain treated with acupuncture. This study suggested that acupuncture is effective for the treatment of chronic pain including back and neck pain, osteoarthritis, and chronic headache and acupuncture is a reasonable option. There is scientific evidence how acupuncture works. Many research suggested that acupuncture relives pain by affecting neurotransmitters, hormone levels, or the immune system.

What is important when using acupuncture to treat chronic pain

Many researches with huge sample sizes showed that acupuncture is effective to treat chronic pain. Acupuncture is not a standardized treatment method. If you see different acupuncturists, you would receive acupuncture with different characteristics for sure. There are different styles of acupuncture, Chinese acupuncture, Western acupuncture or mixed Chinese and Western acupuncture, which are based on different theories. Even for the same style of acupuncture, the duration and frequency of the treatments could be different performed by different acupuncturists. The points used are different by different acupuncturists which give you different effects.

From research point of view, there is a great variation of acupuncture characteristics. MacPherson et al analysed the research trials for acupuncture effect on chronic pain. Majority of research trials (59%) was based on traditional Chinese acupuncture and majority of points (55%) selected were flexible. Most of the research trials are manually stimulated and only a few trials used electrical stimulation and a few trials added with moxibustion. Attempts to obtain de qi sensation were made in all 25 trials which provided this information. The maxium number of sessions varied broadly from 3 to 30 and duration of sessions also varied from 15-32 minutes. The needles or points used were range from 1-18 points. The frequency of treatment was from one session every eight days to two sessions a week.

Their results showed that when comparing acupuncture with sham acupuncture controls, there was little evidence that the effects of acupuncture on pain were modified by any of the acupuncture characteristics evaluated, including style of acupuncture, number or placement of needles, the number, frequency or duration of sessions, patient-practitioner interactions and experience of the acupuncturist. When comparing acupuncture to non-acupuncture controls, better pain outcomes were obtained when more needles were used and also when a higher number of acupuncture treatment sessions were provided. They conclude that there was little evidence that different characteristics of acupuncture or acupuncturists modified the effect of treatment on pain outcomes. Increased number of needles and more sessions are associated with better outcomes when comparing acupuncture to non acupuncture controls. They suggested that dose is the key factor.

There was a report that investigated the outcomes of acupuncture for chronic pain in urban primary care from New York. Patients selected for the acupuncture treatment were over 21 years old with chronic pain caused by osteoarthritis or neck or back pain. Acupuncture was provided by supervised acupuncture students for up to 14 weeks. Pain and function were evaluated before during and after acupuncture treatment. They found that back pain was the most common referring diagnosis 59.5% followed by osteoarthritis 16.3%. Pain severity and function significantly improved at 12 and 24 weeks after baseline assessment. They concluded that weekly acupuncture improved pain severity and quality of life.

Why can acupuncture be used to relive pain?

Acupuncture can act as a pain killer and it is used in many conditions and helps relieve pain. The mechanism is studied by modern research. Studies have shown that pressure pain threshold is increased after acupuncture treatment. The effect could be long-term and short-term. Studies have also shown that acupuncture reduced sensitivity to noxious thermal stimuli which could be mechanical (such as pinching or tissue deformation), chemical (such as exposure to acid or ittitant) or thermal (such as high or low temperature). Sensory threshold changes were equally frequent reported after manual acupuncture as after electroacupuncture. Acupuncture affects sensory perception. Results are most convincing for the pressure pain threshold, especially in pain conditions associated with tenderness.

Acupuncture is used for women with chronic pelvic pain

If you've had pelvic pain for six months or more that either comes and goes or is continuous, it is known as chronic pelvic pain (CPP). CPP is more intense than ordinary period pain and lasts for longer. It affects around one in six women. A research paper studied the prevalence of and factors associated with use of complementary health approaches mong women with CPP. The result has shown that slightly over one-half (51%) of women with CPP used at least one complementary health approach in the past year, including acupuncture (8%), special foods or diets (22%), herbs (27%), and vitamins and minerals (29%). During follow-up surveys conducted annually for 4 years, a substantial proportion of women (44.8%) used complementary health approaches at more than half of the assessments. Users of complementary health approaches were more likely to undergo a hysterectomy or oophorectomy or to use gonadotropin-releasing hormone agonists or opioids during the study compared with nonusers. Women with CPP who used complementary health approaches also had more optimal health-related quality of life measured by the Pelvic Problem Impact Questionnaire.

Acupuncture for chronic knee pain

Chronic knee pain is a common condition. Acupuncture is shown as an effective treatment for chronic knee pain. A new research paper updated new research data and analysed the effectiveness and safety of acupuncture for chronic knee pain. Seventeen randomised controlled trials of acupuncture as the sole treatment or as an adjunctive treatment for CKP were assessed. The results showed that acupuncture alone or combined with other treatment was associated with significantly reduced chronic knee pain at 12 weeks. No risk of application of acupuncture was found in the studies. This study is consistent with previous research that acupuncture is effective for chronic knee pain and support the management for knee pain using acupuncture treatment.

Acupuncture is the best option for depression with pain problems

Up to about 70% patients with depression also have pain problems. Depression may make the pain problem worse and more pain may make depression worse as well. The existing research data has shown that acupuncture is an effective treatment option for several chronic pain conditions. Acupuncture is also suggested to treat depression, though this is not available option in NHS. Counselling for depression is widely available in primary care practices, however there is limited evidence for counselling compared to usual care as a treatment for patients with depression and a chronic physical health problem. Recently a report compared acupuncture or counselling with usual care alone for 755 patients with depression complicated with pain. They found that at 3 months, both acupuncture and counselling interventions were effective for depression compared to usual care alone whether there was pain or not. Patients in the pain group had greater reductions in both depression symptoms with acupuncture from baseline to 3 months than those who received counselling or usual care. All treatment options were effective in reducing pain between baseline and 3-month follow-up after controlling for baseline pain, however, acupuncture delivered a greater degree of pain relief than counselling or usual care in the short-to-medium term. Reductions in both depression and pain were most marked in the acupuncture group, followed by the counselling group and then the usual care group.

Complex regional pain syndrome (CRPS) is a condition in which a person experiences persistent severe and debilitating pain. This condition is poorly understood. The pain is usually confined to one limb, but it can sometimes spread to other parts of the body. The main symptom of CRPS is pain, which can sometimes be severe, continuous and debilitating. The pain may be a mix of burning, stabbing or stinging sensations, but there may also be a tingling sensation and numbness. The skin of the affected body part can become so sensitive that just a slight touch, bump or even a change in temperature can provoke intense pain. Other symptoms accompanied with the pain include muscle tremor and spasm, affected joints stiffness, sleep problem and changes of the skin etc. Acupuncture is an effective way for pain relief. Why not try to see if it works for you.

People benefit most from acupuncture treatment

The effects of acupuncture vary depending on the conditions, skills of acupuncturists, individuals sensitivities to the treatment. A research from Gemany studied the patient characterisitics and variation in acupuncture treatment outcome to find out which pateitns benefit most from acupuncture for chronic pain. Patients with chronic low back pain, headache, neck pain, or pain due to osteoarthritis of the knee or hip, were included. All patients received routine care; the patients randomized to the acupuncture group received additional acupuncture treatment. In this study total of 9,990 patients were treated by 2,781 physicians. The results have shown significant improvement in the acupuncture group. Patients benefit most from acupuncture for chronic pain are that enlarged the acupuncture effects were being female, living in a multi-person household, failure of other therapies before the study, and former positive acupuncture experience.

Acupuncture for chronic pain, acupuncture points used is important

The effect of acupuncture treatment for chronic pain is controversial in research paper, though acupuncture is widely used in clinical practice and accepted by many doctors and patients. The concern is if acupuncture is effective for chronic pain or the effect lasts. Recently a study analysed individual patient data to examine the effect of acupuncture for chronic pain condition including non-specific musculoskeletal pain, osteoarthritis, chronic headache, or shoulder pain. 20,827 patient data were included. The pain and function were measured in this study. The result has shown that there was a clear effect of acupuncture compared to control and the effects of acupuncture persist over time with only a small decrease, approximately 15%, in treatment effect at one year. They conclude that acupuncture is effective for the treatment of chronic pain, with treatment effects persisting over time; the specific effects of needling at correct acupuncture point locations are important contributors to the treatment effect and a course of treatment is necessary for the treatment.

References

Hopton A BMJ Open (2014) 4:e004964

Macpherson H et al PLoS One (2014) 9:E93739

Tan MG et al Ann Acad Med Singapore (2013) 42:133-7

Vikers AJ et al Arch Intern Med (2012) 10:1-10

Mao et al Prim Care (2010) 37:105-117

MacPherson et al PLOS ONE (2013) 8:e77438

J Am Board Fam Med (2013) 26:692-700

Aranha et al Rev Bras Fisioter (2011) 15:371-9

Chou LW et al Evid Based Complement Alternat Med (2012) 2012:705327

Wong Lit Wan D et al Eur J Pain (2015) Feb 17. doi: 10.1002/ejp.671. [Epub ahead of print]

Bastos JL et al J Acupunct Meridian Stud (2013) 6:163-8

http://archinte.jamanetwork.com/article.aspx?articleid=1357513

Baeumler PI et al PLoS One (2014) 9:e113731

Zhang Q et al Acupunct Med (2017) Dec;35(6):392-403. doi: 10.1136/acupmed-2016-011306. Epub 2017 Nov 8.

Vickers AJ et al J Pain (2017) Nov 30. pii: S1526-5900(17)30780-0. doi: 10.1016/j.jpain.2017.11.005. [Epub ahead of print]

Witt CM et al Clin J Pain (2011) 27:550-5

Tuesday, 6 February 2018

To get rid of age spots, acupuncture can help

There are special cells in the skin making melanin which gives the skin color. When these cells become damaged or unhealthy, it affects melanin production causing skin pigmentation which affects the color of the skin. Age spots (known as liver spots) are the result of an excess production of melanin caused by overactive pigment cells. The cause for this is not clear, but ultraviolet (UV) light (sun exposure, tanning beds etc) accelerates the production of melanin. Age spots appear when melanin becomes clustered or is produced in high concentrations. On the areas of skin that have had years of frequent and prolonged sun exposure, it is more likely to get age spots such as the face. The risk factors for age spots are being older than 40 years old, having fair skin and having a history of frequent sun exposure and tanning bed use. Age spots range from light brown to black in color. The spots have the same texture as the rest of your skin. They do not cause any pain. Age spots are harmless and don't need treatment. For cosmetic reasons, some people like to get rid of age spots. Facial acupuncture can help to get rid of the age spots on the face.

What can you about your health from your tonger?

 Read more about acupuncture at < drmaggiejuacupuncture.co.uk >