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.

Sunday, 31 July 2022

How to cope anxiety?

What is anxiety?

Anxiety is a feeling of unease, such as worry or fear. This feeling can be mild or severe. Everyone has feelings of anxiety at some point in their life, you may feel worried or anxious about something that is important such as job interview, exam etc. This is quite normal. However, for some people their feelings of anxiety are constant and hard to control their worries which can affect their daily lives. Excessive or persistent anxiety can have a detrimental effect on your physical and mental health.

Generalised anxiety disorder (GAD): is a condition that makes one to feel anxious about a wide range of situations and issues, rather than one specific event. People with GAD feel anxious most days and have difficulty to relax. The symptoms include feeling restless or worried, or anxious, having trouble to concentrate or sleep, dizziness, tension on the chest, or heart palpitations. The exact cause of GAD isn't clear. Research suggested that overactivity in areas of the brain involved in emotions and behaviour is one of the causes; an imbalance of the brain chemicals serotonin and noradrenaline, which are involved in the control and regulation of mood is also a possible cause.

The symptoms of anxiety include restlessness, a feeling of dread and being on edge, difficulty concentrating, difficulty sleeping and being easily irritated. Anxiety increases breathing and heart rate, to increase blood flow to the brain which needs the energy to cope an intense situation. you might feel lightheaded and nauseous. Anxiety disorders can happen at any age, but they usually begin by middle age. Women are more likely to have an anxiety disorder than men. There are several types of anxiety disorders. They include: Generalized anxiety disorder (GAD) which is excessive worry about everything; Social anxiety disorder or social phobia which is a fear of social situations; Post-traumatic stress disorder (PTSD) which develops after witnessing or experiencing something traumatic; Obsessive-compulsive disorder (OCD) which is overwhelmed to perform particular rituals (compulsions) over and over again; phobias which is a fear of something extremely; panic disorder which causes panic attacks.

Acupuncture helps reducing anxiety

Acupuncture is used by many people to reduce their anxiety. Recent research has supported the application. A study investigated the effect of acupuncture and massage on anxiety. In this study anxiety levels were measured by a self-perception 5 points scale and at the end of the 5th and the 10th treatment. After a maximum of ten treatments, the levels of anxiety were reduced (98.39% after five sessions). Women at their tenth treatment reached lower anxiety levels than those of men.This study suggested that acupuncture is efficient to treat anxiety. A review analysed 13 publications for acupuncture on anxiety. They encourage using acupuncture for anxiety treatment with effective outcomes and fewer side effects than conventional treatment. The most common used acupuncture points for anxiety is Yintang(EX-HN 3), an acupoint located between the eyebrows.Recent research has shown that acupuncture is effective to treat anxiety. there were many studies all around the world on this aspect. A review analysed current data from 19 articles. These studies were done by many countries: the United States of America had the highest number of articles on this topic (31.6%), followed by Brazil (15.7%). In turn, Canada, the United Kingdom, and Australia presented the same production percentages (10.5%). Sweden, Turkey, Austria, and Israel also had the same production percentage (5.3%).The results from these studies show that the effects from acupuncture for treating anxiety have been shown to be significant as compared to conventional treatments.

A report comparing acupuncture with clonazepam in treating GAD. 80 patients were participated the study. 40 patients were acupuncture group and another 40 patients were in clonazepam group. Twelve medridians acuppoints were applied. Meaning quick needling at the apecific acupoints of each meridian for example, LU7, LI4 and HT7were applied. The total treatments were 6 weeks. Hamilton Anxiety Scal (HAMA) and brain activity were used to evaluate the effects. The improvements of the total HAMA scores could be seen in 2, 4 and 6 weeks in both group but the improvements were greater in acupuncture group. The brain activity was improved in both groups. This indicates that acupuncture could be a potential option for treatment of GAD.

Which part of the brain involved anxiety?

Everyone experiences fear and anxiety at some point in their lives. Constant fear and worry without specific stimulants are not normal. Which part of the brain is related to anxiety? Research has found that amygdala, a brain region deep inside of the brain that governs many intense emotional responses. Hyperactive amygdala causes inappropriate fear and anxiety. There are also other brain regions formed a network and involved in anxiety by communicating with amygdala. The frontal cortex and hippocampus are the parts of the network. A part of the frontal cortex called the dorsal anterior cingulate cortex (dACC), amplifies fearful signals coming from amygdala producing anxiety which is shown on the functional magnetic resonance imaging (fMRI). A different part of the frontal lobe, called the ventromedial prefrontal cortex, seems to reduce the signals coming from the amygdala. Patients with damage to this brain region are more likely to experience anxiety, since the brakes on the amygdala have been lifted. The hippocampus is the part of the brain that put threatening events into memories.

Functional magnetic resonance imaging (fMRI) is a new and effective tool to study brain activity. A study investigated the effect of acupuncture on the Amygdala and hippocampus. They compared the activity of these regions before and during acupuncture treatment. They found that acupuncture reduces Amygdala and hippocampus activities. There are also other studies showing that after acupuncture treatment these regions activities reduced. Acupuncture improves stress induce memory impairment and increases AchE activity in the hippocampus. Acupuncture reduces stress hormone level such as serotonin, noradrenaline, dopamine, GABA, neuropeptide Y and ACTH; Acupuncture increases production of endogenous opioids--endorphins that affect the autonomic nervous system decreasing the sympathetic nerve activities. Acupuncture reduces inflammation and stress induced changes. These researches provide evidence that acupuncture is effective to release stress, anxiety and mood changes.

Anxiety impairs immune function, acupuncture reverses it.

It is widely accepted that anxiety impaired immune system function. Immune system defended you from illness. If your immune system is compromised, it does no good to your health.

Arranz L et al studied the effect of acupuncture in 34 women aged 30-60 with anxiety diagnosed and impaired immune function. Acupuncture was performed manually on 19 acupoints. A single session 30 min was employed. Before acupuncture and 72 hours after acupuncture, immune function was measured by blood test. They found that the best effect was seen at 72 hours after a single acupuncture treatment. They also studied long term effect of acupuncture. 12 patients completed 10 sessions in a year until the anxiety symptoms disappeared. The immune function was measured after a month at the end of a year treatment. They found that the immune function in these women was returned to the level closed to that in healthy control women. This study suggested that acupuncture improve immune function in women caused by anxiety.

References

Arranz L et al Am J Chin Med (2007) 35:35-51

Zhou XF et al Zhongguo Zhen Jiu (2013) 33:395-8

Goyata SL et al Rev Bras Enferm (2016) 69: 602-609
Hu KK et al Auton Neurosci. 2010 Oct 28;157(1-2):81-90. doi: 10.1016/j.autneu.2010.03.022. Epub 2010 May 21.
https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/stress.html
Amorim D et al Complement Ther Clin Pract. 2018 May;31:215-219. doi: 10.1016/j.ctcp.2018.02.016. Epub 2018 Mar 1.
Amorim D et al Complement Ther Clin Pract. 2018 May;31:31-37. doi: 10.1016/j.ctcp.2018.01.008. Epub 2018 Jan 31.
Kwon CY and Lee B Med Acupunct. 2018 Apr 1;30(2):73-79. doi: 10.1089/acu.2017.1268.

Stroke rehabilitation, how can acupuncture help?

Can acupuncture help patients with stroke?

Stroke is a serious condition which blood supply to the brain is cut off. It is the second most common cause of death worldwide, and the leading cause of adult disability. Patients with mild strokes or rapidly improving symptoms usually have a good prognosis, while patients with major strokes have a poor prognosis. Acupuncture help reduce brain damage and brain recovery. The mechanisms are as follows: Acupuncture has anti-inflammatory effects and increases cerebral blood flow which would protect the brain from ischaemic injury; acupuncture reduces cerebral odema after cerebral ischaemia and protect neuron damage; acupuncture also regulates biochemical changes involved in post stroke condition. Acupuncture acts on brain region which reduces sensitivity to pain and stress and promotes relaxation reducing anxieties. There have been many researches published recently to support the effectiveness of acupuncture on stroke recovery. In China, stroke is treated with acupuncture. A survey of 1095 physicians from 247 hospitals in China between 1993 and 1994 has shown that 66% of Chinese doctors routinely used acupuncture to treat patients with stroke and 63% of them believed its effectiveness. Another survey in 2007 from patients with acute stroke has shown that 63% patients with stroke would choose acupuncture as part of medical intervention. Many researches were carried out to examine the effectiveness of acupuncture on stroke to support the clinical application of the interventions. Some research has shown that acupuncture can slightly help acute stroke by decreasing mortality rate and dependency at the end of long term follow up and improving neurological deficit scores. Acupuncture treatment for strokes has been listed as a proved effective treatment for stroke in world health organisation (WHO) website http://apps.who.int/medicinedocs/en/d/Js4926e/5.html.

Post stroke rehabilitation is an important part of the treatment of stroke to reduce disability and improve quality of life for patients with stroke. Available evidence suggested that acupuncture may be effective for treating poststroke neurological impairment and dysfunction

In Korea, integrative treatment is also used for patients with stroke. For inpatients, integrative management is applied at the request of the primary physician with consent of patients or their families. In the acute stage, neurologists or neurosurgeons take charge as the primary physicians. Korean medicine doctors cooperate as secondary physicians to the neurologists and neurosurgeons. When patients passed the acute stage, responsibilities are changed between primary and secondary doctors. The rehabilitation program is conducted under the supervision of rehabilitation medicine doctors. The most frequently used complementary and alternative medicines are acupuncture including manualacupuncture, electroacupuncture, and intradermal acupuncture, moxibustion, herbal prescriptions and acupuncture point injection. From their experiences, they believe the integration of complementary and alternative medicine and Western medicine have benefit for patients with stroke.

Acupuncture improves spasticity in post stroke patients

Post stroke patients can be seriously affected by many complications as handicaps, unclear consciousness, aphasia, dementia, psychological abnormalities and incomplete bladder emptying. Spasticity is very common in post stroke patients. Spasticity is a condition in which muscles are constantly tight and stiff. It could cause reduced flexibility, posture and functional mobility; it could also cause joint pain, muscle and joint shortening etc. In post stroke patients, muscle spasm in one side of the body are in constant contraction state is very common. The affected side of the body is rigid, weak and has low functional abilities. Treatment includes antispastic medication such as baclofen, diazepam etc. Physiotherapy including muscle stretching and exercises could help preventing muscle shortening and atrophy. Acupuncture is use to help stroke rehabilitation and it improves post stroke motor ability. Some research study showed that acupuncture reduces spasticity by stroke and maintain a reduced level of spasticity. A study showed that combining a 6 week electroacupuncture and standard rehabilitation treatment reduced the spasticity of the elbow for chronic post stroke patients. The effect depends on the acupuncture points chosen for the treatment to improve spasticity.

Recently a study investigated the effect of acupuncture on muscle spasm. In this study, 44 patients were allocated in acupuncture group in which patients received acupuncture combined with rehabilitation treatment while 42 patients were in control group in which patients received only rehabilitation treatment. The key acupuncture points selected were from head, face, chest, abdomen, shoulder, back, hands, feet and ankles. Routine limb rehabilitation program was applied to both groups. One course included 10 treatments and two courses were performed in total. The effective rate of antispasm was 90% in acupuncture group which was superior to control group (73.8%). The improvement of motro function was significantly greater in acupuncture group. This study showed that acupuncture combined with rehabilitation therapy effectively relieves the muscle spams in post stroke patients, improves the limb function and the life activity.

References

Tong S Zhongguo Zhen Jiu (2013) 33:399-402

Bi-huei Wang et al Clin Interv Aging (2014) 9:147-156

Zhang JH et al Neuroepidemiology (2014) 42:50-8

Park SU et al Complement Ther Clin Pract (2014) 20:37-41

Acupuncture helps hemiplegia in post stroke patients.

Hemiplegia which is severer than hemiparesis is paralysis of one half of the body on the same side. Brain damage is one of the causes. The paralysis occurs on the opposite side of the damaged brain. For example if one has an injury to the right side of the brain, the hemiplegia will be on the left side of the body. It is a common post stroke complication. Acupuncture is used in hemiplegia treatment in China. There was a study that investigated the immediate effects of acupuncture at GB34 acupoint on passive movement in stroke patients with hemiplegia using modern technique MRI to provide reference for clinical treatment. Six patients with right brain stroke and left hemiplegia in recovery stage were selected and scanned during passive fingers movement before and after acupuncture at acupoint GB34. The activated areas of the passive movement in all the patients were mainly motor sensory cortex on the right side. Compared with sham control, acupuncture had better effect on activating brain motor related network. This study used advanced technique and demonstrated that acupuncture is potential treatment method for hemiplegia in post stroke patients.

Treating upper limb hemiparesis with acupuncture and other interventions

Hemiparesis is a common complication for stroke survivors. The intervention for the conditions is aimed to improve quality of life for these patients. Pulman and Buckley from University of Liverpool UK reviewed the efficacy of different upper limb hemiparesis interventions on improving health-related quality of life in stroke patients. This is their findings:

Of the 22 studies, 12 reported significant findings within groups and between control groups. Interventions including BTX-A injections, CIMT, exercise programs, baclofen pump, robotic-assisted therapy, electrical stimulation, and acupuncture were reported to significantly improve either overall health-related QOL or certain individual QOL domains, such as strength, hand function, memory, mood, activities of daily living, mobility, social participation, communication, energy, pain, and sleep.

Example of acupuncture improves limb function in post stroke patients

Scalp acupuncture is that the needles are inserted in the acupuncture points on the scalp, while body acupuncture is that the needles are inserted in acupuncture points on the body. Both types of acupuncture are combined to treat stroke in China. Recent research showed the effectiveness of combined scalp and body acupuncture on limb function in stroke patients. Tang et al studied the effect of acupuncture n limb function in subacute stroke patients using scalp and body acupuncture. These patients were treated by routine neurological therapies. After 20 days, the limb function was better improved in acupuncture plus routine treatment group than that routine treatment only group. There were no significant differences between two groups in the ratios of mortality/disability and recurrence rates at the end of 3 and 6 months follow-up. He et al also studied the combined application of scal and body acupuncture on limb function in stroke patients. They also found better improvement in lower limb function in acupuncture group. After 8 weeks treatment, the walking ability rate in acupuncture group wa higher than that in the control group. The walking speed in the acupuncture group was faster than that in the control group.

Acupuncture point injection of herbal extract and floating acupuncture helps post stroke shoulder pain.

Shoulder pain is very common after stroke. It can be treated with pain killers, steroid injections, positioning and handling, shoulder strapping, electrical stimulation. Recently acupuncture point injection of herbal extract on post stroke shoulder pain was studied. There were 24 patients participated the study. Acupuncture points injection of herbal extract was carried out three times a week for 2 weeks. The effects of treatment were assessed with a numerical rating scale (NRS), painless passive range of motion (PROM) of external shoulder rotation, and the motor function assessment (FMMA). The acupuncture point injection group showed significant improvement on the NRS compared with that for control group after 2 weeks of treatment. PROM decreased significantly in both groups with greater pain reduction in treatment group. This study showed that acupuncture point injection of herbal extract was an option for patients with post stroke shoulder pain. Another study compared acupuncture with medicine and herbs for shoulder pain in post stroke patients. They found that shoulder pain was relived and the daily life activity was improved in the patients with post stroke using floating acupuncture technique. The pain relief was superior to the oral western medicine mobic and local Chinese herbs fumigation.

Current situation of stroke with acupuncture treatment

There is an increase in interest in using acupuncture on stroke and its effectiveness. Much of the recent research has been carried out in the Scandinavian countries and the USA. In China many studies have compared different techniques and point combinations which often involved in very large numbers of patients. The studies carried out so far have developed a variety of methods and are strongly indicative of therapeutic benefit, though the precise details of acupuncture treatment given are not always clearly stated in the studies. And there was lack of standardization in the treatments. Recently Wu et al analysed recent existing data to investigate the spectrum of acupuncture points in post stroke patients treated with acupuncture and moxibustion. They collect 652 clinical research papers. They found 143 nonacupuncture points were used and the application frequency were 737; 253 acupuncture points were used and the application frequency were 5395. According to application frequency, the acupuncture points were divided into often used points (23points); sometime used points (100 points) and less used points (130 points). Apparently there was lack of standardization in stroke treatment with acupuncture. The selected acupuncture points were distributed in fourteen meridians and most common used meridians were Yangming and Shaoyang.

References

Wu et al Zhonguo Zhen Jiu (2013) 33:547-52

Si WJ et al Zhongguo Zhen Jiu (2013) 33:131-6

Seo YR et al Evid Based Complement Alternat Med (2013) 2013:504686

Wang J Zhongguo Zhen Jiu (2013) 33:294-8

Pulman and Buckley Top Stroke Rehabil (2013) 20:171-88

Tang et al Zhen Ci Yan Jiu (2012) 37:488-92

He et al Zhongguo Zhen Jiu (2012) 32:887-90



Acupuncture is effective with post-stroke constipation

Acupuncture could help motor function, cognition, speech problems, shoulder pain, urinary incontinence, constipation, depression, fatigue and dysphagia etc.

Constipation can occur after a stroke. This is because you are not drinking enough liquids and you are in bed most of the time; or you are taking certain medicines as part of your treatment. If you have constipation, drink extra water and set a regular time for using toilet. Acupuncture can help post stroke constipation. There is a case report about treating post stroke constipation using acupuncture. There were 39 patients with post-stroke constipation received acupuncture treatment for 2 weeks and another 35 patients with post-stroke constipation received Chinese herb medicine Shengrue Tongbian Capsules for 2 weeks. After two weeks treatment, constipation symptoms were improved in these patients received both acupuncture and Chinese medicine. The improvement was greater in patients with acupuncture treatment. Acupuncture was potential treatment option for patients with post-stroke constipation.

Acupuncture could help post-stroke urinary incontinence.

Urinary incontinence is the unintentional passing of urine. This is a common problem in patients with stroke. In China, acupuncture is used to treat this problem. Recent clinical research compared the effect of acupuncture with that indwelling catheter. Acupuncture was received 5 times a week. The points used included Qugu (CV2), Zhongji (CV3), Shuidao (ST28, Qihai (CV6) and Guanyuan (CV4) etc. The effect was compared after 4 weeks of treatment. The urinary diary (including the interval of urination, nocturia frequency, urination difficulty, urinary incontinence severity), bladder capacity, patients’s satisfaction were assessed before and after the treatments and compared between the two groups. After treatments, the effects were observed in both groups with better effect in acupuncture group especially in total score, the patients’ satisfaction and bladder capacity. Acupuncture is potential treatment option for post stroke urinary incontinence.

Acupuncture has potential benefit for stroke patients with incomplete bladder emptying

Urinary retention and incomplete bladder emptying (IBE) are not uncommon in patients with stroke rehabilitation. This significantly increased the risk of urinary infection. Recently there was a study investigating the effect of acupuncture on IBE. The patients selected were diagnosed with infarction or hemorrhagic stroke for the first time; they did not suffer from an active urinary tract infection. During the study period, these patients continued to receive conventional therapy without major changes of medication. These patients received acupuncture five times a week for two weeks. Among the 49 patients in the study, nine (18%) had IBE, and seven of the stroke patients with IBE were treated with electroacupuncture. Increased spontaneous voiding volume and decreased PVR urine volume were noted after ten sessions of acupuncutre. They suggested electroacupuncutre may have beneficial effects on stroke survivors with IBE. Acupuncture is a potential intervention to improve urinary function.

Acupuncture for ischemic stroke

Most stroke (87% cases) is ischemic stroke which caused by blood clot blocking blood vessel in the brain. The blood clot can form in the blood vessel in the brain or it formed elsewhere and travelled to the vessel in the brain which cannot pass because the vessel is too narrow to pass. Loss of blood supply damages brain function. The recovery of brain function such as speech and walking was attributed to reduction of inflammation in the brain region of damage and rewire of the area. Recently a randomised controlled trial from China studied efficacy of integrated rehabilitation techniques of Chinese Medicine for ischemic stroke. They used acupuncture combined with massage techniques and compared this with conventional rehabilitation technique. They compared the related parameters on day 0, day 21 and day 90. They found better improvement in acupuncture and massage compared with baseline and conventional technique. They suggested there is potential benefit from acupuncture and massage for ischemic stroke rehabilitation.

Acupuncture is beneficial for cognitive function in post stroke patients

Jing well points are very powerful points located at the end of fingers and toes. These points are very often used to treat stroke. Temple points on the side of the head are also used for stroke in China. Recently a research showed that these points are beneficial for patients with early vascular congnitive impairment in China. They compared acupuncture at Jing well points and temple points and conventional treatment in patients with stroke. They observed improvement with acupuncture treatment but not conventional treatment. This indicates that acupuncture has potential to improve cognitive function in post stroke patients with mild cognitive impairment.

Acupuncture for post stroke depression

Patients with stroke not only suffer from physical disability but also emotional problems. Post stroke depression (PSD) is very common in patients with stroke in different stages. PSD is linked to increased disability, and poor functional and cognitive outcomes of stroke survivors. Reducing PSD could improve quality of life in patients with stroke. Anti-depression drugs could used to treat PSD. Because of their side effects, combination drugs and non drug treatments were recommended. Acupuncture is one of therapies without drugs, but its use in PSD is still in debate. Recently a pilot study investigated whether acupuncture is an effective treatment for PSD and whether the effect of acupuncture differs according to the degree of motor function impairments of the stroke patients. In this study 28 PSD patients were assessed and participated the study. They were treated with acupuncture every day for 16 weeks. Depression status was significantly improved during the treatment sessions. The depression of the good motor function groups was significantly more reduced than that of the poor motor function group. This study indicates that acupuncture therapy can improve PSD and that the effects depend on the degree of motor function impairment.

Another research from China studied the combination of herbs and acupuncture for post stroke depression. They compared herbs plus acupuncture with western medicine fluoxetine hydrochloride for treating post stroke depression. The treatments were given for four weeks. On six month followup, improvement was seen in herbs plus acupuncture and western medicine treatment with greater improvement in herbs plus acupuncture.

There was also study combined acupuncture and moxibustion or antidepression medication (using aroxetine hydrochloride tablets) on post stroke patients with depression. They compared the efficacy of medication only, acupuncture plus moxibustion and acupuncture plus medication. Daily acupuncture except weekends was offered for 4 weeks. The improvement of depression was superior in acupuncture plus medication group and acupuncture plus moxibustion group to medication only group.

Acupuncture helps post stroke swallowing difficulty

Swallowing difficulty can be present in post stroke patients. This problem is treated with acupuncture in China. Recently Zhou et al studied the effect of acupuncture on post stroke swallowing problem using modern research methods to provide evidence from conventional medicine point of view. They combined acupuncture with rehabilitation training program. There were 80 patients with post stroke swallowing difficulty. 40 patients were in control group treated with conventional approach and other 40 patients in acupuncture group treated with acupuncture. After treatment, assessment was carried out. They found there were improvements after the treatments in swallowing tests for both groups compared with those before the treatments. The improvements in acupuncture group were significantly greater. This showed that acupuncture is a potential effective treatment for swallowing difficulty in post stroke patients.

References

Yu KW et al Clin Interv Aging (2012) 7:469-74

Song et al Zhongguo Zhen Jiu (2013) 33:769-73

Ren et al Zhongguo Zhen Jiu (2013) 33:893-6

Youn JI et al J Phys Ther Sci (2013) 25:725-8

Hu JF et al Zhongguo Zhong Yao Za Zhi (2013) 38:2403-5

Nie and Huang Zhongguo Zhen Jiu (2013) 33:490-4

Li F et al Zhongguo Zhen Jiu (2013) 33:784-8

Zhang et al Am J Chin Med (2013) 41:971-81

Zhou XM et al Zhongguo Zhen Jiu (2013) 33:587-90

Saturday, 30 July 2022

How does acupuncture assist fertility-IVF success?

Infertility is defined as failure to achieve pregnancy after 12 months of regular and unprotected sexual intercourse. Approximately 15% of couples worldwide are affected by infertility which is caused by various factors. In vitro fertilization (IVF) is one of the therapeutic options for couples with infertility, however IVF success rate is not 100%. Acupuncture can activate nerve fibers and peripheral afferent receptors, produce sensory interactions at various levels of the central nervous system, and release various transmitters and modulators, thus producing anti-inflammatory signals as well as neuroendocrine and neuroimmune signals. Acupuncture is one of the candidates that applied during IVF procedure to increase its success rates.

The mechanisms of acupuncture related to application of IVF is

1, modulating neuroendocrine factors. Acupuncture improves female infertility through modulation of the hypothalamic–pituitary– ovarian (HPO) axis, estrogen regulation, and increased ß-endorphins to correct the imbalance of the endocrine system. Acupuncture can stimulate ovulation through modulation of the HPO axis in women with anovulatory infertility.

2, increasing blood flow to the uterus and ovaries. As a result, acupuncture increases endometrial and follicular receptivity, and also helps repair the endometrial lining; it improves the quality of oocytes produced by the follicles. Acupuncture can reduce uterine contractility to prevent embryo expulsion after ET. Therefore, Acupuncture increases pregnancy rates in patients undergoing IVF.

3, modulating immune factors. Acupuncture moudlates immune system. I-helper cells are a type of immune cells which is related to pregnancy and is affected strongly by pregnancy hormones. If there is a dysregulation of T-helper cells systemically and locally, pregnancy failure will occur. Acupuncture has been reported to increase T-helper cells both locally and systemically, thus, increasing pregnancy rates.

4, reducing stress, anxiety. During IVF procedure, a woman’s psychological status affects the IVF success rate greatly. Acupuncture is very effective for reducing stress and anxiety caused by changes in the cortisol hormone and the psychologic effects of IVF itself. This is because acupuncture modulates neuropeptide in the amygdala, increasing ß-endorphin production, suppressing the system’s sympathetic nerves, increasing vagus-nerve activity, and increasing levels of neurotropic factors in the hippocampus. In addition, acupuncture affects the hypothalamic–pituitary– adrenal axis so to change the physiologic response to stress.

Recent research provided more evidences for acupuncture supporting IVF

Acupuncture for in vitro fertilization in women with poor ovarian response

Poor ovarian response (POR) is one reason for infertility. Poor ovarian response (POR) has been accepted as a predictor of delivery in women over 40 undergoing IVF. The criteria of diagnosis of POR are: 1) advanced maternal age (≥40 years) or any other risk factor for POR; 2) a previous POR (≤3 oocytes after a conventional stimulation protocol); or 3) an abnormal ovarian reserve test (i.e., antral follicle count (AFC) <5-7 follicles or anti-Mullerian hormone (AMH) <0.5-1.1 ng/ml). AMH is used as a predictor for ovarian reserve, and a higher level of AMH tends to increase during natural pregnancy. Low AFC is the basis for diagnosing POR, and AFC testing is more accurate than basal follicle stimulating hormone (FSH) testing for women aged over 44 years in predicting IVF outcome.

Acupuncture has been used to treat infertility and has been very popular in assist IVF. This is because it improves the endometrium, promotes ovulation, and reduces pain during egg retrieval, and improves fertilization rates. Consequently it increases pregnancy rates in women undergoing IVF. A study evaluated the effectiveness of acupuncture in improving clinical pregnancy rate (CPR) after IVF, in women with POR from randomized controlled trials (RCTs). Their result has shown that clinical pregnancy rate is 37.8% in acupuncture group vs 24.3% in control group. This study suggests that acupuncture may improve CPR, AMH, AFC and the number of retrieved oocytes in women with POR undergoing IVF.

Research shows that acupuncture combined with medication improves endocrine hormone levels and ovarian reserve function in poor ovarian response patients undergoing in vitro fertilization-embryo transplantation

This research has studied the clinical effect of acupuncture plus medication in the treatment of poor ovarian response (POR) patients.

A total of 100 volunteer POR women undergoing in vitro fertilization-embryo transplantation (IVF-ET) were recruited and were randomly divided into control, medication (Climen, composed of estradiol valerate and cyproterone acetate), acupuncture and acupuncture+medication (combined treatment) groups. Patients of the medication group were asked to orally take Climen (1 tablet/d for 21 days) beginning from the 3rd day of the menstruation, which was repeated for 3 menstrual cycles. Patients of the acupuncture group received manual acupuncture stimulation of Guanyuan (CV4), and bilateral Taixi (KI3), Sanyinjiao (SP6) of and Tai-chong (LR3) from day 8 to 15 of menstruation (follicular phase), once daily for 3 menstrual cycles. On the 2nd day of menstruation of the cycle, the ovarian reserve function was detected, including measurement of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) contents. At the end of ovulation induction, the assisted pregnancy indexes and outcomes were studied, including administration of dosage and days of gonadotropin (Gn), the diameter of dominant oocyte, level of E2 on the trigger day, the numbers of ultrasound-guided-retrieved oocyte and the cultivated high-quality embryo (grade 1 and 2).

Their result has shown that after the treatment, the contents of serum FSH, LH and E2 in the medication, acupuncture and combined treatment groups were significantly reduced and the content of serum AMH and ovary AFC in the medication, acupuncture and combined treatment groups were obviously increased in comparison with their own pre-treatment or with the control group. The group with medication plus acupuncture has the lowest levels of FSH, LH and E2. The dosage of Gn in the combined treatment group and the number of Gn administration days in the acupuncture and combined treatment groups were significantly fewer; serum E2 levels on the trigger day in the medication, acupuncture and combined treatment groups, and the high-quality embryo number in the combined treatment group were considerably higher. The high-quality embryo number in the combined treatment group was significantly larger.

Research added evidence that acupuncture increased pregnancy success rates for women with unexplained infertility undergoing IVF.

A recent research studied the effect of acupuncture on pregnancy success rates applied before and after embryo transfer (ET) among women undergoing in vitro fertilization (IVF). Three sessions of acupuncture were offered to the 36 women with unexplained infertility undergoing IVF; another 36 women with unexplained infertility without acupuncture were in the control group. Acupuncture was applied a week before embryo transfer and 30 min before and after embryo transfer. Pregnancy rate and anxiety level were measured in the result. The result has shown that clinical pregnancy, ongoing pregnancy, and live birth rates were significantly higher in the acupuncture group compared to the control group. The anxiety level was significantly lower in the acupuncture group.

Very recently, C Smith group published a review to analyse the research data to study acupuncture performed around the time of embryo transfer. This is a systematic revie and meta-analysis to examine the efficacy, effectiveness and safety of acupuncture as an adjunct treatment to embryo transfer. 20 trials and 5130 women were included in the review which is not a small sample study. The result found that there are increased pregnancies, live births and reduced miscarriage when acupuncture was compared with no adjunctive control, but no significant differences between acupuncture and sham controls. They suggested that acupuncture may have a significant effect on clinical pregnancy rates, independent of comparator group, when used in women who have had multiple previous IVF cycles, or where there was a low baseline pregnancy rate. The findings suggest acupuncture may be effective when compared with no adjunctive treatment with increased clinical pregnancies, but is not an efficacious treatment when compared with sham controls, although non-specific effects may be active in both acupuncture and sham controls.

References

Djaali W Med Acupunct. 2019 Dec 1;31(6):361-365. doi: 10.1089/acu.2019.1394. Epub 2019 Dec 13.

Guven PG et al Taiwan J Obstet Gynecol. 2020 Mar;59(2):282-286. doi: 10.1016/j.tjog.2020.01.018.

Dong XLet al Zhen Ci Yan Jiu. 2019 Aug 25;44(8):599-604. doi: 10.13702/j.1000-0607.180779.

Jang S et al Integr Med Res. 2020 Jun;9(2) Epub 2020 Feb 27.

https://www.sciencedirect.com/science/article/pii/S1472648318306758

Having sciatic pain? What to do?

The sciatic nerve is the longest nerve in the body and begins from nerve roots in the lumbar spinal cord in the low back and runs through the buttock area down to the lower limb ending at the feet. Sciatic pain is caused by irritation of the sciatic nerve. Anything that irritates this nerve can cause pain, ranging from mild to severe. It is one of the causes for low back pain.

Sciatic pain or Sciatica is an extremely common pain condition and is estimated to affect around 5 percent of men and 4 percent of women in their lifetimes.

The main symptom is a shooting pain anywhere along the sciatic nerve; from the lower back, through the buttock, and down the back of either leg. The pain may be stabbing, burning or shooting. It can be also accompanied with tingling like pins and needles, or numbness, and muscle weakness. The most typical symptom is unilateral leg pain radiating to the foot or toes that is greater than low back pain. It may involve increased pain on straight leg raising and neurological symptoms limited to one nerve root. The pain may last just a few days or for months or years. The pain often gets worse over time and may also be made worse by: sneezing, coughing or laughing, standing or sitting for a long period of time, bending backwards. The treatment for sciatica is primarily aimed at pain control. Early treatment can help release the pain quicker.

Many studies investigated the effect of acupuncture on sciatica. For example, a study involved with 962 patients with sciatica has shown that acupuncture significantly released sciatic pain and related other symptoms. Acupuncture was more effective than pain killers NSAIDs (ibuprofen, meloxicam, and diclofenac). Another study involved with a total of 1842 patients with sciatica has also shown that acupuncture reduces sciatic pain significantly and reduction of pain was greater than conventional medication such as ibuprofen as mentioned above. Acupuncture is clinically effective, reduces pain intensity, and increases pain threshold in patients with sciatica.
Another study examined the effect of acupuncture in treating sciatica. 57 patients with non-acute sciatica aged 35-70 were recruited. The acupuncture treatment was administered twice weekly for 4 weeks. The pain was measured before and 4 weeks after acupuncture treatments. Result has shown that the pain is significantly improved for all patients. They suggested that acupuncture is safe and may effectively relieve symptoms and disability in patients with non-acute sciatica.

How does acupuncture work? Acupuncture stimulates inhibitory nerve fibers for a short period, reducing transmission of pain signal to the brain. Acupuncture also activates endogenous analgesic mechanisms causing secretion of endorphin which is an endogenous opioid and triggering release of adenosine producing a rapidly effective analgesic action on radicular sciatica. Extensive research has shown that acupuncture analgesia may be initiated by stimulation of high-threshold, small-diameter nerves in the muscles.

References

Liu CH et al J Pain Res. 2019 Dec 31;12:3511-3520. doi: 10.2147/JPR.S210672. eCollection 2019.
Qin et al Evid Based Complement Alternat Med. 2015;2015:425108. doi: 10.1155/2015/425108.
Ji m et al Evid Based Complement Alternat Med. 2015;2015:192808. doi: 10.1155/2015/192808.

Friday, 29 July 2022

Unexplained fertility? what does it mean? Can acupuncture help?

Acupuncture is effective for unexplained infertility

What is infertility? Infertility is defined as inability to conceive after 1 year of regular unprotected intercourse. It is 6 months with women older than 35 years. If you were told that you had unexplained infertility, what does that mean? If you have difficulty to conceive for some time, you would be put on some tests to evaluate the underlying causes for the infertility. There is some standard infertility evaluation. It includes a semen analysis, assessment of ovulation, and a hysterosalpingogram (to detect uterine and fallopian tube pathology); ovarian reserve and laparoscopy are further tests that could be done to examine function of reproductive system. When these results are normal, you would be diagnosed unexplained infertility which means that there are no underlying causes for your infertility found. Are there many people suffer from this condition? Yes. 1 in 6 couples are seeking specialist help in trying for a baby. There are about 30% of infertility is unexplained which means the causes for the infertility are unknown. This diagnosis will be based on a series of fertility tests without revealing any abnormality. The frustrating thing is that there is no reason for the infertility, how can you improve the fertility? Change life style? Many people have already had a very healthy life style, good nutritious diet. They do exercises regularly. General health is good. Nothing on this aspect needs to be improved. What causes their reproductive system problems?

Research showed that subclinical pelvic inflammatory disease (PID) is very common in women. Women with undetected subclinical PID have no symptoms, but the pathological mechanisms are similar to those of acute PID. Wiesenfeld et al studied whether women with subclinical PID are at an increased risk for infertility. They found that women with subclinical diagnosed at enrolment had a 40% reduced incidence of pregnancy compared with women without PID. Undetected subclinical PID could be one of the unfound causes for infertility. Subclinical conditions do not cause symptoms but they make reproductive system not functioning properly causing infertility. Embryos are so delicate and they cannot survive in any unfavourable environment.

Genetic reasons, there are many inflammation events going on in women’s reproductive system. Women’s body has an ability to clear this inflammation very quickly, but some women have difficulty to clear the inflammation in their reproductive system. This may affect their ovarian function including egg quality and poor microenvironment. As a result, they present difficult to get pregnant.

Stress, having been trying to conceive for a long time without success makes those couples stressed. Furthermore they are told that the reasons for the difficulty of conceiving are not clear and the diagnosis of the infertility is unexplained. This makes them more stressed. At least some unexplained infertility is caused by stress and all of this stress mentally and physically also makes the condition worse. Stress makes hormone unbalanced and this affects egg development in female and sperm development in male resulting poor quality of eggs and sperms. This makes low fertilization rate and low quality of embryo.

Do you need to be treated to get pregnant, if you were diagnosed unexplained infertility? Is there a chance to get pregnant on your own without any treatment? What treatments are available for unexplained infertility? Yes, you do need treatment. Many studies showed that the pregnant rate was 1.3 to 4.1% in the untreated group with unexplained infertility. This was lower than most treatment intervention. You have more chances to get pregnant with less than two years duration of unexplained infertility and fewer chances when the duration of infertility exceeds three years and greater than 35 years of age. The duration of infertility is important. The longer the infertility, the less likely the couple is to conceive on their own. With infertility 1 year duration, the couple have 20% chances to get pregnant after a year on their own. After 5 year infertility, the chances dropped to less than 10% without any treatments.

What treatments are available for couples with unexplained infertility? There are some treatment approaches available for unexplained infertility, but they are empiric. The standard protocol is to start from low technology to high technology treatment options. There is no evidence showing that any one treatment is better than the other. The treatment of unexplained infertility is dependent on availability of resources and patients’ age and duration of infertility.

Here are some treatment options:

Controlled ovarian hyperstimulation (COH) and Intrauterine insemination (IUI): To maximize the chance of fertilization, COH and IUI have been used. COH involves medications stimulating the development of multiple eggs of the ovaries in one single cycle, resulting in multiple ovulations. Both clomiphene citrate and gonadotropins have been used for COH. This expects more eggs available for fertilisation. IUI involves placement of washed sperms into uterine cavity around the time of ovulation. IUI may increase the density of motile sperm available to ovulated eggs. There has been a marked increase in the use of COH with or without IUI in the treatment of unexplained infertility over the past decades.

In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI): IVF is most expensive, but also most successful treatment of unexplained infertility; it could be done with or without ICSI. IVF involves stimulating multiple eggs to develop; egg collection to get eggs; fertilising the eggs in the laboratory; and embryo transfer to the uterus. ICSI involves picking up individual sperm and injecting the sperm into the cytoplasm (the inner part) of the egg. The same procedure as IVF in women is also involved.

About ten years ago Guzick DS et al from University of Rochester New York analysed the efficacy of alternative treatments for unexplained infertility from 45 published reports. They found that combined pregnancy rates per initiated cycle were IUI 3.8%, clomiphene citrate (CC) 5.6%, CC + IUI 8.3%, gonadotropins (hCG) 7.7%, hCG + IUI 17.1%, IVF 20.7%. More recently research also showed that IVF is more effective technique for unexplained infertility treatment.

Is acupuncture effective for unexplained infertility? Yes, acupuncture is effective and it is one option for couples with unexplained infertility. Acupuncture is playing an important role in infertility treatment. The treatment for infertility with acupuncture increased fivefold in 10 years time. Currently there are many researches show that acupuncture stimulates brain to improve hormone balance. Acupuncture is well known to produce endorphins in brain releasing pain and also affect the levels of pituitary and ovarian hormones which regulate ovulation. Acupuncture stimulates nerve ending, as a result it improves reproductive system blood flow. Subsequently egg quality and ovulation are improved, fallopian tube spam is released, intrauterine environment is more suitable for embryo implantation and growth. Acupuncture regulates immune function to benefit fertilized eggs survival. Acupuncture also increases in sperm count and improves sperm quality in men suffering from infertility. Acupuncture can help reduce stress both in women and men. After a few month acupuncture treatment, women have better quality of eggs and men have better quality of sperms. Better fertilization and good quality of embryos will be obtained.

Acupuncture is also a useful tool for IVF support to increase IVF success rate because of high quality of eggs and sperms. Acupuncture increases two fold of the pregnancy rate of IVF, if acupuncture is performed during IVF treatment. A study has shown that when combining IUI with acupuncture treatments, 65.5 per cent of the test group pregnancy rate was achieved, compared with 39.4 per cent of the control group, who received no acupuncture therapy. These are major benefits of acupuncture

Here are some case studies showing the effectiveness of acupuncture for unexplained infertility.

There is a report in Chinese for effectiveness of acupuncture on unexplained infertility. 58 patients with unexplained infertility were included in acupuncture group. The age was from 26-38 and trying to conceive from 2-5 years. 41 patients had primary infertility and 17 patients had secondary infertility. All patients had normal fertility evaluation. After 3-5 period cycles of acupuncture treatment, 42 patients achieved pregnancy. Following is a typical case. A 26 year old woman was trying to conceive for 4 year without success. Her period was normal but she had a severe period pain. All fertility tests were normal and the diagnosis was unexplained infertility. After 4 month acupuncture treatment, she was pregnant and gave birth to a lovely girl.

There was a study using acupuncture to treat explained infertility.104 women with unexplained infertility were involved in this study. The age of participants was from 26 to 41 and the average age was 32. The length of history of infertility was from 20.8 to 50.3 weeks with average 33.5 weeks. 41 participants (39.4%) had undergone an assisted reproductive technology (ART) treatment before joining the study. The average number of the ART treatments was 1.4 cycles. Acupuncture were offered for 6 month. At the end of the study, 60% of the patients achieved pregnancy.

Acupuncture increased pregnancy success rates for women with unexplained infertility undergoing IVF

A recent research studied the effect of acupuncture on pregnancy success rates applied before and after embryo transfer (ET) among women undergoing in vitro fertilization (IVF). Three sessions of acupuncture were offered to the 36 women with unexplained infertility undergoing IVF ; another 36 women with unexplained infertility without acupuncture were in the control group. Acupuncture were applied a week before embryo transfer and 30 min before and after embryo transfer. Pregnancy rate and anxiety level were measured in the result. The result has shown that clinical pregnancy, ongoing pregnancy, and live birth rates were significantly higher in the acupuncture group compared to the control group. The anxiety level was significantly lower in the acupuncture group.


References

Wiesenfeld H et al Obstet Gynecol (2012) 120:37-43

Ray A et al Reprod Biomed Online (2012) 24:591-602

Hopton AK et al Acupuncture in practice: mapping the providers, the patients and the settings in a national cross-sectional survey. BMJ Open. (2012)11:2-9

Yu Ng et al Fertility and Sterility 2008, 90: 1-13

Gnoth C et al Hum Reprod (2005) 20:1144-7

Guzick DS et al Fertil Steril (1998) 70:207-13

Pandian Z et al Cochrane Database Syst Rev (2012) 4:CD003357

Park JJ et al J Altern Complement Med (2010) 16:193-8
Guven PG et al Taiwan J Obstet Gynecol. 2020 Mar;59(2):282-286. doi: 10.1016/j.tjog.2020.01.018.

How to get rid of bladder pain?

Bladder is located in the lower abdomen and it is for storing urine. As the urine goes into the bladder, bladder muscles relax so that it can expand. As the bladder empties during urination, the muscles contract to squeeze the urine out through the urethra.

Some condition can cause bladder pain. It is very painful as urinate. The most common condition causing urination pain is interstitial cystitis. Interstitial cystitis (IC) is a chronic condition in which the bladder becomes inflamed and irritated. The inflammation stiffens the bladder wall, and makes it difficult for the bladder to fully expand when filling with urine. Patients with IC have painful urination and have to urinate more frequently and have a feeling of urgency to urinate, though there is no much urine each time. The main symptom of IC is pain which is generally located in the lower back, abdomen or groin region. Bladder pain is often recurring.

Acupuncture is effective for interstitial cystitis/bladder pain syndrome

Interstitial cystitis (IC)/bladder pain syndrome (BPS) is a chronic bladder condition. It is a feeling of pain and pressure in the bladder area and the symptoms have lasted for more than 6 weeks, without having an infection or other clear causes. Symptoms range from mild to severe. For some patients the symptoms may come and go, and for others they don't go away. The pain may be worse when the bladder is full and may be temporarily relieved after urination. The pain could be worse during periods or after having certain foods or drinks. IC/BPS is not an infection, but it may feel like a bladder infection. Women with IC/BPS may feel pain when having sex. Some patients feel pain in other areas, such as the urethra, lower abdomen, lower back, or the pelvic or perineal area (in women, behind the vagina and in men, behind the scrotum). Women may feel pain in the vulva or the vagina, and men may feel the pain in the scrotum, testicle, or penis. This condition is poorly understood.

Apart from the pain, it is also accompanied with problems of urination. Another common symptom is urinary frequency. Frequency is the need to pass urine more often than normal. A patient with IC/BPS often has to urinate frequently both day and night, more frequent urination than normal, pain when passing water, waking up quite a few times during the night to urinate. The average person urinates no more than 7 times a day and does not have to get up at night more than once to use the bathroom. Urgency to urinate is also a common IC/BPS symptom. Some patients feel sudden, strong urges to urinate and an urge that never goes away, even right after voiding. Physical or mental stress can make the symptoms worse.

The exact cause of interstitial cystitis isn't clear. Unlike other types of cystitis, there's no obvious infection in the bladder and antibiotics don't help.

The European Society for the Study of Interstitial Cystitis/Bladder Pain Syndrome in 2008 defined bladder pain syndrome (BPS) as pelvic pain, pressure or discomfort perceived to be related to the bladder, lasting for at least 6 months, and accompanied by at least one other urinary symptom. Urinary symptoms include the persistent urge to void or frequency, in the absence of other identifiable causes. The International Urogynaecological Association (IUGA) and the International Continence Society (ICS) produced a joint report on terminologies by Haylen et al. in 2010, defining bladder pain as a complaint of supra pubic or retro-pubic pressure, discomfort or pain, associated with the bladder, generally aggravated by bladder filling. The symptom may persist or alleviate after voiding. An estimated 400,000 people in the UK suffer from BPS, the majority being women. There is no definitive evidence to support an autoimmune, inflammatory, structural or infectious aetiology. Consequently, treating these patients is often challenging.

Acupuncture can effectively treat IC/BPS syndrome. This is studied by many researchers.

For example, recently research studied the effect of acupuncture for IC/BPS syndrome. In this study, 12 female patients with IC/BPS syndrome received 10 sessions of acupuncture. The visual analog score (VAS), interstitial cystitis symptom index (ICSI), interstitial cystitis problem index (ICPI), O'Leary-Saint symptom score (OSS), Patient Health Questionnaire (PHQ9), Pelvic pain and urgency & frequency patient symptom scale tests (PUF) and maximum voided volume (MVV) was completed in 1st, 3rd, 6th and 12th months following the treatment. The result has shown that there was a statistically significant decrease in all of the scores evaluated at first month compared with the baseline. While the change in VAS score in 1, 3, 6 and 12th months were found statistically significant. Response to treatment for the first three months after acupuncture application was (100%). They concluded that acupuncture appears to be an effective, useful, non-invasive method in IC/BPS patients. A study reviewed a recent research papers and found that acupuncture significantly reduces the 24-h urinary frequency and pain score.

A recent research studied the effect of acupuncture for bladder pain. 12 female patients with bladder pain received 10 sessions of acupuncture twice a week.

The following signs were monitored including visual analog score (VAS), interstitial cystitis symptom index (ICSI), interstitial cystitis problem index (ICPI), O'Leary-Saint symptom score (OSS), Patient Health Questionnaire (PHQ9), Pelvic pain and urgency & frequency patient symptom scale tests (PUF) and maximum voided volume (MVV) was completed in 1st, 3rd, 6th and 12th months following the treatment. The results have shown that t here was a statistically significant decrease in all of the scores evaluated at first month compared with the baseline. While the change in VAS score in 1, 3, 6 and 12th months were found statistically significant, measurements of ICSI, OSS and PUF scores and MVV values in the 6th and 12th months. The results of this study suggest that acupuncture appears to be an effective, useful, non-invasive method in IC/BPS patients. It can be used as an appropriate treatment method not only in refractory but also in IC patients since it is rather advantageous compared to other treating agents.

Another recent research has investigated the effect of acupuncture for the treatment of bladder pain, urinary freaquency and urgency caused by interstitial cystitis.

In this study 10 patients (1 male, 9 females) suffering from the symptoms due to interstitial cystitis were treated by acupuncture. The treatment was repeated once a week for 4 weeks for the initial treatment (1st to 4th acupuncture). All patients recorded a frequency volume chart as well as IPSS-QOL questionnaire for 1 week before treatment as a baseline, and again after the 4th acupuncture. All patients with complaining of pain recorded visual analogue scale of pain for 1 week before treatment as a baseline, and again after the 4th acupuncture. Acupuncture has improved the clinical symptoms of urinary frequency and urgency and QOL scores, accompanied with increase of bladder capacity as well as with possible inhibition of the sensitivity of C-fiber dysfunction. This study suggested that acupuncture is a safe promising therapeutic alternative for the difficult-to-treat patients with overactive bladder and/or suspicious pelvic pain syndrome.

Recurrent urinary tract infections, acupuncture can help

Acute lower urinary tract infections (UTIs) are common in adult women, and as many as 6% of members of the adult female population experience 3 or more episodes during a given year. Women with frequently recurrent cystitis may need prophylactic antibacterial treatment, however if the infection is recurring and this causes development of antimicrobial resistance. Acupuncture is used to treat UTIs. Recently there was a research from Norway which studied the effect of acupuncture on recurring UTIs in women. In this study, it included women aged 18-60 year old who had to have had 3 or more episodes of distal urinary symptoms (i.e., dysuria and frequent urination or suprapubic discomfort) during the previous 12 months, and at least 2 of these episodes had to have been diagnosed and treated as acute lower UTIs by a medical doctor. Acupuncture was offered twice a week for 4 weeks. Following treatment, 73% of women in the acupuncture group were free of UTIs during the 6-month observation period. Several episodes of acute distal urinary symptoms were noted in which bacterial cultures either were not obtained or were negative. One third as many episodes per person-month occurred in the acupuncture group as in the control group. Women in the acupuncture group experienced a 50% reduction in residual urine after 6 months relative to baseline, whereas women in the untreated group exhibited no significant change in residual urine. This study indicated that acupuncture treatment may be effective in preventing recurrent lower UTIs .

Overactive bladder, acupuncture can help

Overactive bladder is a condition in which the increased urination frequency with other symptoms are found. The symptoms include more frequent urination in the day and night; urine urgency which is sudden, strong need to urinate and leak urine. It could be painful, when one pass the urine.

Overactive bladder is one of the most common urinary tract problems in women. Women have to go to bathroom frequently, feeling severe urge to urinate and feeling fullness of the bladder. This condition is not life threatening, but it affects quality of life in women. At minimum, 11 to 16 million women in the United States cope on a daily basis with symptoms that include sudden strong urges to urinate, difficulty delaying voids, frequent urination, and in many cases involuntary loss of urine when urgency strikes. This causes much stress in women. However the treatments are not satisfactory. Studies have shown that acupuncture can help reducing the symptoms. A recent review from journal Medicine (Baltimore) assessed the efficiency and safety of acupuncture for overactive bladder. 794 patients with 10 randomised controlled trials were included in the study. The result has shown that acupuncture could decrease urination frequency and improve quality of life. Wang S et al studied long-term effect of acupuncture for overactive bladder. At least 5 years were evaluated. 106 patients participated the study. Evaluation was based on a questionnaire including questions on storage, voiding, and postmictutrition syndromes. The mean treatment sessions were 21.2. The results showed that complete resolution was 42.5% and 50% improvement was 85.5%. 62 patients were followed up for 5-10 years. 35 of these 62 patients maintained the posttreatment effect; 18 changed from better to complete resolution; 7 got back to less than 50% improvement; 4 changed less 25% improvement.

Acupuncture is effective for leaking urine

Urinary incontinence is the involuntary leakage of urine from the bladder. It affects 10% of the population. Women are more commonly affected. The most common types of leaking urine are stress incontinence and urge incontinence. Stress incontinence is when urine leaks out at times when the bladder is under pressure, such as coughing, sneezing, heavy lifting exercising and laughing. Stress incontinence is usually the result of the weakening of or damage to the muscles used to prevent urination, such as the pelvic floor muscles and the urethral sphincter. Urge incontinence is when urine leaks as a sudden, intense urge to pass urine is needed. Urge incontinence is usually the result of overactivity of the muscles, which control the bladder. It is also known as overactive bladder. Pelvic floor muscle training is one of the treatments used to treat this condition. Acupuncture is also used to treat this condition. Research on leaking urine with acupuncture treatment is emerging. For example

Recently Xu et al investigated the effectiveness of acupuncture on stress urinary incontinence. Before treatment a 72-hour bladder diary recorded by participants at baseline (week 0) and then acupuncture treatment was applied and the bladder diary was recorded during the treatment period (weeks 2, 4 and 6) and follow-up period (weeks 15–18 and weeks 27–30). In the bladder diary, the participants recorded in detail the time and frequency of UI, activity that occurred at the time of leak, and the type and volume of liquid intake.

80 women participated the study and they reported significant improvement after 6, 18, and 30 weeks acupuncture treatments.

References

Sonmez MG and Kozanhan B Ginekol Pol (2017) 88(2):61-67. doi: 10.5603/GP.a2017.0013.

Hartmann KE Evid Rep Technol Assess (Full Rep) (2009) 187:1-20

Wang S Int Urogynecol J 2013 [Epub ahead of print]

Liu Z et al Trials 2013 14:315

Alraek T et al Am J Public Health (2002) 92:1609

Xu et al PloS One ( 2016) 11(3):e0150821.

Zhao Y et al Medicine (Baltimore). 2018 Feb;97(8):e9838. doi: 10.1097/MD.0000000000009838.

Sonmez MG & Kozanhan B Ginekol Pol (2017) 88:61-67

Verghese TS et al Int Urogynecol J (2016) 27:1127-36

https://www.ics.org/Abstracts/Publish/43/000541.pdf

Thursday, 28 July 2022

Knee is painful, what to do?

Acupuncture is a valuable treatment for chronic knee pain

Thanks to the knee joint, we can move around freely and go wherever we want without any difficulties. Knee is the largest joint in the body which can bend and straighten bringing us about. It bears most of the body weight and pressure loads. It supports 1.5 times the body weight when one walks and 3-4 times the body weight when one climbs stairs. Knee is vulnerable which can be injured and can suffer from some diseases causing pain, swelling, stiffness, redness, locking, weakness or instability etc. The symptoms may vary depending on the type of injury. Pain may occur when you bend or straighten the knee.

There could be swelling; difficulty bearing weight on the knee and trouble with knee motion. Some of the most common reasons for knee pain are sprained ligaments, meniscus (cartilage) tears, tendonitis. Other conditions that cause knee pain include as follows:

Knee injury: a knee injury can affect any of the ligaments, tendons, bone or fluid-filled sacs (bursae) that surround the knee joint as well as the bones, cartilage and ligaments that form the joint itself.

Bursitis: A bursa is connective tissue below the skin over the knee. Overuse, a fall, or repeated bending and kneeling can irritate the bursa overlying the knee cap (patella), causing pain and swelling.

Illiotibial band syndrome: The iliotibial band is a piece of tough tissue that runs from your hip down to the outer part of your knee. If it's irritated by overuse or other problems, it can become inflamed and cause pain on the outer side of the knee.

Overuse during repetitive motions as are found during certain exercises (jogging, skiing) or work conditions (long periods of kneeling) can cause breakdown of cartilage and lead to pain.

Others Include osteoarthritis, dislocated kneecap, patellofemoral pain syndrome and patellar tendonitis, a condition caused by inflammation of the tendons around the knee.

Hip or foot pain: If you have hip or foot pain, you may change the way you walk and this can place extra stress on the knee joint. In some cases, problems in the hip or foot can refer pain to the knee.

Acupuncture can help release the pain by reducing the inflammation and improving circulation to speed up the healing process.

Iliotibial band syndrome, acupuncture can help

The iliotibial band (IT band) is a thick band of fibers on the outside part of the thigh. It starts from the border of the most prominent bone of the pelvis and ends into the tibia bone, to which the gluteal muscles and tensor fscia latae muscle attached. IT band coordinates muscle function and stabilize the knee during running. This band is one of the most common overused among the runners causing Iliotibial Band Syndrome (ITBS). ITBS is caused by inflamed of IT band. When it happens, knee pain is the most common symptom and can be mild to severe. Pain is most severe with the heel strike of walking or running and may radiate from the knee up the leg to the hip. Pain may also be felt with knee flexing, especially going up or down steps. Swelling on the outside of the knee can be seen in some cases. Tightness of IT band is very common. MRI can show a partial thickening of the IT band, which results from inflammation. When the IT comes near the knee, it becomes narrow, and rubbing can occur between the band and the bone. This causes inflammation. ITBS is more common in women, possibly because some women's hips tilt in a way that causes their knees to turn in. Tenderness over the site of the iliotibial band insertion at the knee joint, and specific tender points may be found over the lateral femoral condyle.

Initial treatment for most overuse injuries remains the same: rest, ice, elevation and antiinflammatory medications. If the pain prolonged, it can become chronic. Physical therapy is often used to treat ITBS. Acupuncture is effective to treat acute and chronic ITBS. It releases the pain and inflammation; reduces tightness of IT band; improves circulation and improves scarring.

knee pain from osteoarthritis, acupuncture can help.

If you are over 40 year old female and you are overweight with knee disease history, you are at great risk of having knee osteoarthritis. You could have pain and swelling in your knee and the pain is accompanied with stiffness and restricted movement. You could have grinding feeling when you move the knee. Osteoarthritis (OA) of the knee is the most common disabling condition and major cause of chronic pain. Knee pain or osteoarthritis affects 25% of people older than 55 year old and one third of populations over 65’s. There is a clear link between knee osteoarthritis and obesity. This may be due to mechanical, hormonal and genetic factors involved.

Acupuncture is one of the most commonly used applications and is very effective treatment for knee osteoarthritis. Its use for relieving knee pain is supported by many research data. Here are some examples, Lansdown H from the University of York UK performed a pilot study for a randomized control trial to compare effectiveness of acupuncture and usual care for knee osteoarthritis. 10 sessions of acupuncture was given to patients in acupuncture group on weekly basis. They found acupuncture has significantly better effect than usual care in patients with knee osteoarthritis.

Cao L et al analysed 14 randomised control trials from July to October 2011, involving 3835 patients with knee osteoarthritis. They found that acupuncture has significantly better effects on reducing pain and restore joint function both in the short term and long term compared to sham acupuncture or standard care.

A new research was just published about acupuncture on knee osteoarthritis. This was a double-blinded randomised trial to identify specific and non specific effects of acupuncture on osteoarthritis of the knee by Karner et al from Heidelberg University Hospital Germany. Karner et al recruited 160 patients aged from 35-82 with knee osteoarthritis in three study centers. These patients were double-blindedly allocated into three groups: classic Chinese acupuncture group, modern acupuncture group and non specific needling. Knee flexibility and pain sensation were tested to measure the effectiveness of the treatment. Their result showed that improvement of knee flexibility was the highest for Chinese acupuncture among three groups, following by modern acupuncture. Pain relief for Chinese acupuncture was also the highest among these groups which was 73% for classic Chinese acupuncture, 64% for modern acupuncture and 48% for non-specific needling. They suggested that there was a specific effect of acupuncture in knee mobility and both non-specific and specific effects of needling in pain relief.

Case report, knee pain with acupuncture treatment

Though long term effect of acupuncture in treating osteoarthritis is to be confirmed, there are many cases in which long term benefit can be seen clinically. For example Mary was 51, she had knee pain for a few years and she was diagnosed osteoarthritis. Her knee pain was getting worse in winter and getting better in summer. She had difficulty to climb stairs. In last winter, her knees were extremely painful and she hardly walked without pain. She decided to seek help from acupuncture. After first session of acupuncture, she felt less pain. With continuing a few sessions of acupuncture her knee pain was completely gone. A year on another winter arrived, she still did not have any pain on her knees.

Acupuncture reduces pain in patients with osteoarthritis by altering brain cortical thickness and brain activity

Recent research data have suggested that knee OA patients can benefit from acupuncture treatment. Some studies have shown that acupuncture may produce an analgesic effect through the endogenous descending pain modulatory system. Brain imaging studies have also shown that acupuncture needle stimulation can evoke widespread brain activity changes and modulate the functional connectivity of the pain processing network. A recent research has studied the effect of acupuncture on patients with knee osteoarthritis. Each patient received a total of 6 acupuncture treatment sessions in one month (twice per week for the first two weeks, once per week for the last two weeks). Result has shown that pain reduction in acupuncture group was significantly higher than that for control group. Daily living and quality of life showed significant improvement in acupuncture group compared to control group. Cortical thickness remained static in acupuncture group and decreased in control group. There was significantly stronger brain connectivity in acupuncture group compared to control group. This study has shown that acupuncture treatment can significantly modulate cortical thickness, functional connectivity, and clinical pain rating in OA patients. These results suggest that acupuncture may achieve its therapeutic effect on knee OA pain by preventing cortical thinning and decreases in functional connectivity in major pain related areas, therefore modulating pain in the descending pain modulatory pathway.

References

Sridhar MS, et al J Bone Joint Surg Br. (2012) 94:433-40.

Iwamoto, Jun et al World J Orthop (2011) 2: 37-42

Lansdown H et al BMC Musculoskelet Disord. (2009) 24;10:130.

Cao L, et al Saudi Med J. ( 2012) 33:526-32.

Karner M et al Evid Based Complemennt Alternat Med (2013): 2013:427265

White A et al Rheumatology (2007) 46:384-390

Plaster R et al Acupunct Med (2014) Feb 24. doi: 10.1136/acupmed-2013-010489

Chen X et al Sci Rep (2014) 4:6482

Having prostatitis? Tried acupuncture?

Effectiveness of acupuncture for Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)

The prostate is a small gland in men located at between the penis and bladder. The prostate can be inflamed called prostatitis which can be very painful and distressing. Prostatitis can develop in men of all ages. However, it commonly affects men aged between 30 and 50. It can be acute or chronic and it also can be caused by infection and non-infection. Chronic nonbacterial prostatitis is most common. About 90% men with chronic prostatitis have chronic prostatitis/chronic pelvic pain syndrome (CPPS). Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) affects approximately 90% to 95% of men worldwide. The most prominent symptom is chronic pain in the region of the pelvis. Pain can be in the perineum, testicles, tip of penis, pubic or bladder area and may spread out to the back and rectum; and it is often associated to accompanied with bladder pain, urination pain, frequent urination and urgency, ejaculatory pain, erectile dysfunction, and psychosocial symptoms, lasting for at least 3 to 6 months. Post ejaculatory pain may be present. The cause of CP/CPPs is not clear, but it may be related to hormonal changes, autonomic nervous system imbalance, abnormal local or systemic inflammation, altered immune function and genetic factors. Stress could be a contributing factor for CP/CPPS.

The idea of acupuncture treatment for CP/CPPS has been accepted in Western countries. Capodice JL et al in USA investigated the effect of acupuncture on CP/CPPS. There were 10 men aged between 18-65 participated the study. They have been diagnosed with chronic prostatitis for greater 6 months, had at least 1 conventional therapy antibiotics, anti-inflammatory agents, 5-α reductase inhibitors or α-1 blockers), scoring >4 on the pain subset of the NIH-CPSI which was used to assess the severity of the CP/CPPS. After 3 weeks, 6 weeks of acupuncture treatment and 6 weeks of followup the NIH-CPSI scores were significantly decreased. Pain and urinary symptoms and quality of life were also significantly improved. No side effects were reported. They suggested that acupuncture cold be the effective treatment option for patients with CP/CPPS.

The benefits of acupuncture on CP/CPPS have been well established according to clinical trials. It is listed in the guidelines of European Association Urology. How many treatments needed depend on individuals. In published research paper 6-24 sessions are normally used. A study using meta-regression approach explored the dose-response association between acupuncture sessions and acupuncture effects on chronic prostatitis/chronic pelvic pain syndrome. The result involving 329 participants has shown that overall, more acupuncture sessions received for CP/CPPS patients is associated with increased symptom relieving. After 6 acupuncture sessions, the NIH-CPSI decreased from 26.1 to 18.5 and 18 acupuncture sessions could reach a clinically meaningful improvement regarding NIH-CPSI score. Prolonged acupuncture sessions were associated with less NIH-CPSI score. They concluded that there is dose-response relationship between acupuncture sessions and CP/CPPS outcome. Six acupuncture sessions might be the minimal required 'dose' to reach its clinical effects.

A study summarised research paper up to February 2019 about acupuncture on CP/CPPS with total 11 studies involved in 748 patients with CP/CPPS. The result has shown that acupuncture significantly reduced the pain score for CP/CPPS ad improved patient’s quality of life with little side effects.

Why can acupuncture be used to treat chronic prostatitis/CPPS? Acupuncture has been proved in effectively treating chronic prostatitis/CPPS. The mechanisms are also studied in current research to provide scientific evidence for the treatment and it is suggested that acupuncture reduces local inflammation and improves local microcirculation. Acupuncture was seen to increase immunoglobulin A in the prostatic fluids and improve local immune function of the prostate. It was also seen that interleukin-2 and testosterone, tumor necrosis factor-α (TNF-α) and the expression of intercellular adhesion molecule 1 (ICAM-1) were altered which were involved in inflammatory reaction. For example a recent study participated by 47 patients with CP/CPPS. After received acupuncture treatments pain or discomfort score decreased remarkably as compared with that before treatment. The levels of IL-8, IL-10 and TNF-alpha which were inflammatory markers were lower than those before treatment. The positive correlation was obtained between IL-10 level and pain score. They suggested that acupuncture has significant efficacy on CP/CPPS through reducing IL-10 level to ease pain, and reducing the levels of IL-8 and TNF-alpha to relieve inflammatory reaction. Recently, a small sample clinic trial was conducted to investigate the mechanism of acupuncture underlying the treatment of chronic prostatitis/CPPS. 12 patients participated the study. Immune function tests were performed before and after 10 weeks acupuncture treatment. At the end of study 67% responded the treatments. The acupuncture group averaged a 5% increase in natural killer cell levels compared to control group. Similarly, patients randomized to acupuncture reported a reduction in other white blood cell parameters examined. This study supported the possibility that immunity might be important in the pathophysiology of CP/CPPS and suggested potential mechanism of acupuncture treatment. 

References
Qin Z et al Ann Transl Med 2019 Mar;7(6):116. doi: 10.21037/atm.2018.11.45.
Engeler D, Baranowski AP, Borovicka J, et al. EAU Guidelines on Chronic Pelvic Pain. 2017. Available online: http://uroweb.org/wp-content/uploads/23-Chronic-Pelvic-Pain_2017_web.pdf
Capodice JL et al Chin Med (2007) 2:1
Li J et al Pain Res Manag. 2020 Mar 9;2020:5921038. doi: 10.1155/2020/5921038. eCollection 2020. Yang ZX et al Zhong Xi Yi Jie He Xue Bao (2012) 10:293-7 Yuan SY et al Zhongguo Zhen Jiu (2011) 31:11-4 Ohlsen BA J Chiropr Med (2013) 12:182-90 Lee SW et al Complement Ther Med (2014) 22:965-9
Chen G et al Zhongguo Zhen Jiu (2016) Dec 12;36(12):1247-1251. doi: 10.13703/j.0255-2930.2016.12.006.

Wednesday, 27 July 2022

How to let it go? emotional release with acupuncture

Emotion and the brain

The limbic system is a complex set of brain structures just beneath the medial temporal lobe of the cerebrum. It includes the hypothalamus, the hippocampus, the amygdala, and several other nearby areas. This part of the brain supports emotion, behaviour, motivation and memory. Amygdalal is the key emotion center. There are 6 basic emotinos including happiness, anger, sadness, fear, surprise, and disgust. Positron Emission Tomography (PET) scanning and functional MRI studies have shown that some emotions are more likely to be associated with different regions of limbic system activity than other emotions. Happiness is related to the right frontal cortex, the precuneus, the left amygdala, and the left insula. Fear is linked to the bilateral amygdala, the hypothalamus and areas of the left frontal cortex. Sadness is associated with increased activity of the right occipital lobe, the left insula, the left thalamus the amygdala and the hippocampus which is strongly linked with memory, and it makes sense that awareness of certain memories is associated with feeling sad. Disgust is associated with activation and connections between the left amygdala, the left inferior frontal cortex, and the insular cortex. Anger is associated with activation of the right hippocampus, the amygdala, both sides of the prefrontal cortex and the insular cortex. Surprise is related to the bilateral inferior frontal gyrus and the bilateral hippocampus. Alteration of the limbic system activities can cause emotion changes.

Release emotion with acupuncture

The mood and emotion are influenced by many events in lives, such as sleep, hormones or even weather. A trauma particularly affects emotion which can last longer than it should. When a trauma happens, no matter how big or small, its memory makes a mark in the brain. This creates negative, painful emotions or distress which put you in a state of constant stress, anxiety or depression. They not only are harmful to the mental health, but the physical health too. With recent new research techniques, Positron Emission Tomography (PET) scanning and functional MRI studies, the brain region that is associated with emotion is clearer. The right occipital lobe, the left insula, the left thalamus the amygdala and the hippocampus is related with sadness. The hippocampus is strongly linked with memory, and it makes sense that awareness of certain memories is associated with feeling sad. Sadness has been studied more than the other emotions because depression may last for a long time; the effects of antidepressants can be measured based on improved symptoms. Research has shown that acupuncture can help rebalance the brain activities to release emotion.

Acupuncture changes brain activities

Functional magnetic resonance images (fMRI) is a new technique to study brain activities. This technique is also help to study the effect of acupuncture on the brain. Many studies used fMRI to investigate the effect of acupuncture on the brain. For example a study collected 229 papers in Chinese and 109 in English published in journals from January of 1995 to January of 2018. In this study they analysed 11 papers containing 235 cases. Acupuncture increases brain activities on some regions including the right and left anterior cingulated gyrus, right caudate, left superior frontal gyrus, right middle frontal gyrus, and the right paracentral lobe, and decreases other region activities including the left mid-inferior occipital gyrus, left and right precentral and postcentral gyrus.

Acupuncture on St 36 acupuncture point increased some regions activities including the right inferior parietal lobe, left middle inferior gyrus, right posterior lobe of cerebellum, and the left angular gyrus and deceased activities on the right middle superior frontal gyrus.

A recent paper showed the brain activities effect of acupuncture at Liangqiu (ST34), Xuehai (SP-10), Neixiyan (EX-LE4), and Dubi (ST-35). Acupuncture activated the postcentral gyrus, precuneus, temporal, posterior lobe, and occipital lobe.

Get better mood with acupuncture

Everyone has mood changes in some degree, however too much mood changes could be caused by ill health and further affects one’s health. Mood expressions include positive scales like "activity, joy, contemplation, calmness" and negative scales like "anger, irritation, depression, fatigue”. Patients with chronic disease supposed to have dominant negative mood scales. Do you know acupuncture can help you improve mood changes. A research has shown that there was an immediate, fast suppression of unusual slow high amplitude EEG waves in response to acupuncture needle rotation. Also there was a significant improvement on positive mood scales and a decline in negative mood scales after 10 acupuncture sessions. Patients with chronic pain reported a significant decrease of pain intensity after 10 sessions.

Winter blue help with acupuncture

Winter brings with its darker mornings and evenings, and some may feel they hardly see the sunlight at all---going to work in the dark and coming back home in the dark. Many people find themselves feeling sad, blue and even depressed around the winter. The medical name for winter depression is seasonal affective disorder (SAD). It’s fairly common, and it’s more mild than serious. You wake up before the sun even rises, you might start feeling a persistent low mood or lack of energy.

The cause of SAD is not fully understood, shorter days seem to be a main trigger for it. Reduced sunlight in winter can disrupt your body’s internal clock, or circadian rhythm. This 24-hour clock responds to cues in your surroundings, especially light and darkness. At night, the brain produces melatonin, helping you sleep. Light stops the brain producing melatonin to help keep you awake. Shortened daylight in winter may increase the production of melatonin and affect the body’s internal clock or circadian rhythm leading to SAD in certain people.

To cope with winter blue or SAD, eating healthy food, keeping active, taking vitamin D may help. Also light therapy and talking therapy may help too. Don’t forget acupuncture. Acupuncture can help reduce winter blue symptoms such as fatigue, low mood and depression.

Menstrua mood swing help with acupuncture

Women have menstrual cycles every month, this could cause emotional problem in many women. It is a part of premenstrual syndrome. Apart from physical signs, they feel tired, stressed, anxious, having bad mood and difficulty to sleep and having headache. Mood swing sometimes is unbearable and could ruin their relationships. Abnormal spontaneous brain activity is found in PMS patients. Acupuncture effectively treated the emotional problems such as stress, anxiety, mood swing, insomnia and headache. A recent research has found that acupuncture can regulate brain activities to reduce these emotional symptoms such as mood swing.

References

Xiang AF et al Zhen Ci Yan Jiu. 2019 Jan 25;44(1):66-70. doi: 10.13702/j.1000-0607.180138.

Li A et al Medicine (Baltimore). 2018 Dec;97(50):e13655. doi: 10.1097/MD.0000000000013655.

Acker H et al Med Hypotheses. 2015 Sep;85(3):371-9. doi: 10.1016/j.mehy.2015.05.013. Epub 2015 May 22.

Liao H et al Front Hum Neurosci. 2017 Feb 13;11:62. doi: 10.3389/fnhum.2017.00062. eCollection 2017.

Pang Y et al Front Hum Neurosci. 2018 May 31;12:104. doi: 10.3389/fnhum.2018.00104. eCollection 2018.

How to release neck pain?

Neck pain is very common. About 2 in 3 people had neck pain at some point in their life. A survey in the UK has shown that 1 in 4 women and 1 in 5 men between ages 45 and 75 had current neck pain.

The cervical spine and the muscles and ligaments are at the back of the neck. The cervical spine is made up of seven vertebraes between which is a disc. Spinal cord is within the spine and protected by the spine. Nerves come out from the cervical spine and innervated the neck and arms.

Non specific neck is the most common type of neck pain. The exact cause is unknown. It may caused by minor strains to the muscles and ligaments in the neck. Poor posture is often related to the neck pain.

The nuchal ligament and neck pain

The nuchal ligament is a ligament at the midline of the neck which extends from the bottom of the skull to the spinous process of the seventh cervical vertibrae which is the lowest cervical vertebrae on the neck. It forms a septum between the muscles on the either side of the neck. There are four muscles including trapezius, splenius capitis, rhomboid minor and serratus posterior superior attached the nuchal ligament. The nuchal ligament limits flexion of the neck, stabilizes the neck and affects muscular activity in the neck. Trauma and overuse of nuchal ligament can result in ossification of the ligament which causes neck stiffness and pain, progressive cervical spine instability and malalignment and nerve route irritation. Acupuncture can help release neck stiffness and neck pain.

Acupuncture treatment for chronic neck pain

Chronic neck pain is a long-lasting pain on the neck or back. This pain commonly started from improperly healed acute injury. Scar tissues formed during the healing process. These scar tissues are called fibrosis. They can develop inside of the body, under the skin, muscles, tendons or inside of a joint capsule. Fibrosis always occurs at the end stage of inflammation and it causes adhesion which grabs the connective tissue and surrounding muscles together causing pain and tension, limiting the function. There are more pain receptors in the fibrosis tissue making the area more sensitive to protect the area by the body automatically.

Acupuncture can help to release the pain and tension to help the area functioning. Also acupuncture can help the body repair to get rid of the scar tissue and remodel the tissue.

Acupuncture for sudden severe pain in the neck

Acute neck pain is a sudden-onset pain in the neck. It is often due to neck muscles strain and muscle spasm. This can be caused by poor posture, sleep in an awkward position, carrying heavy loads, stay in one position for a prolonged period of time etc. One might not find exactly causes. The pain is sudden and can be very severe. This makes the person with the pain panicking. Movement of the neck is restricted because of the pain. The recovery can take a few days or a week. Acupuncture can help release the pain and speed up the recovery.

Acupuncture helps a stiff neck

Neck pain or a stiff neck is a common problem. The neck becomes sore and tender and movement is limited. it is difficult to move the neck and turn the head to the side. It could be associated with a headache, neck pain, shoulder pain or arm pain. The most common cause of a stiff neck is a muscle strain or soft tissue sprain. The levator scapula muscle located at the back and side of the neck connecting the neck with the shoulder is most affected. These muscles can be strained by everyday activities: for example, sleep in an awkward position, use a computer for a prolonged period of time, have a bad posture or have some sports injury such as swimming sudden fall, hold a phone between the neck and shoulder etc. Anxiety and stress can cause tension in the neck muscles leading to neck pain. Tight muscles are often chronic and need to be treated. Tight muscles block blood circulation of the body and muscles don’t get enough nutrition and become weak and easily get further damage. Because of blocked energy supply, you will feel tired all the time. Poor posture is a common cause of tight neck and shoulders. This causes overuse some groups of muscles and causes micro injury to the muscles which become tight to protect themselves from further injury. Furthermore the tight neck and shoulders will make poor posture worse. It becomes a viscous circle. This needs to be treated, otherwise tight neck and shoulders would not resolve itself. Stretching the muscles, applying heat or warm bath may help. Acupuncture is very effective to release the muscle tension, reduce the tightness, correct poor posture and improve blood circulation. Acupuncture can help stiff neck by relaxing muscles spasm.

Poor posture, acupuncture can help

Poor posture is a major cause of neck pain; while neck pain prevents the neck from getting back to normal posture. Poor posture results from certain muscles shortening and lengthening in an abnormal way. Poor posture can place strain on the related muscles and other soft tissues causing pain, such as neck and back pain. Inflammation is one of the causes of poor posture. If there is an inflammation in somewhere in the body, it causes pain. The body automatically protects itself to avoid the pain resulting in an abnormal posture. For example, people with neck pain would tilt the head involuntarily to one side to avoid the neck pain. Acupuncture can help to reduce the inflammation and pain to help to correct the poor posture.

Acupuncture treatment is recommended for acute and chronic neck pain

Current interventions for neck pain include themal, electrotherapy, ultrasound, mechanical traction, laser, and acupuncture.  But definitive knowledge about optimal modalities and dosage for neck pain is limited. Granham N et al from McMaster University, Hamilton Canada analysed existing data to provide the evidence for recommendations on physical modalities for acute to chronic neck pain. The data included was from January 2000 to July 2012. Their result showed that short term pain relief- moderate evidence of benefit: acupuncture, intermittent traction and laser were shown to be better than placebo for chronic neck pain. Moderate evidence of no benefit: pulsed ultrasound, infrared light or continuous traction was no better than placebo for acute whiplash associated disorder, chronic myofacial neck pain or subacute to chronic neck pain. There was no added benefit when hot packs were combined with mobilization, manipulation or electrical uscle stimulation for chronic neck pain, function or patient satisfaction at six month follow-up. They concluded that the current state of the evidence favours acupuncture, laser and intermittent traction for chronic neck pain.

Liang Z et al in China studied the effect of acupuncture on chronic neck pain. 178 patients with chronic neck pain were recruited. These patients were allocated into two groups 88 in acupuncture group and 90 in control group which received acupuncture and placebo treatment respectively. The Northwick park neck pain questionnaire (NPQ), visual analogue scale (VAS), short from 36 health survey (SF-36) and doctor’s judgement were applied for measuring effectiveness. The effect was assessed before treatment, immediately after the treatment, at the end of first month of follow-up and at the end of third month follow up. They found that the NPQ, VAS and SF 36 scores in acupuncture group were significantly improved after the treatment and the two follow-ups compared with before the treatment. Acupuncture group had better effect than that for control group. They concluded that acupuncture has immediate effect and lasting effect for chronic neck pain.

Another research of effectiveness of acupuncture on neck pain by Dong and Lin was published recently. They compared different effects of acupoints. 60 patients with neck pain were divided into two groups with 30 patients of each group. In first group, the acupoints selected at the start and end of trapezius muscle including Tianzhu (BL10), Fengchi (GB20), Quyuan (SI 13), Jugu (LI16) and Ashi points. In the second group, Jiaji (Ex-B2) on the neck were selected. The patients received acupuncture 5 times a week for 2 weeks. The Pain Rating Index (PRI, VAS and Present Pain Intensity (PPI) were measured before and after the treatments. They found that the scores were significantly reduced in both group. The better effect in first group was observed. They concluded that the points at the start and end of trapezius muscle had better effects than Ex-B2 points. 

A review summarised the most current scientific evidence on the effectiveness of acupuncture for neck pain. They found 27 studies investigated this subject. Of the 27 included studies, three represented individuals with whiplash-associated disorders (WADs) ranging from acute to chronic (205 participants), five explored chronic myofascial neck pain (186 participants), five chronic pain due to arthritic changes (542 participants), six chronic non-specific neck pain (4011 participants), two neck pain with radicular signs (43 participants) and six subacute or chronic mechanical neck pain (5111 participants). They found that acupuncture is beneficial at immediate-term follow-up compared with sham acupuncture for pain intensity; at short-term follow-up compared with sham or inactive treatment for pain intensity; at short-term follow-up compared with sham treatment for disability; and at short-term follow-up compared with wait-list control for pain intensity and neck disability improvement. Acupuncture appears to be a safe treatment with minor adverse effects. Reported adverse effects include increased pain, bruising, fainting, worsening of symptoms, local swelling and dizziness. These studies reported no life-threatening adverse effects and found that acupuncture treatments were cost-effective. 

Tech neck pain, acupuncture can help

Modern technology such as smart phone and tablet may cause stress to the neck. When using them, you hold your head flexed and forward while looking down at your handheld device causing severe angle to the neck. Over long periods of time, maintaining this head-forward posture can lead to muscle strain, disc injury, nerve impingement and arthritic changes of the neck—and the potential for developing ongoing neck and shoulder pain, headaches, and pain radiating down the arms. The symptoms of tech neck pain include pain in the neck, upper back, and/or shoulder; the pain may be mild or intense and feeling stabbing, achiness and soreness; the pain is associated with neck, upper back or shoulder tightness and reduced movement of the region; it may also accompanied with headache due to muscle spasm at the base of the neck; pain may be worse with neck movement. Acupuncture is very effective to release tech neck pain by releasing muscle spasm and tension.

Neck spasm and sudden neck pain, acupuncture can help

Neck spasm occurs when the muscles in the neck contract involuntarily and sudden tightening of the muscles can cause severe pain. The pain come up suddenly. Other symptoms accompanied with the pain include problems moving the neck and shoulder, increased pain when moving the neck and shoulder, headaches, dizziness or tingling at the neck. Neck spasm can be caused by a few reasons: repeated or prolonged movements of the neck, sitting at one position for a long time, poor posture, turning suddenly while sleeping, carrying too much weight at one shoulder or one arm, cradling a handset against neck, stress, and dehydration.

One of the first muscles to cause headache and neck pain is trapezius. This is a broad triangular muscle at neck and upper back, one of the largest superficial muscles at the back. It attaches to the base of the skull and extends down to the neck, the upper back until mid back; laterally it inserts to the shoulder blades. There are three functional regions to the muscle: the Upper, middle, and lower trapezius, and each region has its own function: upper region moves the shoulder blades and support the arms; the middle region retracts the shoulder blades and the lower region rotates and depresses the shoulder blades.

Acupuncture can effectively release muscle spasm.

Acupuncture is recommended for non specific neck pain by two guidelines from the Danish Health Authority.

There are twelve recommendations for neck pain treatment based on research evidence. . For neck pain treatment, guidelines suggest different types of supervised exercise and manual therapy; combinations of exercise and manual therapy are recommended before medicine and acupuncture is also recommended. Oral NSAID (oral or topical) and Tramadol after careful consideration are also recommended. These guidelines are agreed with the guidelines from North America.

 

References

Ceccherelli F et al Clin J Pain 2010 26:807-12

Liang Z et al Complement Ther Med (2011) 19 supple 1:S26-32

Dong WK and Lin XH Zhongguo Zhen Jiu (2012) 32:211-4

Graham N et al Open Orthop J (2013) 7:440-60

Carlesso LC et al Chieopr Man Thera (2014) 22:11

Trinh K et al Cochrane Database Syst Rev (2016) May 4;5:CD004870. [Epub ahead of print]

Kjaer P et al Eur Spine (2017) May 18. doi: 10.1007/s00586-017-5121-8. [Epub ahead of print]

 

How does acupuncture work? Research shows that acupuncture alters brain activities.

Acupuncture is originated from China thousands years ago and has been used since. It is now more popular than ever in all over the world. Ho...