A Hypothesis for the Anti-Inflammatory and Mechanotransduction Molecular Mechanisms Underlying Acupuncture Tendon Healing

Almeida, Marcos dos Santos de; Guerra, Flávia Da Ré; Oliveira, Letícia Prado; Vieira, Cristiano Pedrozo; Pimentel, Edson Rosa

doi:10.1136/acupmed-2013-010455

Cited by 15 publications

(10 citation statements)

References 49 publications

(48 reference statements)

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“…MAPK, the most prominent kinase activated by mechanotransduction, initiates the extracellular signal regulated-kinase ½ (ERK½) pathway [117]. ERK stimulates the production of Type-1 collagen fibers via transcription factors such as activator protein-1 [115,117]. Interestingly, a recent study by Park et al found that DN at GB34 turned on 236 genes secondary to the ERK cascade [118].…”

Section: Dry Needling Mechanotransduction and Tissue Healingmentioning

confidence: 99%

“…This action sets an appropriate environment for collagen remodeling and production. DN-mediated mechanotransduction stimulates rho/rac kinases, disrupting the actin cytoskeleton, and allowing the tissue to be reorganized [108,115]. Finally, mechanical stimulation of fibroblasts results in collagen synthesis via activation of mitogen activated protein kinases (MAPK).…”

Section: Dry Needling Mechanotransduction and Tissue Healingmentioning

confidence: 99%

“…Inflammation typically reduces type 1 collagen synthesis, but DN has been shown to decrease cytokines responsible for inflammation via activation of toll-like receptors on fibroblasts [115,116]. This action sets an appropriate environment for collagen remodeling and production.…”

Section: Dry Needling Mechanotransduction and Tissue Healingmentioning

confidence: 99%

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Peripheral and Spinal Mechanisms of Pain and Dry Needling Mediated Analgesia: A Clinical Resource Guide for Health Care Professionals

Butts¹,

Dunning²

2016

Int J Phys Med Rehabil

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There are a number of biochemical, biomechanical, endocrinological and neurovascular mechanisms underpinning the anti-nociceptive and anti-inflammatory effects of dry needling (DN). While myofascial trigger points likely play a role in peripheral pain, a diagnostic tool for localizing them has not been validated, and DN studies that have targeted trigger points to elicit localized twitch responses have reported mixed results. Therefore, the mechanism responsible for DN-mediated analgesia may be more complicated. DN activates opioid-based pain reduction, mediated by endogenous cannabinoids and the sympathetic nervous system, and non-opioid pain relief via serotonin and norepinephrine from the brain stem. DN also triggers the hypothalamic-pituitary-adrenal axis centrally and the corticotropin releasing hormone-proopiomelanocortin-corticosteroid axis locally to inhibit cox-2, reducing inflammatory cytokines. Recent studies demonstrate that DN combined with mechanical and/or electrical stimulation may reverse PKC-mediated peripheral hyperalgesic priming by normalizing nociceptive channels, to include TRPV, ASIC, TTX and P2X/Y. Electrical DN (EDN) stimulates immune cells, fibroblasts and keratinocytes to release CGRP and substance-P, altering the stimulation of TTX receptors to reverse hyperalgesia. It also encourages the supraoptic nucleus to release oxytocin to quiet ASIC receptors peripherally and stimulate opioid interneurons spinally. Moreover, EDN inhibits ERK1/2 kinase pathways of inflammation in the spinal cord and stimulates Aδ fibers and N/OFQ to reverse C-fiber mediated central changes. Mechanotransduction of fibroblasts and peripheral nerves via TRPV1 and P2X/Y-mediated intracellular Ca 2+ wave propagation and subsequent activation of the nucleus accumbens inhibits spinal pain transmission via glycinergic and opioidergic interneurons. The increased ATP is metabolized to adenosine, which activates P1 purinergic receptors, events considered key to DN analgesia and rho kinase-based tissue remodeling. Mechanotransduction-mediated release of histamine further explains analgesia secondary to needling points distal to pain. DN-mediated analgesia is dependent on a number of synergistic physiologic events involving biochemical and mechanical processes in neural, connective and muscle tissue.

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Section: Dry Needling Mechanotransduction and Tissue Healingmentioning

confidence: 99%

Section: Dry Needling Mechanotransduction and Tissue Healingmentioning

confidence: 99%

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Peripheral and Spinal Mechanisms of Pain and Dry Needling Mediated Analgesia: A Clinical Resource Guide for Health Care Professionals

Butts¹,

Dunning²

2016

Int J Phys Med Rehabil

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“… 18 Studies using MRI, US and Doppler have also shown degenerative structural tendon changes and hypervascularity, most commonly affecting the extensor carpi radialis brevis (ECRB). 19 20 With this renewed understanding there is increased interest in providing treatments aimed at the regeneration of tissues with poor healing potential (eg, platelet-rich plasma (PRP), 21 radiofrequency, 22 percutaneous needle tenotomy (PNT), 23 24 dry needling, 25 26 acupuncture 27 or percutaneous needle electrolysis (PNE) 28 ).…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Guided Percutaneous Needle Electrolysis in Chronic Lateral Epicondylitis: Short-Term and Long-Term Results

2014

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BackgroundUltrasound (US)-guided percutaneous needle electrolysis (PNE) is a novel minimally invasive approach which consists of the application of a galvanic current through an acupuncture needle.ObjectiveTo evaluate the clinical and ultrasonographic effectiveness of a multimodal programme (PNE, eccentric exercise (EccEx) and stretching) in the short term for patients with chronic lateral epicondylitis, and to determine whether the clinical outcomes achieved decline over time.MethodsA one-way repeated measures study was performed in a clinical setting in 36 patients presenting with lateral epicondylitis. The patients received one session of US-guided PNE per week over 4–6 weeks, associated with a home programme of EccEx and stretching. The main outcome measures were severity of pain, disability (Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire), structural tendon changes (US), hypervascularity and patients’ perceptions of overall outcome. Measurements at 6, 26 and 52 weeks follow-up included recurrence rates (increase in severity of pain or disability compared with discharge), perception of overall outcome and success rates.ResultsAll outcome measures registered significant improvements between pre-intervention and discharge. Most patients (n=30, 83.3%) rated the overall outcome as ‘successful’ at 6 weeks. The ultrasonographic findings showed that the hypoechoic regions and hypervascularity of the extensor carpi radialis brevis changed significantly. At 26 and 52 weeks, all participants (n=32) perceived a ‘successful’ outcome. Recurrence rates were null after discharge and at follow-up at 6, 26 and 52 weeks.ConclusionsSymptoms and degenerative structural changes of chronic lateral epicondylitis are reduced after US-guided PNE associated with EccEx and stretching, with encouragingly low recurrences in the mid to long term.Trial registration numberClinicalTrials.gov identifier: NCT02085928.

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“…In animal models and experimental studies, acupuncture has been shown to increase concentration and reorganization of collagen, improve ultrastructure of collagen fibrils [25] and exert anti-inflammatory effects [26,27]. The effectiveness of acupuncture and moxibustion on pain relief and function improvement has also been proven in randomized controlled trials [7,8].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Traditional Chinese Medicine Use in Pediatric Dislocations, Sprains and Strains

Chang

Sung

et al. 2017

IJERPH

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Background and Objectives: Dislocations, sprains and strains are common childhood musculoskeletal injuries, requiring medical attention. We investigated the characteristics associated with using traditional Chinese medicine (TCM) for children suffering from these injuries. Methods: From a nationwide representative insurance database of Taiwan, this cross-sectional study identified 50,769 children with dislocations, sprains and strains under 18 years of age, newly diagnosed between 1999 and 2009, without previous TCM experience. Children who initiated treatment with TCM (n = 24,063, 47.4%) were defined as TCM users, others were in the non-TCM group. Multivariable logistic regression models estimated odds ratios (ORs) of TCM use. Results: Girls and children living in central Taiwan (vs. northern) were associated with higher TCM use. The adjusted ORs (95% confidence interval (CI)) of TCM uses were 1.60 (1.42–1.79) for patients of 3–5 years, 2.20 (1.99–2.42) of 6–12 years and 1.82 (1.64–2.01) of 13–17 years, compared with those of the <2 years group. TCM users were less likely to have outpatient visits for Western medicine care and hospitalizations in the previous year. The TCM group was nearly twice more likely than the non-user group to receive treatments at local clinics (99.1% vs. 53.3%, p < 0.001). Conclusions: This study reveals important demographic and medical factors associated with TCM uses for children with dislocations, sprains and strains. Interestingly, local clinics are the main healthcare facilities providing TCM services. Further studies are needed to evaluate the outcomes of TCM treatment for these musculoskeletal injuries.

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A Hypothesis for the Anti-Inflammatory and Mechanotransduction Molecular Mechanisms Underlying Acupuncture Tendon Healing

Cited by 15 publications

References 49 publications

Peripheral and Spinal Mechanisms of Pain and Dry Needling Mediated Analgesia: A Clinical Resource Guide for Health Care Professionals

Peripheral and Spinal Mechanisms of Pain and Dry Needling Mediated Analgesia: A Clinical Resource Guide for Health Care Professionals

Ultrasound-Guided Percutaneous Needle Electrolysis in Chronic Lateral Epicondylitis: Short-Term and Long-Term Results

Characteristics of Traditional Chinese Medicine Use in Pediatric Dislocations, Sprains and Strains

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