Manual and Electrical Needle Stimulation in Acupuncture Research: Pitfalls and Challenges of Heterogeneity

Langevin, Hélène M.; Schnyer, Rosa N.; MacPherson, Hugh; Davis, Robert T.; Harris, Richard E.; Napadow, Vitaly; Wayne, Peter M.; Milley, Ryan J.; Lao, Lixing; Stener-Victorin, Elisabet; Kong, Jiang-Ti; Hammerschlag, Richard

doi:10.1089/acm.2014.0186

Cited by 93 publications

(96 citation statements)

References 64 publications

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“…A recent white paper by Langevin and colleagues highlighted the inherent difficulties in comparing MA and EA, as all of the included trials that used EA obtained de qi via manual stimulation before the addition of EA; therefore, the included studies may be more accurately interpreted as comparing MA versus MA+EA rather than MA versus EA. 31 The importance of de qi in treating menstrual pain is still unclear; while Xiong 26 found an effect on immediate menstrual pain, a more recent analysis on the importance of de qi in the treatment of primary dysmenorrhoea casts doubt on this finding. 32 When considering the number of needles used, there were no obvious dose-response relationship across studies; interestingly, however, one study suggested that treatment using a single needle during menses may give better results, whereas multiple needles may be superior before menses.…”

Section: Immediatementioning

confidence: 99%

Treating Primary Dysmenorrhoea with Acupuncture: A Narrative Review of the Relationship between Acupuncture ‘dose— and Menstrual Pain Outcomes

Armour

Smith

2016

Acupunct Med

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Objective A number of randomised controlled trials have been performed to determine the effectiveness or efficacy of acupuncture in primary dysmenorrhoea. The objective of this review was to explore the relationship between the ‘dose’ of the acupuncture intervention and menstrual pain outcomes. Methods Eight databases were systematically searched for trials examining penetrating body acupuncture for primary dysmenorrhoea published in English up to September 2015. Dose components for each trial were extracted, assessed by the two authors and categorised by neurophysiological dose (number of needles, retention time and mode of stimulation), cumulative dose (total number and frequency of treatments), needle location and treatment timing. Results Eleven trials were included. Components of acupuncture dose were well reported across all trials. The relationship between needle location and menstrual pain demonstrated conflicting results. Treatment before the menses appeared to produce greater reductions in pain than treatment starting at the onset of menses. A single needle during menses may provide greater pain reduction compared to multiple needles. Conversely, multiple needles before menses were superior to a single needle. Electroacupuncture may provide more rapid pain reduction compared to manual acupuncture but may not have a significantly different effect on overall menstrual pain. Conclusions There appear to be relationships between treatment timing and mode of needle stimulation, and menstrual pain outcomes. Needle location, number of needles used and frequency of treatment show clear dose-response relationships with menstrual pain outcomes. Current research is insufficient to make definitive clinical recommendations regarding optimum dose parameters for treating primary dysmenorrhoea.

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Section: Immediatementioning

confidence: 99%

Treating Primary Dysmenorrhoea with Acupuncture: A Narrative Review of the Relationship between Acupuncture ‘dose— and Menstrual Pain Outcomes

Armour

Smith

2016

Acupunct Med

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“…It is perhaps worth pointing out that RCTs from the acupuncture literature achieve better analgesia by adding electricity than by brief or intermittent manual stimulation alone [132]. While only one systematic review has directly compared …”

Section: Calcitonin Gene Regulated Peptide and Substance-pmentioning

confidence: 99%

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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“…Acupuncture is a minimallyinvasive therapeutic modality that originated in China 2000 years ago as a component of traditional Chinese medicine (Kaptchuk, 2002). While acupuncture therapy is rooted in a complex practice ritual, the acupuncture needle procedure, particularly when coupled with electrical needle stimulation, overlaps significantly with many conventional peripheral neuromodulatory therapies (Langevin et al, 2015) that have generated significant excitement as 'electroceuticals' targeting peripheral nerve receptors (Famm et al, 2013;Waltz, 2016). However, the neurophysiological mechanisms by which acupuncture impacts subjective/psychological (i.e.…”

Section: Introductionmentioning

confidence: 99%

Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture

Maeda

Kim

Kettner

et al. 2017

Brain

Self Cite

130

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Ã These authors contributed equally to this work.Carpal tunnel syndrome is the most common entrapment neuropathy, affecting the median nerve at the wrist. Acupuncture is a minimally-invasive and conservative therapeutic option, and while rooted in a complex practice ritual, acupuncture overlaps significantly with many conventional peripherally-focused neuromodulatory therapies. However, the neurophysiological mechanisms by which acupuncture impacts accepted subjective/psychological and objective/physiological outcomes are not well understood. Eligible patients (n = 80, 65 female, age: 49.3 AE 8.6 years) were enrolled and randomized into three intervention arms: (i) verum electro-acupuncture 'local' to the more affected hand; (ii) verum electro-acupuncture at 'distal' body sites, near the ankle contralesional to the more affected hand; and (iii) local sham electro-acupuncture using non-penetrating placebo needles. Acupuncture therapy was provided for 16 sessions over 8 weeks. Boston Carpal Tunnel Syndrome Questionnaire assessed pain and paraesthesia symptoms at baseline, following therapy and at 3-month follow-up. Nerve conduction studies assessing median nerve sensory latency and brain imaging data were acquired at baseline and following therapy. Functional magnetic resonance imaging assessed somatotopy in the primary somatosensory cortex using vibrotactile stimulation over three digits (2, 3 and 5). While all three acupuncture interventions reduced symptom severity, verum (local and distal) acupuncture was superior to sham in producing improvements in neurophysiological outcomes, both local to the wrist (i.e. median sensory nerve conduction latency) and in the brain (i.e. digit 2/3 cortical separation distance). Moreover, greater improvement in second/third interdigit cortical separation distance following verum acupuncture predicted sustained improvements in symptom severity at 3-month follow-up. We further explored potential differential mechanisms of local versus distal acupuncture using diffusion tensor imaging of white matter microstructure adjacent to the primary somatosensory cortex. Compared to healthy adults (n = 34, 28 female, 49.7 AE 9.9 years old), patients with carpal tunnel syndrome demonstrated increased fractional anisotropy in several regions and, for these regions we found that improvement in median nerve latency was associated with reduction of fractional anisotropy near (i) contralesional hand area following verum, but not sham, acupuncture; (ii) ipsilesional hand area following local, but not distal or sham, acupuncture; and (iii) ipsilesional leg area following distal, but not local or sham, acupuncture. As these primary somatosensory cortex subregions are distinctly targeted by local versus distal acupuncture electrostimulation, acupuncture at local versus distal sites may improve median nerve function at the wrist by somatotopically distinct neuroplasticity in the primary somatosensory cortex following therapy. Our study further suggests that improvements in primary somatosensory cortex ...

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Manual and Electrical Needle Stimulation in Acupuncture Research: Pitfalls and Challenges of Heterogeneity

Cited by 93 publications

References 64 publications

Treating Primary Dysmenorrhoea with Acupuncture: A Narrative Review of the Relationship between Acupuncture ‘dose— and Menstrual Pain Outcomes

Treating Primary Dysmenorrhoea with Acupuncture: A Narrative Review of the Relationship between Acupuncture ‘dose— and Menstrual Pain Outcomes

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

Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture

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