Somatosensory Processing and Pain Workshop 1
Title: “What is acupuncture, and does electro acupuncture evoke analgesia by the same mechanism? Are these effective alternatives to analgesics drugs?” Reference 2: Casimiro, L., et al., “Acupuncture and electro acupuncture for the treatment of rheumatoid arthritis”. Cochrane Database Syst Rev, 2005(4).
Vasileios Belitsiotis
What is acupuncture? Acupuncture is a traditional Chinese medical practice, in which specific body areas are pierced with fine needles, in order to relieve pain or create anaesthesia.
From, http://www.answers.com/acupuncture
What is the theory for acupuncture? It is based on the premise that patterns of energy flow (Qi) existing all through the body, are essential for health, and their disruption causes disease. Energy flow circulates into the meridians. Meridians are specific interconnected channels form head to foot, made up of clusters of "aligned water" in the body. Through them ions, light, and sound waves to flow more readily.
From, http://www.answers.com/
What is the theory for acupuncture?
There are twelve main and eight extra meridians in the body, bearing about 800 specific anatomical acupuncture points. 400 of these are basic acupoints.
Upon needle insertion, morphine like substances are released in the patient’s system, causing analgesia or anaesthesia.
Electro acupuncture
It is similar to traditional acupuncture. The same points are stimulated by needle insertion. Difference is that after insertion, needles are attached to a device generating electric pulses of continuous or alternating current. Main point is: In order for impulses to travel trough the tissue, pairs of needles are needed.
There can be up to a few such pairs, according to the protocol/knowledge for effective treatment.
From http://www.acupuncturetoday.com/abc/electroacupuncture.html
Electro acupuncture Is considered to be very useful for conditions of chronic pain, where there is accumulation of energy flow (Qi), or when (Qi) is difficult to stimulate.
One advantage: Precise insertion of needles is not as important as in acupuncture, because current, trough the needle, covers a wider tissue area.
From http://www.acupuncturetoday.com/abc/electroacupuncture.html
Electro acupuncture A major recent breakthrough is: It can be applied without use of needles. The technique is called acupuncture like TENS (ALTENS).
(TENS stands for transcutaneous nerve electrical stimulation )
Both use low frequency, high intensity stimulation, below 4pps to prevent muscle spasms.
From http://www.acupuncturetoday.com/abc/electroacupuncture.html,
http://www.paintechnology.com/054.htm
Mechanism of acupuncture and electro acupuncture is in principle the same.
Enkephalins and dynorphin are produced at the spinal cord
and endorphin, dynorphin and serotonin at the brain stem and hypothalamus-pituitary.
From: http://www.paintechnology.com/054.htm, www.intl.elsevierhealth.com/e-books/pdf/131.pdf THEORY AND BASIC SCIENCE p.69-83
Mechanism of acupuncture and electro acupuncture is in principle the same.
C fibre is in primary afferent polymodal nociceptor, projecting to (SG) subtantia gelatinosa (lamina I, II in the superficial dorsal horn of spinal cord), then potentially to (WDR) wide dynamic range (or convergent) cells, then to brain creating pain sensation. Aδ fibre is in primary afferent pinprick receptors, projecting to (M) marginal cells, then either to the brain with pinprick information, or to (St) stalked cells that release (ENK) enkephalin and block the (SG) subtantia gelatinosa cells.
From: www.intl.el sevierhealt h.com/ebooks/pdf/ 131.pdf from ‘Eurekah Bioscience Collection’ 2003 THEORY AND BASIC SCIENCE p.69-83
Mechanism can be more complicated and affords much more explanation than we have found today.
From: www.intl.elsevierhealth.com/ebooks/pdf/131.pdf THEORY AND BASIC SCIENCE p.69-83
Conventional TENS (high frequency, low intensity), acts via Aβ fibres of primary afferent tactile receptors, and inhibits (SG) cells through GABA release.
From: www.intl.elsevierhealth.com/ebooks/pdf/131.pdf THEORY AND BASIC SCIENCE p.69-83
Casimiro et al review focuses on the chronic pain disease rheumatoid arthritis (RA) in the knee for the use of acupuncture and electro acupuncture.
There are major problems in the review. A main problem of general nature is: Overall, there is very little evidence in the scientific world, to support the use of acupuncture. This is stated in the review as well.
Another problem of general nature: No global protocol for the use of each technique, not only for (RA), but for all other diseases, that can be useful, and not one for which diseases they are effective, and for which are not.
Other problems.
Due to costs of translation only articles written in French or English are used for the review. The two studies used nevertheless, received much and evident criticism from other scientists/practitioners.
It also seems that the main inclusion criterion for the studies in the review is to abide by “validated assessment tools” (like randomisation, double blinding, description of withdrawals), and not if the method was appropriately used for (RA) according at least to the ancient/traditional practice.
The two studies included for the review were:
• David et al. (1994) for acupuncture. • Man (1974) for electro acupuncture.
David et al. (1994):
• Sixty-four patients aged 46-66 participated. Assignment to experimental or
placebo group was random. Eight withdrew prior to the start of study. • Li3, single point treatment was used in both knees for 4 minutes. Needles used
were 0.25 x 30 mm.
• Needles were manipulated for five seconds, two minutes after being inserted. • Placebo group: the guides for needle insertion were placed without pressure, on
the surface of the skin, at the Li3 points. Needles were not inserted. • Patients were treated supine. Screen was blocking their vision from their waist down. • Treatments occurred once a week for five weeks. • After six weeks wash-out period, patients were crossed-over (experimental to placebo and vice versa). Five weeks of treatment followed as before.
• Results: • No significant difference was found between
experimental and placebo groups for any of the study outcomes.
Man (1974):
• Twenty patients participated. Age not determined. Assignment to
experimental or placebo group was random.
• Needles were inserted in one of the knees at the GB 34, SP 9 and S43 acupuncture • • •
points. Electro acupuncture was applied once for 15 minutes at 6.26 5mA, using 15mm needles. Other knee was injected with 50 mg of hydrocortisone, hence parallel design. Placebo group: electro acupuncture was applied to three incorrect points around the knee. Instrumentation was the same as the experimental group.
• Results: • Significant decrease in knee pain was reported in the
experimental group compared to placebo group upon assessment. Assessment occurred 24 hours, and 4 months post treatment.
David et al. (1994) study received a lot of criticism from the reviewers (despite choosing it) and also Tukmachi (2000).
• J. David reply to E.Tukmachi, published in Tukmachi (2000), depicts the study’s
weaknesses very well: “We accept that traditional acupuncture would generally use more than one point in the holistic therapy of rheumatoid”. “Liver 3 (Li3) allows one to deal with the practical problems of blinding”. “The short duration of treatment, i.e. 4 min, also allows the placebo needle to be held in place for a practical length of time”.
•
• •
• One should not alter efficient treatment practice, simply for the
•
sake of blinding, efficient placebo treatment or other reasons of lesser importance that the practice itself. Also, if any newer method does not give efficient results, it ought to refer if the traditional method is successful and try to explain the reasons, rather than diminishing it.
Tukmachi (2000) comments:
• “I have had success in treating osteoarthritis and RA by using at least four
acupuncture points”.
• The author also mentions other points for effective treatment like: • use of ear acupuncture points, • specific proposals for duration and frequency of treatments by the traditional
Chinese and Western acupuncture theory for treating various painful disorders and chronic like RA.
• These show that there is indicated and possibly effective
practice for RA, mainly based on traditional ways of treatment.
Comments on the Man (1974) study in the review.
• We don’t know if treatment was effective after the three months. • Hydrocortisone injection to the other knee might be affecting pain alleviation to the • • •
acupunctured one. Statistical analysis was poor. The outcome measure is not recognised and did not provide strong objective data. Poor quality of the data and small sample size.
• These of course do not prove that electro acupuncture
is not effective for RA. They simply state the need for more and clear proof.
Acupuncture today:
• It is widely used in China in the treatment of hay
fever, headaches, and ulcers, and some types of blindness, arthritis, diarrhoea, and hypertension
• It is also used, especially in China, as a general
anaesthetic during childbirth and some types of surgery.
From, http://www.answers.com/acupuncture
Acupuncture today in the western world today:
• It has good results in adult postoperative and •
chemotherapy nausea and vomiting and in postoperative dental pain. “May be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program in other situations such as: addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma”.
From, http://www.answers.com/acupuncture
All the previous show that acupuncture in a few diseases/cases, already is an effective alternative to analgesic drugs, and has the potential to expand far more.
An opinion: Pain relief by administrating pain killers produced by man is one thing, but putting needles in the body and inducing it to produce pain killer substances on its own, is a different thing. Maybe the second requires more time to be effective, and might cause changes to the body itself, even long term ones. The one to five treatments used in these studies, might not be enough.
An opinion: In general, in the scientific world there might not be important knowledge for acupuncture yet, but this doesn't mean that this knowledge does not exist at all.
Since acupuncture has been in use for thousands of years in the far East, knowledge might be there and ought to be retrieved and then understood.
It is possible that the value of acupuncture is underestimated to day.
The main question still remaining unexplained:
To undoubtedly prove the effectiveness of the method in each disease/case separately,
and to explain scientifically the potential mechanism.