Low-level laser acupuncture reduces postoperative pain and morphine consumption in older patients with total knee arthroplasty: A randomized placebo-controlled trial / 中西医结合学报

BACKGROUND@#Patients commonly develop postoperative pain after total knee arthroplasty (TKA). Acupuncture-related techniques and low-level laser therapy could be beneficial for pain management for older individuals.@*OBJECTIVE@#To examine the effect of low-level laser acupuncture (LA) in reducing postoperative pain, pain-related interference in daily life, morphine consumption, and morphine-related side effects in older patients with knee osteoarthritis who underwent TKA.@*DESIGN, SETTING, PARTICIPANTS AND INTERVENTION@#A single-blind randomized placebo-controlled trial was conducted. Patients (N = 82) were recruited and randomly assigned via a computer-generated list to the LA group or a placebo group. The LA group received low-level laser therapy at Sanyinjiao (SP6), Taixi (KI3), Kunlun (BL60), Fengshi (GB31), Futu (ST32) and Neiguan (PC6) after TKA, while the placebo acupuncture group received the same treatment procedure without laser energy output.@*MAIN OUTCOME MEASURES@#The primary outcome was postoperative pain intensity, and it was measured at baseline and hours 2, 6, 10, 24, 48 and 72 after TKA. The secondary outcomes, including relative pain, postoperative pain-related interference in daily life and morphine consumption, were measured at hours 24, 48 and 72 after TKA.@*RESULTS@#Generalized estimating equations revealed significant between-group differences in pain intensity (P = 0.01), and trend differences in pain intensity for the LA group starting at hours 10 to 72 (P < 0.05) and morphine consumption at hours 48 and 72 (P < 0.05). The changes in pain-related interference in daily life were significant (P < 0.05) at 72 h, with the exception of the parameters for worst pain, mood, and sleep. Nausea and vomiting side effects from morphine had significant between-group differences at hours 10 and 24 (P < 0.05).@*CONCLUSION@#Low-level LA gradually reduced older patients' postoperative pain intensity and morphine consumption within the first 72 h after their TKA for osteoarthritis. Low-level LA may have benefits as an adjuvant pain management technique for clinical care.@*TRIAL REGISTRATION@#ClinicalTrials.gov registration number NCT03995446.

Modern use of Chinese herbal formulae from Shang-Han Lun / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The Chinese medical archive, Shang-Han Lun, is said to be written by ZHANG Zhong-jing (150 - 219 A.D.). This great influential work introduced the specific symptoms of six-channel disorders (Tai-Yang, Yang-Ming, Shao-Yang, Tai-Yin, Shao-Yin, and Jue-Yin) and their corresponding treatments, the combined syndromes, deterioration due to malpractice, and the concept of six-channel transitions. The concept of Shang-Han Lun is widely accepted by Chinese herbal doctors. However, no clinical data about Shang-Han symptoms are described in oriental or western medical reports.</p><p><b>METHODS</b>The clinical prescription data of traditional Chinese medicine visits were extracted under the National Health Insurance in Taiwan. The application rate of 42 Shang-Han formulae in clinical practice was analyzed in detail with the software SPSS.</p><p><b>RESULTS</b>Between 1999 and 2002, the prescription rate of Shang-Han formula was only 5.22% among a total of 528 889 576 Chinese herbal formula prescriptions. The most frequently used formula was Tai-Yang formulae (71.31%), followed by Shao-Yang formulae (17.49%) and the most commonly prescribed individual Shang-Han formulae were Ge-Gen Tang (16.11%), Shao-Yao-Gan-Cao Tang (12.97%), Xiao-Qing-Long Tang (11.79%), Ban-Xia Xie-Xin Tang (10.24%), and Xiao-Chai-Hu Tang (9.11%), which comprised 60.22% of the utilization rate of total Shang-Han formulae.</p><p><b>CONCLUSIONS</b>From the prescription patterns of Shang-Han formulae, there was no evidence of transitions among the six channels. Despite the fundamental role of Shang-Han Lun in traditional Chinese medicine, prescription of Shang-Han formulae was limited in clinical practice.</p>