Multidisciplinary treatment program for improvement in pain and disability associated with nonspecific chronic low back pain / Programa de tratamento multidisciplinar para melhora da dor e incapacidade associada a dor crônica lombar inespecífica

ABSTRACT BACKGROUND AND OBJECTIVES: Lumbar disorders, which contribute to significant workplace absenteeism and chronic disability, are associated with a considerable financial and social burden. Although a conservative approach provides satisfactory pain relief, biomechanical improvement and is associated with a low risk of adverse effects, there is lack of consensus in the literature regarding the best therapeutic strategy in such cases. METHODS: This retrospective longitudinal study used secondary data from the institutional medical records of patients who completed a multidisciplinary program for the treatment of low back pain between 2019 and 2021. Data regarding pain levels and motor skills were obtained from patients who completed the care program at a private hospital in Bento Gonçalves, RS. The following step-wise treatment algorithm was used: evaluation by a specialist physician for the etiological diagnosis of pain, pharmacological management and dry needling, followed by standard rehabilitation intervention performed by the physiotherapy team and exercises by the physical education team. The visual analogue scale (VAS) was used to measure pain at the start and at the completion of the intervention, and the Oswestry Disability Index (ODI) was used to measure motor skills at the start and at 6 and 12 months following the multiprofessional intervention for rehabilitation. RESULTS: A reduction in pain and motor disability in patients who completed all stages of the treatment program was observed. Pain by the VAS presented the following scores: baseline 7 [5-8] and after treatment 2 [0-4]; and the scores of the ODI were: at baseline 0.34 [0.26 - 0.40], at 6 months 0.16 [0.08 - 0.26] and after treatment 0.12 [0.04 - 0.21]. CONCLUSION: The treatment program reduced the pain and disability associated with low back pain and can serve as the basis for further studies carried out to confirm the effectiveness of this intervention.

RESUMO JUSTIFICATIVA E OBJETIVOS: As doenças lombares, que contribuem para um absenteísmo significativo no local de trabalho e para a incapacidade crônica, estão associadas a um encargo financeiro e social considerável. Embora a abordagem conservadora proporcione alívio satisfatório da dor, melhore a biomecânica e esteja associada a baixo risco de efeitos adversos, não há consenso na literatura sobre a melhor estratégia terapêutica nesses casos. MÉTODOS: Neste estudo longitudinal retrospectivo, foram utilizados dados secundários dos prontuários médicos institucionais de pacientes que completaram um programa multidisciplinar para tratamento de dor lombar entre 2019 e 2021. Dados sobre níveis de dor e habilidades motoras foram obtidos de pacientes que completaram o programa assistencial de um hospital privado de Bento Gonçalves, RS. Foi utilizado o seguinte tratamento passo a passo: avaliação por médico especialista para diagnóstico etiológico da dor, manejo farmacológico e agulhamento a seco, seguido de intervenção de reabilitação padrão realizada pela equipe de fisioterapia e exercícios pela equipe de educação física. A escala analógica visual (EAV) foi utilizada para medir a dor no início e após a conclusão da intervenção, e o Índice de Incapacidade de Oswestry (ODI) foi usado para medir as habilidades motoras no início e aos 6 e 12 meses após a intervenção multiprofissional para reabilitação. RESULTADOS: Observou-se redução na dor e na incapacidade motora em pacientes que completaram todas as etapas do programa de tratamento. A intensidade da dor medida pela EAV apresentou as seguintes pontuações: basal 7 [5-8] e após tratamento 2 [0-4]; enquanto o ODI apresentou as pontuações: basal 0,34 [0,26 - 0,40], até 6 meses 0,16 [0,08 - 0,26] e após o tratamento 0,12 [0,04 - 0,21]. CONCLUSÃO: O programa de tratamento reduziu a dor e a incapacidade associadas à dor lombar e pode servir de base para novos estudos realizados para confirmar a eficácia desta intervenção.

Treating myofascial pain with dry needling: a systematic review for the best evidence-based practices in low back pain / Tratamento da dor miofascial com agulhamento a seco: uma revisão sistemática para as melhores práticas baseadas em evidências em lombalgia

Abstract Background Myofascial pain syndrome (MPS) is a common source of pain in primary care or pain clinics. There are many different ways to manage and treat MPS, such as physical exercise, trigger points massage, and dry needling. Objective The objective of this overview is to highlight and discuss the evidence-based treatment of myofascial pain by dry needling in patients with low back pain. Methods A systematic review was made based on meta-analysis (MA) and randomized controlled trials (RCTs) related to dry needling treatment for myofascial pain in patients with lumbar pain, published from 2000 to 2023. Results A total of 509 records were identified at first. Seventy were published before 2000, so they were excluded. From the remaining 439 studies, ninety-two were RCTs or MA, of which 86 additional studies were excluded for the following reasons: not related to dry needling treatment (n = 79), not published in English (n = 4), duplicated (n = 1), project protocol (n = 1), and not related to myofascial pain (n = 1). So, this review was based on 4 RCTs and two MA. These studies compared dry needling efficacy to other treatments, such as acupuncture, sham dry needling, laser therapy, physical therapy, local anesthetic injection, ischemic compression, and neuroscience education. Despite outcomes and follow-up period varied between them, they showed that dry needling can decrease post-intervention pain intensity and pain disability. Conclusion Dry needling is an effective procedure for the treatment of myofascial pain in patients with acute and chronic low back pain. Further high-quality studies are needed to clarify the long-term outcomes.

Resumo Antecedentes A síndrome dolorosa miofascial (SDM) é uma fonte comum de dor em centros primários de atenção à saúde ou nas clínicas de dor. Existem muitas formas diferentes de manejar e tratar a SDM, como o exercício físico, a massagem dos pontos de gatilho e o agulhamento a seco. Objetivo O objetivo desta revisão é destacar e discutir o tratamento baseado em evidências da dor miofascial por agulhamento a seco em doentes com dor lombar. Métodos Foi realizada uma revisão sistemática baseada em metanálises (MA) e ensaios clínicos randomizados (RCTs) relacionados ao tratamento da dor miofascial com agulhamento a seco em pacientes com dor lombar, publicados de 2000 a 2023. Resultados Foram identificados, inicialmente, um total de 509 registos. Setenta deles, publicados antes de 2000, foram excluídos. Dos 439 estudos restantes, 92 eram RCTs ou MA, dos quais 86 foram excluídos pelas seguintes razões: não relacionados a tratamento com agulhamento a seco (n = 79), não publicados em inglês (n = 4), duplicados (n = 1), protocolo de projeto (n = 1) e não relacionados com dor miofascial (n = 1). Assim, esta revisão baseou-se em quatro RCTs e duas MA. Esses estudos compararam a eficácia do agulhamento seco com outros tratamentos, tais como acupuntura, agulhamento a seco "sham", terapia com laser, fisioterapia, injeção de anestésico local, compressão isquêmica e educação em neurociências. Apesar de os resultados e o período de seguimento variarem entre os estudos, os estudos demonstram que o agulhamento a seco pode diminuir a intensidade da dor pós-intervenção e a incapacidade relacionada à dor. Conclusão O agulhamento a seco é um procedimento eficaz para o tratamento da dor miofascial em pacientes com dor lombar aguda e crônica. Mais estudos são necessários para esclarecer sua eficácia a longo prazo.

Combinação de terapia por ondas de choque extracorpórea e agulhamento seco no tratamento de lombalgia crônica incapacitante: um relato de caso / Combination of extracorporeal shockwave therapy and dry needling as treatment of disabling chronic low back pain: a case report

Paciente do sexo masculino, 55 anos, apresentava antecedente clínico de radiculopatia lombar abordado cirurgicamente (discectomia e artrodese L5-S1) em dezembro de 2021, com resolução completa da dor associada. Iniciou com quadro de dor pós-operatória de características distintas. A primeira sessão de tratamento iniciou-se com terapia por ondas de choque extracorpóreas focal direcionada ao quadrado lombar, glúteo médio, glúteo mínimo e região peritrocantérica à direita. Posteriormente, associou-se agulhamento seco em pontos-gatilho presentes nesses mesmos 3 músculos e também no ligamento sacrotuberal direito, junto à inserção do glúteo máximo direito. Numa reavaliação uma semana depois, o paciente referiu uma redução de 70% da intensidade da dor inicial. O mesmo tratamento foi repetido, com resolução completa dos sintomas no final da sessão. Três meses depois, o doente manteve o controle álgico e recuperou totalmente a sua funcionalidade e qualidade de vida anteriores. Neste caso de limitação funcional a longo prazo devido a dor lombar crônica, a combinação da terapia por ondas de choque extracorporais e do agulhamento seco resultou num método eficaz e rápido para obter o alívio da dor e restaurar a funcionalidade anterior. No entanto, são necessários mais estudos para investigar o impacto desta combinação de terapias no controle da dor e na perda de funcionalidade devido à dor lombar crônica.

Male patient, 55 years old, had a clinical background of lumbar radiculopathy and a surgical approach (L5-S1 discectomy and arthrodesis) in December of 2021, with complete resolution of associated pain. One year later, the patient seeks medical treatment, referring a new, different pattern of low back pain, which initiated post-surgery. The first treatment session began with focused extracorporeal shockwave therapy directed at the right quadratus lumborum, gluteus medius, gluteus minimus and peritrochanteric region. Afterwards, dry needling was associated in trigger-points present in those same 3 muscles and also in the right sacrotuberal ligament, close to the insertion of the right gluteus maximus. In a reevaluation one week later, the patient reported a reduction of 70% of initial pain intensity. The same treatment was repeated, with complete resolution of symptoms at the end of the session. Three months later, the patient-maintained symptom control and fully recovered his previous functionality and quality of life. In this case of long-term functional limitation due to chronic low back pain, the combination of extracorporeal shock wave therapy and dry needling resulted in an effective and quick method to achieve pain relief and restore previous functionality. However, more studies are needed to investigate the impact of this combination of therapies in pain management and functionality loss due to chronic low back pain.

Dry needling in the treatment of myofascial trigger points and painful shoulder dysfunctions: narrative review of the literature / Agulhamento a seco no tratamento de pontos-gatilho miofasciais e disfunções dolorosas do ombro: revisão narrativa da literatura

ABSTRACT BACKGROUND AND OBJECTIVES: Shoulder painful dysfunctions comprises one of the most common musculoskeletal disorders that requires specialized assistance. Dry Needling (DN) became an adjuvant approach with increased use in clinical practice to treat this type of condition. The present study discusses the literature related to DN in the treatment of myofascial trigger points (MTPs), shoulder dysfunctions and associated pain. METHODS: A narrative review through search of articles from 2010 to 2022 written in Portuguese, English or Spanish was performed in Latin American and Caribbean Literature on Health Sciences (LILACS), Health Information from the National Library of Medicine (Medline), Web of Science and the Scientific Electronic Library Online (Scielo) databases using the keywords: <"Dry Needling">; <"Agulhamento a Seco">; <"Myofascial Trigger Points">; <"Pontos-Gatilhos Miofasciais">; <"Shoulder Dysfunctions">; <"Disfunções do ombro">. The qualitative analysis was performed determining the level of evidence for DN treatment of MTPs, shoulder dysfunctions and pain. RESULTS: A total of 45 citations were found, 22 citations were excluded because they did not meet the selection criteria. The 23 remaining citations were examined for titles and abstracts and duplicate studies were removed. Finally, 10 articles met the selection criteria and were included in the present review. No articles were excluded after full-text screening. The analysis showed poor advances and knowledge regarding the application of DN for the treatment of pain, painful and general shoulder dysfunctions and MTPs, with few evidence regarding treatment effectiveness, patient's pain scores data, mechanisms of action and statistical analysis. CONCLUSION: There is still a lack of concrete scientific evidence to assess DN effectiveness in modulating pain in patients with MTPs shoulder. More systematic reviews and meta-analyses together with experimental and clinical searches must be conducted to provide stronger evidence of this modality to relief painful symptoms in the shoulder, as well as a treatment of MTPs and general shoulder disorders.

RESUMO JUSTIFICATIVA E OBJETIVOS: As disfunções dolorosas de ombro constituem uma das disfunções musculoesqueléticas mais comuns que requerem assistência especializada. O agulhamento a seco (AS) tornou-se uma abordagem adjuvante com uso crescente na prática clínica para tratar esse tipo de condição. O objetivo deste estudo foi rever na literatura aspectos relacionados ao AS no tratamento de pontos-gatilho miofasciais (PGMs), disfunções do ombro e dores associadas. MÉTODOS: Foi realizada uma revisão narrativa através da busca de artigos de 2010 a 2022 escritos em português, inglês ou espanhol, na Literatura Latino-Americana e do Caribe nos bancos de dado Ciências da Saúde (LILACS), Informações em Saúde da Biblioteca Nacional de Medicina (Medline), Web of Science e Scientific Electronic Library Online (Scielo) utilizando as palavras-chave <"Dry Needling">; <"Agulhamento a Seco">; <"Myofascial Trigger Points">; <"Pontos-Gatilhos Miofasciais">; <" Disfunções do ombro">. A análise qualitativa foi realizada determinando o nível de evidência para tratamento de AS para o tratamento de PGMs, disfunções do ombro e dor. RESULTADOS: Um total de 45 citações foram encontradas, 22 citações foram excluídas porque não atenderam aos critérios de seleção. As 23 citações restantes foram examinadas para títulos e resumos e estudos duplicados foram removidos. Finalmente, 10 artigos atenderam aos critérios de seleção e foram incluídos na presente revisão. Nenhum artigo foi excluído após a triagem de texto completo. A análise mostrou poucos avanço e conhecimento sobre a aplicação de AS para o tratamento da dor, disfunções dolorosas e gerais do ombro e PGMs, com poucas evidências sobre a eficácia do tratamento, dados dos escores de dor do paciente, mecanismos de ação e análise estatística. CONCLUSÃO: Ainda faltam evidências científicas concretas para avaliar a eficácia do AS na modulação da dor em pacientes com PGMs no ombro. Mais revisões sistemáticas e meta-análises associadas a pesquisas experimentais e clínicas devem ser realizadas para fornecer evidências dessa modalidade promissora para alívio de sintomas dolorosos no ombro, bem como tratamento de PGMs e distúrbios gerais do ombro.

Suture manipulation post-trabeculectomy: A practical guide

Background: Trabeculectomy is the gold standard filtration surgery for diverting aqueous from anterior chamber to the subconjunctival space. More than the surgery, postoperative follow?ups and management of the blebs play a critical role in the long?term success. This video is aimed at showing the real?world management of blebs postoperatively. Purpose: This video will serve as a practical guide to the postoperative management of trabeculectomy blebs with specific focus on the suture manipulation. Synopsis: This video will demonstrate various suturing techniques of trabeculectomy and their manipulation in the postoperative period. Complications related to each will be discussed. Highlights: We demonstrate how to place and remove, releasable, and fixed sutures. We also address the practical points on why and when to remove the sutures. Suture?related complications and their management have been shown along with practical examples

A comparative evaluation of therapeutic efficacy and safety of Falknor’s needling versus autoimplantation in cutaneous warts

Background: Warts, the most common manifestation caused by human papillomaviruses. Treatment is needed because of risk of transmission, cosmetic point of view, multiple, painful, and disfigurement caused by warts. Aims and Objectives: In this study, two techniques of autologous therapy are compared in terms of safety and efficacy. Falknor’s needling and autoimplantation, both are minimally invasive procedures with the aim of treating one wart and inducing immunity against the viral infected cells. Materials and Methods: Forty patients of clinically diagnosed cutaneous warts were randomly divided into two groups. In Group A, Falknor’s needling was performed on a single lesion in each patient. In Group B, autoimplantation was done by harvesting a single lesion and then implanting the tissue in subcutaneous tissue of the patient at other body site. Results: Data were analyzed using SPSS software v. 23 (IBM Statistics, Chicago, USA) and Microsoft Office 2007. Both the modalities showed excellent response (P = 0.504) in the treatment of warts with Grade 4 improvement in 85% (17 patients each) in both the modalities, with 5% of the patients showing Grade 2 and Grade 3 improvement each in needling group. Conclusion: Both the modalities of autologous therapy are simple, easy to perform, safe, and cheap modalities with excellent results in the treatment of cutaneous warts.

Clinical features of early-onset pediatric traumatic glaucoma and predictive factors for the need of early glaucoma surgery

Purpose: To assess the clinical presentation of pediatric patients having early traumatic glaucoma and to analyze early predictors for the need of filtration surgery. Methods: Patients with early traumatic glaucoma after close globe injury (CGI) from January 2014 to December 2020 were retrospectively reviewed. Clinical features, treatment provided (medical and surgical), and visual outcomes were documented. Patients were divided into two groups based on the management required: group A? trabeculectomy and group B? medication + minor surgery. Results: A total of 85 patients were studied after applying the necessary inclusion and exclusion criteria. Out of these, 46 underwent trabeculectomy for the control of intraocular pressure (IOP) and the remaining 39 were managed with antiglaucoma medications. Significant male predominance of 9.6:1 was observed. Patients presented to the hospital after a mean duration of 8.5 days posttrauma. Wooden objects were most commonly responsible for trauma. Mean best corrected visual acuity at presentation was 1.91 log of minimum angle of resolution (logMAR). Mean IOP at presentation was 40 mmHg. The common anterior segment finding were severe anterior chamber (AC) reaction (63.5%), followed by angle recession (56.4%). Severe AC reaction (P = 0.0001) and corneal microcystic edema (P = 0.04) were significant predictive factors for early need of trabeculectomy. Conclusion: Need of trabeculectomy was higher in patients with severe AC reaction and corneal microcystic edema. The threshold to perform trabeculectomy should be lower, as glaucoma is often relentless, severe, and may result in irreversible vision loss.

Dong's extraordinary point needling technique combined with medication for postoperative complications of anal fistula: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effect of Dong's extraordinary point needling technique on postoperative complications of anal fistula.@*METHODS@#A total of 241 patients undergoing anal fistula surgery were randomly divided into an observation group (121 cases, 3 cases dropped off) and a control group (120 cases, 2 cases dropped off). The patients in the control group were treated with intramuscular injection of compound diclofenac sodium injection and oral administration of tamsulosin hydrochloride sustained release capsules. In addition to the treatment in the control group, the patients in the observation group were treated with Daoma needling technique at the "Sanqi points" (Qimen point, Qijiao point, and Qizheng point) combined with Dongqi needling technique at "Sanhuang points" (sub-Tianhuang point, Dihuang point, Renhuang point), with each session lasting 30 min. The treatment in the two groups both started on the first day after surgery, and was given once daily for 14 consecutive days. Visual analog scale (VAS) score was compared between the two groups on postoperative day 1, 7, and 14; bladder residual urine volume, spontaneous voiding volume, and urinary catheterization frequency were assessed after treatment on postoperative day 1; and anorectal dynamic indexes (anal canal resting pressure, rectal resting pressure, maximum squeeze pressure of the anal canal, and minimum rectal sensory threshold) were evaluated before surgery and on postoperative day 4. Clinical efficacy was assessed in both groups one month after surgery.@*RESULTS@#On postoperative day 7 and 14, the VAS scores of both groups were lower than those on postoperative day 1 (P<0.05), and the VAS scores in the observation group were lower than those in the control group (P<0.05). The bladder residual urine volume and urinary catheterization frequency in the observation group were lower than those in the control group (P<0.05), while the spontaneous voiding volume was higher than that in the control group (P<0.05). On postoperative day 4, the anal canal resting pressure, maximum squeeze pressure of the anal canal, and the minimum rectal sensory threshold were lower than preoperative values (P<0.05), while the rectal resting pressure was higher than preoperative value (P<0.05) in both groups. The anal canal resting pressure, maximum squeeze pressure of the anal canal, and minimum rectal sensory threshold were lower than those in the control group, and the rectal resting pressure was higher than that in the control group (P<0.05). The effective rate was 93.2% (110/118) in the observation group, which was higher than 84.7% (100/118) in the control group (P<0.05).@*CONCLUSION@#Dong's extraordinary point needling technique could reduce postoperative pain, alleviate urinary retention, and improve defecation in patients undergoing anal fistula surgery.

Application of "eliminating stagnation and bloodletting/fire needling" in treatment of jingjin diseases / 中国针灸

Based on the development of conditions, the etiology and pathogenesis of jingjin (muscle region of meridian) diseases are summarized as 3 stages, i.e. stagnation due to over-exertion at early stage, manifested by tendon-muscle contracture and tenderness; cold condition due to stagnation, interaction of stasis and cold, resulting in clustered nodules at the middle stage; prolonged illness and missed/delayed treatment, leading to tendon-muscle contracture and impairment of joint function at the late stage. It is proposed that the treatment of jingjin diseases should be combined with the characteristic advantages of fire needling and bloodletting technique, on the base of "eliminating stagnation and bloodletting/fire needling". This combined therapy warming yang to resolve stasis and dispels cold to remove nodules, in which, eliminating the stagnation is conductive to the tissue regeneration, and the staging treatment is delivered in terms of the condition development at different phases.

Evolution of acupuncture techniques for jin diseases and the rise and fall of jingjin doctrine / 中国针灸

It has the important enlightenment and reference significance for the inheritance and innovation of jin (sinew/fascia) diseases and its theoretic basis, jingjin (muscle region of meridian) doctrine by sorting out the origin of the acupuncture techniques for jin diseases and exploring the root of its rise and fall. Using context analysis, overall investigation and practice test, the paper elaborates the basic concepts, e.g. needling techniques for jin, jingjin, jinji (muscular contracture) and jiejin (knotted tendon), and jingjin doctrine. In particular, the three key concepts, i.e. fanzhen jieci (heating after needling), yizhi weishu (feelings from patients and acupuncture operators) and yitong weishu (the worst painful sites of muscle spasm) are deeply investigated. These three concepts, involved in the treatment of jingjin disorders, treatment principles and methods, are of a great controversy in the current academic circle. The author clarified the category of needling for jin disease and main needling techniques, investigated specially the origin of fanzhen jieci and guancifa (repeated needling directly on the foci), and explored the evolution of the needling methods that had been controversial or neglected for a long time, i.e. neire cifa (technique for inducing heat inside for cold obstruction), guancifa, tiaocifa (inserting the needles around the foci), fencifa (intramuscular needling) and mucifa (deep puncturing to the peritoneum or on front-mu points). Finally, from the relationship between jin and mai (meridian), and the differences between dry needling and acupuncture technique for jin diseases, the author explored the crucial problems and countermeasures urgently required in the future development of jingjin doctrine so as to provide the references for the theoretical innovation of acupuncture- moxibustion science.

Clinical observation of contralateral needling combined with Maitland ankle mobilization for chronic ankle sprain / 针灸推拿医学（英文版）

Objective: To observe the efficacy of contralateral needling combined with Maitland ankle mobilization in the treatment of chronic ankle sprain.Methods: A total of 106 patients with chronic ankle sprain were included in the study. They were numbered according to their order of visit, with odd numbers assigned to the control group and even numbers assigned to the observation group, with 53 cases in each group. Patients in the control group were treated with Maitland ankle mobilization, while those in the observation group were given additional contralateral needling treatment. After treatment, we observed the indicators including, ankle circumference, range of motion (ROM) of dorsiflexion, ROM of plantar flexion, thickness of ankle ligaments, and the changes in Baird-Jackson ankle score, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and visual analog scale (VAS) score to compare the efficacy between the two groups. Results: After treatment, the total effective rate of the observation group was 94.3％ and was significantly higher than that of the control group (81.1％), indicating statistical significance (P<0.05). After treatment, the ankle circumference of both groups decreased, and the ROM of dorsiflexion and the ROM of plantar flexion increased (P<0.05). The changes in the observation group were more significant, indicating inter-group statistical significance (P<0.05). After treatment, the thickness of the anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament, as well as the VAS scores decreased in both groups; the changes in the observation group were more significant, indicating inter-group statistical significance (P<0.05). After treatment, the Baird-Jackson ankle score and the AOFAS ankle- hindfoot score increased in both groups, and the scores in the observation group were higher than those in the control group, indicating inter-group statistical significance (P<0.05). Conclusion: The efficacy of contralateral needling combined with Maitland ankle mobilization in the treatment of chronic ankle sprain is superior to that of Maitland ankle mobilization alone.

Effects of the combination of acupuncture and medication on orthostatic hypotension after incomplete cervical spinal cord injury / 针灸推拿医学（英文版）

Objective: To observe the effect of the combination of acupuncture and medication on orthostatic hypotension after incomplete cervical spinal cord injury. Methods: Ninety-two patients with orthostatic hypotension after incomplete cervical spinal cord injury were divided into two groups according to the random number table method, with 46 cases in each group. The control group was treated with oral midodrine hydrochloride on the basis of conventional treatment, and the observation group was treated with acupuncture in addition to the intervention used in the control group. Both groups were treated for 4 weeks. The changes in supine and orthostatic blood pressures, motor and sensory scores, quadriplegic function index score, clinical efficacy, and safety evaluation were observed. Results: During the treatment, 2 cases dropped out in the observation group, and 3 cases dropped out in the control group. After 4 weeks of treatment, the clinical efficacy of the observation group was better than that of the control group (P<0.05). After treatment, the supine systolic blood pressure and diastolic blood pressure in the two groups had no significant changes (P>0.05), while the orthostatic systolic blood pressure and diastolic blood pressure, the motor and sensory scores, and the quadriplegic function index score were significantly higher than those before treatment (P<0.05), and the scores in the observation group were higher than those in the control group (P<0.05). Adverse reactions were mild in both groups. Conclusion: The combination of acupuncture and medication can significantly improve the orthostatic blood pressure, motor and sensory function and daily living ability of patients with orthostatic hypotension after incomplete cervical spinal cord injury, and it is safe and reliable.

Effect of microneedling combined with Lumin OX and Brightline in treatment of melasma / 中华医学美学美容杂志

Objective:To observe the clinical efficacy of micro-needle therapy combined with Biotrisse BTS Lumin OX and Biotrisse BTS Brightline in the treatment of melasma.Methods:From September 2019 to June 2021, 80 patients with facial chloasma, aged 28-48 (37.3±4.9) years, were selected from Nanjing Jiangning Guze Clinic. The micro-needle therapy was combined with lumin OX and brightline for 6 times, and the observation time was 120 days. The mMASI score and VISIA photos before and after treatment were used to improve the results.Results:Eighty patients with refractory melasma on the face were treated with micro-needle therapy for 7 times (1 time per week for the first 5 times, and twice a week for the 9th and 10th weeks). The photos before and after treatment were compared and the mMASI of the patients' facial chloasma was compared. The scores were analyzed statistically, and the melasma were improved to varying degrees. Before treatment, the mMASI score was 5.4±3.22; 90 days later, the mMASI was 3.22±2.16, and the score decreased significantly ( t=5.9, P<0.05); after 120 days, mMASI score was 1.6±0.68, and the score decreased significantly ( t=7.55, P<0.05). Pigmentation occurred in one patient after treatment, and hypopigmentation after repair treatment; none of the patients had adverse reactions such as hypopigmentation. All the 80 patients had different degrees of improvement in pores and skin texture. Conclusions:The combination of micro-needling with lumin OX and brightline in the treatment of chloasma has a definite effect without obvious side effects. It provides a new method for the treatment of chloasma.

Discussion on Acupuncture in the Treatment of Female Stress Urinary Incontinence Based on the Theory of Channel Sinew / 中医杂志

Female stress urinary incontinence （SUI） caused by support structure damage or relaxation of the urethra and bladder belongs to the category of “channel sinew disease” in traditional Chinese medicine （TCM）. The pathogenesis of this disease is “loss of nourishment in the channel sinews， and failure to contract because of relaxation”， which can be divided into two situations： deficiency syndrome mainly refers to qi deficiency， closely related to the three zang （脏） organs including lung， spleen， and kidney； and the excess syndrome mainly refers to heat pathogen and blood stasis. Therefore， the treatment principle of “nourishing the channel sinews， regulating sinews and controlling fluid” is proposed. The acupoints in the lower abdomen， lumbosacral region， and lower limbs are mainly selected in the treatment of SUI with channel sinew needling， such as Qihai （RN 6）， Guanyuan （RN 4）， and Baliao. The selection of acupoints also emphasizes the pain area. Channel sinew needling includes floating needling， round-sharp needling， penetrating needling， and prickly needling， which reflects the integrity of channel sinew system， and emphasizes the local therapeutic effects highlighting arrival of needling effects at the location of disease. The theory of channel sinew opens up new ideas for treating SUI with acupuncture and moxibustion.

Application status and analysis of Fu's subcutaneous needling in the treatment of peripheral facial paralysis / 中国针灸

This paper summarizes the status of application and research of Fu's subcutaneous needling for peripheral facial paralysis, and the characteristics of different stages of peripheral facial paralysis treated with Fu's subcutaneous needling are analyzed from the aspects of intervention timing, protocol design, needle insertion point, sweeping and reperfusion activity, tube retaining time and acupuncture frequency. It is found that there are no norms and standards in sweeping and reperfusion, tube retention and acupuncture frequency in clinical application，and the exploration of staged treatment is insufficient in the research. In the future, it is necessary to form standardized operation to promote clinical promotion, and improve the research on treatment rules and mechanism according to the characteristics of disease stage.

Clinical Efficacy of Guizhi Shaoyao Zhimutang Combined with Fire Needling in Treatment of Periarthritis of Shoulder with Wind-cold-dampness Impediment Syndrome by Stimulating Pain Points and "Shoulder Three Acupoints" / 中国实验方剂学杂志

ObjectiveTo investigate the clinical efficacy of Guizhi Shaoyao Zhimutang （GZSYZM） combined with fire needling in the treatment of periarthritis of shoulder with wind-cold-dampness impediment syndrome by stimulating pain points and "shoulder three acupoints". MethodA total of 120 patients with periarthritis of shoulder with wind-cold-dampness impediment syndrome， admitted to Hainan General Hospital from August 2020 to August 2022， were randomly divided into two groups using a random number table. The control group （60 cases） received treatment with GZSYZM for two weeks， while the observation group （60 cases） received treatment with GZSYZM combined with fire needling at pain points and "shoulder three acupoints" for two weeks. The clinical efficacy， adverse reactions， shoulder pain intensity， shoulder joint function， and levels of calcitonin gene-related peptide （CGRP）， cyclooxygenase-2 （COX-2）， interleukin （IL）-2， and IL-17 before and after treatment were compared between the two groups. ResultThe total effective rate in the observation group was 88.33% （53/60）， significantly higher than 68.33% （41/60） of the control group （χ²=7.070， P<0.01）. Compared with the results before treatment， both groups showed significant reductions in pain rating index （PRI）， visual analog scale （VAS） scores， present pain intensity （PPI）， and Simplified McGill Pain Questionnaire （SF-MPQ） total scores， as well as serum levels of CGRP， COX-2， IL-2， and IL-17 after treatment （P<0.01）， and improved pain intensity， daily life abilities， joint mobility， muscle strength， and Constant-Murley score （P<0.01）. Compared with the control group after treatment， the observation group showed significantly reduced PRI， VAS score， PPI， SF-MPQ total score， as well as serum levels of CGRP， COX-2， IL-2， and IL-17 （P<0.01）， and increased pain intensity， daily life abilities， joint mobility， muscle strength， and Constant-Murley score （P<0.01）. There was no significant difference in the incidence of adverse reactions between the two groups. ConclusionGZSYZM combined with fire needling at pain points and "shoulder three acupoints" can effectively reduce the levels of serum inflammatory factors and pain mediators， alleviate pain， and improve shoulder joint function in patients with periarthritis of shoulder with wind-cold-dampness impediment syndrome.

Professor ZHANG Wei-hua's clinical experience in chronic somatic pain treated with zhidong needling techniques / 中国针灸

The paper summarizes professor ZHANG Wei-hua's clinical experience for the treatment of chronic somatic pain with zhidong needling techniques. In terms of the characteristics of chronic somatic pain, professor ZHANG has integrated zhidong needling with acupuncture kinetic therapy. The satisfactory therapeutic effects are obtained by selecting the painful points and regions as the treatment sites and the specific techniques of zhidong needling depending on the size of affected area, the depth of illness, the size and shape of the cord-like muscle, etc. Five techniques of zhidong needling are used accordingly with twirling, pulling, lifting and thrusting, surrounding needling methods involved, as well as with the manipulation speed, direction and frequency considered.

Exploration on acupuncture treatment ideas for knee osteoarthritis from the perspective of Dongyuan needling technology / 中国针灸

The treatment ideas with acupuncture for knee osteoarthritis (KOA) are explored on the base of Dongyuan needling technology. Regarding the rules of acupoint selection, Zusanli (ST 36) is predominant, the back-shu points are used for the disorders related to the invasion of exogenous factors, and the front-mu points are for the cases caused by internal injury. Besides, the xing-spring points and shu-stream points are preferred. In treatment of KOA, besides the local points, the front-mu points, i.e. Zhongwan (CV 12), Tianshu (ST 25) and Guanyuan (CV 4), are selected specially to tonifying the spleen and stomach. The earth points and acupoints on the earth meridians (i.e. Yinlingquan [SP 9], Xuehai [SP 10], Liangqiu [ST 34], Dubi [ST 35], Zusanli [ST 36] and Yanglingquan [GB 34]) are optional to coordinate yin and yang, essence and qi , and regulate the qi movement of spleen and stomach. The shu-stream points of liver, spleen and kidney meridians (Taichong [LR 3], Taibai [SP 3] and Taixi [KI 3]) are chosen to promote meridian circulation and regulate zangfu functions.

Empirical analysis on lumbar disc herniation treated with "sinew-bone three needling technique" of Chinese medicine / 中国针灸

The paper presents professor WU Han-qing's experience in treatment of lumbar disc herniation (LDH) with "sinew-bone three needling technique" of Chinese medicine. Based on the theory of meridian sinew, the points are located by "three-pass method" in terms of the distribution of meridian sinew and syndrome/pattern differentiation. The cord-like muscles and adhesion are relieved by relaxing technique to work directly on the affected sites and alleviate the local compression to the nerve root. The needle technique is operated flexibly according to the affected regions involved, due to which, the needling sensation is increased while the safety ensured. As a result, the meridian qi is enhanced, the mind and qi circulation is regulated; and the clinical effect is improved.

Overview on the modern development of fire needling device: from tradition to innovation / 中国针灸

The appropriate needle device is crucial for obtaining the curative effect of fire needling therapy. The article introduces the material specification, clinical operation, indications, characteristics and advantages of the contemporary traditional fire needling devices (e.g. He's fire needle and Shi 's fire needle) and the contemporary new-type ones (e.g. fire needling with filiform needle and micro-needle); and determines the innovations of modern fire needling. It is anticipated that the needle specifications, production process and operation standard of fire needling devices should be further unified so as to provide the references for the selection of fire needling devices in treatment based on clinical syndrome differentiation and expand the clinical application of fire needling therapy.