RESUMO
Acupuncture and moxibustion therapy in Japan has a long history, and it has developed differently from the Chinese or Korean procedures. The use of a guide tube for the insertion of a fine acupuncture needle without pain, shallow needling and use of intradermal needle without “de-qi” are known as Japanese acupuncture techniques. Our previous study clearly demonstrated variations of the point selection and methods of procedures among the Japan, Korea and Chinese traditional acupuncture therapy on the same subjects. The results obtained by three kinds of traditional acupuncture therapies were also different.<BR> The majority of basic research and clinical trials of acupuncture have used Chinese acupuncture procedure using thick needles with “de-qi” sensation. Participation of the endogenous opioids in relatively intense electro-acupuncture induced analgesia has been well established, but similar analgesia is also induced by stressful stimuli such as electrical foot shock, so opioid-mediated analgesia is not the specific phenomena induced by acupuncture therapy. <BR> Recent literature survey of the Ma Wang Dui（馬王堆）tomb clearly demonstrated the moxibustion (cauterization) was the primitive therapeutic procedure and the meridian concept was established by moxibustion not by acupuncture therapy. On the peripheral mechanisms, various sensory receptors could be activated by acupuncture but receptors responsive to moxibustion are limited. The polymodal receptors (PMRs), which responsive to mechanical, thermal and chemical stimuli, are activated by both acupuncture and moxibustion. They are also responsive to gentle skin scratching and pressure application with blunt acupuncture needle which used as sham acupuncture in recent clinical trials. Sensitization of the PMRs might be a possible cause of acupuncture point formation. These several lines of evidence suggest the PMRs are the key candidates of the action mechanisms of acupuncture and moxibustion. Figure 1 shows schematic illustration of the polymodal receptor hypothesis of action mechanisms of acupuncture and moxibustion.
RESUMO
Acupuncture and moxibustion therapy in Japan has a long history, and it has developed differently from the Chinese or Korean procedures. The use of a guide tube for the insertion of a fine acupuncture needle without pain, shallow needling and use of intradermal needle without “de-qi” are known as Japanese acupuncture techniques. Our previous study clearly demonstrated variations of the point selection and methods of procedures among the Japan, Korea and Chinese traditional acupuncture therapy on the same subjects. The results obtained by three kinds of traditional acupuncture therapies were also different. The majority of basic research and clinical trials of acupuncture have used Chinese acupuncture procedure using thick needles with “de-qi” sensation. Participation of the endogenous opioids in relatively intense electro-acupuncture induced analgesia has been well established, but similar analgesia is also induced by stressful stimuli such as electrical foot shock, so opioid-mediated analgesia is not the specific phenomena induced by acupuncture therapy. Recent literature survey of the Ma Wang Dui（馬王堆）tomb clearly demonstrated the moxibustion (cauterization) was the primitive therapeutic procedure and the meridian concept was established by moxibustion not by acupuncture therapy. On the peripheral mechanisms, various sensory receptors could be activated by acupuncture but receptors responsive to moxibustion are limited. The polymodal receptors (PMRs), which responsive to mechanical, thermal and chemical stimuli, are activated by both acupuncture and moxibustion. They are also responsive to gentle skin scratching and pressure application with blunt acupuncture needle which used as sham acupuncture in recent clinical trials. Sensitization of the PMRs might be a possible cause of acupuncture point formation. These several lines of evidence suggest the PMRs are the key candidates of the action mechanisms of acupuncture and moxibustion. Figure 1 shows schematic illustration of the polymodal receptor hypothesis of action mechanisms of acupuncture and moxibustion.
RESUMO
[Objective]Capsaicin induces flare reaction in the human skin, and repetitive capsaicin applications induce capsaicin desensitization. To investigate the receptors related to flare reaction by acupuncture and moxibustion, we measured pain thresholds and flare reaction in two areas. <BR>[Methods]Thirteen healthy volunteers with informed consent participated in this study. Capsaicin (0.1%) was applied repetitively (6 h/3days) to the forearm skin to desensitize the area. Then, mechanical and heat pain thresholds, flare reactions that induced by acupuncture and moxibustion were measured. <BR>[Results]In the desensitized area, the heat pain threshold was significantly increased but the mechanical pain threshold did not change. Moxibustion induced flare reaction and it was significantly diminished under capsaicin desensitization. On the other hand, acupuncture induced flare reaction and it disappeared completely under capsaicin desensitization. <BR>[Discussion and Conclusion]These results revealed that the flare reaction induced by acupuncture and moxibustion requires TRPV1 activation. For the moxibustion, flare reaction was significantly diminished under capsaicin desensitization but remained significant. Therefore we suggest that TRPV1 mainly mediates the flare reaction but other heat sensitive receptors might be involved in flare reaction. While the mechanical pain threshold was not changed under capsaicin desensitization, flare reaction induced by acupuncture disappeared completely. This suggests that flare reaction is not induced by the mechanical stimuli of acupuncture itself, but other factors such as inflammatory mediators released from damaged cell causing flare reaction by acupuncture.
RESUMO
On this coming June 12, 2009, the 2nd JSAM International Symposium on Evidence-based Acupuncture on "Evidence of the Effectiveness of Acupuncture for Low Back Pain"is to be held in Saitama. We briefly outline the background and expected controversial points in this symposium.<BR>There are three sessions including 1) Present status of RCT research on low back pain, 2) Treatment method for low back pain in China, Korea and Japan based on the database research, and 3) Sham acupuncture. When we assess the effectiveness of acupuncture for low back pain within the realm of Evidence-Based Medicine, the following discussions may be expected:<BR> 1) Therapeutic effect of sham needling -are we able to distinguish placebo effect?<BR> 2) Masking using sham needle -are we able to conduct double-blind trials on acupuncture?<BR> 3) Specific treatment technique -which factors contribute to "more effective acupuncture technique"?<BR>Most of invited speakers are specialists who published their papers on RCT or sham needle in top medical journals in the world. We hope that issues, such as working together with other medical professionals and reflecting evidence to medical policies, to be tackled in the future for the development of acupuncture will become clearer in this symposium.
RESUMO
The purpose of this symposium was to clarify clinical significance of the pulse diagnosis at the wrist used for detecting the function of various organs. Base of the literature survey and his personal experiences, the importance of reliability (reproducibility) test of the pulse diagnosis in blinded manner and necessity of clinical trials with “_??_”-specific intervention was proposed by Ogawa. A unique training program of the pulse diagnosis was introduced by Kido, and he also demonstrated a significant positive result of “_??_”-specific intervention determined by the pulse diagnosis procedure in his program and suggested the clinical significance of the pulse diagnosis. Detection of various changes in pulse waveforms at the wrist using pressure transducer was demonstrated by Maruyama, and he also suggested a possible progress of objectivity in pulse diagnosis by various sensors and biomedical devices in future. From circulatory physiological point of view, factors which may affect the pressure pulse wave at the wrist were explained with several examples of pathologic conditions by Chihara. He also suggested a possibility of reflection of general condition in the pressure pulse at the wrist although it might be partial one, and stressed the necessity of other information for the accurate diagnosis. In general discussion, it was pointed out that evidence of the pulse diagnosis was still limited, and further experimental approaches of the pulse diagnosis will be required.
RESUMO
The purpose of this workshop was to discuss on various issues for the development of a protocol for the Ja pan-Korea research collaboration. An important issue is to select/develop the experimental design of the clinical trial for individualized therapy done in Japan and Korea. Randomizedn-of-1 trial and randomization test were proposed as an possible candidate. A pilot study using randomized n-of-1 trial was done using intradermal acupuncture on pollinosis, and the methodological issues on the generalizability of randomized n-of-1 trial and the need of the selection of target disease were discussed. Onthe other hand, the literature survey has shown that the individualized acupuncture therapy is more effective than those of the standardized' fixed acupuncture therapy in usual RCTs. The diagnosis and selection of acupuncture point and method of manipulation were also shown to be an important factor. Further discussions will be required for the development of the adequate protocol for the individualized therapy.
RESUMO
Effects of acupuncture and moxibustion on chronic pain in human and animals were reviewed. Firstly, the role of sensitization of pheripheral and/or central nervous systems on the mechanisms of chronic pain was introduced based on the basic researches in experimental animals. Secondly, the effects of acupuncture on neuropathic pain and postoperative pain patients were reviewed and its possiblemechanisms were discussed. Finally, effectiveness of acupuncture and moxibustion on several kinds of chronic nociceptive pain (low back pain, neck pain, headache) was systematically reviewed based on the online database
RESUMO
[Objective] The effect of indirect moxibustion on cold symptoms was examined in elderly subjects living in a nursing home.<BR>[Design] A single-case experimental design that enables clinical trials in small a number of subjects was used in this study.<BR>[Methods] Two elderly subjects living in a nursing house participated for 16 weeks. The experimental periods were allocated at random as treatment periods and control periods of eight weeks each. During the treatment periods, subjects were treated with indirect moxibustion GV 14 and BL 12 (both sides) 3 units each, 3 times a week. Rating scores with 4 and/or 5 grades were used to evaluate common cold symptoms.<BR>[Results] Concerning the presence of common cold, there were no significant differences between the treatment and control periods. Moreover, concerning common cold symptoms, there were no significant differences between treatment and control periods.<BR>[Conclusion] Effects of an indirect moxibustion on the common cold symptoms were not detected in this study. We speculated that the living environment of these subjects and the intensity of stimulation were factors. Furthermore, we suspected that a single-case experimental design was unsuitable for common cold research.
RESUMO
[Objective] To clarify the prevalence and aim of acupuncture and moxibustion treatment as well as reasons for choosing this remedy in Japan.<BR>[Methods] We conducted direct interviews with 2, 000 adults (aged 20 years or older) in a stratified two stage sampling in March, 2003.<BR>[Results] Of those interviewd, 71% (1, 420 / 2, 000) responded to the survey of demographics, experience, aim and reasons for choosing acupuncture and/or moxibustion. A total of 7.5% of the population had used Acupuncture and/or Moxibustion during the past 12 months and a total of 26.4% had experienced at least one of these treatment during their lifetime. The most frequent symptoms being treated involved musculoskeletal prob-lems (81.6%), and the most frequent reason for choosing the treatment was the recommendation of family or friends (58.7%).<BR>[Conclusion and Discussion] The prevalence of choosing acupuncture and moxibustion in Japan was higher than that in the U. S. or Europe, which might reflect the history of these methods as popular folk remedies in Japan. The most frequent reason for choosing these remedy might be related to the treatment methods requiring direct contact and stimulation of the body.
RESUMO
[Objective] To estimate the average cost per acupuncture treatment and to assess patients' opinions about the cost of the treatment in Japan.<BR>[Methods] We summarized data concerning the cost of acupuncture treatment and patients' opinions about its cost in a survey that was conducted in July 2000 among patients who visited acupuncture clinics where thepractitioners were the members of alumni association of Meiji University of Oriental Medicine.<BR>[Results] Of 2, 210 questionnaires distributed to the subjects, 1, 319 (59.7%) responded and 1, 264 (57.2%) were relevant to the analysis. 425 (33.6%), 331 (26.2%) and 203 (16.1%) paid 3, 001-4, 000 yen, 2, 001-3, 000 yen and 1, 001-2, 000 yen per treatment, respectively. The average (95%CI) fee paid by patients who wanted the treatment to be 'cheaper' (group 1), and 'slightly cheaper' (group 2) was 3, 310 yen (3081-3538) and 3, 508 yen (3328-3689), respectively. Among those who thought the fee was 'reasonable' (group 3), it was 3, 060 yen (2, 947-3, 172). For those who were able to pay more (group 4), it was 2, 927 yen (2655-3188). The average (95%CI) fee which were considered as 'reasonable' by each group, classified according to opinion, were 2, 080 (1, 906-2, 254), 2, 411 (2, 292-2, 529), 3, 046 (2, 930-3, 161) and 3, 923 (3, 582-4, 263) for groups 1, 2, 3 and 4, re-spectively. The 'reasonable' and 'maximum' costs suggested by the patients were significantly correlated with the current fees paid. Patients' satisfaction with the treatment, which was evaluated with VAS, was related to the opinion of the patients on the cost per treatment.<BR>[Conclusion] Most of the respondents paid 3, 001-4000 yen for an acupuncture session, although the reasonable cost suggested by the patients varied according to the current cost and the patients' satisfaction with the treatment.
RESUMO
The first Japan-Korea workshop on acupuncture and EBM was held on June 4, 2004 at Chiba in the 53rd annual scientific meeting of the JSAM. The purpose of this workshop was to exchange the experiences of clinical researches on acupuncture and moxibustion therapies, and to find out the issues and their solutions for developing the excellent clinical research to establish strong evidence. The final purpose was to develop aprotocol for the collaborative work between both countries.<BR>Drs. Kawakita (JSAM) and Jang (KAMS) chaired the workshop. Three speakers from Japan (Drs Takahashi, Nabeta, and Tsukayama) and three Korean speakers (Drs Seo, Lee and Moon) presented their data on the clinical researches of acupuncture, moxibustion and bee-venom injection. After their paper presentations, various issues were discussed on their research methodology for establishing more strong evidence of acupuncture.We got interesting new findings and understood various issues for conducting clinical researches especially RCT.<BR>Although we could not develop a protocol for the collaborative research in this workshop, it was very fruitful workshop as the first step for the future Japan-Korea collaborative clinical study. The most important product of this workshop was we could understand each other and we confirmed the necessity of the future collaborative clinical research on acupuncture.
RESUMO
To identify indications for acupuncture treatment, we examined certain evidence-based medicine (EBM) practices by acupuncture/moxibustion clinicians who are novices in this field and identified problems and solutions from the perspective of an acupuncture/moxibustion clinician.<BR>We collected cases of lumbago, shoulder disorders and strokes from the literature, and critically assessed these reports. We also investigated Cochrane Library's acupuncture/moxibustion reviews and evaluated the quality of domestic studies using randomized controlled trials and controlled clinical trials (RCT/CCT). Simultaneously, one of the authors evaluated her own clinical reports in light of EBM.<BR>As a result, acupuncture/moxibustion treatments showed promise for treating lumbago and shoulder disorders, but the higher the quality of studies, the lower the effect of treatment after stroke. According to research by the Cochrane Library (as of issue 1, 2003), the effects of acupuncture/moxibustion was measured only for cases of idiopathic headache but those for other disorders were measured more severely. In Japan, RCT started as early as the 1960 s, but the studies were sluggish and high quality studies were not produced until the late 1990 s.<BR>We presented problems of RCT assessment score, the gap between RCT designs and actual clinical scenes, and the difficulty of masking at the bed-side. To contribute to the accumulation of more evidence-based data, it would be desirable for clinicians to acquire EBM methods, consider clinical problems and collaborate positively with investigators in the field.
RESUMO
[Purpose] The characteristic of electrical activities recorded at the clinical trigger point was examined.<BR>[Materials] A 26-year-old woman complained of chronic shoulder pain. She had a trigger point near GB 21 (Jianjing, Kensei). The electrical activities were recorded at the trigger point and a non- tender point.<BR>[Results] Electrical activities were detected only when the electrode was located on the trigger point andthere was a subjective dull pain sensation. The amplitudes of electrical activities did not change during psychological stress. [ Conclusion ] These results suggest that the electrical activities were the result of nociceptive reflex.
RESUMO
Nobody studies economic evaluation of acupuncture and moxibustion in Japan. To establish a method of economic evaluation of acupuncture and moxibustion, we introduced case study of economic evaluation of acupuncture and moxibustion at work. In addition, we examined a course of study that annex economic evaluation to a study of acupuncture and moxibustion. This manuscript introduces two case studies of economic evaluation and essential points of economic evaluation.
RESUMO
The results of multi-center RCT of acupuncture and moxibustion for the prevention of the symptoms of common cold conducted by the financial support of the foundation for training and licensure examination in anma-massage-acupressure, acupuncture and moxibustion were briefly reviewed. Traditional acupuncture manipulation to the throat induced significant positive effects, however, more common indirect moxibustion to the neck for longer period did not induce the significant effect compared with no-treatment control. Several issues to be resolved were discussed and the shortage of duration of intervention was pointed out as one of the major issues. Then four pilot studies with long-lasting intervention of acupuncture or moxibustion were con-ducted. The effects tended to be more positive, however, they were still unclear. The selection of subjects (students in the acupuncture school) will be the next important issue to be examined.
RESUMO
Objective : To research reports of economic analysis of acupuncture therapy.<BR>Method : Searches were performed in Medline for reports of cost description, economic, randomized controlled trial, cost effectiveness, or cost benefit. Studies were included if they reported original data from any form of standard economic analysis.<BR>Results : A total of 15 papers was found. These studies were investigated as follows : angina pectoris, carpal tunnel syndrome, stroke, knee osteoarthrosis, low back pain, musculoskeletal disease, migraine, acupuncture analgesia. On the other hand, only one paper was found in Japan.<BR>Conclusion : Almost studies were noncntrolled trial, non-rigorous and retrospective studies. In future there is a need for high quality and rigorous studies of the cost and benefits of acupuncture.
RESUMO
Treatment of tender points has widely been used for diagnosis and treatment, but there are few studies elucidating the usefulness of this approach to diagnosing knee pain. This study investigated the diagnostic importance of tender points. The symptoms and the pressure pain threshold (PPT) in osteoarthritis of the knee (pain and motion of knee joint) were measured in 45 patients being treated at the Acupuncture Center of Meiji University of Oriental Medicine. The change in PPT was related to symptoms of knee pain (staircase and flexion pain). It is suggested that changes in PPT around the knee joints are a useful indicator for evaluating knee pain.
RESUMO
Electrical activities detected from the experimentally-induced trigger points in human subjects.<BR>Objectives : To examine the pathogenic mechanisms of the trigger points, electrical activities were recorded from the experimentally-induced trigger points.<BR>Methods : Nine healthy volunteers who gave informed consent were used. The adjustable loads were set around the third finger and repetitive eccentric contraction was loaded on the extensor digital muscles. The subjects were asked to keep the position as long as possible. The loadings (about 10s) were continued until his all-out effort and were repeated 3 times with 5 min resting periods. The electrical activities in the skin, fascia and muscle of the trigger point and non-tender region of palpable band and 10mm outside the band were recorded on the second day after the eccentric exercise.<BR>Results : Repetitive eccentric exercise produced a trigger point within the palpable band, which developed on the second day after the exercise. Electrical activities were detected only when the electrode tip was located in or near the fascia of the trigger point and there were subjective dull pain sensations. When the radial nerve was blocked by lidocaine, the needle EMG activity could not be recorded.<BR>Conclusions : These results suggest that the EMG activities are the result of nociceptive reflex, and the sensitized nociceptors in the fascia of the palpable band might be a substrate for the trigger point.
RESUMO
The tender points treatment has been widely used for both treatment and diagnosis, but there have been very few studies that have examined its diagnostic usefulness. Thus, the purpose of this study was to clarify the diagnostic importance of tender points. The subject was a patient who had osteoarthritis of the knee of Meiji University of Oriental Medicine Hospital. The relationship between pressure pain thresholds (PPTs) and symptoms in osteoarthritis of the knee (painful knee motion) were evaluated with the Japanese Orthopaedic Association scale (JOA scale), a knee scale and the subject's knee pain diary (starting pain, flexion pain, walking pain and total pain Wong-Baker faces pain rating scale). After 40 acupuncture treatments, improvement was noted in the symptoms and PPTs. The changes in PPTs were related to the symptoms of the knee (flexion and walking pain). This suggests that changes in PPTs (around the knee) are a useful indicator for evaluating knee pain.
RESUMO
The nature of an experimental trigger point model produced by eccentric exercise was examined in seven healthy volunteers who gave their informed consent. Adjustable loads were set around the third finger and the subjects were asked to keep the position as long as possible. The loadings (about 10s) were continued until his all-out effort and were carried out 3 times interspersed with 5 min rest periods. Pressure pain thresholds (PPT) and deep pain thresholds (DPT) before exercise, and on the 2nd and 7th day after the exercise, were measured in the skin, fascia and muscles. On the 2nd day after the exercise, the PPT of the restricted area of the taut band was the minimum. A similar reduction of the DPT was observed only in the fascia of the restricted area. These results suggest that the present experimental model is useful for the further investigation of trigger points.