[Analysis on the distribution of pressure- and heat-sensitive acupoints in patients with allergic rhinitis].

OBJECTIVE: To explore the distribution of pressure- and heat-sensitive acupoints of the Large Intestine of Hand-Yangming, Stomach Meridian of Foot-Yangming and the Lung Meridian of Hand-Taiyin below the elbow and knee joints in patients with allergic rhinitis, so as to explore the positive reaction points at the body surface of allergic rhinitis. METHODS: Thirty variant rhinitis volunteer subjects and 30 healthy subjects were recruited in the present study. The subcutaneous induration, reaction points of emptiness-like feeling or pressing pain below the elbow- and knee-joints along the Large Intestine Meridian, Stomach Meridian and the Lung Meridian were inspected first, then re-examined by using heat-sensitized moxibustion method and a hand-held pain threshold tester (mechanical pressure), respectively. The frequency and coincidence rate of pressing-pain sensitive and heat-sensitive points were analyzed. RESULTS: In the 30 patients with allergic rhinitis, 10 positive reaction points as Kongzui (LU6), Chize (LU5), Hegu (LI4), Quchi (LI11), Shousanli(LI10), Zusanli (ST36), Shangjuxu (ST37), Fenglong (ST40), Xiajuxu (ST39), and non-acupoint of the Lung Meridian were found. Among them, the duration of heat-sensitive reaction in the LU6, LI10, ST37, ST40, and ST39 regions was obviously shorter in patients than in healthy subjects (P<0.01,P<0.005). The heat-sensitive forms of the positive reaction points were mainly heat transmission, heat-penetration and local reaction. The mechanical pain thresholds of the positive reaction points (LI4, LU6, LI10, LI11 and non-acupoint of the Lung Meridian) at the upper limbs and those (ST36, ST37 and ST40) at the lower limbs were evidently lower in patients than in healthy volunteer subjects (P<0.05). The pressure- and heat-sensitive acupoints were basically coincide in the patients, but being higher in patients than in healthy subjects in the frequency of occurrence. The mechanical pain threshold of the pressure-sensitive acupoints in patients was remarkably lower on the left side than on the right side of the upper limb, and obviously higher on the left side than on the right side of the lower limb (P<0.05). No significant differences were found between the right and left sides in the pain threshold in healthy subjects (P>0.05). CONCLUSION: There is a high overlap in the distribution of pressure- and heat-sensitive acupoints of the Lung, Large Intestine and Stomach meridians below the elbow and knee joints in patients with allergic rhinitis, and there is an imbalance between the left and right limbs in the mechanical pain threshold of the pressure- and heat-sensitive acupoints, but needing being further confirmed.

Measuring sensory and pain thresholds by Semmes-Weinstein monofilaments in patients with leg ulcers: a pilot study.

OBJECTIVE: Pain is a common and disabling symptom in patients with leg ulcers. Clinical quantification of pain mostly depends on subjective pain reports, which do not reveal underlying mechanisms. The aim of this pilot study is to identify mechanisms underlying the pain in patients with leg ulcers by documenting alterations in pain processing using quantitative sensory testing. METHODS: In nine ulcer patients the mechanical sensory thresholds and the mechanical pain thresholds were determined by Semmes-Weinstein monofilaments (SWM) at three different sites: on the contralateral (unaffected) leg, on the skin of the affected leg 10cm from the ulcer margin, and on the affected leg, close (1-2cm) to the ulcer margin. Besides the mechanical sensory thresholds and mechanical pain thresholds, pain at the site of the ulcer, using an 11-point numeric rating scale (NRS), was documented. RESULTS: Mechanical sensory thresholds were increased in all subjects. Almost half (44%) of patients consistently showed allodynia at the unaffected site. The lowering of mechanical pain thresholds correlated with higher scores on the NRS. CONCLUSION: All patients showed diminished touch and/or protective sensation, which might have contributed to ulcer development via (partial) loss of protective function. The allodynia at the unaffected site suggests the presence of central sensitisation of pain processing.

Effect of sleep restriction on somatosensory sensitivity in the oro-facial area: An experimental controlled study.

BACKGROUND: No studies have addressed the effect of SR on somatosensory function in the oro-facial area. OBJECTIVES: The aim of this study was to investigate the effect of sleep restriction (SR) on the somatosensory perception of the tip of the tongue. MATERIALS AND METHODS: Using a crossover study design, 13 healthy participants took part in a random order, to a two arms experiments: the SR and control/no SR-arms. For all participants, the Epworth Sleepiness Scale (ESS) was used to assess sleepiness and mechanical sensitivity, and pain detection threshold was estimated at the tongue tip and right thumb (as a body area control site). In the SR-arm of the study, on day one, we estimated sensory baseline perception and repeated tests on day two, after a night of voluntary SR, and on day 3, after a recovery night. In the second arm, same sensory tests were done but no SR was requested. RESULTS: Significantly more sleepiness was observed after SR in comparison with baseline and recovery testing days (P < 0.05). After SR, mechanical pain threshold on the tip of the tongue was significantly lower on day after SR (day 2) and a rebound, higher values, were observed on the third day (P < 0.05); no difference on thumb site. In the control arm, no SR and no significant differences between days were observed for all the variables of interest. CONCLUSIONS: The present results suggest that SR may affect somatosensory perception in the oro-facial area.

Analysis on the distribution of pressure- and heat-sensitive acupoints in patients with allergic rhinitis / 针刺研究

OBJECTIVE: To explore the distribution of pressure- and heat-sensitive acupoints of the Large Intestine of Hand-Yangming, Stomach Meridian of Foot-Yangming and the Lung Meridian of Hand-Taiyin below the elbow and knee joints in patients with allergic rhinitis, so as to explore the positive reaction points at the body surface of allergic rhinitis. METHODS: Thirty variant rhinitis volunteer subjects and 30 healthy subjects were recruited in the present study. The subcutaneous induration, reaction points of emptiness-like feeling or pressing pain below the elbow- and knee-joints along the Large Intestine Meridian, Stomach Meridian and the Lung Meridian were inspected first, then re-examined by using heat-sensitized moxibustion method and a hand-held pain threshold tester (mechanical pressure), respectively. The frequency and coincidence rate of pressing-pain sensitive and heat-sensitive points were analyzed. RESULTS: In the 30 patients with allergic rhinitis, 10 positive reaction points as Kongzui (LU6), Chize (LU5), Hegu (LI4), Quchi (LI11), Shousanli(LI10), Zusanli (ST36), Shangjuxu (ST37), Fenglong (ST40), Xiajuxu (ST39), and non-acupoint of the Lung Meridian were found. Among them, the duration of heat-sensitive reaction in the LU6, LI10, ST37, ST40, and ST39 regions was obviously shorter in patients than in healthy subjects (P0.05). CONCLUSION: There is a high overlap in the distribution of pressure- and heat-sensitive acupoints of the Lung, Large Intestine and Stomach meridians below the elbow and knee joints in patients with allergic rhinitis, and there is an imbalance between the left and right limbs in the mechanical pain threshold of the pressure- and heat-sensitive acupoints, but needing being further confirmed.

Mechanical Pain Thresholds and the Rubber Hand Illusion.

We manipulated the sense of body ownership with the rubber hand illusion (RHI) to determine if perception of a potentially painful threat to the rubber hand can modify the mechanical pain threshold (MPT). Simultaneous tactile stimulation of the subject's concealed hand and the appropriately positioned visible rubber hand generated the illusion of false body ownership. The MPT was recorded on the left hand of the subjects before and after induction of the RHI, as well as during the phase in which the model hand was pricked with a sharp knife or touched by the blunt knife handle. The results indicate that the RHI could be successfully generated with our set-up. Mechanical stimuli were perceived as more painful in the condition where the rubber hand was simultaneously pricked with a knife. Our findings suggest that the illusion of body ownership gates nociceptive processing of potentially painful stimuli.

[Correlation Between Referred Pain Region and Sensitized Acupoints in Patients with Stable Angina Pectoris and Distribution of Sensitized Spots in Rats with Myocardial Ischemia].

OBJECTIVE: To observe the correlation between the referred pain regions of stable angina pectoris (SAP) and the acupoints in coronary heart disease (CHD) patients and to investigate the rule of regional sensitized point distribution in rats. METHODS: A total of 1 046 CHD patients with SAP from 8 hospitals in China were recruited in the present study. The tenderness was palpated along the left and right chest, back, shoulder, upper limb, etc. by a specially-assigned researcher in each hospital. Among them, 77 patients accepted pain threshold (PT) measurement by using a hand-held esthesiometer. In animal experiments, 14 SD rats were subjected to occlusion of the left anterior descending branch of the left coronary artery for 4 h for establishing myocardial ischemia (MI) model, and other 4 normal rats were used as the sham-operation control group. Four hours after MI, all the rats accepted tail venous injection of 5% Evans blue (50 mg/kg) for examining the distribution of the blue dye exudation spots at the body surface where the mechanical PT was also detected by a von Frey. RESULTS: In 1 046 CHD patients, 987 (94.36%) were found to have at least one tenderness spot. The tenderness spots were found at the left chest (87.47%), right chest (13.67%), left arm (ulnar side, 41.30%), right upper limb (4.68%), left shoulder back (30.21%), right shoulder back (7.07%), etc., accompanied with rash or pigmentation, subcutaneous induration, cord-like tissue contracture, skin sag, etc. The mechanical PT level was significantly lower at the tenderness spots of the left upper limb than at non-tender points of the right upper limb in CHD patients (P<0.001). Tenderness and cutaneous abnormal changes in angor pectoris patients distributed mostly on the left chest, back, shoulder and upper limb, and some also on the right. Tender points scattered on, near or outside acupoints. A similar distribution of the blue exudation spots and lower mechanical PT spots were found in MI rats, but not in sham-MI rats. CONCLUSION: In the case of MI, a regular "referred sensitization" response frequently occurs in the dermatomere area innervated by the corresponding segments (T 1－T 5) in both CHD patients and MI rats, which may be closely associated with the formation of acupoints in ancient China.

The effect of myofascial release and microwave diathermy combined with acupuncture versus acupuncture therapy in tension-type headache patients: A pragmatic randomized controlled trial.

BACKGROUND AND PURPOSE: Nonpharmacological therapies for tension-type headache (TTH) and cervicogenic cephalalgia are often a treatment choice, despite the weak to moderate evidence. The aim of this study was to compare the effectiveness of an acupuncture/stretching protocol versus acupuncture/stretching plus physiotherapy techniques, in patients with TTH cephalalgia. METHODS: A single-blind, prospective, multicentre, randomized controlled trial was designed considering the pragmatic situation of administering such protocols and treating the 44 headache patients participating in this study. The patients were randomly assigned in 2 treatment groups (control group, n = 20, acupuncture/stretching; experimental group, n = 24, acupuncture/stretching plus physiotherapy) and completed 10 treatment sessions within 4 weeks with measurements taking place before treatment, after the fifth treatment and after the 10th treatment. The mechanical pressure pain threshold (PPT) was considered as the main outcome measure, using a mechanical algometer to measure 7 bilateral somatic points. Acupuncture in both groups included 17-20 acupuncture points, whereas stretching was initially taught and subsequently self-administered (self-stretches), following a standardized set of movements of the cervical spine. Physiotherapy consisted of microwave diathermy and myofascial release with hands-on techniques. RESULTS/FINDINGS: An improvement was noted in both groups/treatments regarding the main outcome measure PPT, all the way from the first to fifth and the 10th treatment, at all measuring sites and at all measurements in both groups (p < .001). When comparing the 2 groups, differences were noted after the 10th treatment (p < .05). DISCUSSION: In conclusion, patients with TTH headache were benefited from acupuncture and stretching but further PPT improvements were evidenced when physiotherapy hands-on techniques were added. In clinical terms, the combination of physiotherapy in the form of myofascial release and microwave diathermy with acupuncture and stretching in order to improve the analgesic effect (PPT) is strongly recommended.

Correlation Between Referred Pain Region and Sensitized Acupoints in Patients with Stable Angina Pectoris and Distribution of Sensitized Spots in Rats with Myocardial Ischemia / 针刺研究

OBJECTIVE: To observe the correlation between the referred pain regions of stable angina pectoris (SAP) and the acupoints in coronary heart disease (CHD) patients and to investigate the rule of regional sensitized point distribution in rats. METHODS: A total of 1 046 CHD patients with SAP from 8 hospitals in China were recruited in the present study. The tenderness was palpated along the left and right chest, back, shoulder, upper limb, etc. by a specially-assigned researcher in each hospital. Among them, 77 patients accepted pain threshold (PT) measurement by using a hand-held esthesiometer. In animal experiments, 14 SD rats were subjected to occlusion of the left anterior descending branch of the left coronary artery for 4 h for establishing myocardial ischemia (MI) model, and other 4 normal rats were used as the sham-operation control group. Four hours after MI, all the rats accepted tail venous injection of 5% Evans blue (50 mg/kg) for examining the distribution of the blue dye exudation spots at the body surface where the mechanical PT was also detected by a von Frey. RESULTS: In 1 046 CHD patients, 987 (94.36%) were found to have at least one tenderness spot. The tenderness spots were found at the left chest (87.47%), right chest (13.67%), left arm (ulnar side, 41.30%), right upper limb (4.68%), left shoulder back (30.21%), right shoulder back (7.07%), etc., accompanied with rash or pigmentation, subcutaneous induration, cord-like tissue contracture, skin sag, etc. The mechanical PT level was significantly lower at the tenderness spots of the left upper limb than at non-tender points of the right upper limb in CHD patients (P<0.001). Tenderness and cutaneous abnormal changes in angor pectoris patients distributed mostly on the left chest, back, shoulder and upper limb, and some also on the right. Tender points scattered on, near or outside acupoints. A similar distribution of the blue exudation spots and lower mechanical PT spots were found in MI rats, but not in sham-MI rats. CONCLUSION: In the case of MI, a regular "referred sensitization" response frequently occurs in the dermatomere area innervated by the corresponding segments (T 1－T 5) in both CHD patients and MI rats, which may be closely associated with the formation of acupoints in ancient China.

Neurotropin® inhibits calpain activity upregulated by specific alternation of rhythm in temperature in the mesencephalon of rats.

AIMS: Neurotropin® (NTP), an analgesic for chronic pain, has antihyperalgesic effects in specific alternation of rhythm in temperature (SART)-stressed rats. Previous studies have shown that SART stress induces hyperalgesia, as well as post-translational modification of proteins (including substrates for calpain, a calcium-dependent cysteine protease) in the mesencephalon of rats. To better understand the mechanism of action of NTP, we investigated whether SART stress activates calpain in the mesencephalon of rats and whether NTP inhibits this activation. MAIN METHODS: Wistar rats were exposed to SART stress for 5days. NTP (200NU/kg/day) was administered intraperitoneally every day from the onset of SART stress. The mechanical pain threshold was measured using the Randall-Selitto test on the 6th day. Thereafter, the rat mesencephalon was immediately collected and calpain activity was examined using western blot analysis with a calpain cleavage site-specific antibody. KEY FINDINGS: SART stress induced hyperalgesia and increased the calpain activity in the mesencephalon of rats. In contrast, NTP treatment attenuated the hyperalgesia and prevented the increase in calpain activity in the mesencephalon of SART-stressed rats. Interestingly, a negative correlation was identified between calpain activity and mechanical pain threshold in SART-stressed rats treated with or without NTP. Furthermore, NTP inhibited calpain activity on mammalian uncoordinated-18 in rat mesencephalon homogenate and Ac-LLY-AFC as substrates in an in vitro cell-free system. SIGNIFICANCE: Our data demonstrate that NTP treatment prevents SART stress-induced calpain activation in the mesencephalon of rats and suggests that NTP-mediated antihyperalgesia is associated with an inhibition of calpain activity in the mesencephalon.

Correlative exploration in changes of mechanical pain thresholds and autophagy levels with chronic pelvic pain syndrome mice model / 中国实验动物学报

Objective To observe the changes of mechanical pain thresholds and autophagy related proteins microtubule-associated protein 1 light chain 3 (LC3) and sequestosome 1 (SQSTM1 also known as p62) expression levels in the C57BL/6 mouse models of chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS),and provide animal experimental evidence for CP/CPPS pain and autophagy study.Methods 36 male C57BL/6 mice were randomly divided into three groups: the model group,control group and na(i)ve group.The CP/CPPS model was established by subcutaneous injection in the lower abdomen region with suspension liquid,containing protein extract of male SD rat prostate gland and complete Freund adjuvant.At 1month and 6 months after modeling,the mice were sacrificed and prostate tissues were harvested for histological examination using HE staining.Mechanical tactile hyperalgesia was measured with von Frey filaments.The autophagy-related proteins LC3 and p62 expression levels were detected by immunohistochemistry,respectively.The average IOD was measured by Image Pro Plus 6.0,and the statistical analysis was performed with GraphPad Prism 5 software.Results The histopathology showed the appearance of chronic prostatitis in the model group,representing hyperplasia and lymphocytic infiltration to a different degree and lasted for 6 months after modeling.Moreover,prostate intraepithelial neoplasia (PIN) appeared in the model group at 6 months after modeling,characterized by the disappearence of basement membrane and obvious nuclear abnormality,while the control and na(i)ve groups showed normal histology during the 1-6 months.Compared with the control and na(i)ve groups,the mechanical pain threshold in the model group was significantly decreased along with the time from (0.353±0.154) g at 0 week to (0.008±0.00) g at 22 weeks (P<0.05).The average IOD of LC3 and p62 expression in the model group was significantly increased with timing from [(2.767±0.464)%,(2.872±1.642)%] at 1month to [(13.501±1.900)%,(9.07±0.49)%] at 6 month,P<0.05.Conclusions A CP/CPPS model is successfully established in C57BL/6 mice.For the model group,the mechanical pain threshold is decreased and autophagy levels are increased gradually with time.These phenomena show that chronic inflammation microenvironment may promote pain and autophagy activity in the prostate,which is closely related with the occurrence and development of prostatic intraepithelial neoplasia.

A new protocol to evaluate the effect of topical anesthesia.

This double-blind, placebo-controlled, randomized cross-over clinical experimental study tested the reliability, validity, and sensitivity to change of punctuate pain thresholds and self-reported pain on needle penetration. Female subjects without orofacial pain were tested in 2 sessions at 1- to 2-week intervals. The test site was the mucobuccal fold adjacent to the first upper right premolar. Active lidocaine hydrochloride 2% (Dynexan) or placebo gel was applied for 5 minutes, and sensory testing was performed before and after application. The standardized quantitative sensory test protocol included mechanical pain threshold (MPT), pressure pain threshold (PPT), mechanical pain sensitivity (MPS), and needle penetration sensitivity (NPS) assessments. Twenty-nine subjects, mean (SD) age 29.0 (10.2) years, completed the study. Test-retest reliability intraclass correlation coefficient at 10-minute intervals between examinations was MPT 0.69, PPT 0.79, MPS 0.72, and NPS 0.86. A high correlation was found between NPS and MPS (r = 0.84; P < .001), whereas NPS and PPT were not significantly correlated. The study found good to excellent test-retest reliability for all measures. None of the sensory measures detected changes in sensitivity following lidocaine 2% or placebo gel. Electronic von Frey assessments of MPT/MPS on oral mucosa have good validity.

The activation of astrocytes in post herpetic neuralgia in mouce / 实用医学杂志

Objective To investigate the role of astrocytes activation in post herpetic neuralgia (PHN). Methods The kunming mice (20-25 g) were used in this study. Resiniferatoxin was injected into the peritoneal cavity.Immunofuorescence was used to detect the activation of astrocytes , mechanical paw withdrawal threshold (MWT)and thermal withdrawal latency (TWL) were used to assay the mechanical allodynia and thermal hyperalgesia, respectively. Fluorocitrate, an inhibitor of astrocytes was intrathecally (i.t.) or intraperitonealy (i. p.) injected into the mice. Results Compared with the vehicle group, MWT was decreased, and TWL was increased significantly in the RTX group. Pre-treatments of fluorocitrate (Fc, i.t.,or i.p.) inhibited the decrease of MWT. Conclusion The activation of astrocytes mediates the post herpetic neuralgia.

Hand-arm vibration syndrome: clinical characteristics, conventional electrophysiology and quantitative sensory testing.

OBJECTIVE: Workers exposed to vibrating tools may develop hand-arm vibration syndrome (HAVS). We assessed the somatosensory phenotype using quantitative sensory testing (QST) in comparison to electrophysiology to characterize (1) the most sensitive QST parameter for detecting sensory loss, (2) the correlation of QST and electrophysiology, and (3) the frequency of a carpal tunnel syndrome (CTS) in HAVS. METHODS: QST, cold provocation tests, fine motor skills, and median nerve neurography were used. QST included thermal and mechanical detection and pain thresholds. RESULTS: Thirty-two patients were examined (54 ± 11 years, 91% men) at the more affected hand compared to 16 matched controls. Vibration detection threshold was the most sensitive parameter to detect sensory loss that was more pronounced in the sensitivity range of Pacinian (150 Hz, x12) than Meissner's corpuscles (20 Hz, x3). QST (84% abnormal) was more sensitive to detect neural dysfunction than conventional electrophysiology (37% abnormal). Motor (34%) and sensory neurography (25%) were abnormal in HAVS. CTS frequency was not increased (9.4%). CONCLUSION: Findings are consistent with a mechanically-induced, distally pronounced motor and sensory neuropathy independent of CTS. SIGNIFICANCE: HAVS involves a neuropathy predominantly affecting large fibers with a sensory damage related to resonance frequencies of vibrating tools.

Association between opioid receptor gene polymorphism and postoperative pain response in Koreans

BACKGROUND: The objective of this study was to investigate the association between A118G single nucleotide polymorphism (SNP) of human micro-opioid receptor (OPRM1) gene and the postoperative pain response in Korean patients undergoing thyroidectomy. METHODS: Fifty two adult patients undergoing thyroidectomy were enrolled in this study. Their blood samples were genotyped for the A118G polymorphism. Pain intensity was assessed by a verbal numerical rating scale (VNRS) at postanesthesia care unit, postoperative 6, 24, and 48 hours. Mechanical pain threshold was assessed using electronic von Frey preoperatively and repeated at postoperative 24 and 48 hours on the forearm and periincisional regions. RESULTS: Of the 50 patients, 23 patients were A118 homozygous (AA), 19 patients were heterozygous (AG), and 8 patients were 118G homozygous (GG). The VNRS score was higher in patients with GG genotype than other genotypes at PACU (P < 0.05). Mechanical pain thresholds on the forearm and periincisional area were decreased at postoperative 24 and 48 hours from the preoperative values in all genotypes (P < 0.05). However, the changes in pain thresholds were similar among the genotypes. CONCLUSIONS: A118G SNP of OPRM1 gene is associated with inter-individual difference in immediate postoperative pain score in Korean population.