[Clinical trial of electroacupuncture at Neimadian-point for cancer pain].

OBJECTIVE: To observe the clinical efficacy and safety of electroacupuncture (EA) at Neimadian-point for cancer pain. METHODS: A total of 140 cancer patients with pain were randomly divided into EA and control groups, with 70 cases in each group. The patients of the EA group received EA at Neimadian-point plus analgesia pump (all prepared with normal saline). The patients of the control group were treated by Sufentanil patient-controlled intravenous analgesia plus sham EA (without stimulation). The treatment was conducted once daily for two days at 8 o'clock every morning. Respectively, in 1 h before treatment (T0), 1 h (T1), 8 h (T2), 24 h (T3) after treatment of the first day, 1 h (T4), 8 h (T5), 24 h (T6) after treatment of the second day, the visual analogue scale (VAS) score of pain, and the plasma levels of norepinephrine, 5-HT, leucine enkephalin, ß-endorphin and dynorphin A1-13 were tested. The security level (1-4 grade) was assessed during the treatment. RESULTS: Compared with their own pre-treatment, in T1 to T6, the VAS scores, and the contents of plasma norepinephrine and 5-HT obviously decreased in both groups （P<0.05）, and the contents of leucine enkephalin, ß-endorphin and dynorphin A1-13 all increased (P<0.05) in the EA group. The analgesia effects were significantly higher in the EA group than in the control group in T1, T2, T4 and T5 (P<0.05,P<0.01). The therapeutic effect of EA at Neimadian-point was significantly superior to that of the Sufentanil in down-regulating plasma norepinephrine and 5-HT levels, and in up-regulating leucine enkephalin, ß-endorphin and dynorphin A1-13 levels (P<0.05,P<0.01). CONCLUSION: EA at Neimadian-point can effectively relieve the pain of cancer patients and improve their quality of daily life.

[Clinical therapeutic effect of hyperlipidemia of turbid phlegm obstruction pattern/syndrome treated with the different Jin's three-needle therapies].

OBJECTIVE: To compare the differences in clinical effects on hyperlipidemia of turbid phlegm obstruction pattern/syndrome treated with the different Jin's three-needle therapies so as to provide a new approach and theoretic evidence for the clinical optimal scheme of acupuncture on hyperlipidemia. METHODS: A total of 90 patients were randomly divided into education group, electroacupuncture group and catgut embedding group (30 cases in each). The routine health education was given to the education group. On the base of the treatment as the education group, electroacupuncture was applied to the electroacupuncture group for 30 min each time, twice a week; and the catgut embedding was applied to the catgut embedding group at the same acupoints as the electroacupuncture group, once a week. The treatment was given consecutively for 8 weeks in each group. Before and after treatment, the obesity indices [weight, waistline, body mass index (BMI)], blood lipid indices[serum total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C)] and insulin resistance indices [fasting blood glucose(FBG), fasting plasma insulin(FINS), homeostasis model assessment-estimated insulin resistance (HOMA-IR)] were observed in the three groups before and after treatment. RESULTS: After treatment, in the electroacupuncture group and the catgut embedding group, the results of the obesity indices, e.g. weight, waistline and BMI, the levels of blood lipid, e.g.TC, TG, LDL-C and the insulin resistance indices, e.g. FINS and HOMA-IR were all obviously decreased compared with those before treatment (P<0.05, P<0.01), and the level of HDL-C apparently increased than that before treatment (P<0.01). In the catgut embedding group, FBG was obviously decreased after treatment as compared with that before treatment (P<0.01). After treatment, the improvements in LDL-C and HDL-C in the catgut embedding group were superior to those in the electroacupuncture group (P<0.05). Regarding the obesity indices and insulin resistance indices, the differences were not statistically significant in comparison between the catgut embedding group and the electroacupuncture group (all P>0.05). The total effective rate was 90.0% in the catgut embedding group (27/30) and it was 83.3% (25/30) in the electroacupuncture group, either of them was better than 60.0% (18/30) in the education group , indicating the statistical significance (P<0.01, P<0.05). CONCLUSION: On the base of health education, either the catgut embedding therapy or electroacupuncture of Jin's three-needle treatment achieves the positive regulation on the abnormal lipid metabolism and insulin resistance. The hypoglycemic effect and the impro-ving effect in LDL-C and HDL-C of the catgut embedding therapy are superior to electroacupuncture.

[Eletroacupuncture improves lipid metabolic disorder by regulating hepatic AMPK/p38 MAPK/RRARγ signaling in rats with high-fat diet-induced insulin resistance].

OBJECTIVE: To observe the effect of eletroacupuncture (EA) intervention on lipid metabolism and expression of AMP-activated kinase (AMPK), p38 mitogen-activated protein kinase (p38 MAPK) and peroxisome proliferator-activated receptor γ (PPARγ) protein in the liver in rats with insulin resistance (IR), so as to reveal its mechanisms underlying improvement of IR. METHODS: Forty male SD rats were randomly divided into blank control, model, medication, and EA groups (n＝8 in each). The IR model was established by feeding the rats with high-fat diet for 12 weeks. After successful establishment of model, the rats in the blank control group and model group were fixed in the self-made rat bag without receiving any treatment. The rats in the medication group were treated by gavage of pioglitazone (10 mL/kg). EA (2 Hz /100 Hz, 1 mA) was applied to bilateral "Fenglong"(ST40) and "Sanyinjiao"(SP6) for 20 min, once a day, for continuous 14 days for rats in the EA group. The ultrastructure of the liver tissue was observed by transmission electron microscope (TEM). Blood samples were taken from the abdominal aorta for detecting serum C-peptide (C-P), adiponectin (ADP), leptin (LEP) and resistin (RES) contents using enzyme linked immunosorbent assay (ELISA). The expression levels of AMPK, p38 MAPK and PPARγ proteins in the liver tissue were detected by Western blot. RESULTS: After modeling, the contents of serum C-P, LEP and RES, and the expression of liver p38 MAPK protein were significantly up-regulated (P<0.01, P<0.05), and the content of ADP and expression of AMPK and PPARγ significantly down-regulated in the model group compared with the blank control group (P<0.01). The increased contents of C-P, LEP and RES, and p38 MAPK protein expression and the decreased serum ADP and hepatic AMPK and PPARγ expression levels were completely reversed in both the EA and medication groups relevant to the model group (P<0.01, P<0.05). No significant differences were found between the EA and medication groups in up-regulating the levels of ADP, AMPK and PPARγ and in down-regulating the levels of C-P, LEP, RES and p38 MAPK(P>0.05). Outcomes of TEM showed that morphological structure of liver mitochondria was damaged, including a large number of lipid droplets, being blur in appearance, rupture of partial membrane, dissapearance of partial mitochondrial crests with vacuolus-like appearance and decrease of rough endoplasmic reticulum in the model group, which was relatively milder in both EA and medication groups. CONCLUSION: EA intervention is able to improve the disorder of lipid metabolism of IR rats, which may be associated with its effects in lowering the activity of fatty acid synthesis-related enzymes and regulating AMPK/p38 MAPK/PPARγ signaling to improve IR in the liver tissue.

Eletroacupuncture improves lipid metabolic disorder by regulating hepatic AMPK/p38 MAPK/RRARγ signaling in rats with high-fat diet-induced insulin resistance / 针刺研究

OBJECTIVE: To observe the effect of eletroacupuncture (EA) intervention on lipid metabolism and expression of AMP-activated kinase (AMPK), p38 mitogen-activated protein kinase (p38 MAPK) and peroxisome proliferator-activated receptor γ (PPARγ) protein in the liver in rats with insulin resistance (IR), so as to reveal its mechanisms underlying improvement of IR. METHODS: Forty male SD rats were randomly divided into blank control, model, medication, and EA groups (n＝8 in each). The IR model was established by feeding the rats with high-fat diet for 12 weeks. After successful establishment of model, the rats in the blank control group and model group were fixed in the self-made rat bag without receiving any treatment. The rats in the medication group were treated by gavage of pioglitazone (10 mL/kg). EA (2 Hz /100 Hz, 1 mA) was applied to bilateral "Fenglong"(ST40) and "Sanyinjiao"(SP6) for 20 min, once a day, for continuous 14 days for rats in the EA group. The ultrastructure of the liver tissue was observed by transmission electron microscope (TEM). Blood samples were taken from the abdominal aorta for detecting serum C-peptide (C-P), adiponectin (ADP), leptin (LEP) and resistin (RES) contents using enzyme linked immunosorbent assay (ELISA). The expression levels of AMPK, p38 MAPK and PPARγ proteins in the liver tissue were detected by Western blot. RESULTS: After modeling, the contents of serum C-P, LEP and RES, and the expression of liver p38 MAPK protein were significantly up-regulated (P0.05). Outcomes of TEM showed that morphological structure of liver mitochondria was damaged, including a large number of lipid droplets, being blur in appearance, rupture of partial membrane, dissapearance of partial mitochondrial crests with vacuolus-like appearance and decrease of rough endoplasmic reticulum in the model group, which was relatively milder in both EA and medication groups. CONCLUSION: EA intervention is able to improve the disorder of lipid metabolism of IR rats, which may be associated with its effects in lowering the activity of fatty acid synthesis-related enzymes and regulating AMPK/p38 MAPK/PPARγ signaling to improve IR in the liver tissue.

Clinical therapeutic effect of hyperlipidemia of turbid phlegm obstruction pattern/syndrome treated with the different Jin's three-needle therapies / 针刺研究

OBJECTIVE: To compare the differences in clinical effects on hyperlipidemia of turbid phlegm obstruction pattern/syndrome treated with the different Jin's three-needle therapies so as to provide a new approach and theoretic evidence for the clinical optimal scheme of acupuncture on hyperlipidemia. METHODS: A total of 90 patients were randomly divided into education group, electroacupuncture group and catgut embedding group (30 cases in each). The routine health education was given to the education group. On the base of the treatment as the education group, electroacupuncture was applied to the electroacupuncture group for 30 min each time, twice a week; and the catgut embedding was applied to the catgut embedding group at the same acupoints as the electroacupuncture group, once a week. The treatment was given consecutively for 8 weeks in each group. Before and after treatment, the obesity indices [weight, waistline, body mass index (BMI)], blood lipid indices[serum total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C)] and insulin resistance indices [fasting blood glucose(FBG), fasting plasma insulin(FINS), homeostasis model assessment-estimated insulin resistance (HOMA-IR)] were observed in the three groups before and after treatment. RESULTS: After treatment, in the electroacupuncture group and the catgut embedding group, the results of the obesity indices, e.g. weight, waistline and BMI, the levels of blood lipid, e.g.TC, TG, LDL-C and the insulin resistance indices, e.g. FINS and HOMA-IR were all obviously decreased compared with those before treatment (P0.05). The total effective rate was 90.0% in the catgut embedding group (27/30) and it was 83.3% (25/30) in the electroacupuncture group, either of them was better than 60.0% (18/30) in the education group , indicating the statistical significance (P<0.01, P<0.05). CONCLUSION: On the base of health education, either the catgut embedding therapy or electroacupuncture of Jin's three-needle treatment achieves the positive regulation on the abnormal lipid metabolism and insulin resistance. The hypoglycemic effect and the impro-ving effect in LDL-C and HDL-C of the catgut embedding therapy are superior to electroacupuncture.

Effect of Acupoint Thread Embedding on the Peripheral Serum Leptin and Insulin Levels in Simple Obesity Patients / 上海针灸杂志

Objective To observe the clinical efficacy of acupoint thread embedding on the peripheral serum leptin and insulin levels in simple obesity patients, and to further explore the mechanism of acupoint thread embedding in treating simple obesity.Method A total of 120 patients with simple obesity were randomized into a control group, an eletroacupuncture (EA) group and a thread embedding group, 40 cases in each group. The control group was intervened by diet plus exercise intervention, the EA group by EA treatment in addition to the intervention given to the control group and the thread embedding group by acupoint thread embedding treatment in addition to the intervention given to the control group. The levels of blood serum leptin and insulin in the three groups were observed before and after 2 treatment courses and the clinical efficacies were compared among the three groups.Result The total effective rate was 87.5% in the thread embedding group, 85.0% in the EA group, and 47.5% in the control group. The total effective rates in the thread embedding group and EA group were significantly different from the rate in the control group (P<0.05). The levels of the fasting serum leptin and insulin were significantly changed in the thread embedding group and EA group after the treatment (P<0.01). After the treatment, the levels of the fasting serum leptin and insulin in the thread embedding group and EA group were significantly different from those in the control group (P<0.01,P<0.05). The insulin level in the thread embedding group was better than that in the EA group, and the difference was statistically significant (P<0.05).Conclusion Acupoint thread embedding is an effective approach for simple obesity, and it can down-regulate the fasting peripheral serum leptin and insulin levels.

Efetividade da eletroacupuntura versus acupuntura manual em pacientes com dor lombar crônica não específica: um ensaio clínico randomizado / Effectiveness of electroacupuncture versus manual acupuncture in patients with chronic nonspecific low back pain: a randomized controlled trial

Introdução: A dor lombar crônica inespecífica é um importante problema de saúde e de ordem socioeconômica responsável por alto índice de absenteísmo no trabalho e redução do desempenho funcional. A utilização da acupuntura manual como terapia alternativa no tratamento de dor lombar e a eletroacupuntura para potencializar o tratamento, tem se mostrado eficaz, entretanto, com poucas evidências sobre sua efetividade. Objetivo: Comparar a efetividade da eletroacupuntura versus acupuntura manual no tratamento da dor e incapacidade funcional em pacientes com dor lombar crônica inespecífica Método: Sessenta e seis pacientes com dor lombar crônica inespecífica foram distribuídos aleatoriamente em dois grupos: Grupo eletroacupuntura (GE n=33) e grupo acupuntura (GA n=33). Os desfechos clínicos primários foram dor, avaliada com a escala numérica de dor e incapacidade funcional pelo questionário de Incapacidade Roland Morris e os desfechos secundários foram: qualidade da dor medida com o questionário McGill de dor, percepção global com escala da percepção do efeito global, qualidade de vida por meio do Short-Form Health Survey questionnaire (SF-36), depressão com o inventário Beck de Depressão, e cinesiofobia com a Escala Tampa de Cinesiofobia. Os grupos foram tratados duas vezes por semana com duração de 40 minutos, durante seis semanas, totalizando 12 sessões. Foram realizadas três avaliações: inicial, final e follow-up de três meses. O nível de significância foi de alfa < 0,05. Resultados: Ambos os grupos relataram melhora na intensidade da dor e incapacidade funcional, sem diferença entre os grupos. Na intensidade e incapacidade escores de dor entre os grupos foram -0,4 (95% intervalo de confiança [IC] = -1,7 a -0,8) e -2,5 pontos (IC 95% = -5,6 a 0,6), respectivamente. Nos desfechos secundários, observamos uma diferença entre grupos apenas para cinesiofobia (diferença = -4.1 pontos, IC95% = -7,0 a -1,1) no grupo acupuntura manual. Conclusão: A eletroacupuntura e a acupuntura manual são eficazes na melhora da dor e incapacidade funcional em pacientes com dor lombar crônica inespecífica.(AU)

Introduction: Chronic nonspecific low back pain is significant problem of health and socioeconomic order responsible for high rate of absenteeism at work and reduced functional performance. The use of manual acupuncture as an alternative therapy in the treatment of low back pain and electroacupuncture to enhance the treatment has been proven effective, however, with little evidence of effectiveness. Objective: Compare the effectiveness of electroacupuncture versus manual acupuncture in patients with chronic nonspecific low back pain. Methods: Sixty-six patients with chronic nonspecific low back pain were divided into: electroacupuncture (n=33) and acupuncture group (n=33). The primary clinical outcomes were pain, assessed with the numerical Scale of Pain and functional disability by questionnaire Disability Roland Morris and secondary outcomes were quality of pain measure with the McGill Pain Questionnaire, global perception with the perception of the Global Scale Effect, quality of life through the Short-Form Health Survey questionnaire (SF- 36), depression with the Beck depression inventory, and kinesiophobia with Tampa Scale kinesiophobia. The groups were treated twice a week lasting 40 minutes for six weeks, 12 sessions. Were three evaluations: baseline, post treatment and follow-up of three months. The level of significance was alfa < 0.05. Results: Both groups reported improvements in pain intensity and disability with no difference between groups. Differences in intensity and disability scores of pain between groups were -0.4 (95% confidence interval [CI] = -1.7 to - 0.8) and -2.5 points (95% CI = -5 6 to 0.6), respectively. Regarding secondary outcomes, we observed a difference between-groups for kinesiophobia (difference= -4.1 points, 95% CI - 7.0 -1.1) in acupuncture group. Conclusion: Electroacupuncture and manual acupuncture have similar efficacy in reducing pain and disability in patients with chronic nonspecific low back pain.(AU)

Effects of electroacupuncture on angiogenesis after ischemia and reperfusion / 中华物理医学与康复杂志

Objective To explore the effect of eletroacupuncture (EA) on angiogenesis after cerebral ischemia and reperfusion through observing the number of peripheral blood endothelial progenitor cells (EPCs) and the expression of vascular endothelial growth factor (VEGF) in the hippocampus.Methods Among 50 male Sprague-Dawley (SD) rats,10 were randomly selected as a control group (CG).Qi deficiency and blood stasis were induced in the other 40 rats by intragastric administration of dahuang daily for 7 days.A model of focal cerebral ischemia and reperfusion injury was then created by thread-occlusion of the middle cerebral artery,except in 10 rats selected for the sham operation group (SOG) who received the same operation without tightening the thread.The successfully modeled rats were divided into a model group (MG,n =10) and an electroacupuncture group (EAG,n =10).The rats in EAG started acupuncture treatment the next day after modeling,while no treatment was given to those in the other groups.On day 1,3 and 7 after the modeling,the neurological functioning of the 4 groups was assessed using Basso-Beattie-Bresnahan locomotion scoring and the number of EPCs in the peripheral circulation was detected by flow cytometry.On the 8th day,all the rats were decapitated and the VEGF expression was detected immunohistochemically.Results The average BBB locomotion score of the EAG rose significantly from (4.50 ± 1.05) on day 1,to (13.67 ± 1.21) on day 3,and then further to (20.00 ±0.89) by day 7,significantly higher than that of MG at the same time points,but still significantly lower than that of the control group.The average number of EPCs in the peripheral circulation in the MG also increased from (26.83 ± 6.05) on day 1 to (33.67 ± 5.39) on day 3,and decreased to (32.83 ± 5.04) on day 7 after modeling,significantly lower than that of the CG [(45.50 ±9.40),(42.17 ±4.62) and (41.33 ±5.50)],the SOG [(58.00 ±8.05),(59.67±4.84) and (53.83 ±5.38)[and the EAG [(66.17 ±4.36),(127.50 ±73.75) and (55.00 ±35.15)] at each time point.After occlusion,the average expression of VEGF-positive cells in the hippocampus of the EAG [(27.80 ± 2.39)％] was significantly higher than that of the MG,and both were significantly higher than that of the CG.Conclusions Eletroacupuncture can up-regulate VEGF expression and EPCs in the peripheral blood in rats after cerebral ischemia-reperfusion,which can promote angiogenesis and neural functional recovery.

Avaliação de pontos-gatilho miofasciais por imagens de ultrassom e elastografia ultrassonográfica em mulheres tratadas pela acupuntura, eletroacupuntura e acupuntura sham: estudo piloto / Two-dimensional ultrasound and ultrasound elastography imaging of myofascial trigger points in women treated by acupuncture, electroacupuncture and sham acupuncture: pilot study

O presente estudo, de caráter experimental, teve como objetivo a avaliação de pontos-gatilho miofasciais (PG) do músculo trapézio descendente (TPz) por imagens de ultrassonografia bidimensional em escala de cinza (US 2D) e elastografia ultrassonográfica (ELASTO), bem como avaliar a eficácia das técnicas de acupuntura (AC) e eletroacupuntura (EA) na diminuição da dor em mulheres com síndrome da dor miofascial (SDM) associada a queixas de dor nas regiões de cabeça, pescoço e parte superior do tronco. Uma amostra de conveniência de 24 voluntárias, com idades entre 20 e 40 anos (27,33±5,05), IMC entre 18,03 e 27,09 Kg/m² (22,59±3,11), ciclo menstrual regular, presença de ao menos um PG ativo em ambos os TPz, queixa de dor local e/ ou referida há pelo menos seis meses foi selecionada para o estudo. Após a assinatura do Termo de Consentimento Livre e Esclarecido (TCLE), as voluntárias foram randomizadas em três grupos, sendo: dois grupos de tratamento (AC e EA) e um grupo controle (SHAM). Oito sessões de tratamento foram então realizadas, duas vezes por semana, durante aproximadamente um mês, levando em consideração o ciclo menstrual das voluntárias. Imagens do músculo trapézio foram adquiridas pelas técnicas de US 2D e ELASTO para avaliação e diagnóstico das propriedades mecânicas e viscoelásticas do tecido miofascial e a comparação dessas características pré e pós-tratamento. Nas imagens de US 2D, as áreas dos PG foram mensuradas. Nos elastogramas adquiridos pela ELASTO, o índice de resistência (IR) foi calculado. Tanto as voluntárias quanto o examinador eram cegos em relação aos grupos. A intensidade de dor geral e localizada nos TPz direito e esquerdo (TPzD e TPzE, respectivamente) pré e pós-tratamento foi mensurada com o auxílio da escala visual analógica (EVA). A ocorrência de fatores influenciadores e as fases do ciclo menstrual foram monitoradas. Os dados foram analisados quanto à normalidade e simetria. Na avaliação intragrupo todos os dados apresentaram distribuição normal, sendo analisados pelo teste t student para dados pareados. Observou-se diminuição da intensidade de dor geral para o grupo AC (P<0,001) e de dor geral e local para a EA (geral, P=0,027; TPzD, P<0,001; TPzE, P=0,005); sem resultados estatisticamente significantes para o grupo SHAM (geral, P=0,296; TPzD, P=0,052; TPzE, P=0,198). Quanto à avaliação de PG nas imagens de US 2D , observou-se diminuição da área do PG para ambos os TPzD e TPzE nos grupos AC (TPzD e TPzE, P<0,001) e EA (TPzD, P=0,003; TPzE, P=0,005); e não para o grupo SHAM (TPzD, P=0,117; TPzE, P=0,093). Em relação à ELASTO, os dados não apresentaram significância estatística para a amostra analisada, contudo, o IR de ambos os lados apresentou-se menor após o tratamento para a EA e AC, e maior para a SHAM. Na comparação entre grupos, diferenças estatisticamente significantes não foram observadas para as variáveis testadas. Os resultados do presente trabalho sugerem a possibilidade de utilização da US 2D e ELASTO na caracterização do tecido miofascial e de PG, apontando para a possibilidade de confirmação objetiva de efeitos subjetivos de tratamentos propostos para a SDM. Ainda, as técnicas de AC e EA demonstraram eficácia no alívio da dor geral, sendo a efetividade da EA observada também na diminuição da intensidade de dor local. O nível de significância adotado foi ?=0,05.(AU)

The aim of this study was to evaluate upper trapezius (TPz) myofascial trigger points (MTrP) through two-dimensional ultrasonography (2D US) and ultrasound elastography (ELASTO) images, as well as, to evaluate the effectiveness of acupuncture (AC) and electroacupuncuture (EA) in decreasing pain in women with myofascial pain syndrome (MPS) associated with head, neck and upper back complaints. A convenience sample of 24 volunteer aged between 20 and 40 years (27.33±5.05 years), body mass index (BMI) from 18.03 to 27.09Kg/m² (22.59±3.11), presenting regular menstrual cycle, at least one active MTrP at both right and left TPz (RTPz and LTPz, respectively) and local or referred pain for up to six months were selected. After signing the Informed Consent Form (ICF), subjects were randomized into three groups, being: two treatment groups (AC and EA) and one control group (SHAM). Eight treatment sessions were than performed, two times per week, for nearly one month, considering each volunteer menstrual cycle. Pre, post-treatment Intensity of pain was assessed by visual analogue scale (VAS) as well as MTrP mean area and strain ratio (SR) by 2D US and ELASTO, respectively, in way to myofascial tissue mechanical and viscoelastic properties assessment and diagnosis. Both, volunteers and examiner were blinded for the three groups. Influencing factors and menstrual cycle phases were monitored. Data were analyzed for normality and symmetry. All intragroup data were normally distributed, so, were analyzed by Student¿s t test for paired data. Decrease in pain intensity was observed for AC (general, P<0.001) and EA (general, P=0.027; RTPz, P<0.001; LTPz, P=0.005); without any significant result for SHAM (general, P=0.296; RTPz, P=0.052; LTPz, P=0.198). Decreased MTrPs area occurred for both sides in AC (RTPz and LTPz, P<0.001) and EA (RTPz, P=0.003; LTPz, P=0.005); on the other hand, SHAM results were not significant (RTPz, P=0.117; LTPz, P=0.093). Concerning ultrasound elastography, although not statistically significant, post-treatment SR in both sides were lower than the beginning for EA and AC, and higher for SHAM group. Regarding within group comparison, no statistically significant difference were observed for the tested variables. 2D US and ELASTO presented the possibility of MTrPs and surrounding tissue diagnosis and characterization, pointing to the possibility of objective confirmation of subjective MPS treatment effects. Also, EA and AC were effective in decreasing general pain intensity, being EA also effective in local pain intensity relief. The level of significance was ?=0.05.(AU)

Estímulos manual e elétrico da acupuntura sistêmica no tratamento da dor crônica: uma revisão sistemática / Manual and electrical stimulation of systemic acupuncture in the treatment of chronic pain: a systematic review

Para a Organização Mundial de Saúde, a condição clínica mais tratada pela acupuntura é a dor, que é caracterizada de acordo com o tempo de acometimento do indivíduo em aguda ou crônica. Os resultados do efeito analgésico da acupuntura estão relacionados a diversos aspectos, dentre eles o tipo de estímulo utilizado (manual ou elétrico). O objetivo desta revisão sistemática foi verificar se existe diferença do efeito analgésico entre a acupuntura com estímulo manual e a eletroacupuntura na redução da dor crônica. Foram selecionados ensaios clínicos que utilizaram acupuntura manual ou eletroacupuntura de forma sistêmica no tratamento de pacientes com dor crônica. Escala Visual Analógica foi utilizada como desfecho primário para mensuração da dor. A partir das bases de dados PUBMED, COCHRANE, LILACS e utilizando as palavras-chave acupuncture, electroacupuncture, electro-acupuncture e chronic pain foram obtidos 12 artigos nesta revisão, os quais abordaram seis condições clínicas diferentes. Rigor metodológico dos estudos não esteve associado à eficiência do grupo teste na redução da dor crônica, aspecto este que parece estar relacionado ao número de sessões realizadas. Não houve diferença entre eletroacupuntura e acupuntura com estímulo manual em relação à eficácia no tratamento da dor crônica. Sugere-se que os trabalhos futuros sobre acupuntura e dor crônica sejam realizados seguindo, primeiramente, os itens do STRICTA para um maior rigor metodológico. Espera-se que os resultados do tratamento da dor crônica por estímulos manual ou elétrico da acupuntura sejam mais detalhados, contribuindo para elucidar os fatores que realmente estão associados à ocorrência de seus efeitos. Palavras-chave: acupuntura, dor crônica, eletroacupuntura e eletroacupuntura.(AU)

For the World Health Organization, the clinical condition more treated by acupuncture is pain, which is characterized according to the time of onset of the individual in acute or chronic. The results of the analgesic effect of acupuncture are related to various aspects, including the type of stimulus used (manual or electric). The aim of this systematic review was to determine whether there are differences in analgesic effect between acupuncture with manual stimulation and electroacupuncture in reducing chronic pain. There were selected clinical trials of systemically manual acupuncture or electroacupuncture in the treatment of patients with chronic pain. Visual Analogue Scale was used as the primary outcome measure for pain. From the databases PubMed, Cochrane Library, and Lilacs using the keywords acupuncture, electroacupuncture, electro-acupuncture and chronic pain were obtained 12 articles in this review, which addressed six different clinical conditions. Methodological rigor of the studies was not associated with the efficiency of the test group in reducing chronic pain, a factor that seems to be related to the number of sessions. There was no difference between electroacupuncture and manual acupuncture stimulation in efficacy in the treatment of chronic pain. It is suggested that future work on acupuncture and chronic pain are carried out using, first, items STRICTA for greater methodological rigor. It is hoped that the results of the treatment of chronic pain by manual or electrical stimulation of acupuncture are more detailed, helping to elucidate the factors that are actually associated with the occurrence of its effects.(AU)

Electro-acupuncture reduces the need for additional anesthetics in experimental studies / Eletroacupuntura reduz a necessidade de doses adicionais de anestésicos em estudos experimentais

PURPOSE: To evaluate the possible beneficial effects of electro-acupuncture in rats subjected to ketamine/xylazine (KX) intra-peritoneal (i.p.) anesthesia. METHODS: Forty-eight male Wistar rats were distributed in four equal groups. All rats received i.p. injections of ketamine (90 mg/kg) +xylazine (10 mg/kg) anesthesia. Basal values group (control) rats (BV) received no additional treatment. The equivalent of the human right ST36 (Zusanli) and CV-12(Zhongwan) acupoints were chosen for needling and electrical stimulation. AC rats were needled with sterilized disposable stainless steel needles at right ST36 and CV12 acupoints; needles were retained for 30 minutes. EAC10 rats, after needle insertion as described, had electrodes connected to both needles and to an electro stimulator model NKL EL-608; pulsed square waves, 10 Hz, 10 mA, was applied for 30 minutes. EAC100 rats were submitted to EA as described. However, a greater frequency (100 Hz) was used. RESULTS: Thirty-seven rats remained under adequate anesthetic level during the experiment. However, maintenance anesthesia was required by 11 rats. Need for additional anesthesia decreased to 9.1 percent in EAC100 rats compared to BV (36.3 percent). CONCLUSION: Both the AC and the EAC10/100 prolong the anesthetic effect of the combination Ketamine-xylazine in rats, allowing longer duration of anesthesia with a lower dose of anesthetic, thereby reducing the occurrence of complications.

OBJETIVO: Avaliar os possíveis efeitos benéficos da eletroacupuntura em ratos submetidos à anestesia intraperitoneal (i.p.) com ketamina / xilazina. MÉTODOS: Quarenta e oito ratos Wistar foram randomizados em quatro grupos iguais. Todos os ratos receberam injeções i.p. de ketamina (90 mg / kg) + xilazina (10 mg / kg). Os ratos do grupo Valores Basais (controle - BV) não receberam nenhum tratamento adicional. Os acupontos equivalentes aos humanos E-36 (Zusanli) e VC-12 (Zhongwan) foram escolhidos para inserção de agulhas e estimulação elétrica. Os ratos do grupo AC foram estimulados com agulhas esterilizadas descartáveis, de aço inoxidável, nos acupontos E-36 direito e VC12. As agulhas foram mantidas por 30 minutos. Nos ratos do grupo EAC10, após agulhamento, como descrito, eletrodos foram conectados às agulhas e ao eletro-estimulador modelo NKL EL-608 e aplicadas ondas quadradas pulsantes, 10 Hz, 10 mA, por 30 minutos. Os ratos do grupo EAC100 foram submetidos à EA como descrito. No entanto, uma maior freqüência (100 Hz) foi utilizada. RESULTADOS: Trinta e sete ratos permaneceram no nível anestésico adequado durante o experimento. No entanto, a manutenção da anestesia foi se fez necessária em 11 animais. Nos ratos do grupo EAC100 a necessidade de anestesia complementar diminuiu para 9,1 por cento em comparação com ratos do grupo BV (36,3 por cento). CONCLUSÃO: Tanto a AC como a EAC10/100 prolongam o efeito anestésico da combinação ketamina-xilazina em ratos, permitindo maior duração da anestesia com menor dose de anestésico, reduzindo assim a ocorrência de complicações.

Eletroacupuntura no reparo do tendão calcanear comum em coelhos após enxertia com peritônio bovino / Eletro-acupuncture in the rabbit acchiles tendon repair using bovine peritoneum graft

Avaliou-se o efeito da eletroacupuntura (EA) sobre os aspectos macroscópicos e microscópicos em 36 coelhos que tiveram o tendão calcanear comum seccionado e que, após 30 dias, receberam enxerto de peritônio bovino conservado em solução saturada de sal. Após a cirurgia, os animais foram distribuídos em três grupos de igual número: os do grupo E10 foram estimulados pela EA do segundo ao 11º dia de pós-operatório, os do grupo E20 do 11º ao 31º dia de pós-operatório e os do grupo C não foram estimulados. Posteriormente, os animais foram redistribuídos em três subgrupos de igual número, os quais foram observados no pós-operatório por 11, 31 e 91 dias. Nos coelhos do E10 e E20, ocorreu diminuição de aderência da área enxertada aos tecidos circunvizinhos. Aos 31 dias de pós-operatório, observou-se nos do E10 tecido conjuntivo. Verificou-se intensa neovascularização no local enxertado em todos os animais que receberam estímulo pela EA. Nos coelhos do E10, aos 91 dias, verificou-se intensa quantidade de tecido conjuntivo, com fibras colágenas organizadas e paralelas ao eixo do tendão. O estímulo pela EA na fase precoce do pós-operatório estimulou a maturação cicatricial com mínima reação inflamatória.

The effects of eletro-acupuncture (EA) were evaluated on clinical and histological aspects in 36 rabbits that had the acchiles tendon sectioned and grafted after 30 days using bovine peritoneum graft preserved in saturated salt solution. The animals were randomly distributed into three groups. They were stimulated by EA from the 2nd to the 11th post-operative day (S10 group), from the 11th to the 31st post-operative day (S20 group), and were not stimulated (C group). Then, the rabbits were distributed into three sub-groups and were observed for 11, 31, and 91 days. The rabbits from S10 and S20 groups presented decreased adhesions between graft and adjacent tissues. The rabbits from S10 group showed connective tissue at 31 days of the post-operative period. Intense graft neovascularization was observed in all animals stimulated by EA. Large amounts of connective tissue with organized and parallel to the tendon axis collagen fibers were detected on the day 91st in the S10 group animals. The early EA stimulation during the post-operative period stimulated the tendon healing with minimal inflammatory reaction.

O efeito da eletroacupuntura no tratamento da dor muscular / The electroacupunture effect for the treatment of muscular pain

A eletroacupuntura é um recurso bastante utilizado na prática clínica para alívio da dor muscular, apesar do restrito número de pesquisas avaliando sua efetividade. Desta forma, este trabalho inclui dois capítulos, sendo o primeiro intitulado Electroacupuncture and the muscle pain threshold: a review, no qual foi realizada a revisão crítica da literatura, com o objetivo de verificar a efetividade da eletroacupuntura no tratamento da dor muscular. As bases de dados pesquisadas foram ISI, Pubmed, Scielo, Scopus, Cochrane, Bireme de 1977 a Janeiro de 2010 para artigos contendo as palavras chave electroacupuncture AND muscle AND pain. Apesar dos estudos avaliados apresentarem diferenças metodológicas, o que dificultou a comparação entre os resultados, todos consideraram que a EA é eficaz no tratamento da dor miofascial. Nenhum dos estudos considerou a influência do ciclo menstrual na avaliação do limiar de dor, nem mesmo o efeito obtido durante o tratamento, apresentando-o apenas antes e após todas as sessões. O segundo capítulo intitula-se Electroacupuncture for myofascial pain in the upper trapezius muscle, que teve como objetivo avaliar longitudinalmente os efeitos da EA no tratamento da dor miofascial da parte superior do músculo trapézio, por meio da Escala Visual Analógica, da algometria digital, da eletromiografia de superfície e do questionário de qualidade de vida SF-36. Os resultados mostraram que a EA foi efetiva no alívio da dor miofascial do músculo trapézio. Foi observado tanto efeito imediato após cada aplicação da EA como também efeito cumulativo especialmente a partir da terceira sessão. A fase pré-menstrual e menstrual parece estar relacionada ao aumento no limiar de dor observado na sexta. Concluiu-se que a EA foi eficaz no alívio da dor miofascial na amostra avaliada.(AU)

The electroacupuncture is a commonly used resource for pain relieving, despite the restrict number of studies evaluating its effectiveness. This work includes two chapters, the first Electroacupuncture and the muscle pain threshold: a review, consisted of a literature critical review regarding the effectiveness of electroacupunture on the muscular pain treatment. The electronic database researched was ISI, Pubmed, Scielo, Scopus, Cochrane, Bireme from 1977 to January 2010, for articles containing the key words electroacupuncture AND muscle AND pain. Although the methodological differences raise difficulties to the analysis of their results, all the evaluated articles considered the method as efficient. Neither regarded the menstrual cycle influence at the pain threshold, nor the effect obtained along the treatment, presenting only the before and after the entire treatment effect. The second chapter, Electroacupuncture for myofascial pain in the upper trapezius muscle, purposed to evaluate the effects of electroacupuncture as a treatment to the upper trapezius myofascial pain on a longitudinal study. The efficacy of the treatment was evaluated in terms of pain intensity using the visual analog scale (VAS), the pressure pain threshold (PPT) by algometry, electromyography (EMG) and the SF-36 questionnaire. The occurrence of influencing factors in the sessions was monitored as was the menstrual cycle of each participant. It was observed both immediate and cumulative effect specially after the third session. The menstrual phase seems to be related to the increase of pain threshold observed on the sixth session. The EA was shown to be a reliable method for pain relief in the trapezius muscle at the evaluated sample.(AU)