Acupuncture & Pain Relief

Acupuncture Induced Pain Suppression Opiod, Glutamate, Amino Butyric Acid, NaK Pump

Springer International Publishing AG Part of Springer Science + Business Media

Y. Xia et al. (eds.), Current Research in Acupuncture, 37

DOI 10.1007/978-1-4614-3357-6_2, © Springer Science+Business Media New York 2013

 

Chapter 2
Cellular Mechanisms in Acupuncture Points and Affected Sites

Wolfgang Schwarz and Quanbao Gu

W. Schwarz (*)

Laboratory of Cellular Electrophysiology , Shanghai Research Center for Acupuncture and Meridians , Shanghai 201203 , China

Institute for Biophysics , Goethe University Frankfurt am Main,
Max-von-Laue-Str. 1 , 60438 Frankfurt am Main , Germany

e-mail: wolfgang.schwarz@email.de

Q. Gu

Laboratory of Cellular Electrophysiology , Shanghai Research Center for Acupuncture and Meridians , Shanghai 201203 , China

e-mail: guquanbao@126.com

 

Abstract
The objective of our work is the elucidation of mechanisms underlying initiation, transmission and the fi nal effects of acupuncture and moxibustion. In this chapter, we shall focus mainly on possible cellular events in tissue affected by Chinese medicine treatments using basically electrophysiological techniques combined with molecular biological and radioactive tracer techniques to measure activity of transmembrane transport.

In the fi rst part we will review work of our laboratory suggesting that acupunctureinduced pain suppression involves interaction of d -opioid receptor (DOR) with the neurotransmitter transporters for glutamate (EAAC1), g -amino butyric acid (GAT1) and the sodium pump (Na + , K + -ATPase). Reduced activity of the transporters by co-expression of DOR resulted from intermolecular interaction with DOR. In addition, EAAC1 became stimulated in response to DOR activation, while GAT1 became inhibited. The Na + , K + -ATPase was not affected by DOR activation, but higher sensitivity to DOR agonist was found in response to sodium pump stimulation. Since endorphins are released in response to acupuncture, the effects described here may contribute to acupuncture-induced pain suppression.

In the second part we will review work on effects of drugs on membranetransporters. In treatment of asthmatic rats by acupuncture cyclophilin A (CyPA) becomes over-expressed. Release of airway smooth muscle contraction by CyPAinduced inhibition of Na + , Ca 2+ exchanger may be the underlying mechanism. As an example for effects of Chinese herb extracts on the transporters described in Sect. 2.1 , we will review the effect of Acorus extract on EAAC1 function showing that a -asarone effectively inhibits EAAC1-mediated current but stimulates glutamate transport. These effects may contribute to reduced excitatory activity supplementary to acupuncture.

Conclusion: The generally accepted effect of acupuncture is pain relief. We suggest that modulation of central nervous synaptic activity may be involved through indirect modulation of the activity of neurotransmitter transporters by endorphins. Membrane transporters may also be the target for drugs of Chinese herbs and for endogenous acupuncture-induced “drugs.”

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Acupuncture Induced Pain Supression Opiod, Glutamate, Amino ButyricAacid, NaK Pump

Effect of Acupuncture on Blood Flow Velocity and Volume in Common Carotid and Vertebral Arteries in Migraine Patients

Medical Acupuncture
Published in Volume: 21 Issue 1: February 26, 2009  21(1): 47-54. doi:10.1089/acu.2008.0649.

Effect of Acupuncture on Blood Flow Velocity and Volume in Common Carotid and Vertebral Arteries in Migraine Patients

Kyu-Hyun Park, Hak-Jin Kim, Sun-Yong Baek, Byung-Mann Cho, and Tae-Woo Yoo.

 

ABSTRACT

Background: Acupuncture has been reported to be beneficial for both acute and chronic migraine, albeit controversies about efficacy exist. Migraine may be caused by an imbalance in blood flow; acupuncture manipulations may be able to restore the balance, thereby reducing various symptoms of migraine.

Objective: To study blood flow in extracranial arteries with a new protocol of flow quantification with fast-low angle shot after performing Korean Hand Acupuncture therapy on migraine patients.

Design, Setting, and Participants: The study included 40 healthy volunteers (20 men and 20 women, mean age 33 years), and 40 with a history of migraine headaches without aura (10 men and 30 women, mean age 38 years). The study was performed at Pusan National University Hospital (Medical Center), Pusan, Korea, from June 2004 to February 2007.

Intervention: Flow quantification with fast-low angle shot (FLASH) was performed with a 1.5-T MRI machine on participants attached with 4 gold-coated KHT (Korean Hand Therapy) acupuncture needles with tape at the 2 corresponding points (I-2 and E-8), and 2 of 8 Extraordinary points (I-38 and H-2) on both hands.

Main Outcome Measures: Blood flow and velocity in the carotid and vertebral arteries.

Results: The observed patterns were subdivided into 5 categories, according to arteries, in the migraine patients and healthy individuals. The predominant pattern in the migraine category showed decreased blood flow velocity and volume in the common carotid artery and increased blood flow and volume in the vertebral artery, which was distinctively different from flow in the healthy participants. Repeated measures analysis of variance revealed P < .001 for the intervention and type of artery (carotid vs vertebral), but no significant interaction for group (KHT vs control) or side (left vs right).

Conclusions: Our data indicate that KHT can modulate extracranial blood flow through collateral circulation, which may affect the intracranial blood flow in migraine patients.

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About the Authors
Kyu-Hyun Park, MD

School of Medicine, Pusan National University, Pusan, Korea,

Hak-Jin Kim, MD

School of Medicine, Pusan National University, Pusan, Korea,

Sun-Yong Baek, MD

School of Medicine, Pusan National University, Pusan, Korea,

Byung-Mann Cho, MD

School of Medicine, Pusan National University, Pusan, Korea,

Tae-Woo Yoo, PhD

Korean Hand Therapy Institute, Seoul, Korea.

Review of neuroimaging studies related to pain modulation.The periaqueductal grey (PAG) is an area activated across the majority of mechanisms

Review of neuroimaging studies related to pain modulation

Lone Knudsen, Gitte Laue Petersen, Katherine Naested Norskov, Lene Vase, Nanna Finnerup, Troels Staehelin Jensen, Peter Svensson

Highlights

  • This is a narrative review of neuroimaging studies related to human pain control mechanisms.
  • Neuroimaging techniques have clarified supraspinal sites involved in a number of these.
  • The periaqueductal grey (PAG) is an area activated across the majority of mechanisms.
  • Activity in the rostral ventromedial medulla known to relay descending modulation from the PAG has also been demonstrated.
  • Other possible sites involved in pain control include the anterior cingulate cortex, prefrontal cortex, orbitofrontal cortex and nucleus accumbens.

Abstract

Background and purpose

A noxious stimulus does not necessarily cause pain. Nociceptive signals arising from a noxious stimulus are subject to modulation via endogenous inhibitory and facilitatory mechanisms as they travel from the periphery to the dorsal horn or brainstem and on to higher brain sites. Research on the neural structures underlying endogenous pain modulation has largely been restricted to animal research due to the invasiveness of such studies (e.g., spinal cord transection, brain lesioning, brain site stimulation). Neuroimaging techniques (e.g., magnetoencephalography (MEG), positron emission tomography (PET) and functional magnetic resonance imaging (fMRI)) provide non-invasive means to study neural structures in humans. The aim is to provide a narrative review of neuroimaging studies related to human pain control mechanisms.

Methods

The approach taken is to summarise specific pain modulation mechanisms within the somatosensory (diffuse noxious inhibitory controls, acupuncture, movement), affective (depression, anxiety, catastrophizing, stress) and cognitive (anticipation/placebo, attention/distraction, hypnosis) domains with emphasis on the contribution of neuroimaging studies.

Results and conclusions

Findings from imaging studies are complex reflecting activation or deactivation in numerous brain areas. Despite this, neuroimaging techniques have clarified supraspinal sites involved in a number of pain control mechanisms. The periaqueductal grey (PAG) is one area that has consistently been shown to be activated across the majority of pain mechanisms. Activity in the rostral ventromedial medulla known to relay descending modulation from the PAG, has also been observed both during acupuncture analgesia and anxiety-induced hyperalgesia. Other brain areas that appear to be involved in a number of mechanisms are the anterior cingulate cortex, prefrontal cortex, orbitofrontal cortex and nucleus accumbens, but their exact role is less clear.

Implications

Neuroimaging studies have provided essential information about the pain modulatory pathways under normal conditions, but much is still to be determined. Understanding the mechanisms of pain control is important for understanding the mechanisms that contribute to failed pain control in chronic pain. Applying fMRI outside the brain, such as in the trigeminal nucleus caudalis of the spinotrigeminal pathway and in the dorsal horn of the spinal cord, and coupling brain activity with activity at these sites may help improve our understanding of the function of brain sites and shed light on functional connectivity in the pain pathway.

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About the Authors

Lone Knudsen

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Lone Knudsen
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Affiliations

  • Danish Pain Research Center, Aarhus University Hospital, Nørrebrogade 44, Building 1A, 8000 Aarhus C, Denmark

Correspondence

  • Corresponding author. Tel.: +45 2186 9200.

,

Gitte Laue Petersen

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Gitte Laue Petersen
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Affiliations

  • School of Psychology, Aarhus University, Jens Chr. Skous Vej 4, 8000 Aarhus C, Denmark

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Kathrine Næsted Nørskov

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Kathrine Næsted Nørskov
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  • School of Psychology, Aarhus University, Jens Chr. Skous Vej 4, 8000 Aarhus C, Denmark

,

Lene Vase

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Lene Vase
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  • School of Psychology, Aarhus University, Jens Chr. Skous Vej 4, 8000 Aarhus C, Denmark

,

Nanna Finnerup

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Nanna Finnerup
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  • Danish Pain Research Center, Aarhus University Hospital, Nørrebrogade 44, Building 1A, 8000 Aarhus C, Denmark
  • Center for Functionally Integrative Neuroscience, MindLab, Aarhus University Hospital, Nørrebrogade 44, Building 10G, 8000 Aarhus C, Denmark

,

Troels Staehelin Jensen

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Troels Staehelin Jensen
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  • Danish Pain Research Center, Aarhus University Hospital, Nørrebrogade 44, Building 1A, 8000 Aarhus C, Denmark
  • Center for Functionally Integrative Neuroscience, MindLab, Aarhus University Hospital, Nørrebrogade 44, Building 10G, 8000 Aarhus C, Denmark

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Peter Svensson

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Peter Svensson
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  • Center for Functionally Integrative Neuroscience, MindLab, Aarhus University Hospital, Nørrebrogade 44, Building 10G, 8000 Aarhus C, Denmark
  • Department of Clinical Oral Physiology, School of Dentistry, Aarhus University, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark

Inhibition of ROS-induced p38MAPK and ERK activation in Microglia by Acupuncture relieves Neuropathic Pain after Spinal Cord Injury in Rats

Exp Neurol 2012 Aug 23;236(2):268-82. Epub 2012 May 23.

Inhibition of ROS-induced p38MAPK and ERK activation in Microglia by Acupuncture relieves Neuropathic Pain after Spinal Cord Injury in Rats

Doo C Choi, Jee Y Lee, Eun J Lim, Hyung H Baik, Tae H Oh, Tae Y Yune
Age-Related and Brain Diseases Research Center, School of Medicine, Kyung Hee University, Seoul 130-701, Republic of Korea.

Abstract

Acupuncture (AP) is currently used worldwide to relieve pain. However, little is known about its mechanisms of action. We found that after spinal cord injury (SCI), AP inhibited the production of superoxide anion (O(2)·), which acted as a modulator for microglial activation, and the analgesic effect of AP was attributed to its anti-microglial activating action. Direct injection of a ROS scavenger inhibited SCI-induced NP. After contusion injury which induces the below-level neuropathic pain (NP), Shuigou and Yanglingquan acupoints were applied. AP relieved mechanical allodynia and thermal hyperalgesia, while vehicle and simulated AP did not. AP also decreased the proportion of activated microglia, and inhibited both p38MAPK and ERK activation in microglia at the L4-5. Also, the level of prostaglandin E(2) (PGE2), which is produced via ERK signaling and mediates the below-level pain through PGE2 receptor, was reduced by AP. Injection of p38MAPK or ERK inhibitors attenuated NP and decreased PGE2 production. Furthermore, ROS produced after injury-induced p38MAPK and ERK activation in microglia, and mediated mechanical allodynia and thermal hyperalgesia, which were inhibited by AP or a ROS scavenger. AP also inhibited the expression of inflammatory mediators. Therefore, our results suggest that the analgesic effect of AP may be partly mediated by inhibiting ROS-induced microglial activation and inflammatory responses after SCI and provide the possibility that AP can be used effectively as a non-pharmacological intervention for SCI-induced chronic NP in patients.

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Electro-Acupuncture on Hegu Cerebral Response with fMRI & Pain Relief

Study on the regulatory effect of electro-acupuncture on hegu point (LI4) in cerebral response with functional magnetic resonance imaging.

Author information

  • 1Radiology Department, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan.

Abstract

OBJECTIVE:

To study, through blood oxygen level dependent functional magnetic resonance imaging (BOLD fMRI), the cerebral activated areas evoked by electro-acupuncturing (EA) the right Hegu point (L14) or non-acupoint points on the face, and through comparing their similarities and differences, to speculate on the specific cerebral areas activated by stimulating L14, for exploring the mechanism of its effect in potential clinical application.

METHODS:

EA was applied at volunteers’ right L14 (of 9 subjects in the L14 group) and facial non-acupoint points (of 5 subjects in the control group), and whole brain 3-dimensional T1 anatomical imaging of high resolution 1 x 1 x 1 mm(3) used was performed with clustered stimulatory mode adopted by BOLD fMRI. Pretreatment and statistical t-test were conducted on the data by SPM2 software, then the statistical parameters were superimposed to the 3-dimensional anatomical imaging.

RESULTS:

Data from 3 testees of the 9 subjects in the L14 group were given up eventually because they were unfit to the demand due to different causes such as movement of patients’ location or machinery factors. Statistical analysis showed that signal activation or deactivation was found in multiple cerebral areas in 6 subjects of L14 group and 5 subjects of the control group (P<0.01). In the L14 group, the areas which showed signal activation were: midline nuclear group of thalamus, left supra marginal gyrus, left supra temporal gyrus, right precuneous lobe, bilateral temporal pole, left precentral gyrus and left cerebellum; those which showed signal deactivation were: bilateral hippocampus, parahippocampal gyrus, amygdala body area, rostral side/ audal side of cingulate gyrus, prefrontal lobe and occipital lobe as well as left infratemporal gyrus. In the control group, areas which showed signal activation were: bilateral frontal lobe, postcentral gyrus, Reil’s island lobe, primary somato-sensory cortex, cingulate gyrus, superior temporal gyrus, occipital cuneiform gyrus and/or precuneus gyrus and right brainstem; and the area that showed deactivation was left median frontal lobe.

CONCLUSION:

The effects of EA L14 in regulating cerebral activities could be displayed and recorded through BOLD fMRI, the distribution of signally deactivated area evoked by EA L14 was similar to the known distribution of anatomical orientation of pain in brain, and closely related to the anatomic structure of limbic system, which areas are possibly the acupuncture analgesic effect’s cerebral regulating area. Furthermore, activated portion of left central anterior gyrus, which represent the movement of oral facial muscles, and the activated portion of cerebellum are possibly related with the effect of using EA L14 in treating facial palsy and facial muscle spasm. As for the mechanism of signal deactivation of cerebral activities exhibited in the present study that is unable to be elucidated, it awaits for further research.

PMID: 17578311   [PubMed – indexed for MEDLINE]

 

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NK cells mediate the cumulative analgesic effect of electroacupuncture in a rat model of neuropathic pain

Gao et al. BMC Complementary and Alternative Medicine 2014, 14:316

Yong-Hui Gao1, Jun-Ying Wang1, Li-Na Qiao1, Shu-Ping Chen1, Lian-Hong Tan1, Qiu-Ling Xu2 and Jun-Ling Liu1*     2014

Abstract

Background: Cumulating evidence has revealed the effectiveness of acupuncture therapy in relieving pain via immunoregulation. However, its underlying mechanism remains unknown. The present study was designed to determine the changes of immunogenic responses at different time-points of electroacupuncture (EA) interventions in neuropathic pain rats.

Methods: The neuropathic pain model was established by ligature of the left sciatic nerve to induce chronic constriction injury (CCI). EA was applied at Zusanli (ST36) and Yanglingquan (GB34) for the EA groups. The thermal pain threshold was detected with an algesia-detector. The subgroups of plasma and splenic lymphocytes were determined via fluorescence-activated cell sorting. Specific inflammatory cytokines were assayed using an ELISA-based bead multiplex assay. The activities of splenic natural killer (NK) cells and cytotoxic T lymphocytes were detected by methyl thiazolyl tetrazolium colorimetric method. For confirming the involvement of NK cell in EA-analgesia, anti-asialo-ganglio-N-tetraosylceramide (anti-asialo-GM1) antibody was given to CCI rats before EA.

Results: Following CCI, the thermal pain threshold of the affected hind footpad was significantly decreased, and increased from the 3rd day to the 12th day after EA interventions, presenting a time-dependent tendency from the 5th day on. From day 3 to 5 of EA interventions, the percentages and activity of splenic NK cells, concentrations of splenic interleukin-2 (IL-2) and beta-endorphin (β-EP) were significantly increased. Meanwhile, the concentrations of plasma IL-2, IL-1β and gamma-interferon (IFN-γ) were significantly decreased and returned to the normal level on day 12 following EA. Plasma transforming growth factor-β (TGF-β) levels were considerably upregulated on day 5 and 12 following EA. The CD4+/CD8+ T cell ratio was markedly downregulated compared with the control and CCI groups on day 5 and returned to the normal level on day 12 following EA. After depleting NK cells by anti-asialo-GM1 antibody, the increased thermal pain threshold following EA intervention was obviously reduced.

Conclusions: Repeated EA interventions have a time-dependent cumulative analgesic effect in neuropathic pain rats, which is closely associated with its regulatory effects on NK cells, splenic IL-2, β-EP, and plasma IL-2, IL-1β, IFN-γ and TGF-β levels.

Keywords: Acupuncture analgesia, Cumulative effect, Chronic constriction injury, Innate immunity, Acquired immunity, NK cells *

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Acup & Pain NK Cells medicate cumulatite efect of Electro-acup neurpathic pain 1472-6882-14-316

 

 

 

Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis

BMC Complement Altern Med. 2014 Aug 23;14:312. doi: 10.1186/1472-6882-14-312.

Manyanga T1, Froese M, Zarychanski R, Abou-Setta A, Friesen C, Tennenhouse M, Shay BL.

Author information

  • 1Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. ummanyan@myumanitoba.ca.

Abstract

BACKGROUND:

The utility of acupuncture in managing osteoarthritis symptoms is uncertain. Trial results are conflicting and previous systematic reviews may have overestimated the benefits of acupuncture.

METHODS:

Two reviewers independently identified randomized controlled trials (up to May 2014) from multiple electronic sources (including PubMed/Medline, EMBASE, and CENTRAL) and reference lists of relevant articles, extracted data and assessed risk of bias (Cochrane’s Risk of Bias tool). Pooled data are expressed as mean differences (MD), with 95% confidence intervals (CI) (random-effects model).

RESULTS:

We included 12 trials (1763 participants) comparing acupuncture to sham acupuncture, no treatment or usual care. We adjudicated most trials to be unclear (64%) or high (9%) risk of bias. Acupuncture use was associated with significant reductions in pain intensity (MD -0.29, 95% CI -0.55 to -0.02, I2 0%, 10 trials, 1699 participants), functional mobility (standardized MD -0.34, 95% CI -0.55 to -0.14, I2 70%, 9 trials, 1543 participants), health-related quality of life (standardized MD -0.36, 95% CI -0.58 to -0.14, I2 50%, 3 trials, 958 participants). Subgroup analysis of pain intensity by intervention duration suggested greater pain intensity reduction with intervention periods greater than 4 weeks (MD -0.38, 95% CI -0.69 to -0.06, I2 0%, 6 trials, 1239 participants).

CONCLUSIONS:

The use of acupuncture is associated with significant reductions in pain intensity, improvement in functional mobility and quality of life. While the differences are not as great as shown by other reviews, current evidence supports the use of acupuncture as an alternative for traditional analgesics in patients with osteoarthritis.

SYSTEMATIC REVIEW REGISTRATION:

CRD42013005405.

PMID: 25151529 [PubMed – in process]  PMCID: PMC4158087

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Pain Management with Acupuncture in Osteoarthritis_A systemic Review and Meta-analysis

Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials

Oxford Journals Medicine & Health BJA Volume 101, Issue 2 Pp. 151-160.

  1. Y. SunT. J. GanJ. W. Dubose and  A. S. Habib*
  2. + Author Affiliations
  3. Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC 27710, USA
  4. *Corresponding author. E-mail: habib001@mc.duke.edu

Abstract

Postoperative pain management remains a significant challenge for all healthcare providers. The objective of this systematic review was to quantitatively evaluate the efficacy of acupuncture and related techniques as adjunct analgesics for acute postoperative pain management. We searched the databases of Medline (1966–2007), CINAHL, The Cochrane Central Register of Controlled Trials (2006), and Scopus for randomized controlled trials (RCTs) using acupuncture for postoperative pain management. We extracted data about postoperative opioid consumption, postoperative pain intensity, and opioid-related side-effects. Combined data were analysed using a random effects model. Fifteen RCTs comparing acupuncture with sham control in the management of acute postoperative pain were included. Weighted mean difference for cumulative opioid analgesic consumption was −3.14 mg (95% confidence interval, CI: −5.15, −1.14), −8.33 mg (95% CI: −11.06, −5.61), and −9.14 mg (95% CI: −16.07, −2.22) at 8, 24, and 72 h, respectively. Postoperative pain intensity (visual analogue scale, 0–100 mm) was also significantly decreased in the acupuncture group at 8 and 72 h compared with the control group. The acupuncture treatment group was associated with a lower incidence of opioid-related side-effects such as nausea (relative risk, RR: 0.67; 95% CI: 0.53, 0.86), dizziness (RR: 0.65; 95% CI: 0.52, 0.81), sedation (RR: 0.78; 95% CI: 0.61, 0.99), pruritus (RR: 0.75; 95% CI: 0.59, 0.96), and urinary retention (RR: 0.29; 95% CI: 0.12, 0.74). Perioperative acupuncture may be a useful adjunct for acute postoperative pain management.

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Acup & related techniques for postoprative pain_a systemic review of randomized controlled trials

 

* Acupuncture anesthesia and analgesia for clinical acute pain in Japan

Evid Based Complement Alternat Med. 2008 Jun;5(2):153-8. doi: 10.1093/ecam/nem056.

Taguchi R.

Author information

  • Department of Clinical Acupuncture and Moxibustion II Meiji University of Oriental Medicine, Kyoto, Japan.

Abstract

Acupuncture anesthesia has been practiced in China since about 1960. In Japan, Hyodo reported 30 cases of acupuncture anesthesia in 1972. However, from around 1980, the direction of acupuncture investigations turned from anesthesia to analgesia. Acupuncture analgesia is presently considered a way to activate the body’s endogenous analgesic system. Recently, with the rise of acupuncture as one of the most well known CAM therapies, acupuncture or moxibustion treatment has been reported for both acute and chronic pain. Even so, few clinical reports and original articles have been reported in Japan. This review illustrates how acupuncture is being used in Japan for acute pain such as surgical operations, post- operative pain (POP), neuropathic pain, pain associated with teeth extractions and after the extraction of impacted wisdom teeth.

KEYWORDS:

acupuncture analgesia; acupuncture anesthesia; acute pain; individual variation; neuropathic pain; pain after extraction of impacted wisdom teeth; pain from teeth extractions; post-operative pain; surgery operation

PMID: 18604250  [PubMed]   PMCID: PMC2396469

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Acup Anesthesia & Analgesia for Clinical Acute Pain in Japan