The Role of Scalp Acupuncture for Relieving the Chronic
Pain of Degenerative Osteoarthritis A Pilot Study
of Egyptian Women
Hemat Allam, MD,1and Nagwa Hassan Mohammed, PhD2
Background: Osteoarthritis (OA) is a common chronic and painful condition secondary to deterioration of
cartilage. OA-related pain can be managed pharmacologically together with complementary therapies, such as
Objective: The aim of this trial was to evaluate the effectiveness of Yamamoto New Scalp Acupuncture
(YNSA) for relieving pain associated with OA in Egyptian women.
Design and Setting: At the Female Outpatient Pain Clinic, of the National Research Centre, in Cairo, Egypt,
between March 2008 and June 2009, 30 females (ages 27–80) presenting with chronic pain caused by OA were
Intervention: The affected YNSA points were treated for 20 minutes in a single session.
Main Outcome Measure: Pain was assessed by a visual analogue scale (VAS) prior to, and 1 hour after, the
Results: Preintervention VAS scores were: 3–10 (mean 7.43–1.9; P>0.05). Postintervention VAS scores
ranged from 0 to 8 (mean 3.37–2.1) with a statistically significant positive correlation between these scores
and pretreatment values (P=0.01). Postintervention VAS scores were significantly related to pain locations.
Post-hoc analysis showed statistically significant lower postintervention VAS scores for cervical OA, compared
to those of lumbosacral OA.
Conclusions: YNSA acupuncture is effective in immediate pain relief among females suffering from degen-
Key Words: Chronic Pain, Osteoarthritis, Scalp Acupuncture
most common of all chronic conditions. It is characterized
by the degeneration of cartilage and its underlying bone
withina jointas well as bony overgrowth. The breakdownof
these tissues eventually leads to pain and joint stiffness.1
steoarthritis (OA) is a clinical syndrome of joint
pain accompanied by varying degrees of functional
Joints most commonly affected are: knees; hips; hands; and
spine. Overall, OA affects 13.9% of adults ages 25 and older
and 33.6% (12.4 million) of people who are 65 years old. An
estimated 26.9 million U.S. adults in 2005 of 21 million in
1990 had OA—and this is believed to be a conservative
estimate.2Women between ages 65 and 74 were twice as
likely as men to have knee OA. Men have a 45% lower
incident risk of knee OA and a 36% reduced risk of hip OA
than do women.3
1Anaesthesia and Pain Therapy, Medical Research Division, National Research Centre, Cairo, Egypt.
2Complementary Medicine Research Department, National Research Centre, Cairo, Egypt.
Volume 25, Number 3, 2013
# Mary Ann Liebert, Inc.
There is currently no cure for OA. Treatment for OA
focuses on relieving symptoms and improving function.
Treatment should be multidisciplinary, including a combi-
nation of patient education, physical therapy, weight con-
trol, and use of medications. Nonpharmacological and
pharmacological management of symptoms are approached
according to established guidelines.4The 2000 update of the
American College of Rheumatology (ACR) recommenda-
tions has mentioned acupuncture as a viable therapeutic
approach for OA.4
Acupuncture is one of the oldest treatment modalities,
and has been successfully practiced in China for 4000 years.
Traditionally, acupuncture has been used to treat various
mental and physical disabilities.5Classical acupuncture is
based on the theory that vital energy (Qi), flows through the
body along meridians. There are specific points along these
meridians (acupuncture points or acupoints) at which Qi
may be accessed. Inserting needles into these points permits
a practitioner to restore harmony to a patient’s system by
rebalancing the flow of Qi within that patient.6
In 1996, the U.S. Food and Drug Administration re-
classified acupuncture needles from Class III (investiga-
tional use) to Class II (general acupuncture use).7The
National Institutes of Health stated that acupuncture might
be useful as an adjunct or alternative treatment for osteo-
In the Western medical model, acupuncture is thought to
relieve pain through the gate-control mechanism or through
the release of neurochemicals.9Pomeranz and Berman10
described the possible neural mechanisms of acupuncture
analgesia as follows: Small diameter muscle afferents are
stimulated, sending impulses to the spinal cord, which then
activates 3 centers (spinal cord, midbrain, and pituitary
gland) to release neurochemicals (endorphins and mono-
amines) that block pain messages.
Chronic disorders of the locomotor system are important
fields of indication for Yamamoto New Scalp Acupuncture
(YNSA).11This is an acupuncture method that provides
rapid relief of pain of the locomotor system. YNSA, used
since 1973, is a complete acupuncture microsystem.
While relatively unknown in the United States, YNSA
deserves recognition and further research into its reliability
and validity as well as its compatibility with other forms of
treatment. YNSA is providing new insights into the elec-
tromagnetic circuitry of the body.12
MATERIALS AND METHODS
After institutional approval, between March 2008 and
June 2009, 30 female patients with chronic degenerative OA
were randomly selected from a list of patients with the same
pathology who were referred to the Outpatient Women’s
Pain Clinic, of the National Research Institute, in Cairo,
Egypt. Inclusion criteria were: women between ages 27 and
80; presence of neck, shoulder, and/or low-back pain diag-
nosed by plain X-ray, computed tomography scan, or
magnetic resonance imaging; no motor deficits (noted dur-
ing a neurological examination); and chronic symptoms of
more than 12 weeks’ duration.
Written informed consent was obtained from the patients
prior to the study. The Human Ethics Research committee of
the National Research Centre granted the treatment approval.
Women were excluded if they refused to sign the in-
formed consent form or had had previous treatments with
acupuncture for any reason in the past 3 months. Women
with conditions, such as cancer, metastasis of cancer, ver-
tebral fractures, herniated discs, and bone infections, were
Certain concomitant treatments were not permitted dur-
ing the 4 weeks prior to the study treatment (opioids,
invasive-therapy methods, or neuromuscular blocks in the
region of treatment and parenteral or oral corticosteroids);
during the week prior to treatment (nonsteroidal anti-
inflammatory drugs, topical antirheumatics, topical corti-
costeroids, and muscle relaxants); or during the day prior to
treatment (analgesics, heat, massage, and cold or rheuma-
tism bath therapy).
Patients were examined clinically by a trained physician,
who informed them about the visual analogue scale (VAS)
that was to calculate each patient’s VAS score before
therapy and 1 hour after receiving treatment. The latter was
calculated for the main pain location for patients with
multiple pain sites.
The VAS enables patients to adjust a red slide in a white
visual field to represent their sensation of pain subjectively
on a scale between ‘‘no pain’’ (the red bar is withdrawn
completely from the window) and ‘‘most intense pain’’ (the
red bar completely fills the window). On the reverse of
the VAS, hidden from the patient, the therapist can read the
person’s subjective assessment in figures on an 11-number
scale between 0 and 10 (0 means no pain; 10 means most
The trial was based on revised Reporting Interventions in
Clinical Trials of Acupuncture (STRICTA) guidelines.13
YNSA was given to all patients in the trial. The affected
scalp points were defined by the treating clinician, who was
a medical physician licensed to perform acupuncture.
Details of Needling
The intervention was conducted as follows:
? Only one session was given to each patient.
? Sterile, stainless-steel disposable acupuncture needles,
sized 0.15·0.15, were used.
2 ALLAM AND MOHAMMED
? 4–6 needles were inserted, mainly in the basic points
and the brain area (according to the YNSA protocol),
during the session.
? The depth of insertion was 5mm–15mm, until De Qi
? The needles were retained for 15–20 minutes.
? Manual stimulation only was applied to the needles.
The primary outcome measure was pain relief, as mea-
sured by the VAS.
Statistical analysis was performed, using PASW Statistics
18, Release 18.0.2, Serial Number 10146966. Data were
presented as mean–standard deviation or numbers and per-
centages, as necessary. The distribution of qualitative data
amonggroupswas evaluatedbyachi-square testoraFisher’s
exact test, as necessary. A Spearman’s test was used for
evaluating the correlation between continuous variables.
Pre- and postintervention differences were calculated for
each patient and the statistical significance of this difference
was evaluated by a paired Student’s t-test. However, the
means of the differences were compared among patients’
gender, pain locations, and multiplicity of pain locations,
using an unpaired Student’s t-test or analysis of variance, as
indicated. The Bonferroni test was used for post-hoc anal-
ysis for a two-by-two comparison of any statistically sig-
nificant differences among the compared groups. A P-value
of<5 was necessary for establishing statistical significance.
This study included 30 females. Their ages ranged from
27 to 80, with a mean value of 50.1–11.6 years. Duration of
pain among these patients ranged from 12 weeks to 4 years
(mean value of 18 months–4 months). The main pain lo-
cations were the cervical region (n=12, 40%), the lumbo-
sacral region (n=11, 36.7%), the shoulder region (n=4,
13.3%), and the knee (n=3, 10%). Seven patients (23.3%)
had multiple pain locations that were: cervical and lumbar
regions in 3 patients (43%); cervical and shoulder regions in
2 patients (28.6%); shoulder and knee in 1 patient (14.3%);
and shoulder and lumbar regions in another patient (14.3%).
Preintervention VAS scores ranged from 3 to 10, with a
mean value of 7.43–1.9, and the scores calculated for OA
affecting the knee, lumbosacral region, cervical region, and
shoulder were 9–1, 7.6–1.6, 7.3–1.8, and 6.3–3, re-
spectively (P>0.05). A high preintervention VAS score was
significantly related to the presence of multiple pain loca-
tions; with this latter group of patients having a score of
8.7–1.9, compared to only 7.04–1.74 for patients pre-
senting with a single pain location (P=0.038).
However, the pre-VAS score was not significantly related
to patients’ ages (P>0.05).
Postintervention VAS scores ranged from 0 to 8, with a
mean value of 3.37–2.1 and a statistically significant pos-
itive correlation between postintervention and preinterven-
tion values (P=0.01). Postintervention VAS scores were
significantly related to pain location; values calculated for
patients with OA affecting the lumbosacral, knee, shoulder,
and cervical regions were: 4.8–1.6; 4.33–1.2; 2.75–1.71;
and 2–1.95 (P=0.005), respectively. Post-hoc analysis
showed a statistically significantly lower postintervention
VAS scores for patients presenting with OA of the cervical
region, compared to those with pain in the lumbosacral re-
gion (P=0.004). In addition, post-intervention VAS scores
were unrelated to patients’ age, gender,
pain locations (P>0.05).
The VAS score difference calculated for each patient
ranged from 2 to 8, with a mean value of 1.77–0.43, indi-
cating a high, statistically significant improvement after
therapy for the whole group of patients (P=0.001). There
was a statistically significant relationship between relative
pain relief, as indicated by a higher VAS score difference,
and location of pain (P=0.032). The score differences
calculated for patients presenting with OA affecting the
cervical, knee, shoulder, and lumbosacral regions were:
4.8–2; 4.7–1.5; 3.5–1.7; and 2.8–0.9, respectively. Post-
hoc analysis showed a more statistically significant im-
provement in patients presenting with OA of the cervical
region, compared to patients with chronic lumbosacral pain
bAU1or multiplicity of
(1) Patients presenting with OA affecting multiple lo-
cations had significantly higher preintervention VAS
scores, compared to patients with OA affecting only
one location (P=0.038).
(2) There was a statistically significant positive correla-
tion between the pre- and post-VAS scores (P=0.01).
In other words, the higher the preintervention values
were, the more higher postintervention values were
(3) All participants benefited from this single-session
treatment, as indicated by a statistically significant
VAS score difference (P=0.001).
(4) Both calculated postintervention VAS scores and
VAS score differences were significantly related to
pain location (P=0.005 and P=0.032, respectively).
Patients with cervical OA had significantly lower
post-VAS scores and score differences, compared to
patients with lumbosacral pain (P=0.004 and
The aim of this study was to determine the effectiveness
of YNSA for relieving pain of the locomotor system among
YNSA FOR CHRONIC OA PAIN3
women seeking pain relief at the Outpatient Clinic. The trial
was intended to show how rapidly YNSA produces pain-
relieving effects. The data presented here offers support that
YNSA is a form of microsystem acupuncture that is suc-
cessful for relieving acute and chronic nonspecific muscu-
loskeletal pain secondary to a variety of causes. YNSA is
another form of acupuncture that complements the Tradi-
tional Chinese Medicine (TCM) teachings while providing
new insights into the electromagnetic circuitry of the
The VAS score difference calculated for each patient
revealed a high, statistically significant improvement after
therapy for the whole group of patients, as indicated by the
P-value (P=0.001). This was in accordance with the study
by Shaladi et al. in 2010.15The degree of reduction of pain
was 71%, as evaluated with a VAS used in that study to
evaluate the effectiveness of YNSA for relief of neck pain;
this study also used a 1- session technique. Another study
conducted by Feelyin 200611emphasized the results ob-
tained in the current study: Where YNSA was applied for
treating pain and dysfunction, secondary to different diag-
noses, YNSA showed very promising results for relieving
back pain immediately, even with the use of a minimal
number of needles.11
In a survey of experts performed by Schokert in 2009,16
therapists were asked which indication for YNSA they
regarded as being the most important. The rapid and reli-
able effects of YNSA for producing immediate pain relief
was emphasized in the survey responses, recommending
YNSA’s global application in integrative medicine and
fostering further studies to prove the value of this technique
for pain management.
In the current study, neither the site of pain nor the
diversity of the underlying pathological diagnoses pre-
disposing to pain limited the application of the modality.
Patients with neck, low-back, and knee pain were treated
equally. In all of the studied conditions, the patients had
significant reductions of pain, as measured by the VAS.
This was in accordance with a study carried out by
Schokert and colleagues in 200317to evaluate the effec-
tiveness of YNSA for relieving pain of the locomotor
system, with no pathological specificity. The rapidity of
the onset of relief was studied subjectively using a VAS
and objectively applying topometry. In addition, YNSA’s
long term effects were evaluated.17In that study, the
average VAS values calculated for 104 German people
were 63/100 points before treatment and 19/100 points
after treatment (measured on a 100-point scale), as ex-
pressed by treated patients immediately after an acu-
puncture session of 3–9 minutes duration. The difference
in the mean before/after values was 44. Of those 104
patients, a total of 45 (43.3%) reported relief, and 52
participants (50%) reported freedom from symptoms for
different periods of time. One important advantage of that
study17was that the needles were left in place for only for
3–9 minutes, with the aim of evaluating YNSA’s its ef-
fectiveness in emergency conditions. In the current study,
this point was not addressed; only a single session of
YNSA was applied. However, it was also concluded, that
YNSA is effective, in a single session, for immediate pain
relief secondary to upper and lower locomotor chronic
pain. In another pilot study, performed at the Mayo
clinic,18involving participants with chronic refractory
musculoskeletal pain, it was demonstrated that acupunc-
ture stimulation provided pain relief. That study used
laser needles, which appeared to be clinically equivalent
to the metal needles used in the current study.
In a review article of randomized controlled trials re-
porting on the role of acupuncture for managing knee OA,1
10 trials, representing 1456 patients, provided evidence that
this modality is effective for pain relief and physical dys-
function associated with OA.1In accordance with the cur-
rent study, these studies had pain in common as an outcome
measure; mostly grading pain using a VAS. Other outcome
measures studied had included: QoL measures; physician
global assessment; examination-based measures, such as
joint range-of-motion; and performance-based measures,
such as walk times. Pain was the main outcome reported in
all the studies, with an observed significant reduction re-
corded by a VAS scale. One of these studies also found that
the reduction in pain was significantly greater for an acu-
puncture group versus a medication treatment (diclofenac)
YNSA is an effective modality for immediate relief of
chronic pain. Although results are promising, still larger
studies are required to assess this acupuncture modality
further and widen its application, teaching, and accredita-
tion. YNSA deserves recognition and further research into
its reliability and validity as well as its compatibility with
other forms of treatment.
Special thanks to A. Hassouna, MD, at Ain Shams Uni-
versity, for his assistance and contribution to this article.
The authors herewith certify that they have no commer-
cial, proprietary, financial or nonfinancial interest in prod-
ucts mentioned in this article. The authors did not receive
grants to conduct this study, write the article, or otherwise
assist in the preparation of this article.
4 ALLAM AND MOHAMMED
ACU-2012-0892-ver9-Allam_1P.3d05/22/13 8:59pmPage 4
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prevalence of arthritis and other rheumatic conditions in the
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Address correspondence to:
Hemat Allam, MD
Mukattam P.O. Box 93
YNSA FOR CHRONIC OA PAIN5
ACU-2012-0892-ver9-Allam_1P.3d05/22/138:59pm Page 5
AUTHOR QUERY FOR ACU-2012-0892-VER9-ALLAM_1P Download full-text
AU1: Given that only women were in this study, how could comparisons be made according to patients’ gender?
They were all the same. Please fix this.
AU2: For ref. 7, this publication was not found on the FDA Consumer Magazine Web site. Provide publisher,
city, and state for print publication or working web site with Accessed Month Date and Year.
AU3: We do not have information on Medical Acupuncture prior to 2007; please provide complete page ranges
for articles in refs. 11 and 17.
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