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P-163 Using acupuncture to treat hot flashes and night sweating for patients with breast cancer



Background Hot flashes and night sweating are a common disruptive clinical problem that affects nearly two-thirds of all breast cancer survivors. Adjuvant hormonal therapies are an essential part of the treatment regimen for early breast cancer, and are used to prevent recurrence. However, hot flashes and night sweating are the most frequently occurring side effects of these interventions. Aim To assess the effectiveness of acupuncture in breast cancer related hot flashes and sweating. Methods A 44 year -old woman with a diagnosis of breast cancer had been suffering from intractable hot flashes and night sweating for the past two years. She had tried all other measures but these had very little or no effects on her symptoms. The subject received acupuncture treatment once a week for eight weeks, and the needles were stimulated manually every 10 min during each sessions. In all the treatment sessions, acupuncture points were stimulated manually and the needles were left in situ for 30 mins. Subjective measurement of vasomotor symptoms used Visual Analogue Scale (VAS). Results A noticeable reduction in hot flashes and night sweating were observed after six sessions of treatment, which had a huge impact on her sleep pattern and psychological wellbeing. By the end of eight weeks of treatment the subject reported a significant reduction in both her vasomotor and associated symptoms such as palpitations, anxiety, irritability and headaches. Conclusion It would appear that eight sessions of acupuncture treatment had been shown to be effective in reducing vasomotor symptoms, especially for breast cancer patients who are seeking nonpharmacological therapies.
Acupuncture in Physiotherapy, Volume 28, Number 1, Spring 2016, 9398
Acupuncture for cancer-related hot flashes and
night sweating in a 44-year-old woman with
breast cancer
V. Ramasamy
John Taylor Hospice, Birmingham, UK
The aim of this study was to assess the effect of acupuncture treatment for cancer-related
hot flashes and night sweating. The subject was a 44-year-old woman with a diagnosis of
breast cancer who had suffered from intractable hot flashes and night sweating for the past
2 years. Other measures failed to improve her symptoms, but she responded to a course of
acupuncture treatment. The subject’s hot flashes and sweating decreased from 9/10 to 2/10,
as measured on a visual analogue scale. There was also an improvement in her quality of
sleep and overall sense of well-being. Acupuncture may have potential as a treatment
modality since the current therapeutic options for hot flashes and night sweating are limited,
especially for patients with hormone-sensitive carcinoma.
Keywords: acupuncture, breast cancer, hot flashes, night sweating.
Sweating is the natural way of lowering body
temperature. This is achieved because sweat
results in heat loss through the skin. In patients
with cancer, sweating may be caused by an
infection, a tumour or cancer treatment.
A hot flash is defined as a sudden onset of
heat in the upper trunk that spreads to the arms
and face, often with subsequent sweating and
then a chill. A combination of hot flashes and
sweating is frequently the result of vasomotor
symptoms, and may occur during the day and
also at night (Kronenberg 1990). The severity
and frequency of hot flashes vary from person
to person, and these can be extreme in patients
with breast or prostate cancer who are under-
going anticancer therapy (Filshie 2005).
Early research by Carpenter et al. (1998) dem-
onstrated that hot flashes are a common and
Correspondence: Visweswaran Ramasamy, John Taylor
Hospice, 76 Grange Road, Erdington, Birmingham
B24 0DF, UK (e--mail:
disruptive clinical problem that affects nearly
two-thirds of all breast cancer survivors. These
individuals experience hot flashes and sweating
more frequently than women undergoing a
natural menopause, and cancer-related flashes
may be more severe, distressing and of greater
duration (Carpenter et al. 2002).
Hot flashes and night sweating may be
accompanied by a range of physical sensations,
including sweating, flashing or redness, palpita-
tions, dizziness, feelings of suffocation, nausea,
tingling sensations in the hands, and chills
before or after the flash. Associated emotional
symptoms may include anxiety, feelings of
panic, irritation, annoyance and frustration, and
even suicidal ideation. Night sweating disturbs
sleep patterns, leading to fatigue and irritability
(Miller 2004).
Adjuvant hormonal therapies such as tamox-
ifen are an essential part of the treatment
regimen for early breast cancer, and are used to
prevent recurrence. However, Hunter et al.
(2004) mentioned that hot flashes and night
© 2016 Acupuncture Association of Chartered Physiotherapist 93
Cancer-related hot flashes and night sweating
sweating are the most frequently occurring side
effects of these interventions, with up to 80% of
women taking tamoxifen reporting these as
troublesome. Many patients do not wish to expe-
rience further side effects of pharmacological
preparations during their cancer treatment. For
these women, complementary and alternative
medicine approaches may offer an alternative
(Hunter et al. 2004). Preliminary studies suggest
that acupuncture may reduce hot flashes and
night sweating in breast cancer survivors, and
have fewer side effects than conventional phar-
macological therapies (Hervik et al. 2009;
Walker et al. 2010).
Mechanism of action
The specific pathophysiology of acupuncture for
hot flashes remains a mystery, although several
hypotheses exist. Acupuncture is known to
stimulate neuropeptide synthesis, which controls
bodily functions such as cardiovascular physiol-
ogy and hormonal secretions (Omura 1975). This
is believed to activate peripheral nerve endings,
muscles and also connective tissue. The
stimulation of the nerves produces affer-ent
signals, which increase, for example, central β-
endorphins and serotonin, and probably also
activate receptors (Guo et al. 2008; Moazzami et
al. 2010). Using functional magnetic resonance
imaging, Hui et al. (2010) demonstrated that acu-
puncture decreased activity in the amygdala and
hypothalamus. Calcitonin gene-related peptide
(CGRP) is a neuropeptide that is released into the
circulatory system during a hot flash (Wyon et al.
2000). Acupuncture stimulation causes the release
of ß--endorphin, which has an inhibitory effect on
CGRP. A study by Wyon et al. (1995) showed that
urinary excretion of CGRP was reduced following
acupuncture. It is possible that neuronal activity in
the hypothalamus is elevated during hot flashes,
and acupuncture may reduce this, perhaps
mediated by increased ß-endorphin release and
decreased noradrenaline activity.
Case report
The present subject was a 44-year-old woman
with a diagnosis of breast cancer. She had been
suffering from intractable hot flashes and night
sweating for the past 2 years, and this had had a
severe impact on her quality of life (QoL). Her
sweating was very bad, especially when she tried
to sleep. She needed to change her bedclothes
several times a night, which had an effect on her
sleep and QoL. The subject’s poor sleep pattern
impacted on her energy level during the day,
leading to fatigue. The hot flashes made her feel
uncomfortable when socializing with friends,
and increased her anxiety level every time she
experienced them. She had tried all other
measures, i.e. medications, using a fan,
maintaining ambient room temperature, wearing
cotton clothing, avoiding caffeine-related drinks,
relaxation and listening to music, but these had
had very little or no effect on her sweating.
Having previously worked as a librarian, she had
quit her job because of the increasing side effects
of her cancer treatment.
Clinical impression
The subject was alert and appeared well.
Based on the subjective history and objective
findings, the vasomotor symptoms that she
was experiencing were directly linked to her
breast cancer diagnosis. Medical assessment
ruled out any infection or pyrexia as a cause of
sweating. She had begun to have vasomotor
symptoms following breast cancer treatment.
The subject described her experience of a hot
flash as “a sudden warmth all over the body
and then accompanied by a feeling of skin
peeling from inside”. During hot flashes, she
experienced associated symptoms such as
palpitation, anxiety, irritability and headaches.
Prior to acupuncture treatment, precautions were
taken and contraindications were checked. The
subject’s left arm was not needled because of
axillary clearance. She was given an informa-
tion leaflet that explained acupuncture treatment
and possible adverse reactions to it. Written
informed consent was gained once all the infor-
mation had been provided (AACP 2012).
The acupuncture points that were selected
are listed in Table 1. The majority of the points
94 © 2016 Acupuncture Association of Chartered Physiotherapist
Table 1. Acupuncture points selected: (LI) Large Intestine;
(PC) Pericardium; (TE) Triple Energizer; (HT) Heart; (LR)
Liver; (SP) Spleen; (ST) Stomach; and (KI) Kidney
Size of needle
Depth of
Acupuncture point
needling (cun)
De Qi
LI4 (right)
PC6 (right)
PC8 (right)
TE5 (right)
HT6 (right)
HT7 (right)
HT8 (right)
LI11 (right)
LR2 (bilateral)
SP9 (bilateral)
SP6 (bilateral)
ST36 (bilateral)
KI3 (bilateral)
KI6 (bilateral)
KI7 (bilateral)
used corresponded to those employed in the
largest trial of acupuncture for hot flashes
(Borud et al. (2009). In all treatment sessions,
the acupuncture points were stimulated manu-
ally, and the needles were left in situ for 30
min. The subject received treatment once a
week, and the needles were stimulated
manually every 10 min during each session in
order to improve the therapeutic effects. The
depth of needling was dependent on whether
De Qi was elicited. The needles used were all
sterile and made of stainless steel (Classic
Plus, HMD Europe Ltd, Chipping Norton,
The subject did not notice any changes in her
symptoms until three sessions of treatment had
been completed, after which the frequency and
severity of her hot flashes and night sweating
reduced slightly. A noticeable reduction in
vasomotor symptoms was observed after six
sessions of treatment, which had a huge impact
on her sleep pattern and psychological well-
being. By the end of 8 weeks of acupuncture
treatment, the subject reported a significant
reduction in both her vasomotor and associated
symptoms, including palpitation, anxiety,
irritability and headaches. Her hot flashes and
sweating decreased from 9/10 to 2/10, as
measured on a visual analogue scale (VAS).
A significant reduction in the present subject’s
hot flashes and night sweating was brought
V. Ramasamy
about by 8 weeks of acupuncture treatment.
Prior to this, she had reported between three
and four hot flashes every hour, and from four
to six incidents of sweating every night.
Following the completion of her treatment, she
reported that she now only experienced a mild
damp feeling two or three times a day, and that
her palpitations and feelings of irritability had
considerably improved. Similarly, her night-
time sweating had reduced considerably to
only one or two incidents a night, and since
these were less intense, she could manage the
problem without changing her nightclothes.
The hot flashes had lessened significantly fol-
lowing acupuncture, and the distress caused by
these had decreased even more. The outcomes
of the acupuncture treatment are detailed in
Table 2.
Current treatment options for hot flashes in
patients with breast cancer include pharma-
cological agents, especially selective serotonin
reuptake inhibitors (e.g. venlafaxine and
parox-etine), but these have adverse side
effects and are considered to be undesirable
options for most women (Loprinzi et al. 1998;
Nelson et al. 2006). Hormone replacement
therapy reduces hot flashes in women by 90
95%, compared to 1050% with placebo
treatment (Carpenter et al. 2007), and may
improve QoL (Fahlén et al. 2011), but it also
increases the risk of breast cancer (MWSC
2003) and probably that of a recurrence of this
form of cancer (Holmberg et al. 2008).
This situation has led to an increasing demand
for alternative treatments for hot flashes and
night sweating. Although there has been no
clearly defined treatment for hot flashes in
patients with breast cancer for whom oestrogen
replacement is contraindicated (Studdard 1999),
alternatives are available. One modality that has
only been investigated to a limited extent is
acupuncture (Towlerton et al. 1999), possibly
because the conclusions of many trials of are not
robust enough and are generally inconsistent.
Nevertheless, acupuncture has been shown to be
effective for postmenopausal hot flashes, and
clinical experience suggests that it is an effective
alternative treatment for reducing hot flashes
and night sweating, especially for patients with
© 2016 Acupuncture Association of Chartered Physiotherapist 95
Cancer-related hot flashes and night sweating
Table 2. Treatment outcomes: (LI) Large Intestine; (PC) Pericardium; (HT) Heart; (SP) Spleen; (ST) Stomach; (KI) Kidney; (LR)
Liver; and (TE) Triple Energizer
Treatment session
Number of hot flashes
Number of night sweats
34 every hour, with warmth all over
46 every night; the subject needed to
the body and then a feeling of skin
change her clothes several times
peeling from inside
34 every hour, with warmth all over
46 every night; the subject needed to
the body and then a feeling of skin
change her nightclothes several times
peeling from inside
34 every hour, with warmth all over
46 every night; the subject needed to
the body and then a feeling of skin
change her nightclothes several times
peeling from inside
34 hot flashes every 23 h; a slight
46 every night, but with less intensity;
reduction in warmth and feeling of
the subject needed to change her
skin peeling from inside
nightclothes at times
34 hot flashes every 23 h with less
34 every night, but with less intensity;
intensity; no warmth or feeling of
the subject managed her sweating
skin peeling from inside
without any need for a change of
46 hot flashes in a day with less
34 every night but with less intensity;
intensity; no warmth or feeling of
the subject managed sweating without
skin peeling from inside*
any need for a change of nightclothes
23 hot flashes in a day with less
12 mild ones every night; quality of
intensity; no warmth or feeling of
sleep had improved
skin peeling from inside
0; only a damp feeling two or three
12 mild ones every night; overall sense
times a day without any hot flashes
of well--being had improved
*The subject experienced palpitation, anxiety, irritability and headaches at the time of the hot flashes. These associated symptoms began to lessen from
week 6 onwards, and a considerable reduction was reported at the end of 8 weeks of treatment.
breast cancer who are seeking non-
pharmacological therapies.
There is good evidence that acupuncture can
be effective in the treatment of breast-cancer-
related hot flashes and night sweating. For
example, Walker et al. (2010) demonstrated that
12 weeks of acupuncture is as effective as ven-
lafaxine in managing vasomotor symptoms in
patients with breast cancer. In addition to this,
the above authors demonstrated that hot flashes
remained at low levels in the acupuncture group
2 weeks after treatment, whereas the venlafaxine
group had experienced significant increases in
hot flashes by this time. Positive results were
maintained in the acupuncture group 12 weeks
after treatment ended. The acupuncture group
had the additional benefits of an improvement in
their energy levels, and a sense of well-being
without any adverse effects. On the other hand,
the venlafaxine group experienced side effects
such as nausea, dry mouth, dizziness and anxiety.
Similarly, De Valois et al. (2010) explored the
use of traditional acupuncture to manage tamoxifen
related hot flashes and night sweating in women
with early breast cancer. Furthermore, they
extended the focus of their study to measure
physical and emotional well-being using the
Women’s Health Questionnaire (WHQ), and the
Hot Flashes and Night Sweats Questionnaire.
Acupuncture treatment was given on a weekly
basis for 8 weeks, and its effects were monitored
for up to 30 weeks after treatment. In contrast to
Walker et al. (2010), De Valois et al. (2010)
reported that a number of participants did not
adhere to the weekly acupuncture schedule, and
had treatments beyond the allocated 8-week period
because leaving gaps between sessions. This could
have influences both short and long-term
96 © 2016 Acupuncture Association of Chartered Physiotherapist
outcomes of the study. Nevertheless, the present
subject reported improvements in her physical
and emotional well-being, as well as reductions
in hot flashes and night sweating.
The VAS was used as a subjective outcome
measure in the present case study. On reflec-
tion, it might have been beneficial to use more-
-measurable markers (e.g. the WHQ) of the
frequency and intensity of hot flashes and
night sweating, and health-related QoL. The
WHQ subscales focus on aspects of emotional
and physical health, such as depression, sleep
problems, anxiety and somatic symptoms.
Establishing the optimum dose, frequency and
duration of acupuncture is an outstanding issue
with regard to this form of treatment. It might
be worthwhile extending the present subject’s
treatment to determine whether her hot flashes
and night sweating could be further reduced.
It would appear that eight sessions of acupunc-
ture treatment had a very good effect on the
present subject’s hot flashes and night
sweating. The symptoms associated with hot
flashes and night sweating reduced
considerably, and this improved her QoL.
Acupuncture has a good safety profile and a
low incidence of side effects, and is a low-risk
form of non-pharmacological treatment. On
the basis of the present single case study, it is
possible that acupuncture may be an accept-
able treatment option in the management of
hot flashes and night sweating in patients with
breast cancer.
I would like to thank the subject for consenting
to the publication this case study. I would also
like to thank Mr Roger Wheelwright, a
prostate cancer nurse specialist, for his advice
and sup-port during this process.
Acupuncture Association of Chartered Physiotherapists
(AACP) (2012) AACP Guidelines for Safe Practice,
Version 2. [WWW document.] URL http://www.
© 2016 Acupuncture Association of Chartered Physiotherapist
V. Ramasamy
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Visweswaran Ramasamy qualified as a chartered physio-
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moving to the UK in 2005. He graduated with an MSc in
Musculoskeletal Physiotherapy from Sheffield Hallam
University. Visweswaran works as a clinical specialist
physiotherapist at John Taylor Hospice in Birmingham. He
uses acupuncture for complex pain management, and to
treat various cancer-related symptoms.
98 © 2016 Acupuncture Association of Chartered Physiotherapist
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Full-text available
Hormone replacement therapy (HT) is known to increase the risk of breast cancer in healthy women, but its effect on breast cancer risk in breast cancer survivors is less clear. The randomized HABITS study, which compared HT for menopausal symptoms with best management without hormones among women with previously treated breast cancer, was stopped early due to suspicions of an increased risk of new breast cancer events following HT. We present results after extended follow-up. HABITS was a randomized, non-placebo-controlled noninferiority trial that aimed to be at a power of 80% to detect a 36% increase in the hazard ratio (HR) for a new breast cancer event following HT. Cox models were used to estimate relative risks of a breast cancer event, the maximum likelihood method was used to calculate 95% confidence intervals (CIs), and chi(2) tests were used to assess statistical significance, with all P values based on two-sided tests. The absolute risk of a new breast cancer event was estimated with the cumulative incidence function. Most patients who received HT were prescribed continuous combined or sequential estradiol hemihydrate and norethisterone. Of the 447 women randomly assigned, 442 could be followed for a median of 4 years. Thirty-nine of the 221 women in the HT arm and 17 of the 221 women in the control arm experienced a new breast cancer event (HR = 2.4, 95% CI = 1.3 to 4.2). Cumulative incidences at 5 years were 22.2% in the HT arm and 8.0% in the control arm. By the end of follow-up, six women in the HT arm had died of breast cancer and six were alive with distant metastases. In the control arm, five women had died of breast cancer and four had metastatic breast cancer (P = .51, log-rank test). After extended follow-up, there was a clinically and statistically significant increased risk of a new breast cancer event in survivors who took HT.
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To study the effects of menopausal hormone therapy (HT) on health-related quality of life in women after breast cancer. In the Stockholm trial, breast cancer survivors were randomized to HT (estradiol and progestogen) or to a control group (no treatment). A subgroup of 75 women was studied (38 with HT, 37 controls). Fifty patients were on concomitant tamoxifen. Patients completed three questionnaires (EORTC QLQ C-30, EORTC QLQ-BR 23 and the Hospital Anxiety and Depression Scale (HADS)) during 1 year of treatment. A significant group-by-time interaction was found for improvement of insomnia in the HT group (p < 0.001). Within the HT group, but not in the control group, there was significant improvement for HADS anxiety, HADS depression, emotional, cognitive, and social functions and global quality of life. When HT was added to tamoxifen, the increase in global quality of life was significant (p < 0.01). The effects of HT on quality of life in breast cancer survivors have not previously been reported. The present data suggest that this controversial treatment may improve quality of life after breast cancer.
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We have demonstrated that stimulation of somatic afferents during electroacupuncture (EA) inhibits sympathoexcitatory cardiovascular rostral ventrolateral medulla (rVLM) neurons and reflex responses. Furthermore, EA at P5-P6 acupoints over the median nerve on the forelimb activate serotonin (5-HT)-containing neurons in the nucleus raphe pallidus (NRP). The present study, therefore, examined the role of the NRP and its synaptic input to neurons in the rVLM during the modulatory influence of EA. Since serotonergic neurons in the NRP project to the rVLM, we hypothesized that the NRP facilitates EA inhibition of the cardiovascular sympathoexcitatory reflex response through activation of 5-HT1A receptors in the rVLM. Animals were anesthetized and ventilated, and heart rate and blood pressure were monitored. We then inserted microinjection and recording electrodes in the rVLM and NRP. Application of bradykinin (10 microg/ml) on the gallbladder every 10 min induced consistent excitatory cardiovascular reflex responses. Stimulation with EA at P5-P6 acupoints reduced the increase in blood pressure from 41+/-4 to 22+/-4 mmHg for more than 70 min. Inactivation of NRP with 50 nl of kainic acid (1 mM) reversed the EA-related inhibition of the cardiovascular reflex response. Similarly, blockade of 5-HT1A receptors with the antagonist WAY-100635 (1 mM, 75 nl) microinjected into the rVLM reversed the EA-evoked inhibition. In the absence of EA, NRP microinjection of dl-homocysteic acid (4 nM, 50 nl), to mimic EA, reduced the cardiovascular and rVLM neuronal excitatory reflex response during stimulation of the gallbladder and splanchnic nerve, respectively. Blockade of 5-HT1A receptors in the rVLM reversed the NRP dl-homocysteic acid inhibition of the cardiovascular and neuronal reflex responses. Thus activation of the NRP, through a mechanism involving serotonergic neurons and 5-HT1A receptors in the rVLM during somatic stimulation with EA, attenuates sympathoexcitatory cardiovascular reflexes.
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Vasomotor symptoms are common adverse effects of antiestrogen hormone treatment in conventional breast cancer care. Hormone replacement therapy is contraindicated in patients with breast cancer. Venlafaxine (Effexor), the therapy of choice for these symptoms, has numerous adverse effects. Recent studies suggest acupuncture may be effective in reducing vasomotor symptoms in menopausal women. This randomized controlled trial tested whether acupuncture reduces vasomotor symptoms and produces fewer adverse effects than venlafaxine. Fifty patients were randomly assigned to receive 12 weeks of acupuncture (n = 25) or venlafaxine (n = 25) treatment. Health outcomes were measured for up to 1 year post-treatment. Both groups exhibited significant decreases in hot flashes, depressive symptoms, and other quality-of-life symptoms, including significant improvements in mental health from pre- to post-treatment. These changes were similar in both groups, indicating that acupuncture was as effective as venlafaxine. By 2 weeks post-treatment, the venlafaxine group experienced significant increases in hot flashes, whereas hot flashes in the acupuncture group remained at low levels. The venlafaxine group experienced 18 incidences of adverse effects (eg, nausea, dry mouth, dizziness, anxiety), whereas the acupuncture group experienced no negative adverse effects. Acupuncture had the additional benefit of increased sex drive in some women, and most reported an improvement in their energy, clarity of thought, and sense of well-being. Acupuncture appears to be equivalent to drug therapy in these patients. It is a safe, effective and durable treatment for vasomotor symptoms secondary to long-term antiestrogen hormone use in patients with breast cancer.
A majority of postmenopausal women experience vasomotor symptoms, which have a significant impact on the women's quality of life. Estrogens are the treatment of choice but can for different reasons not be used by all women. There is therefore a great need for viable alternative treatments. The patophysiology behind hot flushes and sweatings is so far not fully understood. Several studies have concluded that low levels of estrogens after menopause will lead to instability in the thermoregulatory center in the hypothalamus probably due to low [s-endorphin levels. Since acupuncture is known to increase central [s-endorphin activity, we wanted to evaluate if this treatment could ameliorate vasomotor symptoms which, to our knowledge, has not been scientifically evaluated previously. We also aimed to reveal if the vasoactive neuropeptides Calcitonin Gene-related peptide (CGRP), neuropeptide Y (NPY), neurokinin A, and substance P were involved in the mechanisms behind these symptoms.Results: Electro-acupuncture decreased flushes by 50 %, and superficial needle insertion by 30 %. The difference in reduction between the groups was not significant. Along with the decrease of flushes we found a significant reduction of the 24h urinary excretion of the neuropeptide CGRP, which is one of the most potent vasodilators known. When we later compared electro-acupuncture (EA), superficial needle insertion (SNI) and estrogen treatment, we found a significant reduction of 24h flushes by almost 60 % after EA and SNI. However, about 20% were non-responders in both groups. The responders in the EA group reduced their flushes and sweatings by 82 % and in the SNI group the reduction was 68%. We found no significant difference in effect between the acupuncture groups. Estrogen was the most effective treatment with a 91% reduction of flushes (range 58-100 %). We found a higher excretion of CGRP/24h urine in postmenopausal women with vasomotor symptoms, than in women without symptoms. Furthermore we found a 73 % elevation of CGRP in plasma, along with a 34% increase ofNPY concentration, during flushes in postmenopausal women.Conclusion: The results indicate that acupuncture is as a viable alternative or complement to traditional pharmacological treatments in postmenopausal women with vasomotor symptoms. The vasoactive neuropeptide CGRP is most likely involved in the mechanisms of vasomotor symptoms, probably as an executor or mediator of the skin vasodilatation and sweating that occur during the hot flush.
Most perimenopausal women suffer from vasomotor symptoms. Changes in central opioid activity have been proposed to be involved in the mechanisms of hot flushes after menopause. Because acupuncture increases central opioid activity, it may affect postmenopausal hot flushes. The aim was to study if and to what extent two different kinds of acupuncture affected postmenopausal hot flushes, urinary excretion of certain neuropeptides, and quality of life in a group of postmenopausal women. Twenty-four women with natural menopause and hot flushes were included. Twenty-one women completed the study. One group was randomized to electroacupuncture at 2 Hz, whereas the other group was treated with another form of acupuncture (i.e., superficial needle insertion) for a total of 8 weeks. All women daily registered the number and severity of flushes from 1 month before to 3 months after treatment. They completed Quality of Life questionnaires before, during, and after treatment. Twenty-four-hour urine was sampled before, during, and after treatment and analyzed for neuropeptides using radioimmunoassay methods. The number of flushes decreased significantly by >50% in both groups and remained decreased in the group receiving electroacupuncture, whereas in the superficial-needle-insertion group, the number of flushes increased again during the 3 months after treatment. The Kupperman Index decreased significantly in both groups during and after treatment. The excretion of the potent vasodilating neuropeptide calcitonin gene-related peptide-like immunoreactivity decreased significantly during treatment. Acupuncture significantly affects hot flushes and sweating episodes after menopause, with effects persisting at least 3 months after the end of treatment. Changes in calcitonin gene-related peptide, which is a very potent vasodilator, could be involved in the mechanisms behind hot flushes. (C)1995The North American Menopause Society
The study of the mechanism of acupuncture action was revolutionized by the use of functional magnetic resonance imaging (fMRI). Over the past decade, our fMRI studies of healthy subjects have contributed substantially to elucidating the central effect of acupuncture on the human brain. These studies have shown that acupuncture stimulation, when associated with sensations comprising deqi, evokes deactivation of a limbic-paralimbic-neocortical network, which encompasses the limbic system, as well as activation of somatosensory brain regions. These networks closely match the default mode network and the anti-correlated task-positive network described in the literature. We have also shown that the effect of acupuncture on the brain is integrated at multiple levels, down to the brainstem and cerebellum. Our studies support the hypothesis that the effect of acupuncture on the brain goes beyond the effect of attention on the default mode network or the somatosensory stimulation of acupuncture needling. The amygdala and hypothalamus, in particular, show decreased activation during acupuncture stimulation that is not commonly associated with default mode network activity. At the same time, our research shows that acupuncture stimulation needs to be done carefully, limiting stimulation when the resulting sensations are very strong or when sharp pain is elicited. When acupuncture induced sharp pain, our studies show that the deactivation was attenuated or reversed in direction. Our results suggest that acupuncture mobilizes the functionally anti-correlated networks of the brain to mediate its actions, and that the effect is dependent on the psychophysical response. In this work we also discuss multiple avenues of future research, including the role of neurotransmitters, the effect of different acupuncture techniques, and the potential clinical application of our research findings to disease states including chronic pain, major depression, schizophrenia, autism, and Alzheimer's disease.