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Comparative Effects of Acupressure at Local and Distal Acupuncture Points on Pain Conditions and Autonomic Function in Females with Chronic Neck Pain

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Acupressure on local and distal acupuncture points might result in sedation and relaxation, thereby reducing chronic neck pain. The aim was to investigate the effect of acupressure at local (LP) and distal acupuncture points (DP) in females with chronic neck pain. Thirty-three females were assigned to three groups: the control group did not receive any stimuli, the LP group received acupressure at local acupuncture points, GB 21, SI 14 and SI 15, and the DP group received acupressure at distal acupuncture points, LI 4, LI 10 and LI 11. Verbal rating scale (VRS), Neck Disability Index (NDI), State-Trait Anxiety Inventory (STAI), muscle hardness (MH), salivary alpha-amylase (sAA) activity, heart rate (HR), heart rate variability (HRV) values and satisfaction due to acupressure were assessed. VRS, NDI, STAI and MH values decreased after acupressure in the LP and the DP group. HR decreased and the power of high frequency (HF) component of HRV increased after acupressure in only the LP group. Although acupressure on not only the LP but also the DP significantly improved pain conditions, acupressure on only the LP affected the autonomic nervous system while acupuncture points per se have different physical effects according to location.
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Hindawi Publishing Corporation
Evidence-Based Complementary and Alternative Medicine
Volume 2011, Article ID 543291, 6pages
doi:10.1155/2011/543291
Research Article
Comparative Effects of Acupressure at Local and
Distal Acupuncture Points on Pain Conditions and
Autonomic Function in Females with Chronic Neck Pain
Takako Matsubara,1, 2 Young-Chang P. Arai,2Yukiko Shiro,3Kazuhiro Shimo,2
Makoto Nishihara,2Jun Sato,4and Takahiro Ushida2
1Department of Rehabilitation, Faculty of Health Sciences, Nihon Fukushi University, 26-2 Higashihaemicho, Handa, Aichi
475-0012, Japan
2Multidisciplinary Pain Centre, School of Medicine, Aichi Medical University, Aichi 480-1195, Japan
3Department of Rehabilitation, Faculty of Health Sciences, Nagoya Gakuin University, Aichi 480-1298, Japan
4Futuristic Environmental Simulation Center, Research Institute of Environmental Medicine, Nagoya University,
Nagoya 464-8601, Japan
Correspondence should be addressed to Takako Matsubara, matsubar@n-fukushi.ac.jp
Received 7 July 2010; Accepted 2 September 2010
Copyright © 2011 Takako Matsubara et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Acupressure on local and distal acupuncture points might result in sedation and relaxation, thereby reducing chronic neck pain.
Theaimwastoinvestigatetheeect of acupressure at local (LP) and distal acupuncture points (DP) in females with chronic neck
pain. Thirty-three females were assigned to three groups: the control group did not receive any stimuli, the LP group received
acupressure at local acupuncture points, GB 21, SI 14 and SI 15, and the DP group received acupressure at distal acupuncture
points, LI 4, LI 10 and LI 11. Verbal rating scale (VRS), Neck Disability Index (NDI), State-Trait Anxiety Inventory (STAI), muscle
hardness (MH), salivary alpha-amylase (sAA) activity, heart rate (HR), heart rate variability (HRV) values and satisfaction due to
acupressure were assessed. VRS, NDI, STAI and MH values decreased after acupressure in the LP and the DP group. HR decreased
and the power of high frequency (HF) component of HRV increased after acupressure in only the LP group. Although acupressure
on not only the LP but also the DP significantly improved pain conditions, acupressure on only the LP aected the autonomic
nervous system while acupuncture points per se have dierent physical eects according to location.
1. Introduction
Chronic neck pain is a very common symptom especially in
females. In general, neck pain is felt as a dull pain, stiness,
or discomfort along the trapezius muscles and the muscles
around the scapulae [1]. Common treatment for chronic
neck pain consists of medication, trigger point injection,
massage, and other physical therapies and patient education
[2]. Massage therapy applied on the tender points is popular
in patients with chronic neck pain and provides the patients
not only with comfort during and immediately after it but
also with various side eects such as discomfort/soreness,
tiredness/fatigue, and headache afterwards [3]. Recently,
alternative therapies such as acupuncture and acupressure
have been increasingly sought. Acupressure is a noninvasive
and safe technique, which is manipulated with the fingers
instead of needles on the traditional acupuncture points,
and has been shown to be eective in pain relief, sedation,
and relaxation [4,5]. Tender points located on the trapezius
muscles are consistent with local acupuncture points such as
Jianjing” (GB 21), “Jianwaishu” (SI 14), and “Jianzhongshu
(SI 15) and are applied to massage therapy in patients with
chronic neck pain. On the other hand, distal traditional
acupuncture points, “Hegu”(LI4),“Shousanli” (LI 10),
and “Quchi” (LI 11), are contained in the Large Intestine
Meridian of Hand-Yangming and are suggested to be the
points for improving neck-shoulder-arm disorders in the
Chinese/Japanese traditional medicine.
Chronic pain influences the autonomic nervous system.
For example, sympathetic hyperactivation was shown in
2 Evidence-Based Complementary and Alternative Medicine
SI 15
SI 14
GB 21
Figure 1: Local acupuncture points/tender points. “Jianjing”(GB
21) is located at the highest point on the shoulder and at the
midpoint of the line which connects the prominent vertebra and
the acromion. “Jianwaishu” (SI 14) is located directly above the
superior angle of scapula, at 5-6 cm lateral from the posterior
midline and below the spinous process of the first thoracic vertebra.
Jianzhongshu” (SI 15) is located on the back, at 3-4 cm lateral from
the posterior midline and below the spinous process of the seventh
cervical vertebra.
fibromyalgia (FM) [6], low back pain [7], whiplash associ-
ated disorders [8], and migraine [9]. Furthermore, a study
showed functional change of the sympathetic nervous system
in workers with chronic neck pain [10]. This abnormality in
the sympathetic nervous system might generate and sustain
chronic pain [11]. Several reports showed that acupuncture
and acupressure on the traditional acupuncture points
influence the autonomic nervous system [4,5,11,12]. That
is, these procedures could modulate the activities of the
sympathetic and parasympathetic nerves.
Autonomic nervous function is known to be reflected
in heart rate variability. Rhythmic components of HRV
can be quantitatively assessed by means of power spectral
analysis. HRV is a reliable and noninvasive tool, used to assess
autonomic nervous system regulation of the heart [4,5].
Frequency fluctuations in low frequency of 0.04
0.15 Hz (LF)
component of HRV are considered markers of sympathetic
and parasympathetic nerve activities, and high frequencies
of 0.15
0.4 Hz (HF) component fluctuation of HRV are
considered as a marker of parasympathetic nerve activity.
Thus, the LF/HF ratio is considered to be an index of
sympathetic nerve activity.
We hypothesized that acupressure not only on the
tender points/local acupuncture points, “Jianjing” (GB 21),
Jianwaishu” (SI 14), and “Jianzhongshu” (SI 15), but also
on the distal acupuncture points, “Hegu”(LI4),“Shousanli
(LI 10), and “Quchi” (LI 11), could induce sedation, thereby
reducing pain, muscle tone, and disability and changing
autonomic nervous activity in subjects with chronic neck
pain. In the present study, we therefore investigated what
eect pressure applied on the local and distal acupuncture
points had on the pain conditions and HRV in females with
chronic neck pain.
2. Methods
2.1. Subjects. After obtaining approval from the ethics com-
mittee of Nihon Fukushi University and written informed
consent, 33 female subjects who complained of chronic
neck pain participated in the present study. The subjects
were randomly allocated to three groups. The exclusion
criteria were menstruation, cardiovascular or neurological
disease, or administration of sedatives, analgesic, or other
medication.
2.2. Group, Administration, and Measurements. Subjects in
the local acupuncture point (LP) group received acupressure
at three tender points on the neck/shoulder muscles, which
were consistent with local acupuncture points, “Jianjing
(GB 21), “Jianwaishu” (SI 14), and “Jianzhongshu” (SI
15) (Figure 1), subjects in the distal acupuncture point
(DP) group received acupressure at three distal acupuncture
points, “Hegu”(LI4),“Shousanli” (LI 10), and “Quchi”(LI
11) (Figure 2), and subjects in the control group did not
receive any stimuli.
All measurements were performed during the afternoon
hours. Subjects were assessed regarding pain intensity using
verbal rating scale (VRS), pain-related disability using Neck
Disability Index (NDI), pain-related anxiety using State-
Trait Anxiety Inventory-I (STAI-I), muscle hardness (MH)
on bilateral trapezius muscles, pain-associated stress using
salivary alpha-amylase (sAA) activity, heart rate variability
(HRV), and satisfaction using VRS due to acupressure. For
the VRS, the intensity of neck pain or stiness was evaluated
on a numerical scale from 0 to 3 (0: no pain, 1: mild pain,
2: moderate pain, and 3: severe pain). NDI, which was
published by Vernon in 1991, is the most commonly used
and validated scale designed to assess self-rated disability in
patients with neck pain and disorder [13]. MH was evaluated
using a tissue hardness meter (PEK-1, Imoto Machinery
Co. Ltd., Kyoto, Japan) bilaterally on the midpoint between
the spinous process of seventh cervical vertebra and the
acromion. This point is located on the trapezius muscles, and
the tender point of neck pain often lies on this point, which is
just the acupuncture point, “Jianjing” (GB 21) [1]. sAA was
evaluated using a hand-held sAA monitor (CM-2.1, Nipro,
Osaka, Japan) [14]. Satisfaction due to acupressure was
evaluated on a numerical scale from 0 to 3 (0: no satisfaction,
1: mild satisfaction, 2: moderate satisfaction, and 3: sucient
satisfaction). VRS and STAI-I before, immediately following,
and 1 day after receiving the treatment, MH and sAA before
and immediately after the treatment, NDI before and 1 day
after the treatment, satisfaction immediately following and 1
day after the treatment were sampled.
After the initial assessment, the subjects were allowed to
lie comfortably on the bed in a quiet environment for 5 min.
Then, the record of the electrocardiogram (ECG) signals for
HRV analysis started.
Evidence-Based Complementary and Alternative Medicine 3
Tab le 1: Age, weight, VRS, NDI, STAI, MH, sAA, HR, and HRV values at pretreatment for each group.
C group (n=11) LP group (n=11) DP group (n=11) Pvalue
Age (yr) 34.8 (4.0) 35.5 (6.4) 37.2 (7.0) .637
Weight (kg) 50.4 (6.8) 52.3 (10.1) 52.2 (4.8) .643
VRS 1.8 (0.6) 2.1 (0.5) 1.7 (0.8) .413
NDI 7.9 (3.8) 9.4 (4.4) 7.6 (4.6) .430
STAI 39.2 (9.5) 44.5 (8.0) 43.2 (6.8) .772
MH (N) 56.9 (5.0) 57.4 (4.5) 56.2 (5.3) .507
sAA (kU/l) 38.2 (20.1) 20.0 (9.0) 36.8 (27.9) .079
HR (bpm) 65.4 (8.7) 65.8 (6.7) 62.3 (14.1) .941
LF (ms2) 490.7(409.2) 274.2 (253.3) 494.1 (1050.7) .084
HF (ms2) 381.8(338.3) 212.8 (186.7) 764.8 (1045.2) .587
LF/HF 1.7(1.4) 1.4 (0.8) 1.0 (0.6) .399
Values expressed as mean (SD).VRS: verbal rating scale. NDI: Neck Disability Index. STAI: State-Trait Anxiety Inventory-I. MH: muscle hardness. sAA:
salivary alpha-amylase. HR: heart rate. LF: the power of low-frequency (0.04
0.15 Hz, LF) component of heart rate variability (HRV). HF: the power of high-
frequency (0.15
0.4 Hz, HF) component of HRV. LF/HF: LF/HF ratio of HRV.
LI 11
LI 10 LI 4
Figure 2: Distal acupuncture point. “Hegu” (LI 4) is the most
important analgesic point in the body and is intensively stimulated
in all painful conditions and is located on the highest point of the
adductor pollicis muscle with the thumb and index finger adducted.
Shousanli” (LI 10) is located on the radial side of the dorsal surface
of the forearm at about 3 cm below the lateral transverse elbow
crease and between the extensor carpi radialis longus and brevis.
Quchi” (LI 11) is located on the end of the lateral transverse elbow
crease at the middle of the connection between the biceps tendon
and the lateral epicondylus of the humerus.
0
1
2
3
VRS
PostPre 1 day
Figure 3: Changes in pain intensity (VRS: verbal rating scale).
: control group. : local acupuncture point (LP) group. :
distal acupuncture point (DP) group. Values are presented as mean.
SD represented with error bars in the LP and the DP groups.
significantly dierent from pre-treatment in the DP group (P<
.05). ∗∗ significantly dierent from pretreatment in the LP group
(P<.01). significantly dierent from control group in the DP
group (P<.05).
PostPre 1 day
20
25
30
35
40
45
50
55
STAI
∗∗
∗∗
Figure 4: Changes in pain-associated anxiety (STAI-I: State-Trait
Anxiety Inventory-I). : control group. : local acupuncture point
(LP) group. : distal acupuncture point (DP) group. Values are
presented as mean. SD represented with error bars in the LP and
the DP groups. ∗∗ significantly dierent from pre-treatment in the
LP and the DP groups (P<.01).
Ten minutes later, three sets of acupressure by the pulp
of the right thumb in a rotary fashion at 20
25 cycles per
minute for 30 seconds on each point were administered
at the right side of GB 21, SI 14, and SI 15 consecutively
and afterwards at the left side of these three points in the
LP group. On the other hand, three sets of procedures
conducted in the same way as shown in the LP group were
administered at the right side of LI 4, LI 10, and LI 11
consecutively and afterwards on the left side of these three
points in the DP group. These procedures were applied by
the same investigator. Following release of acupressure, the
subjects were observed for another 10 minutes. The ECG
signals were obtained from a portable ECG (AC301A, GMS,
Tokyo, Japan) and transferred to a computer loaded with
HRV analysis software (TARAWA/WIN; Suwa Trust, Tokyo,
Japan). The R-R intervals (RRIs) were obtained every 10
seconds. The two components of power of the RRI (ms.ms),
LF (0.04
0.15 Hz) and HF (0.150.5 Hz), were calculated.
4 Evidence-Based Complementary and Alternative Medicine
45
50
55
60
65
MH (N)
Post
Pre
∗∗
Figure 5: Changes in muscle hardness (MH). : control group. :
local acupuncture point (LP) group. : distal acupuncture point
(DP) group. Values are presented as mean. SD represented with
error bars in the LP and the DP groups. significantly dierent
from pre-treatment in the DP group (P<.05). ∗∗ significantly
dierent from pre-treatment in the LP group (P<.01).
Heart rate (HR) and the LF and the HF values and the
LF/HF ratio of HRV were analyzed. The data of HR and
HRV values for 30 seconds at 5 minutes before the beginning
of the pressure (pre-treatment) and for 30 seconds at 5
minutes after pressure release (post-treatment) were sampled
for subsequent analysis.
2.3. Data Analysis. Data was presented as mean (SD). VRS,
STAI-I, MH, NDI, HR, and HRV values were analyzed
with Kruskal-Wallis test for intergroup comparison followed
by Dunn’s Multiple Comparison Test. Satisfaction due to
acupressure was analyzed with Mann-Whitney’s U test for
intergroup comparison on the LP and the DP groups. VRS
and STAI-I were analyzed using Friedman test for intragroup
comparison followed by Dunn’s Multiple Comparison Test.
Wilcoxon signed-rank test was used to analyze MH, NDI,
HR, and HRV values for intragroup comparison. P<.05
was considered as statistically significant.
3. Results
Tab l e 1shows the demographic data of the three groups.
There were no significant dierences in age, weight, and pre-
treatment values regarding pain conditions among the three
groups (Table 1).
There were no significant dierences in all parameters in
the control group. VRS (Figure 3), STAI-I (Figure 4), and
MH (Figure 5) values significantly decreased immediately
after treatment, and NDI (Figure 6) was lower at 1 day
following treatment compared with pre-treatment in the LP
and the DP groups. HR (Figure 7) significantly decreased
and the HF component of HRV (Figure 9) significantly
increased after treatment in the LP group only. There were
no dierences on the sAA and the LF components (Figure 8)
and the LF/HF ratio (Figure 10) of HRV among the three
groups. Satisfaction due to acupressure continued to 1 day
after the treatment in the LP and the DP groups (Figure 11).
0
5
10
15
Pre
1day
∗∗
∗†
NDI
Figure 6: Changes in pain-associated disability (NDI:Neck Dis-
ability Index). : control group. : local acupuncture point
(LP) group. : distal acupuncture point (DP) group. Values are
presented as mean. SD represented with error bars in the LP and
the DP groups. significantly dierent from pre-treatment in the
DP group (P<.05). ∗∗ significantly dierent from pre-treatment
in the LP group (p<.01). significantly dierent from control
group in the DP group (P<.05).
45
50
55
60
65
70
75
HR (bpm)
PostPre
Figure 7: Changes in heart rate (HR). : control group. :local
acupuncture point (LP) group. : distal acupuncture point (DP)
group. Values are presented as mean. SD represented with error
bars in the LP and the DP groups. significantly dierent from pre-
treatment in the LP group (P<.05).
4. Discussion
Our results demonstrated that acupressure on the local
and the distal acupuncture points significantly reduced
various parameters of the pain-associated conditions, that
is, VRS, STAI-I, MH, and NDI whereas there were no
significant dierences in all parameters in the control group.
Although acupressure did not change the LF and the LF/HF
ratio of HRV, acupressure on the local acupuncture points
significantly reduced HR and increased the HF of HRV.
Satisfaction due to acupressure continued until 1 day after
treatment on the distal points as well as the local points.
These results show that acupressure on not only the local
points but also the distal acupuncture points improved
pain-related condition, and furthermore acupressure could
influence the autonomic nervous system.
Mechanical pressure such as massage and acupressure has
been known to decrease tissue adhesion, promote relaxation,
Evidence-Based Complementary and Alternative Medicine 5
0
200
400
600
800
1000
1200
1400
1600
1800
2000
LF (ms2)
PostPre
Figure 8: Changes in the low-frequency (LF) component of heart
rate variability. : control group. : local acupuncture point
(LP) group. : distal acupuncture point (DP) group. Values are
presented as mean. SD represented with error bars in the LP and
the DP groups.
0
200
400
600
800
1000
1200
1400
1600
1800
2000
PostPre
HF (ms2)
Figure 9: Changes in the high-frequency (HF) component of heart
rate variability. : control group. : local acupuncture point
(LP) group. : distal acupuncture point (DP) group. Values are
presented as mean. SD represented with error bars in the LP and
the DP groups. significantly dierent from pre-treatment in the
LP group (P<.05).
increase regional blood circulation, increase parasympa-
thetic nervous activity, increase intramuscular temperature,
and decrease neuromuscular excitability [15]. Also, many
researchers have demonstrated the eect of acupressure and
acupuncture for sedation [4,5,16,17].
Acupuncture on the tender points has been commonly
used as a treatment for chronic neck pain and appears
to alleviate pain and stiness [1,18]. The tender points
are known to be located at traditional acupuncture points,
ah si” point, and also to conform with trigger points and
criterion sites for fibromyalgia [1,18,19]. Tender points
are supposed to be the site where there are nociceptors and
polymodal receptors, which have been sensitized by various
factors. Thus, stimulation such as acupuncture and acupres-
sure on the tender points may activate sensitized polymodal
receptors more powerfully, resulting in stronger eects on
pain relief [1]. In traditional acupuncture medicine, tender
points eliciting tenderness or pain could be selected when
treating chronic neck pain [1].
0
0.5
1
1.5
2
2.5
3
LF/HF
Pre Post
Figure 10: Changes in the LF/HF ratio (LF/HF) of heart rate vari-
ability. : control group. : local acupuncture point (LP) group.
: distal acupuncture point (DP) group. Values are presented as
mean. SD represented with error bars in the LP and the DP groups.
Acupuncture treatment typically applies to not only
the tender points but also the distal acupuncture points
for the treatment of chronic pain. Acupuncture at the
distal acupuncture points could improve pain conditions
in chronic neck pain patients, indicating that nonseg-
mental antinociceptive systems may play a major role in
acupuncture analgesia [2]. Also, electroacupuncture at the
acupuncture point “Hegu” (LI 4) decreases the activity on
anterior cingulated cortex (ACC) and cingulum, thereby
inhibiting nociceptive processing in the brain. Acupuncture
point stimulation at a rich nerve junction such as “Hegu”
may reduce pain-induced cingulation processing, thereby
resulting in pain relief/analgesia [20]. A study showed that
acupuncture improved pain-related disability assessed by
NDI [21], as observed in the present study. Furthermore,
acupuncture may improve activities at work, the quality of
sleep and consequently tiredness, pain-related quality of life,
and psychological variables for women with chronic neck
pain [22].
Acupuncture has been reported to aect the autonomic
nervous system [11,23]. However, acupuncture/acupressure
might have dierent physiological eects between local and
distal acupuncture points, since we showed that acupressure
at LI-4, LI-10, and LI-11 did not, but at GB-21, SI-14, and
SI-15 significantly influenced autonomic nervous activity.
There are several limitations to the present study. One
of them is that we did not perform longer term followup
after acupressure. We need further evaluation of the longer
eects of acupressure on chronic neck pain and autonomic
nervous system. Another limitation is that we showed only
the eect of acupressure on either local or distal points. Most
acupuncturists and acupressurists use both local and distal
points together in clinical practice. Therefore, further study
is required in order to assess combinational eects.
In conclusion, acupressure significantly improved pain
conditions on not only the local points but also the distal
acupuncture points in females with chronic neck pain
but aected the autonomic nervous system on only local
acupuncture points, as acupuncture points per se have
dierent physical eects depending on location.
6 Evidence-Based Complementary and Alternative Medicine
0
1
2
3
Satisfaction
1dayPost
Figure 11: Changes in satisfaction due to treatment (VRS: verbal
rating scale). : local acupuncture point (LP) group. : distal
acupuncture point (DP) group. Values are presented as mean. SD
represented with error bars in the LP and the DP groups.
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brain: 3D (124-ch) EEG power spectrum mapping and source
imaging,NeuroImage, vol. 29, no. 4, pp. 1080–1091, 2006.
[21] L. G. F. Giles and R. Muller, “Chronic spinal pain: a
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[22]D.He,A.T.Høstmark,K.B.Veiersted,andJ.I.Medbø,
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... Although many methods have been identified in treating MPS with effective results, no controlled studies have been conducted that demonstrate significant long-term efficacy. The use of non-pharmacologic interventions can be an alternative due to the abundant side effects of the available drugs such as opioids (painkillers) (Simons 2004, Matsubara 2011, Fredin 2017, Dugailly 2018. Opioids are drugs that have effects like those of morphine as they hit opioid receptors (Stromgaard 2009, Hemmings 2013. ...
... This agrees with previous literature. Systematic reviews reported that acupressure is effective in relieving scalene myofascial pain syndrome (Lee 2011) and other musculoskeletal disorders (Matsubara 2011). A physiotherapy treatment approach to neck pain is still lacking. ...
Article
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Objective: To compare the effects of acupressure versus physiotherapy in patients with Scalene Myofascial Pain Syndrome and to investigate the mechanism using endorphin and enkephalin enzymes. Methods: Patients whose clinical findings were consistent with scalene myofascial pain syndrome were included in this randomized control study. The primary outcome measures were Visual Analog Scale; Enkephalin and Endorphin plasma levels. The secondary outcomes were cervical range of motion. These measurements were performed for both groups before and after completion of the treatment sessions. Results: Eighty out of 100 scalene myofascial pain syndrome patients were included in the study, resulting in a prevalence of 80%. The mean age of the patients was 25.48±9.21 years for acupressure; 25.48±9.21 years for physiotherapy with a total score of 25.48±9.15 years. When compared to routine physiotherapy, acupressure was more effective at alleviating pain and increasing cervical range of motion. Furthermore, the endorphin circulatory level was significantly increased following acupressure (P < 0.01) but not after routine physiotherapy. Finally, neither acupressure nor routine physiotherapy affected enkephalin circulatory levels (P > 0.05). Conclusion: The findings of the study revealed that acupressure has been shown to be effective in reducing pain and increasing the cervical range of motion associated with scalene myofascial pain syndrome due to increased circulation of endorphin and can be considered a complementary and alternative treatment for scalene myofascial pain syndrome.
... The myofascial manipulation did not influence the cardiac autonomic control in the current study, contradicting previous studies. 32,33 For instance, acupressure at three tender points in neck-shoulder muscles immediately increased the cardiac parasympathetic activity in females with chronic neck pain. 32 Besides, a pressure inhibition of the suboccipital muscles improved the cardiac parasympathetic response in patients with chronic tension-type headache. ...
... 32,33 For instance, acupressure at three tender points in neck-shoulder muscles immediately increased the cardiac parasympathetic activity in females with chronic neck pain. 32 Besides, a pressure inhibition of the suboccipital muscles improved the cardiac parasympathetic response in patients with chronic tension-type headache. 33 Manual therapists argue that myofascial manipulation could reduce peripheral nerve tension. ...
Article
Study design: Three-arm, parallel, randomized, placebo-controlled, assessor-blinded trial. Objective: To compare the immediate effect of manual therapy at the upper thoracic spine on the cardiovascular autonomic control of patients with musculoskeletal pain. Summary of background data: Musculoskeletal pain increases the risk of cardiovascular events. Thus, manual therapy applied to the upper thoracic region is likely efficient to improve the cardiac autonomic control. Methods: The study included 59 patients with musculoskeletal pain enrolled at an outpatient clinic. Participants were randomly assigned to spinal manipulation (n = 19), myofascial manipulation (n = 20), or placebo (n = 20) administered to the upper thoracic region. Resting heart rate variability provided indexes of the cardiac autonomic control, and the blood pressure response to the cold pressor test as a proxy of the sympathetic responsiveness to a stressor stimulus. Results: Groups were similar for baseline variables except for blood pressure. Two-way repeated-measures ANCOVA revealed that only spinal manipulation induced immediate increase of the square root of the mean squared differences of successive RR intervals (RMSSD), absolute (ms2) and normalized units (n.u.) of the high-frequency power (HF) as compared to pre-intervention evaluation, indicating an improvement in the parasympathetic activity to the heart. Normalized units of low-frequency power (LF) and the LF/HF ratio reduced after the spinal manipulation solely, suggesting a reduction of the sympathetic activity to the heart. There were no significant differences in the blood pressure responsiveness among the three treatments. There were no adverse events. Conclusion: In patients with musculoskeletal pain, spinal manipulation on the upper thoracic spine led to an immediate improvement in the resting cardiac autonomic control without an effect on the blood pressure responsiveness to a sympathoexcitatory stimulus. Myofascial manipulation or placebo did not change cardiovascular autonomic control.Level of Evidence: 2.
... The local point methods treatment was reported to be important to LBP patients in Korea following to distal point on the meridian of pain area(Yong-Suk, 2010). Matsubara et al., (2011) was also reported the benefit of local and distal points method of acupuncture for chronic neck pain in females. In same hand, YNSA method was also reported to be more effective than sham treatment on acute nonspecific LBP (Hasegawa, Baptista, de Souza, Yoshizumi, & Natour, 2013). ...
... Their ability to bind Cu<sup>2 +</sup>, and suppress generation of reactive oxygen species (ROS. Hsp20 was reported to play a role in the protection of hepatocellular carcinoma (HCC) by blocking the proliferation stage through the formation of a cascade cascade on HCC cells (Nagaswara et al., 2014). Hsp 20 and Hsp27 proteins were reported to have a function in apoptosis, namely in the event of Hella cell apoptosis inhibition through inhibition of cytochrome c release from mitochondria and activation of caspase 3 (Nahomi, DiMauro, Wang, & Nagaraj, 2015) when the cells were thermally stressed, the peptide was translocated from the cytoplasm to the nucleus. ...
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Low back pain (LBP) is one of the common symptoms experienced by some of the world community. Acupuncture as a method of healing a disease offers a solution for LBP symptom. This study aimed to determine the effect of acupuncture with local and Yamamoto New Scalp Acupuncture (YNSA) points with biochemical analysis related to total protein, albumin, and globulin, and analysis of blood serum protein profiles using the SDS-PAGE method. This research was conducted using sterile acupuncture needles that inserted in patients with several local points, namely BL22 (Sanjiaoshu), BL23 (Shenshu), BL24 (Qihaishu), BL25C (Dachangshu), and BL26C (Guanyuanshu) and combined with the YNSA points through somatotope D points and extra lumbar points H and I. Blood serum was collected for total protein, albumin, and globulin analysis. That blood serum was also used for protein profile analysis using Sodium Dodecyl Sulfate Polyacrylamide Gel Electrophoresis (SDS-PAGE) method. The results showed that six times of acupuncture treatments gave positive correlation in total protein, albumin, and globulin. Analysis of blood serum protein profiles using SDS-PAGE showed a protein band of about 12 KDa and it might be a interleukin-13 protein. The results were expected can be useful as scientific information especially related to acupuncture for LBP treatment and this of about 12 KDa protein band can be used as biomarker candidates for the symptoms.
... The distal traditional acupuncture points "Hegu" (LI 4), "Shousanli" (LI 10), and "Quchi" (LI 11), on the other hand, are located in the Large Intestine Meridian of the Hand-Yangming and are proposed in Chinese and Japanese traditional medicine to be the points for treating neck, shoulder, and arm disorders. acupressure not only on the tender points/local acupuncture points, "Jianjing" (GB 21), "Jianwaishu" (SI 14), and "Jianzhongshu" (SI 15), but also on the distal acupuncture points, "Hegu" (LI 4), "Shousanli" (LI 10), and "Quchi" (LI 11), could induce sedation, thereby reducing pain, muscle tone, and disability and changing autonomic nervous activity in subjects with chronic neck pain [36] (Young-Chang P. Arai, 2011). ...
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Background:-Pain is a very common discomfort and might be the first response of disease that has to be treated since civilization. The importance of the modulation of pain by emotion is now widely recognised. Exposure to acute or ongoing stress can enhance pain perception and exacerbate clinical pain syndromes. Stress-induced hyperalgesia has been shown to be caused by maladaptive neurobiological alterations in pain-processing pathways caused by chronic or recurrent stress (SIH). Stress induced pain widely affect the cervical area as it is connecting the head to rest of body and mainly connected with the nerves. Existing medications can be used to treat acute pain, but chronic pain medications are frequently less effective and have more negative side effects, such as tolerance, addiction, and gastrointestinal upset. Therefore, there is a dire need for cutting-edge treatments to deal with chronic cervical pain. Chronic stress amplifies pain perception and activates pain pathways when paired with chronic pain, generating a feedback loop that supports chronic pain disorders. Stress-related escalation of chronic pain suggests that the focus of the development of novel treatments should be on centrally active drugs that target the pain-and stress-responsive brain regions. In order to strengthen physical and mental ability to endure additional stressors and diminish internal sources of discomfort, various alternative and complementary techniques just like yoga develops a lifestyle to relaxes both the physical and mental conduct. These techniques along with the medication can be very fruitful to reduce Stress-induced hyperalgesia (SIH). Objective:-This paper gives a summary of how stress emphasises the pain pathway and alternative management of stress induced pain or hyperalgesia (SIH) like yoga, Acupressure, Pranic healing along with non-medicinal Ayurvedic techniques like Jalauka and Agnikarm. Methodology:-The study used reviews of various articles, publications, books and subjects available online i.e. on PubMed, Google scholar etc. related with the SIH ,Yoga and Ayurvedic concepts. Limitations:-This study is based on review of deferent published materials only and not as clinical investigation. Practical implications:-The work can be used to reduce pain and stress through Various Alternative therapies along with medication that can be further utilizes for the clinical investigation of pain management tools. Originality/value:-Proposed work gives a practical and economical solution for the management of stress induced hyperalgesia in reference to Cervical pain.
... The presence of MTrPs is therefore considered to be the first sign of overloading of the muscle. [3] The MTrP in the trapezius is most commonly found at the midpoint of upper border of the muscle. [4] Muscle spasms occur early after injury; this feels like tightness in the muscle and is sometimes painful. ...
... In a recent systemic review about the effects of auricular acupressure on pain management, 12 studies showed a significant improvement in the pain outcomes of auricular acupressure compared with the control groups [16]. In a randomized controlled trial (RCT) of 33 women suffering from chronic neck pain, acupressure provided significant pain relief [17]. In another RCT with 24 individuals with chronic neck pain, a manual therapy technique reduced the visual analog scale (VAS) pain score and increased range of motion (ROM) of the neck [18]. ...
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Meditation and acupressure-like stimulations have been shown to relieve pain. The aim of this study was to determine whether a short bout of mind-body intervention combined with meditation and acupressure-like stimulation was able to alleviate shoulder pain and improve its function in a short time window. Sixty-five adults with shoulder pain were recruited and randomly classified into two groups. One group participated in an intervention which consisted of acupressure-like stimulation and meditation over a 5 min period. The other group was instructed to rest during this time. A visual analog scale (VAS) pain score and objective constant scores were measured before and after intervention to determine shoulder pain and range of motion (ROM), respectively. A two-way repeated measures analysis of variance with Bonferroni correction and a regression analysis were performed. VAS pain, objective constant score, flexion, abduction, and external rotation score showed significant interactions between time and group. The pain intensity was significantly reduced, while flexion and abduction were significantly improved, in the experimental group compared to the control group, after the intervention. In addition, the change of flexion negatively correlated with the change of pain intensity in the experimental group, but not in the control group. These results show that a short-term application of mind-body intervention significantly alleviates shoulder pain and improves shoulder movement, suggesting its potential use as a therapy for people with shoulder pain.
... Furthermore, acupressure can decrease tissue adhesion, increase regional blood circulation, promote relaxation, increase parasympathetic nervous activity, decrease neuromuscular excitability, and increase intramuscular temperature. 50 A randomized clinical trial on 200 pregnant women at 33 weeks of gestational age revealed that the moxibustion technique had no significant effect on the correction of breech presentation. 5 In addition, another trial study conducted by Sananeset al. 14 indicated that stimulation at the BL67 point using a hot needle did not increase the probability of breech correction to cephalic. ...
Article
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Background: Breech is a common fetal presentation in preterm pregnancies. This study aimed to investigate the effect of acupressure at the BL67 point on the spontaneous rotation of fetus with breech presentation. Methods: An unblind, two-armed randomized controlled trial was carried out from September 2017 to April 2020. Research participants were 138 pregnant women at 32-35 weeks of gestational age that had fetal breech presentation approved by ultrasound. They were randomly assigned into intervention and control groups (n=69 in each group). The intervention group received acupressure at the BL67 point on both feet for 10 minutes on day and for two consecutive weeks. The control group received routine care. Demographic and midwifery data questionnaires were used for data collection. Results: After the intervention, the spontaneous rotation of fetus with breech presentation into cephalic was observed in the majority of participants in the intervention group (82.6%) compared to the control group (17.4%) (p<0.001). Statistically significant differences in the fetal presentation at delivery was observed between the groups (84.1% cephalic vs. 18.8% breech, p<0.001). Regarding the type of delivery, cesarean section was reported mostly (85.5%) in the control group compared to the intervention group (21.7%) (p<0.001). However, the first- and fifth-minute Apgar scores of newborns had no statistically significant differences between the groups (p=0.773). Conclusion: It is suggested to incorporate acupressure at the BL67 point into the care process for pregnant women to help with the reduction of the rate of cesarean section and avoid its related complications.
... The Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) guidelines recommend reporting the acupuncturist's educational background when reporting the efficacy of acupuncture treatment [20]. In particular, treatment efficacy and physical effects may vary depending on AP prescriptions [17][18][19][26][27][28]. Hence, the diversity of acupuncture selections needs to be considered to improve the efficacy and clinical research quality of acupuncture treatment. ...
Article
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Acupuncture point (AP) selections can vary depending on clinicians’ acupuncture style, and therefore, acupuncture style is an important factor in determining the efficacy of acupuncture treatment. However, few studies have examined the differences in AP selections according to the acupuncture styles and theoretical backgrounds causing the differences. We compared the AP prescriptions used for 14 diseases in three classical medical textbooks, Dongeuibogam (DEBG), Saamdoinchimgooyogyeol (SADI), and Chimgoogyeongheombang (CGGHB), which represent unique acupuncture styles and have affected clinicians during this time. AP prescriptions showed more diversity between textbooks than between types of diseases. Among the three textbooks, AP prescriptions of SADI were most different compared to those of DEBG and CGGHB. Importantly, we found each style can be more clearly explained by AP attributes than by the APs per se. Specifically, SADI, DEBG, and CGGHB preferred five transport points located on the limbs, APs of the extra meridians, and source points, respectively. This suggests the possibility that the theoretical diversity of acupuncture styles results in the heterogeneity of AP selections.
Article
The current measurement systems for the physical parameters (rotation frequency, and amplitude) of Traditional Chinese Medicine (TCM) manual acupuncture tend to cause disturbance and inconvenience in clinical application and do not accurately capture the tactile signals from the physician's finger during manual acupuncture operations. In addition, the literature rarely discusses classification of the four basic manual acupuncture techniques (reinforcing by twirling and rotating (RFTR), reducing by twirling and rotating (RDTR), reinforcing by lifting and thrusting (RFLT), and reducing by lifting and thrusting (RDLT)). To address this problem, we developed a multi-PVDF film-based tactile array finger cot to collect piezoelectric signals from the acupuncturist's finger-needle contact during manual acupuncture operations. In order to recognize the four typical TCM manual acupuncture techniques, we developed a method to capture piezoelectric signals in related “windows” and subsequently extract features to model acupuncture techniques. Next, we created an ensemble learning-based action classifier for manual acupuncture technique recognition. Finally, the proposed classifier was employed to recognize the four types of manual acupuncture techniques performed by 15 TCM physicians based on the piezoelectric signals collected using the tactile array finger cot. Among all the approaches, our proposed feature-based CatBoost ensemble learning model achieved the highest validation accuracy of 99.63% and the highest test accuracy of 92.45%. Moreover, we provide the efficiency and limitations of using this action recognition method.
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Background: Respiratory tract infections are heterogeneous and complex group of diseases that require pharmaceutical interventions with undesirable side effects. Thus, integration of acupressure in the care of children with respiratory problems may be effective with regard to management of respiratory distress and prevention of medicinal treatment side effects. Aim: To investigate the effect of applying acupressure on the clinical outcomes of critically ill children with respiratory tract infections. Methods: Quasi-experimental, pre-posttests, research design was carried out at the Pediatric Intensive Care Unit of El-Shatby University Hospital in Alexandria, Egypt. Subjects were 60 eligible children who were assigned into two equal groups. The control group received the routine care of the unit only whereas the study group received acupressure in addition to routine care. Findings: Degree of dyspnea decreased dramatically among the study group after three days of acupressure as 56.7% were not troubled at all by dyspnea compared to only 3.3% of children in the control group. Regarding degree of respiratory impairment, all children in study group experienced mild respiratory impairment in the 2 nd and 3 rd days of the study period (100% in each) compared to the control group (23.3% and16.7% respectively) with significant statistical differences (p= 0.000 in each day). Conclusion and recommendations: Integrating acupressure with conventional medical therapy could decrease the severity of dyspnea and enhance pulmonary functioning. In that sense, acupressure was proved to be promising in improving respiratory problems among children with respiratory tract infections. Accordingly, pediatric intensive care nurses can accelerate the improvement of those children using such non-pharmacological approach with the pharmacological one.
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Premedication with sedatives can decrease the discomfort associated with invasive anesthetic procedures. Some researchers have shown that acupressure on the acupuncture extra 1 point is effective for sedation. We investigated whether acupressure on the extra 1 point could alleviate the pain of needle insertion. We investigated the effect of acupressure at the extra 1 point or a sham point on needle insertion using verbal rating scale (VRS) pain scores and heart rate variability (HRV). Twenty-two healthy female volunteers were randomly allocated to two groups: the extra 1 group received acupressure at the extra 1 point, and the sham group received acupressure at a sham point. After starting the electrocardiogram record, a 27-gauge needle was inserted into the skin of a forearm. Thereafter, another needle was inserted into the skin of the other forearm during acupressure. Acupressure at the extra 1 point significantly reduced the VRS, but acupressure at the sham increased the VRS. Acupressure at the extra 1 significantly reduced the low frequency/high frequency ratio of HRV responding to needle insertion. Acupressure at the extra 1 point significantly reduced needle insertion pain compared with acupressure at the sham point. Also, acupressure at the extra 1 point significantly reduced the low frequency/high frequency ratio of HRV responding to needle insertion, which implies a reduction in sympathetic nervous system activity.
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Acupressure applied on the Extra 1 acupuncture point results in sedation, thereby reducing bispectral index (BIS) values. Mental status and hypnotic agents influence the autonomic nervous system. We hypothesized that acupressure at the Extra 1 point would induce sedation and change sympatho-parasympathetic nerve balance. We investigated the effect of acupressure at the Extra 1 point on the EEG spectral entropy values and heart rate variability (HRV). Forty-eight volunteers (24 males and 24 females) were randomly assigned to the control or Extra 1 group. The control group received acupressure at a sham point and the Extra 1 group received acupressure at the Extra 1 point. Acupressure was applied for 5 min. The record of the EEG spectral entropy values and HRV started 5 min before acupressure and stopped 5 min after acupressure. Acupressure significantly reduced the EEG spectral entropy values in both groups, but the values of the Extra 1 group were significantly smaller than those of the control group (P < .01). Acupressure significantly decreased the LF/HF ratio of HRV in both groups (P < .05). When divided upon gender, although acupressure tended to decrease the LF/HF ratio, the ratio significantly decreased during and after acupressure only in females of the Extra 1 group (P < .05). We concluded that acupressure on the Extra 1 point significantly reduced the EEG spectral entropy in both the genders, but affected the LF/HF ratio of HRV only in females.
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Many coaches, athletes and sports medicine personnel hold the belief, based on observations and experiences, that massage can provide several benefits to the body such as increased blood flow, reduced muscle tension and neurological excitability, and an increased sense of well-being. Massage can produce mechanical pressure, which is expected to increase muscle compliance resulting in increased range of joint motion, decreased passive stiffness and decreased active stiffness (biomechanical mechanisms). Mechanical pressure might help to increase blood flow by increasing the arteriolar pressure, as well as increasing muscle temperature from rubbing. Depending on the massage technique, mechanical pressure on the muscle is expected to increase or decrease neural excitability as measured by the Hoffman reflex (neurological mechanisms). Changes in parasympathetic activity (as measured by heart rate, blood pressure and heart rate variability) and hormonal levels (as measured by cortisol levels) following massage result in a relaxation response (physiological mechanisms). A reduction in anxiety and an improvement in mood state also cause relaxation (psychological mechanisms) after massage. Therefore, these benefits of massage are expected to help athletes by enhancing performance and reducing injury risk. However, limited research has investigated the effects of pre-exercise massage on performance and injury prevention. Massage between events is widely investigated because it is believed that massage might help to enhance recovery and prepare athletes for the next event. Unfortunately, very little scientific data has supported this claim. The majority of research on psychological effects of massage has concluded that massage produces positive effects on recovery (psychological mechanisms). Post-exercise massage has been shown to reduce the severity of muscle soreness but massage has no effects on muscle functional loss. Notwithstanding the belief that massage has benefits for athletes, the effects of different types of massage (e.g. petrissage, effleurage, friction) or the appropriate timing of massage (pre-exercise vs post-exercise) on performance, recovery from injury, or as an injury prevention method are not clear. Explanations are lacking, as the mechanisms of each massage technique have not been widely investigated. Therefore, this article discusses the possible mechanisms of massage and provides a discussion of the limited evidence of massage on performance, recovery and muscle injury prevention. The limitations of previous research are described and further research is recommended.
Article
Background: Published in 1991, the Neck Disability Index (NDI) was the first instrument designed to assess self-rated disability in patients with neck pain. This article reviews the history of the NDI and the current state of the research into its psychometric properties--reliability, validity, and responsiveness--as well as its translations. Focused reviews are presented into its use in studies of the prognosis of whiplash-injured patients as well as its use in clinical trials of conservative therapies for neck pain. Special features: The NDI is a relatively short, paper-pencil instrument that is easy to apply in both clinical and research settings. It has strong psychometric characteristics and has proven to be highly responsive in clinical trials. As of late 2007, it has been used in approximately 300 publications; it has been translated into 22 languages, and it is endorsed for use by a number of clinical guidelines. Summary: The NDI is the most widely used and most strongly validated instrument for assessing self-rated disability in patients with neck pain. It has been used effectively in both clinical and research settings in the treatment of this very common problem.
Article
Unlabelled: It has been postulated that sensory stimulation (acupuncture) affects the cardiovascular system via the autonomic nervous system. Previously, skin temperature, thermography, plethysmography and blood pressure changes have been used in evaluation of sympathetic nerve activity following acupuncture. By using power spectral analysis, the low frequency and high frequency components of heart rate variability can be calculated reflecting the sympathetic and parasympathetic activity. The purpose of this study was to investigate to what extent acupuncture applied into the thenar muscle and into the cavum concha of the ear induced changes in the sympathetic and/or parasympathetic nervous system in healthy subjects. Materials and methods: Twelve healthy volunteers, six men and six women, mean age 34.4 (range 23-48) participated in three balanced, randomly distributed sessions. At an individual initial visit the 12 volunteers were introduced to the needle sensation by having a needle inserted into the point LI 11. The needle sensation was evoked and the subject was trained to identify the characteristic needle sensation. The introduction was followed by three test sessions. Session a: A short acupuncture needle, (Seirin no 3, &emptyv;0.20x15 mm) was inserted perpendicular into the earpoint, Lu 1, in the left inferior hemi-conchae. Session b: An acupuncture needle (Hwato, &emptyv;0.30x30 mm) was inserted perpendicular into the Hegu point (LI 4) in the middle of the right dorsal thenar muscle. Session c: An acupuncture needle (Hwato, &emptyv;0.30x30 mm) was inserted perpendicular superficially into the skin overlying the Hegu point on the left hand. Results. Stimulation of the ear induced a significant increase in the parasympathetic activity during the stimulation period of 25 min (P<0.05) and during the post-stimulation period of 60 min (P<0.05). No significant changes were observed in either the sympathetic activity, blood pressure or heart rate. Stimulation of the thenar muscle resulted in a significant increase in the sympathetic and the parasympathetic activity during the stimulation period (P<0.01) and during the post-stimulation period (P<0.01 and P<0.001, respectively). A significant decrease in the heart rate frequency (P<0.05) at the end of the post-stimulation period was also demonstrated. The superficial needle insertion into the skin overlaying the right thenar muscle caused a pronounced balanced increase in both the sympathetic and parasympathetic activity during the post stimulation period of 60 min (P<0.01) while no changes were observed during the stimulation period. Conclusion: It is indicated that sensory stimulation (acupunctura) in healthy persons is associated with changed activity in the sympathetic and parasympathetic nervous system depending on site of stimulation and period of observation.
Article
To evaluate immediate effects of two different modes of acupuncture on motion-related pain and cervical spine mobility in chronic neck pain patients compared to a sham procedure. Thirty-six patients with chronic neck pain and limited cervical spine mobility participated in a prospective, randomized, double-blind, sham-controlled crossover trial. Every patient was treated once with needle acupuncture at distant points, dry needling (DN) of local myofascial trigger points and sham laser acupuncture (Sham). Outcome measures were motion-related pain intensity (visual analogue scale, 0-100 mm) and range of motion (ROM). In addition, patients scored changes of general complaints using an 11-point verbal rating scale. Patients were assessed immediately before and after each treatment by an independent (blinded) investigator. Multivariate analysis was used to assess the effects of true acupuncture and needle site independently. For motion-related pain, use of acupuncture at non-local points reduced pain scores by about a third (11.2 mm; 95% CI 5.7, 16.7; P = 0.00006) compared to DN and sham. DN led to an estimated reduction in pain of 1.0 mm (95% CI -4.5, 6.5; P = 0.7). Use of DN slightly improved ROM by 1.7 degrees (95% CI 0.2, 3.2; P = 0.032) with use of non-local points improving ROM by an additional 1.9 degrees (95% CI 0.3, 3.4; P = 0.016). For patient assessment of change, non-local acupuncture was significantly superior both to Sham (1.7 points; 95% CI 1.0, 2.5; P = 0.0001) and DN (1.5 points; 95% CI 0.4, 2.6; P = 0.008) but there was no difference between DN and Sham (0.1 point; 95% CI -1.0, 1.2; P = 0.8). Acupuncture is superior to Sham in improving motion-related pain and ROM following a single session of treatment in chronic neck pain patients. Acupuncture at distant points improves ROM more than DN; DN was ineffective for motion-related pain.
Article
To compare the effects of real acupuncture to tender points for neck and shoulder pain and stiffness (Japanese: katakori) with those of sham acupuncture. Randomized-controlled trial. Thirty-four volunteers from an acupuncture school with complaints of chronic pain and stiffness, who had no arm symptoms and gave informed consent, were randomly allocated to acupuncture or sham groups. Acupuncture or sham acupuncture was applied to the tender points once a week for 3 weeks. In the acupuncture group the acupuncture needle was inserted to the muscle, then the sparrow pecking technique was applied five times. Sham acupuncture was done without insertion of the needle. Dull pain and stiffness were evaluated by visual analog scale (VAS) before, and every 2 days after the first needling for 1 month. Pressure pain threshold on the tender points was measured before and after each treatment. There was no statistical difference of VAS scores between acupuncture and sham groups 9 days after the last treatment. However, the acupuncture group showed significant reduction of VAS scores immediately after and/or 1 day after the real acupuncture treatments (P<0.01). The effect tended to be prolonged after repeated treatment. Pressure pain thresholds tended to increase after real acupuncture treatment but not after sham acupuncture. Acupuncture applied to tender points appears to have short-term effects on neck and shoulder pain and stiffness, but this study was unable to demonstrate any long-term superiority over sham acupuncture.
Article
A randomized controlled clinical trial was conducted. To compare medication, needle acupuncture, and spinal manipulation for managing chronic (>13 weeks duration) spinal pain because the value of medicinal and popular forms of alternative care for chronic spinal pain syndromes is uncertain. Between February 1999 and October 2001, 115 patients without contraindication for the three treatment regimens were enrolled at the public hospital's multidisciplinary spinal pain unit. One of three separate intervention protocols was used: medication, needle acupuncture, or chiropractic spinal manipulation. Patients were assessed before treatment by a sports medical physician for exclusion criteria and by a research assistant using the Oswestry Back Pain Disability Index (Oswestry), the Neck Disability Index (NDI), the Short-Form-36 Health Survey questionnaire (SF-36), visual analog scales (VAS) of pain intensity and ranges of movement. These instruments were administered again at 2, 5, and 9 weeks after the beginning of treatment. Randomization proved to be successful. The highest proportion of early (asymptomatic status) recovery was found for manipulation (27.3%), followed by acupuncture (9.4%) and medication (5%). Manipulation achieved the best overall results, with improvements of 50% (P = 0.01) on the Oswestry scale, 38% (P = 0.08) on the NDI, 47% (P < 0.001) on the SF-36, and 50% (P < 0.01) on the VAS for back pain, 38% (P < 0.001) for lumbar standing flexion, 20% (P < 0.001) for lumbar sitting flexion, 25% (P = 0.1) for cervical sitting flexion, and 18% (P = 0.02) for cervical sitting extension. However, on the VAS for neck pain, acupuncture showed a better result than manipulation (50% vs 42%). The consistency of the results provides, despite some discussed shortcomings of this study, evidence that in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short-term improvement than acupuncture or medication. However, the data do not strongly support the use of only manipulation, only acupuncture, or only nonsteroidal antiinflammatory drugs for the treatment of chronic spinal pain. The results from this exploratory study need confirmation from future larger studies.