Dominik Irnich

Technische Universität München, München, Bavaria, Germany

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Publications (140)286.17 Total impact

  • D. Irnich

    No preview · Article · Dec 2015 · Deutsche Zeitschrift für Akupunktur
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    ABSTRACT: Our aim was to distinguish between spinal and supraspinal mechanisms in the intact nervous system by comparing homo- and heterosegmental effects of electroacupuncture and manual acupuncture on sensory perception in healthy volunteers by means of Quantitative Sensory Testing (QST).Seventy two healthy volunteers were randomly assigned to receive either manual acupuncture (MA) or electroacupuncture (EA) at SP 6, SP 9, GB 39 and ST 36 at the left leg or relaxed for 30 min (control group, CG). Blinded examiners assessed 13 sensory modalities (thermal and mechanical detection and pain thresholds) at the upper arms and lower legs before and after the intervention by means of a standardized QST battery. Change scores of all 13 sensory thresholds were compared between groups. The main outcome measure was the change score of the pressure pain threshold (PPT).There were no baseline differences between groups. PPT change scores at the lower left leg, in the same segment as the needling site, differed significantly (p = 0.008) between the EA group (median 103.01 kPa) and the CG (median 0.00 kPa) but not between the MA group (median 0.00 kPa) and the CG. No further significant change score differences were found between one of the acupuncture groups and the CG.The PPT can be changed by EA. The PPT increase was confined to the segment of needling, which indicates that it is mainly mediated by segmental inhibition in the spinal cord. This underscores the importance of segmental needling and electrical stimulation in clinical practice.
    No preview · Article · Jul 2015 · Pain
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    Full-text · Article · Apr 2015 · Forschende Komplementarmedizin
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    ABSTRACT: Pre-emptive analgesia in perioperative care has potential benefits for patients. The pre-emptive and postoperative analgesic effects of the cyclooxygenase-2 inhibitor etoricoxib have been investigated using a 2 × 2 factorial trial design. According to the 2 × 2 factorial study design, 103 patients scheduled for visceral surgery, were randomly allocated to two groups prior to surgery. Patients could receive either etoricoxib or placebo (to investigate pre-emptive analgesia). Subsequent to surgery, patients randomly received either etoricoxib or placebo, again. It follows, that four treatment modalities (continuous or replaced intervention) result, to investigate postoperative analgesia. Main Outcome Measure was the cumulative morphine use 48 h post-surgery. Other outcomes included pain intensities, pain thresholds and sensory detection. Eighty-six patients (female n = 42; mean age 53.82 ± 13.61 years) were evaluated on the basis of an intention to treat analysis. Pre-emptive administration of 120 mg etoricoxib did not significantly reduce the cumulative morphine dose within the first 48 h after surgery, when compared to the administration of placebo. The analysis of the post-operative treatment groups showed a non-significant 8% reduction in morphine dose during the continuous administration of etoricoxib. There were no changes in sensory perception as detected with QST before and after surgery or between groups. The effect of administering etoricoxib was not superior to placebo in reducing the morphine dose required for postoperative analgesia. The lack of changes in peripheral nociception suggests that central algetic mechanisms are of higher impact in the development of postoperative pain following abdominal or thoracic surgery. © 2015 European Pain Federation - EFIC®
    No preview · Article · Mar 2015 · European journal of pain (London, England)
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    Full-text · Article · Dec 2014
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    ABSTRACT: Many studies show an effectiveness of hypnotic analgesia. It has been discussed whether the analgesic effect is mainly caused by the relaxation that is concomitant to hypnosis. This study was designed to evaluate the effects of hypnotic relaxation suggestion on different somatosensory detection and pain thresholds. Quantitative sensory testing (QST) measurements were performed before and during hypnosis in twenty-three healthy subjects on the dorsum of the right hand. Paired t-test was used to compare threshold changes. The influence of hypnotic susceptibility was evaluated by calculating correlation coefficients for threshold changes and hypnotic susceptibility (Harvard group scale). During hypnosis significantly changed somatosensory thresholds (reduced function) were observed for the following sensory detection thresholds: Cold Detection Threshold (CDT), Warm Detection Threshold (WDT), Thermal Sensory Limen (TSL) and Mechanical Detection Threshold (MDT). The only unchanged sensory detection threshold was Vibration Detection Threshold (VDT). No significant changes were observed for the determined pain detection thresholds (Cold Pain Thresholds, Heat Pain Thresholds, Mechanical Pain Sensitivity, Dynamic Mechanical Allodynia, Wind-up Ratio and Pressure Pain Threshold). No correlation of hypnotic susceptibility and threshold changes were detected. Hypnotic relaxation without a specific analgesic suggestion results in thermal and mechanical detection, but not pain threshold changes. We thus conclude that a relaxation suggestion has no genuine effect on sensory pain thresholds.Trial Registration: ClinicalTrials.gov, Identifier: NCT02261155 (9th October 2014).
    Preview · Article · Dec 2014 · BMC Complementary and Alternative Medicine
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    ABSTRACT: The effect of acupuncture on sensory perception has never been systematically reviewed; although, studies on acupuncture mechanisms are frequently based on the idea that changes in sensory thresholds reflect its effect on the nervous system. Pubmed, EMBASE and Scopus were screened for studies investigating the effect of acupuncture on thermal or mechanical detection or pain thresholds in humans published in English or German. A meta-analysis of high quality studies was performed. Out of 3007 identified articles 85 were included. Sixty five studies showed that acupuncture affects at least one sensory threshold. Most studies assessed the pressure pain threshold of which 80% reported an increase after acupuncture. Significant short- and long-term effects on the pressure pain threshold in pain patients were revealed by two meta-analyses including four and two high quality studies, respectively. In over 60% of studies, acupuncture reduced sensitivity to noxious thermal stimuli, but measuring methods might influence results. Few but consistent data indicate that acupuncture reduces pin-prick like pain but not mechanical detection. Results on thermal detection are heterogeneous. Sensory threshold changes were equally frequent reported after manual acupuncture as after electroacupuncture. Among 48 sham-controlled studies, 25 showed stronger effects on sensory thresholds through verum than through sham acupuncture, but in 9 studies significant threshold changes were also observed after sham acupuncture. Overall, there is a lack of high quality acupuncture studies applying comprehensive assessments of sensory perception. Our findings indicate that acupuncture affects sensory perception. Results are most compelling for the pressure pain threshold, especially in pain conditions associated with tenderness. Sham acupuncture can also cause such effects. Future studies should incorporate comprehensive, standardized assessments of sensory profiles in order to fully characterize its effect on sensory perception and to explore the predictive value of sensory profiles for the effectiveness of acupuncture.
    Full-text · Article · Dec 2014 · PLoS ONE
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    ABSTRACT: Multimodale Schmerztherapie (MMST) ist eine umfassende Behandlung komplexer Schmerzsyndrome unter Einbindung verschiedener medizinischer Disziplinen und Berufsgruppen auf der Basis eines biopsychosozialen Modells der Schmerzentwicklung. In Deutschland sind in den letzten Jahren verschiedene Einrichtungen etabliert worden, die MMST anbieten. Die MMST wurde für das tagesklinische und das stationäre Behandlungssetting in den Prozedurenkatalog medizinischer Leistungen (OPS) aufgenommen. Dabei besteht in der Versorgungspraxis oft Unklarheit, was MMST ist und welche Bestandteile ein solches Behandlungsprogramm haben soll. Aus diesem Grund hat die Ad-hoc-Kommission Multimodale Schmerztherapie der Deutschen Schmerzgesellschaft in einem mehrstufigen Konsensusprozess das vorliegende Positionspapier erarbeitet. Dabei werden die in der MMST regelhaft zur Anwendung kommenden Behandlungsmaßnahmen in den vier Kernbereichen der MMST – Medizin/Algesiologie, Psychotherapie, Physio-/Bewegungstherapie und Pflege/medizinische Assistenzberufe – dargestellt.
    Full-text · Article · Oct 2014 · Der Schmerz
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    ABSTRACT: Multimodal pain management is a comprehensive treatment of complex chronic pain syndromes. In addition to medical therapy various other specialized therapeutic interventions based on the biopsychosocial model of pain origin and chronic pain development, are added. During the last few years treatment centers for chronic pain have been established throughout Germany. Multimodal pain management has been included in the official catalogue of the recognized medical procedures for day clinic units as well as for inpatient pain management.In daily practice there is, however, still a lack of clarity and of consistency about the components that multimodal pain management should contain. This is the reason for the ad hoc commission on multimodal interdisciplinary pain management of the German Pain Society to propose the following position paper that has been worked out in a multilevel and interdisciplinary consensus process. The paper describes the mandatory treatment measures in the four core disciplines of multimodal pain management, pain medicine, psychotherapy, exercise therapy including physiotherapy and assistant medical professions including nurses.
    Full-text · Article · Sep 2014 · Der Schmerz
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    ABSTRACT: Background We report on the design and implementation of a study protocol entitled Acupuncture randomised trial for post anaesthetic recovery and postoperative pain - a pilot study (ACUARP) designed to investigate the effectiveness of acupuncture therapy performed in the perioperative period on post anaesthetic recovery and postoperative pain. Methods/Design The study is designed as a randomised controlled pilot trial with three arms and partial double blinding. We will compare (a) press needle acupuncture, (b) no treatment and (c) press plaster acupressure in a standardised anaesthetic setting. Seventy-five patients scheduled for laparoscopic surgery to the uterus or ovaries will be allocated randomly to one of the three trial arms. The total observation period will begin one day before surgery and end on the second postoperative day. Twelve press needles and press plasters are to be administered preoperatively at seven acupuncture points. The primary outcome measure will be time from extubation to ‘ready for discharge’ from the post anaesthesia care unit (in minutes). The ‘ready for discharge’ end point will be assessed using three different scores: the Aldrete score, the Post Anaesthetic Discharge Scoring System and an In-House score. Secondary outcome measures will comprise pre-, intra- and postoperative variables (which are anxiety, pain, nausea and vomiting, concomitant medication). Discussion The results of this study will provide information on whether acupuncture may improve patient post anaesthetic recovery. Comparing acupuncture with acupressure will provide insight into potential therapeutic differences between invasive and non-invasive acupuncture techniques. Trial registration NCT01816386 (First received: 28 October 2012)
    Full-text · Article · Jul 2014 · Trials
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    ABSTRACT: Chronic ischemic pain in peripheral arterial disease (PAD) is a leading cause of pain in the lower extremities. A neuropathic component of chronic ischemic pain has been shown independent of coexisting diabetes. We aimed to identify a morphological correlate potentially associated with pain and sensory deficits in PAD. Forty patients with symptomatic PAD (Fontaine stages II-IV), 20 with intermittent claudication, CI), and 20 with critical limb ischemia (CLI) were enrolled; twelve volunteers served as healthy controls. All patients were examined using pain scales and questionnaires. All study participants underwent quantitative sensory testing (QST) at the distal calf and skin punch biopsy at the distal leg for determination of intraepidermal nerve fiber density (IENFD). Additionally, S100beta serum levels were measured as a potential marker for ischemic nerve damage. Neuropathic pain questionnaires revealed slightly higher scores and more pronounced pain-induced disability in CLI patients compared to CI patients. QST showed elevated thermal and mechanical detection pain thresholds as well as dynamic mechanical allodynia particularly in patients with advanced disease. IENFD was reduced in PAD compared to controls (p<0.05), more pronounced in the CLI subgroup (CLI: 1.3 ± 0.5 fibers/mm, CI: 2.9 ± 0.5 fibers/mm, controls: 5.3 ± 0.6 fibers/mm). In particular, increased mechanical and heat pain thresholds negatively correlated with lower IENFD. Mean S100beta levels were in the normal range but were higher in advanced disease. Patients with chronic ischemic pain had a reduced IENFD associated with impaired sensory functions. These findings support the concept of a neuropathic component in ischemic pain.
    No preview · Article · Jun 2014 · Pain
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    ABSTRACT: Background Acupuncture was efficient and superior to sham acupuncture and a control group in the ACUpuncture in Seasonal Allergic Rhinitis (ACUSAR) trial. The article aims to inform about the study intervention, the underlying therapeutic ideas and clinical consequences. Design Three-armed, randomized, controlled multi-center-trial with a 16-week follow-up during the SAR season in the first trial year and an 8 week follow-up during the SAR season in the following year. Setting Outpatient or private clinics in Germany. Intervention 422 Patients with seasonal allergic rhinitis on birch and grass pollen have been randomized to fall into 3 groups: 12 sessions of semi-standardised acupuncture plus rescue medication (RM, Cetirizine) or 12 sessions of sham acupuncture plus RM or RM alone during the initial two months of the study. Study intervention was defined in a Delphi consensus procedure including five experts from two major German acupuncture associations and three experts on trial methodology and statistics. A consensus between the need for standardisation and individualisation was defined using a semi-standardised treatment in the acupuncture group: 4 obligatory acupuncture points, ≥ 3 out of 8 facultative basic points and ≥ 3 facultative local or distant acupuncture points. Sham acupuncture consisted in superficial needling of at least 5 of 7 predefined, bilateral, distant non-acupuncture points. Needling characteristics such as point location, needling time, manipulation and achieved ‘De Qi' had to be documented after each session. Results CM syndrome diagnoss reported most frequently were Wind-Cold invading the lung' and ‘Wind-Heat invading the lung' (37 % each). In the acupuncture group all basic obligatory points were used in 97 % of cases (LI 4, LI 11, LI 20, EX-HN 3 Yintang). The most frequently used basic optional acupuncture points were GB 20, LIV 3, ST 36, LU 7 and SP 6. The total number of needles used was higher in the acupuncture group (15.7 ± 2.5) compared to the sham acupuncture group (10.0 ± 1.6). Conclusions CM syndrome diagnoses and point selection in the acupuncture group of the trial corresponded to clinical experiences in CM treatment of SAR. Point location and a higher number of needles in the acupuncture group compared to the sham acupuncture group may have influenced the positive trial results.
    No preview · Article · Jun 2014 · Deutsche Zeitschrift für Akupunktur
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    ABSTRACT: In a large randomised trial in patients with seasonal allergic rhinitis (SAR), acupuncture was superior compared to sham acupuncture and rescue medication. The aim of this paper is to describe the characteristics of the trial's participating physicians and to describe the trial intervention in accordance with the STRICTA (Standards for Reporting Interventions in Controlled Trials of Acupuncture) guidelines, to make details of the trial intervention more transparent to researchers and physicians. ACUSAR (Acupuncture in Seasonal Allergic Rhinitis) was a three-armed, randomised, controlled multicentre trial. 422 SAR patients were randomised to semi-standardised acupuncture plus rescue medication (RM, cetirizine), sham acupuncture plus RM or RM alone. We sent a questionnaire to trial physicians in order to evaluate their characteristics regarding their education about and experience in providing acupuncture. During the trial, acupuncturists were asked to diagnose all of their patients according to Chinese Medicine (CM) as a basis for the semi-standardised, individualized intervention in the acupuncture group. Every acupuncture point used in this trial had to be documented after each session RESULTS: Acupuncture was administered in outpatient clinics by 46 (mean age 47 +/- 10 years; 24 female/ 22 male) conventionally-trained medical doctors (67% with postgraduate specialization such as internal or family medicine) with additional extensive acupuncture training (median 500 hours (1st quartile 350, 3rd quartile 1000 hours with 73% presenting a B-diploma in acupuncture training (350 hours)) and experience (mean 14 years in practice). The most reported traditional CM diagnosis was 'wind-cold invading the lung' (37%) and 'wind-heat invading the lung' (37%), followed by 'lung and spleen qi deficiency' (9%). The total number of needles used was higher in the acupuncture group compared to the sham acupuncture group (15.7 +/- 2.5 vs. 10.0 +/- 1.6). The trial interventions were provided by well educated and experienced acupuncturists. The different number of needles in both intervention groups could be possibly a reason for the better clinical effect in SAR patients. For future trials it might be more appropriate to ensure that acupuncture and sham acupuncture groups should each be treated by a similar number of needles.Trial registration: ClinicalTrials.gov: NCT00610584.
    Full-text · Article · Apr 2014 · BMC Complementary and Alternative Medicine
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    ABSTRACT: Background Acupuncture was efficient and superior to sham acupuncture and a control group in the ACUpuncture in Seasonal Allergic Rhinitis (ACUSAR) trial. The article aims to inform about the study intervention, the underlying therapeutic ideas and clinical consequences. Design Three-armed, randomized, controlled multi-center-trial with a 16-week follow-up during the SAR season in the first trial year and an 8 week follow-up during the SAR season in the following year. Setting Outpatient or private clinics in Germany. Intervention 422 Patients with seasonal allergic rhinitis on birch and grass pollen have been randomized to fall into 3 groups: 12 sessions of semi-standardised acupuncture plus rescue medication (RM, Cetirizine) or 12 sessions of sham acupuncture plus RM or RM alone during the initial two months of the study. Study intervention was defined in a Delphi consensus procedure including five experts from two major German acupuncture associations and three experts on trial methodology and statistics. A consensus between the need for standardisation and individualisation was defined using a semi-standardised treatment in the acupuncture group: 4 obligatory acupuncture points, ≥ 3 out of 8 facultative basic points and ≥ 3 facultative local or distant acupuncture points. Sham acupuncture consisted in superficial needling of at least 5 of 7 predefined, bilateral, distant non-acupuncture points. Needling characteristics such as point location, needling time, manipulation and achieved 'De Qi' had to be documented after each session. Results CM syndrome diagnoss reported most frequently were Wind-Cold invading the lung' and 'Wind-Heat invading the lung' (37 % each). In the acupuncture group all basic obligatory points were used in 97 % of cases (LI 4, LI 11, LI 20, EX-HN 3 Yintang). The most frequently used basic optional acupuncture points were GB 20, LIV 3, ST 36, LU 7 and SP 6. The total number of needles used was higher in the acupuncture group (15.7 ± 2.5) compared to the sham acupuncture group (10.0 ± 1.6). Conclusions CM syndrome diagnoses and point selection in the acupuncture group of the trial corresponded to clinical experiences in CM treatment of SAR. Point location and a higher number of needles in the acupuncture group compared to the sham acupuncture group may have influenced the positive trial results.
    No preview · Article · Jan 2014
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    ABSTRACT: Arnold 1 · T. Brinkschmidt 2 · H.-R. Casser 3 · A. Diezemann 3 · I. Gralow 4 · D. Irnich 5 · U. Kaiser 6 · B. Klasen 2 · K. Klimczyk 7 · J. Lutz 8 · B. Nagel 3 · M. Pfingsten 9 · R. Sabatowski 6 · R. Schesser 7 · M. Schiltenwolf 10 · D. Seeger 9 · W. Söllner 11 1 Abteilung für Schmerztherapie, Klinikum Dachau, Dachau 2 Algesiologikum, München 3 DRK Schmerz-Zentrum Mainz, Mainz 4 Schmerzambulanz und Schmerz-Tagesklinik, Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Münster 5 Interdisziplinäre Schmerzambulanz, Klinik für Anaesthesiologie, Klinikum der Universität München, München 6 UniversitätsSchmerzCentrum, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden 7 Interdisziplinäres Schmerzzentrum, m&i-Fachklinik Enzensberg, Hopfen am See 8 Interdisziplinäre Schmerztherapie, Zentralklinik Bad Berka, Bad Berka 9 Schmerztagesklinik und -ambulanz, Zentrum für Anaesthesiologie, Rettungs- und Intensivmedizin, Universitätsmedizin Göttingen, Göttingen 10 Bereich konservative Orthopädie, Schmerztherapie, Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Heidelberg 11 Klinik für Psychosomatische Medizin & Psychotherapie und Interdisziplinäre Schmerztagesklinik, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Nürnberg Multimodale Schmerztherapie für die Behandlung chronischer Schmerzsyndrome Ein Konsensuspapier der Ad-hoc-Kommission Multimodale interdisziplinäre Schmerztherapie der Deutschen Schmerzgesellschaft zu den Behandlungsinhalten Einleitung
    Full-text · Article · Jan 2014
  • Chapter: Terminology
    Dominik Irnich · Roland Gautschi · Nicolas Behrens

    No preview · Chapter · Dec 2013
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    ABSTRACT: The German Associations for Acupuncture, after achieving consensus, have unanimously approved and submitted blueprints on the projected revision of professional development in acupuncture and specialization in Chinese Medicine. Subsequently, the propositions will be quoted in full and explained.
    No preview · Article · Dec 2013 · Deutsche Zeitschrift für Akupunktur
  • Nicolas Behrens · Dominik Irnich

    No preview · Chapter · Dec 2013

  • No preview · Chapter · Dec 2013
  • D. Irnich

    No preview · Article · Dec 2013 · Deutsche Zeitschrift für Akupunktur

Publication Stats

2k Citations
286.17 Total Impact Points

Institutions

  • 2009-2014
    • Technische Universität München
      München, Bavaria, Germany
  • 2002-2014
    • Ludwig-Maximilian-University of Munich
      • Department of Anesthesiology
      München, Bavaria, Germany
  • 2010-2013
    • University Hospital München
      München, Bavaria, Germany
    • University of Duisburg-Essen
      • Lehrstuhl für Naturheilkunde und Integrative Medizin
      Duisburg, North Rhine-Westphalia, Germany
    • Universitätsmedizin Göttingen
      Göttingen, Lower Saxony, Germany
  • 2008
    • Interdisciplinary Oncology Center
      München, Bavaria, Germany