Abstracts des SAR Symposion in Minneapolis

Vom 19.–20. Oktober 2001 fand im Pillsbury Auditorium, Hennepin County Medical Center, Minnesota das 8. jährliche Symposion der Society of Acupuncture Research statt.
Das Kongressprogramm war wie 2000 bei dem Symposion in Baltimore hervorragend und fokussierte auf den aktuellen Stand der wissenschaftlichen Forschung zur Akupunktur. 
Auch der aktuelle Stand der von den National Institutes of Health geförderten, klinischen Studien wurden in Vorträgen vorgestellt und diskutiert. Wie bereits in den letzten Monaten stellen wir an dieser Stelle die Abstracts des Symposiums als Serie hier ins Netz.

Zunächst den Beitrag:

"NIH funded acupuncture research in stroke and spinal cord injury"

Samuel C. Shiflett vom Center for Healing and Health, Beth Israel Medical Center, New York, NY

Three small pilot research projects studying acupuncture have been conducted at Kessler Institute for Rehabilitation (and its affiliated research organization, Kessler Medical Rehabilitation Research and Education Corporation). These have been part of a broader research program funded by grant #U24-HD32994, from the NIH, to study complementary and alternative therapies in the treatment of neurological disorders, including stroke, and spinal cord injury. Two studies involved treatment of pain in spinal cord injured subjects, the other involved the treatment of dysphagia in stroke patients. Data collection in all studies has been completed, and is in various stages of preparation for publication.

1. Acupuncture for dysphagia in stroke (Noel Nowicki, MD, and Allison Averell, MD, principal investigators). 18 stroke inpatients diagnosed with swallowing disorders using VFSS (Video fluoroscopic swallowing study) were treated with acupuncture and contrasted to 22 control patients who received only standard of care. Using a specially constructed aspiration rating scale, it was found that the acupuncture treated group was somewhat improved compared to the control group. An interaction suggested that the treatment was more effective for men than for women, who appeared to have a better natural recovery rate.

2. Acupuncture and Trager for wheelchair induced shoulder pain in spinal cord patients. (Trevor Dyson-Hudson, MD, principal investigator). 18 spinal cord injured individuals with shoulder pain attributable to wheelchair overuse were randomized to either acupuncture or a Trager bodywork condition. Both interventions showed substantial and roughly equal improvement in pain following a course of treatment. There was marginal evidence that suggested that acupuncture resulted in quicker resolution of pain than Trager, but that after three months the benefit of acupuncture was beginning to disappear (level of pain was increasing) while in the Trager group, pain remained at a lower level.

3. Acupuncture for pain and depression in spinal cord injured patients (Sangeetha Nayak, Ph.D., principal investigator) (co-funded by grant # 287 from the American Association of Spinal Cord Injury Psychologists and Social Workers). Twenty-two people with SCI who experienced moderate to severe pain of at least 6 months duration. The intervention consisted of a course of 15 acupuncture treatments administered over a 7½-week period. Forty-six percent of the sample showed improvement in pain intensity and pain sequelae following treatment. Treatment success may be related to whether the injury is complete and whether pain is above or below the level of injury. Risk of autonomic dysreflexia was monitored and found to be negligible.

Ein weiterer interessanter Beitrag beschäftigt sich mit dem Phänomen, daß Nadeln in den Akupunkturpunkten festgehalten werden.

Acupuncture needle grasp: Ultrasound analysis and clinical implications

Helene M Langevin, Junru Wu, David L Churchill, Gary J Badger and Jason A Yandow
Department of Neurology, University of Vermont, Burlington, VT

The insertion and manipulation of acupuncture needles is associated with a measurable biomechanical phenomenon termed "needle grasp", characterized by an increase in the force necessary to pull the acupuncture needle out of the skin (pullout force). Needle grasp is not due to a muscle contraction, and histological observations in rat tissue explants suggest that needle grasp involves connective tissue. We used high frequency (50 MHz) ultrasound scanning acoustic microscopy to further confirm quantitatively that changes in connective tissue architecture occur as a result of acupuncture needle rotation. Using this technique, we obtained high-resolution images of viable rat abdominal wall tissue explants into which an acupuncture needle had been inserted and either rotated for 32 revolutions, or not rotated. We hypothesized that the acoustic pattern generated by the main components of connective tissue (collagen, elastic fibers, fat, extracellular matrix) is more ordered after acupuncture needle rotation, compared with needle insertion alone without rotation.

A Fourier Transform analysis was performed on standardized polar coordinate lines (using the center of the needle as the origin) from the bitmap gray scale images created by the scanning acoustic microscope. For each line, this analysis yielded spatial frequency peaks corresponding to spatial periodicity in the image. The maximum peak gray level at a significantly low spatial periodicity (0.3-1.4 mm) was significantly higher with needle rotation (vs. p<) compared with acupuncture needle insertion alone without rotation (mean ± SE: 28.7 ± 2.2 vs. 21.9 ± 1.4, p=0.02). This indicates that connective tissue architectural order increased with acupuncture needle rotation. The images also suggest that this increased order is due to tissue winding around the needle and reorganization of tissue structures relative to the needle. Changes in connective tissue architecture may be perceived by the acupuncturist holding the needle, and therefore may be important clinically. This perception may constitute important feedback affecting how the acupuncturist chooses to further move (or not move) the needle.

During their training, acupuncturists learn to apply needle stimulation that is quantitatively and qualitatively appropriate to each clinical situation. Before needling, the acupuncturist will usually decide roughly what type of manipulation will be used (e.g. reducing method, reinforcing method, deep or shallow needling). Once the needle is inserted, the acupuncturist will carefully observe and feel for changes in the patient, and modify his/her behavior accordingly. This response to the feedback provided by the patient during needling is a key component of the acupuncturist’s skills. This feedback includes verbal communication of sensations experienced by the patient during needling, and also includes direct observation of changes such as skin color, facial expression, as well as local changes in the area of the needle. Local changes in the area of the needle can be perceived by acupuncturists with extremely small amounts of needle movement (less than one revolution of the needle, or up-and-down movements of a few millimeters). These changes can be very subtle, leading some authors to suggest that they occur on an "energetic" plane. Another possibility is that subtle material changes in the tissues are taking place, perhaps accompanied by related energetic phenomena.

In this study, we describe pronounced tissue architectural changes occurring as a result of a relatively large amount of acupuncture needle rotation (corresponding to pullout forces of the order of 500 grams in related experiments). Smaller amounts of needle manipulation are likely to be associated with more subtle tissue architectural changes. Whether large or small in magnitude, these changes in connective tissue architecture may have profound downstream effects. Mounting evidence suggests that mechanical deformation of tissue can lead to mechanical signal transduction into cells, polymerization of cellular actin cytoskeleton, activation of intracellular signaling pathways, changes in gene expression and cell contraction. These biochemical events may further contribute to the sensation perceived by the acupuncturist, and also may be components of acupuncture’s therapeutic effect. Modification of the acupuncturist’s skilled behavior in response to tissue changes caused by needle manipulation therefore may be a key to the treatment’s outcome.