|
|
|
|
Wissenschaft - Klinische Studien | ||||
|
Vom 19. – 20. Oktober 2001 fand im Pillsbury Auditorium, Hennepin
County Medical Center, Minnesota das 8. jährliche Symposion der Society
of Acupuncture Research statt. ACUPUNCTURE NEEDLE GRASP:
ULTRASOUND ANALYSIS AND CLINICAL IMPLICATIONS 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. Funded by the National Center for Complementary and Alternative Medicine, Grant #R21 AT00300. EFFECTIVENESS OF ADHESIVE EAR ACUPRESSURE STRIPS FOR CHRONIC HEADACHE, NECK PAIN AND LOW BACK PAIN George H Kramer, Frederrick T Strobl, James R Hulbert, Patricia D
Culliton Purpose: The research examined the short-term effectiveness of three specially designed adhesive ear acupressure strips for the respective relief of headache, neck pain and back pain. Method: The research is based on a single-group, four-panel, longitudinal survey. One hundred ninety-six participants with headache, neck pain, or low back pain were contacted at an AcuBead® booth at a "Women's Expo" in a large Midwestern city in January, 2001. At the time of the encounters, participants self-reported severity of headache, neck pain, or back pain as well as frequency and duration of their pain. The participants then rated their pain severity level on a 0 to 10 scale before placement of an ear acupressure strip and again at 5 minutes and 30 minutes. Participants were also contacted by telephone after one week, rating their pain one day and one week after application of the strips, as well as overall improvement. Primary analysis involved 12 paired-t analyses of participant-rated change in pain over one week. With the Bonferroni correction for multiple comparisons, the significance criterion (0.05/12) was p< .004. Results: Data from 146 (74%) participants indicating chronic pain (pain of one month duration or longer) were analyzed for this research. Change, as evaluated by paired-t modeling of participant change in pain, indicated significant (p< .004) decreases in VAS pain scores after 5 minutes, 30 minutes, one day, and one week for almost all four time periods for the three primary conditions (10 of 12 tests). In secondary, cross-tabular analyses, 80% (113 of 142) of the "chronic" participants noted some improvement in pain at 5 minutes and 89% (102 of 114) reported improvement at 30 minutes, with 61% (70 of 114) of the latter group reporting "good to excellent" results (decreases in severity of 50% or more). At one day and one week, of 71 participants responding to telephone follow-up interviews, 82% (58 of 71) reported decreased pain, with 59% (42 of 71) rating their pain after one day to be half as severe as it was at their initial visit. At the end of one week, 61% (39 of 64) reported improvement, with 41% (26 of 64) indicating the severity of their pain was cut in half. Conclusion: The evaluation involved a relatively large number of individuals who reported pain of over one month duration prior to their participation. The sample experienced, as a result, a de-facto one-month "natural history" lead-in before receiving acupressure beads. The findings provide strong evidence that adhesive ear acupressure strips offer an effective treatment for headache, neck pain and low back pain in an ambulatory population. Further research is planned, involving a delayed-treatment concurrent control group that will assess more definitively the effect of acupressure beads.
|
