F. Ceccherelli

Comparison of superficial and deep acupuncture in the treatment of lumbar myofascial pain: a double-blind randomized controlled study.

ObjectiveThe aim of the study was to compare the therapeutic effect of the superficial and in-depth insertion of acupuncture needles in the treatment of patients with chronic lumbar myofascial pain. DesignA prospective randomized double-blind study of superficial and deep acupuncture was conducted. SettingThe study was conducted in the Pain Service Unit of the University of Padova. PatientsThe study comprised 42 patients with lumbar myofascial pain who were divided into two equal groups (A and B). InterventionIn group A, the needle was introduced in the skin at a depth of 2 mm, whereas in group B the needle was placed deeply into muscular tissue. The treatment was planned for a cycle of eight sessions. Outcome MeasuresThe intensity of pain was evaluated with the McGill Pain Questionnaire before and after treatment and at the 3-month follow-up examination. ResultsAlthough at the end of the treatment there was no evidence of significant statistical differences between the two different groups, pain reduction was greater in the group treated with deep acupuncture. A statistical difference existed between the two groups at the 3-month follow up, with a better result in the deeply stimulated group. ConclusionsClinical results show that deep stimulation has a better analgesic effect when compared with superficial stimulation.

Acupuncture Modulation of Capsaicin-Induced Inflammation: Effect of Intraperitoneal and Local Administration of Naloxone in Rats. A Blinded Controlled Study

OBJECTIVE It is believed that acupunctural stimulation induces an analgesic response mainly through a central mechanism: that is, through an increase in the production of opioid peptides and their release at different levels in the nervous system. We sought to establish whether the modulating effect of acupuncture on experimental neurogenic edema can be attributed to a central mechanism only or whether a peripheral mechanism could also exist. Intraperitoneal administration was compared to local administration in the same paw in rats that were injected with capsaicin and in the same dermatome of the acupunctural stimulation. MATERIALS AND METHODS Experimentation was conducted on 105 male Sprague-Dawley rats weighing 180-220 g, divided into 7 groups as follows: group 1, control; groups 2-4 (15 animals), stimulated with manual acupuncture; group 3 also treated with intraperitoneal naloxone 1 mg/kg; group 4 also treated locally with naloxone (20 microg); groups 5-7 (15 animals), stimulated with 5 Hz and 5 mA electroacupuncture (EAP); group 6 also treated with intraperitoneal naloxone, 1 mg/kg, group 7 also treated locally with naloxone (20 microg). RESULTS The results indicate that the administration of 1 mg/kg of naloxone intraperitoneally can inhibit the modulating effect of acupunctural stimulation. Equally effective in inhibiting the modulating effect of acupunctural stimulation, although not having a systemic effect, is a 20-microg dose of naloxone administered peripherally on the site of edema induction. CONCLUSION It is possible to conclude that both systemic and peripheral mechanisms seem to be implicated in the modulating effect of acupuncture on the neurogenic inflammation mechanism.

Modifications of [3H]imipramine binding sites in platelets of chronic pain patients treated with mianserin

&NA; Tritiated imipramine binding to whole platelets was measured in 16 chronic pain patients who were free from major depression, and in a control group. The maximum binding was significantly lower in chronic pain patients than in the control group, whereas the binding affinity was not significantly different. Twelve patients were treated with mianserin for 21 days; this produced a significant improvement in the mean scores for pain (evaluated with the McGill Questionnaire) and depressive symptoms (assessed with the Zung Self‐Rating Scale). The improvement in both types of symptom was accompanied by a significant mean increase in the density of the [3H]imipramine binding sites without modifications in the values of the constant of affinity. All the patients who responded well to treatment (N = 8) had a family history of depressive spectrum disorders (DSD), while none of those who failed to respond had a first degree relative with DSD.

Myofascial pain mimicking radicular syndromes.

Myofascial pain is very often underscored and misunderstood in clinical practice. In many cases the localization of myofascial pain may resemble other diseases, such as radicular syndromes (e.g., low back pain from herniated disc) and even diseases of internal organs (e.g., angina pectoris, bowel diseases or gynaecological disturbances). In pain clinics one can routinely see patients with myofascial painful disorders showing a radicular topography and normal CT and MRI: as a consequence, when vertebral abnormalities are present on CT or MRI, it should be checked whether the cause of pain is radicular, myofascial, or both. On the other hand, the conventional approach to painful disorders may lead to errors and wrong diagnosis, depending on several factors: a) pain is often considered a symptom of an organic disease; b) the diagnosis is usually directed towards the structural cause of pain only; c) the functional components of the suffering patient are underscored; d) the site of pain may introduce some bias. When the latter is concerned, it is usually admitted that a neck pain may depend on muscle contraction (e.g. torticollis), while such a cause is less commonly admitted for leg, where the attention is first directed towards the sciatic nerve; myofascial origin of pain is even less considered in abdominal or pelvic painful disorders, where patients with no structural detectable diseases are often considered as neurotic and referred to the psychiatrist. The reason for this topographical dependence of diagnosis lies in the conventional attitude to focus on the most relevant and frequent organic diseases, thus introducing a bias with relevant epistemological implications.

[3H] Imipramine binding sites are decreased in platelets of chronic pain patients

ABSTRACT— Tritiated imipramine binding to whole platelets was measured in sixteen chronic pain patients not suffering from major depression and in a control group. Maximum binding was significantly lower in chronic pain patients than in the control group, whereas the binding affinity was not significantly different.

Neck pain treatment with acupuncture: does the number of needles matter?

ObjectivesAcupuncture has been successfully used in myofascial pain syndromes. However, the number of needles used, that is, the dose of acupuncture stimulation, to obtain the best antinociceptive efficacy is still a matter of debate. The question was addressed comparing the clinical efficacy of two different therapeutic schemes, characterized by a different number of needles used on 36 patients between 29–60 years of age with by a painful cervical myofascial syndrome. MethodsPatients were divided into two groups; the first group of 18 patients were treated with 5 needles and the second group of 18 patients were treated with 11 needles, the time of needle stimulation was the same in both groups: 100 seconds. Each group underwent six cycles of somatic acupuncture. Pain intensity was evaluated before, immediately after and 1 and 3 months after the treatment by means of both the Mc Gill Pain Questionnaire and the Visual Analogue Scale (VAS). In both groups, the needles were fixed superficially excluding the two most painful trigger points where they were deeply inserted. ResultsBoth groups, independently from the number of needles used, obtained a good therapeutic effect without clinically relevant differences. ConclusionsFor this pathology, the number of needles, 5 or 11, seems not to be an important variable in determining the therapeutic effect when the time of stimulation is the same in the two groups.

Postoperative pain treated by intravenous l-tryptophan: a double-blind study versus placebo in cholecystectomized patients

&NA; The effectiveness of intravenous administration (i.v.) of l‐tryptophan, which is the precursor of cerebral serotonin, was verified in the treatment of postoperative pain. The study was carried out on 45 female patients, aged between 34 and 61 years, undergoing cholecystectomy who were randomly divided into three groups. Group 1 (age: 50.33 ± 8.64 years) received 100 ml of 5% mannitol solution i.v.; group 2 (age: 49.80 ± 11.11 years) 100 ml of a mannitol solution containing 7.5 mg/kg l‐tryptophan; and group 3 (age: 53.46 ± 9.60 years) 100 ml of a mannitol solution containing 15 mg/kg l‐tryptophan. Vital capacity (preoperative VC) was measured before surgery. Anesthesia used was isoflurane. Narcotics or neuroleptics were not used. Pain was assessed before treatment (T‐0 min), at the end of administration (T‐30) and at T‐60, 120, 180, 240, 300 and 360 min by the following variables: respiratory rate (RR), heart rate (HR), mean arterial pressure (MAP), Scott‐Huskisson test (VAS), pain vital capacity (PVC), analgesic vital capacity (AVC), and respiratory restoration factor (RRF) calculated from Bromages formula (RRF = (AVC ‐ PVC/preoperative VC ‐ PVC) × 100). As regards variables RR, HR, MAP and VAS, differences between the values from T‐30 to T‐360 and the value at T‐0 were calculated. Means and S.E.M. were calculated on the obtained values and on RRF values for each group. The significance of the differences between groups was calculated using Students t test and Bonferronis test. Results show a significant decrease of pain in groups 2 and 3 treated with l‐tryptophan, in comparison with group 1 (controls). No significant difference was observed between the treated groups, although more lasting pain relief was observed in group 3 in comparison with group 2. Intravenous l‐tryptophan showed its effectiveness in the treatment of postoperative pain even when used alone. Its use may be considered for patients with renal failure, in order to strengthen pharmacological analgesia or to prevent postoperative pain by its intraoperative administration.

Comparison study between acupuncture and pentazocine analgesic and respiratory post-operative effects.

The authors studied the effects of acupuncture and pentazocine on post-operative respiratory function and pain management on patients hysterectomized by means of a subumbilical midline incision. The acupunctural technique consisted of GB-26, St-36, Sp-6 and auricular Shen-Men bilateral electrostimulation for 40 minutes. The analgesic effect of acupuncture was equivalent to that of 30 mg pentazocine, yet the most important effect of acupuncture consisted in a net increase of vital capacity during the period of acupuncture analgesia that lasted for 3-4 hr after stimulation; contrariwise, pentazocine did not cause any vital capacity increment and vital capacity remained at the levels observed prior to narcotic administration.

Analgesic effect of subcutaneous administration of oxygen-ozone. A blind study in the rat on the modulation of the capsaicin-induced edema.

The Authors have explored a new complementary approach, employed in the last 40 years for, among other uses, medical purposes: oxygen-ozone therapy. Anecdotal works have highlighted interesting results obtained in disk herniation with infiltration of paravertebral muscles with oxygen-ozone. To verify the existence of a nociceptive effect and investigate a possible mechanism of action, an experimental model of edema induction by subcutaneous capsaicin injection in the rat paw was employed. Oxygen-ozone, in different concentrations (10 microg/ml, 20 microg/ml and 30 microg/ml) has been injected both ipsi- and contralaterally to the paw 30 minutes before the administration of 50 microg capsaicin in 50 microl of physiological solution. Results show that the contralateral injection of the O2-O3 mixture modulates the edema response in the paw. Statistical significance, for the 20 microg/ml mixture, lasts as far as 45 minutes after administration of the capsaicin. No efficacy has been found for the 10 and 30 microg/ml concentrations. An injection of the same quantity of gas in the ipsilateral paw to the capsaicin-induced edema determines a worse edema than that observed in the control group, as if the ozone mixture added its irritative effect to that of capsaicin. It is interesting to note that the administration of oxygen alone cause a greater edema than the oxygen-ozone mixture.

The effects of acupuncture after thyroid surgery: A randomized, controlled trial.

BACKGROUND Acupuncture is a safe and well-tolerated treatment for pain relief. Previous studies supported the effectiveness of several acupuncture techniques for postoperative pain. The aim of this randomized, controlled trial was to evaluate the efficacy of acupuncture in reducing pain after thyroid surgery. METHODS We randomized 121 patients to a control group (undergoing only standard postoperative analgesic treatment with acetaminophen) and an acupuncture group, undergoing also either electroacupuncture (EA) or traditional acupuncture (TA). Pain was measured according to intraoperative remifentanil use, acetaminophen daily intake, Numeric Rating Scale (NRS), and McGill Pain Questionnaire on postoperative days (POD) 1-3. RESULTS Acupuncture group required less acetaminophen than controls at POD 2 (P = .01) and 3 (P = .016). EA patients required less remifentanil (P = .032) and acetaminophen than controls at POD 2 (P = .004) and 3 (P = .008). EA patients showed a trend toward better NRS and McGill scores from POD 1 to 3 compared with controls. EA patients had a lower remifentanil requirement and better NRS and McGill scores than TA patients. No differences occurred between TA patients and controls. CONCLUSION Acupuncture may be effective in reducing pain after thyroid surgery. EA is more useful; TA achieves no significant effects.