Giuseppe Gagliardi

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.

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.

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 role of the intensity of low frequency electroacupuncture stimulation on the modulation of capsaicin-induced edema in the rat paw. A blind controlled study.

Experimental animal and clinical human data suggest that electroacupuncture (EAP) reduces the release of substance P from sensitive neurons, both at medullar level and in the periphery. Aim of our study is to verify the effect of different intensities of stimulation on edema induced by subcutaneous administration of capsaicin. The study was performed on 72 male Sprague-Dawley rats divided into 4 experimental groups according to the intensity of electrostimulation (5, 10, 50, 70 mA) and a control group. A constant current electrical stimulator delivering positive and negative biphasic wave (duration of one pulse wave complex: 500 microsec; pulse repetition rate: 5/sec) has been used for the stimulation. The lowest intensity of stimulation (5 mA) was effective in the prevention of neurogenic edema. Conversely, higher stimulation intensities, namely 10 and 50 mA, were not effective in reducing edema. Stimulation at 70 mA caused a worsening of edema, probably due to an increased release of substance P in the paw.

Efecto de la metoclopramida sobre la analgesia producida por la acupuntura y la electroacupuntura: estudio simple ciego controlado en ratas

Resumen Antecedentes La metoclopramida es un antagonista selectivo de receptores dopaminergicos DA 2 . En dosis elevadas parece mostrar tambien propiedades antagonistas frente a receptores DA 1 . Se ha demostrado que el sistema dopaminergico esta estrechamente relacionado con los efectos mediados por los opioides; mas concretamente, se ha observado en el modelo de rata que la destruccion de receptores DA 2 aumenta la analgesia producida por los agonistas μ y κ 1 . El papel que desempena la dopamina en la analgesia inducida por la acupuntura aun no se ha aclarado completamente y los datos disponibles sobre este aspecto son escasos y contradictorios. Objetivo El objetivo del presente estudio es aclarar la cuestion de si la metoclopramida puede potenciar la eficacia analgesica de la acupuntura tradicional y la electroacupuntura en las ratas. Metodo En el estudio se utilizaron 140 ratas Sprangue-Dawley de pesos comprendidos entre 180 g y 220 g, distribuidas en 7 grupos de tratamiento de 20 ratas cada uno. El grupo 1 de referencia no fue sometido a ninguna manipulacion, el grupo 2 de referencia fue manipulado pero sin tratamiento (ni acupuntura ni metoclopramida), el grupo 3 fue tratado con metoclopramida, el grupo 4 con acupuntura, el grupo 5 con acupuntura y metoclopramida, el grupo 6 con electroacupuntura y metoclopramida y, finalmente, el grupo 7 recibio solamente electroacupuntura. El umbral del dolor fue medido con una prueba plantar. Resultados En todo el experimento no se observaron variaciones significativas en el umbral del dolor en ninguno de los grupos de referencia. Las ratas que recibieron metoclopramida mostraron un umbral del dolor mas elevado. Los grupos que recibieron acupuntura o electroacupuntura exhibieron en la prueba plantar un umbral del dolor mas alto. El tratamiento previo con metoclopramida aumento el efecto analgesico de la estimulacion. Conclusiones Se pudo demostrar que la metoclopramida posee efectos analgesicos y puede potenciar el efecto analgesico de la acupuntura y la electroacupuntura.