Motohiro Inoue

Relief of low back pain immediately after acupuncture treatment – a randomised, placebo controlled trial

Background The purpose of this study was to examine the immediate effect of single acupuncture stimulation to the most painful point in patients with low back pain. Method A randomised, evaluator-blinded, sham controlled clinical trial was conducted in which 31 patients with low back pain were randomly allocated to either an acupuncture group (n=15) or a sham acupuncture group (n=16). Both acupuncture and sham acupuncture were performed at the most painful point on the lower back of the subjects. For the acupuncture group, a stainless steel needle was inserted to a depth of 20mm and manually stimulated (sparrow pecking method) for 20 seconds, while for the sham treatment a guide tube without a needle was placed at the point and tapped on the skin. Changes in low back pain were evaluated with a visual analogue scale (VAS) and the Schober test. Participants were also asked if they felt the needling sensation or not. The therapy and the evaluation were independently performed by two different acupuncturists. Results VAS score and the Schober test score showed significant improvement after treatment as compared with the sham group (P=0.02, 0.001, respectively). There were no significant differences in the needling sensation between the acupuncture and sham group. Conclusion These results suggest that acupuncture at the most painful point gives immediate relief of low back pain.

Acupuncture Treatment for Low Back Pain and Lower Limb Symptoms—The Relation between Acupuncture or Electroacupuncture Stimulation and Sciatic Nerve Blood Flow

To investigate the clinical efficacy of acupuncture treatment for lumbar spinal canal stenosis and herniated lumbar disc and to clarify the mechanisms in an animal experiment that evaluated acupuncture on sciatic nerve blood flow. In the clinical trial, patients with lumbar spinal canal stenosis or herniated lumbar disc were divided into three treatment groups; (i) Ex-B2 (at the disordered level), (ii) electrical acupuncture (EA) on the pudendal nerve and (iii) EA at the nerve root. Primary outcome measurements were pain and dysesthesia [evaluated with a visual analogue scale (VAS)] and continuous walking distance. In the animal study, sciatic nerve blood flow was measured with laser-Doppler flowmetry at, before and during three kinds of stimulation (manual acupuncture on lumber muscle, electrical stimulation on the pudendal nerve and electrical stimulation on the sciatic nerve) in anesthetized rats. For the clinical trial, approximately half of the patients who received Ex-B2 revealed amelioration of the symptoms. EA on the pudendal nerve was effective for the symptoms which had not improved by Ex-B2. Considerable immediate and sustained relief was observed in patients who received EA at the nerve root. For the animal study, increase in sciatic nerve blood flow was observed in 56.9% of the trial with lumber muscle acupuncture, 100% with pudendal nerve stimulation and 100% with sciatic nerve stimulation. Sciatic nerve stimulation sustained the increase longer than pudendal nerve stimulation. One mechanism of action of acupuncture and electrical acupuncture stimulation could be that, in addition to its influence on the pain inhibitory system, it participates in causing a transient change in sciatic nerve blood blow, including circulation to the cauda equine and nerve root.

The effects of electroacupuncture on peripheral nerve regeneration in rats

This study was designed to examine the effects of electroacupuncture with direct current (DC) on peripheral nerve regeneration. The left sciatic nerve of 55 7-month-old rats was crushed at the thigh. They were ramdomly allocated to four groups: distal cathode DC group (n=15), distal anode DC group (n=14), sham operated group (n=13), and control group (n=13). In the distal cathode DC group, a cathode electrode was connected to an insulated acupuncture needle inserted at 1 cm distal to the injured site, while an anode electrode was connected to a needle inserted at 1 cm proximal to the lesion. In the distal anode DC group, the anode and the cathode electrode were connected to the needle at 1cm distal and proximal to the lesion respectively. In the sham operated group, no electrical stimulation was given to the insulated needle inserted at the same site, and in the control group, no treatment was given. Regeneration of the sciatic nerve was evaluated by the number of evoked EMGs recorded at 12 sites in the plantar region, by their latency, and by the weight ratio of the tibialis anterior at four weeks after the crush injury. Regeneration of the peripheral nerve was faster and more accelerated in the distal cathode DC group than in the other groups, while in the distal anode DC group the regeneration was delayed. This result suggested electroacupuncture with cathode distal orientation might be a useful treatment having the advantage of enabling deeper insertion with minimal tissue damage.

Direct current electrical stimulation of acupuncture needles for peripheral nerve regeneration: an exploratory case series

Objective To examine the therapeutic effect of a novel therapeutic method based on electroacupuncture with intermittent direct current (DCEA) and associated adverse events in patients with peripheral nerve damage and a poor clinical prognosis. Methods In seven older patients with peripheral nerve damage (neurapraxia 2, axonotmesis 4, neuromesis 1), an acupuncture needle connected to an anode electrode was inserted proximal to the site of the injury along the route of the nerve, while the cathode electrode was inserted into the innervated muscle, and DCEA was performed (100 Hz for 20 min, weekly). Muscular paralysis was evaluated weekly with manual muscle testing, the active range of motion of joints related to the muscular paralysis and, when necessary, needle electromyography. Adverse events were also recorded during the course of the treatment. Results Complete functional recovery was observed in the two cases with neurapraxia and two with axonotmesis, while one axonotmesis case achieved improvement and the other showed reinnervation potential without functional recovery. No improvement was observed in the neurotmesis case. Pigmentation of the skin where the anode needle was inserted occurred in three cases. Although there was no definite causal link, one case showed excessive formation and resorption of bone in the area close to the cathode needle site. Discussion Accelerated nerve regeneration caused by DCEA may contribute to recovery. The skin pigmentation and callus formation suggest that the shape of the anode electrode, current intensity and other factors should be examined to establish a safer treatment method.

Comparison of the effectiveness of acupuncture treatment and local anaesthetic injection for low back pain: a randomised controlled clinical trial

Objective To compare the effectiveness of repeated acupuncture stimulation and local anaesthetic injection at the most painful points in patients with low back pain. Method This randomised controlled clinical trial involved 26 patients with low back pain randomly allocated to either an acupuncture group (n = 13) or a local anaesthetic injection group (n = 13). Both acupuncture and anaesthetic injection were performed at two to five of the most painful points on the lower back once weekly for 4 weeks. In the acupuncture group, a 0.18 mm diameter stainless steel needle was inserted to a depth of 10–20 mm and manual stimulation was applied. In the local anaesthetic injection group, a 0.5 mm diameter needle was inserted to a depth of 10–20 mm and a local anaesthetic was injected. Participants evaluated pain using a Visual Analogue Scale immediately before and after the first treatment, before each subsequent treatment, and at 2 weeks and 4 weeks after completion of treatment. Results There was a significant difference between the two groups in the change in Visual Analogue Scale pain scores (p<0.01), with acupuncture providing more favourable results than local anaesthetic injection. The reduction in pain score from baseline calculated at each time period was significantly different between the two groups after the first (p<0.05) and final (p<0.01) treatments, and during the follow-up period (after 2 weeks (p<0.01) and 4 weeks (p<0.05)). Conclusion Both injection and acupuncture relieved pain, but acupuncture was superior for the immediate and sustained effects, suggesting that it is a useful treatment for low back pain. The difference in the effects may be attributable to differences in the mechanism of pain suppression.

Spinal nerve root electroacupuncture for symptomatic treatment of lumbar spinal canal stenosis unresponsive to standard acupuncture: a prospective case series

Objective To study the effectiveness of electroacupuncture of the spinal nerve root using a selective spinal nerve block technique for the treatment of lumbar and lower limb symptoms in patients with lumbar spinal canal stenosis. Methods Subjects were 17 patients with spinal canal stenosis who did not respond to 2 months of general conservative treatment and conventional acupuncture. Under x-ray fluoroscopy, two acupuncture needles were inserted as close as possible to the relevant nerve root, as determined by subjective symptoms and x-ray and MRI findings, and low-frequency electroacupuncture stimulation was performed (10 Hz, 10 min). Patients received 3–5 once-weekly treatments, and were evaluated immediately before and after each treatment and 3 months after completion of treatment. Results After the first nerve root electroacupuncture stimulation, scores for lumbar and lower limb symptoms improved significantly (low back pain, p<0.05; lower limb pain, p<0.05; lower limb dysaesthesia, p<0.01) with some improvement in continuous walking distance. Symptom scores and continuous walking distance showed further improvement before the final treatment (p<0.01), and a significant sustained improvement was observed 3 months after completion of treatment (p<0.01). Conclusion Lumbar and lower limb symptoms, for which conventional acupuncture and general conservative treatment had been ineffective, improved significantly during a course of electroacupuncture to the spinal nerve root, showing sustained improvement even 3 months after completion of treatment. The mechanisms of these effects may involve activation of the pain inhibition system and improvement of nerve blood flow.

The effect of electroacupuncture on tendon repair in a rat Achilles tendon rupture model.

Objective To examine the effect of electroacupuncture (EA) on early post-rupture tendon repair in a rat model of Achilles tendon rupture using histological and mechanical evaluation. Methods An Achilles tendon rupture model was prepared in 90 Wistar rats, which were randomly assigned to EA, manual acupuncture or control groups. Rats in the EA group received EA (pulse width 5 ms; stimulation frequency 50 Hz; stimulation strength 20 μA; stimulation time 20 min) daily from 1 day following model preparation until the day of assessment (either 7 or 10 days after model preparation), when the region of interest was sampled to assess tendon repair using in vitro methods. Total cell count and the number of cells staining positive for transforming growth factor-β1 (TGF-β1) and basic fibroblast growth factor (b-FGF) were measured. Tension tests were performed 10 days after model preparation to measure the maximum breaking strength of the repaired tendon. Results Both the total cell count and the number of cells positive for b-FGF were significantly higher in the EA group (p<0.05). In the EA group only, immunostaining showed strong expression of TGF-β1 7 days after model preparation (p<0.05). Maximum breaking strength of the repaired tendon 10 days after model preparation was significantly higher in the EA group (p<0.01). Conclusions The marked increase in cell count and growth factor expression as well as increased tendon strength in the EA group suggest that EA may be a useful method for promoting tendon repair.

Effect of electroacupuncture on the healing process of tibia fracture in a rat model: a randomised controlled trial

Background Electrical stimulation is used to promote bone reunion, and is most effective when applied directly to the fracture site. Objective To examine the effects of electroacupuncture (EA) on the healing process of tibia fracture in a rat model. Methods Thirty 12-week-old male Wistar rats underwent unilateral open osteotomies of the tibiae. The rats were then assigned randomly to three groups: EA group (n=10), sham group (n=10) and control group (n=10). In the EA group, a cathodal electrode was connected to an acupuncture needle percutaneously penetrated directly at the surgery site, while an acupuncture needle inserted at 15 mm proximal to the surgery site was used as an anodal electrode. EA (50 Hz, 20 μA, 20 min) was performed daily for 3 weeks. In the sham group the acupuncture needles were inserted at the same sites but no electrical stimulation was given and in the control group, no treatment was given. The response was evaluated at 1, 3, 4 and 6 weeks after surgery by radiographic, macroscopic and mechanical examinations. Results The EA group showed accelerated bone healing (EA group 29.92±4.55 mm2, sham group 26.46±5.21 mm2, control group 26.19±2.81 mm2, p<0.05 at 3 weeks) and accretion of the callus (radiographic evaluation: EA group 35.66±4.37 mm2, sham group 32.60±5.73 mm2, control group 29.72±6.39 mm2, p<0.05 at 6 weeks) compared with the other groups. Mechanical testing also showed an excellent result (EA group 16.54±9.92 N, sham group 7.13±3.57 N, control group 6.67±3.12 N, p<0.05) at 6 weeks in the EA group compared with the other groups. There was no difference between the sham and control groups in any evaluation. Conclusion The use of EA enhanced callus development and bone mineralisation during the bone healing process.

The effect of electroacupuncture on osteotomy gap healing in a rat fibula model

Objective To examine the effect of electroacupuncture (EA) on osteotomy gap healing in a rat fibula model. Methods A total of 40 12-week-old male Wistar rats underwent unilateral open osteotomy of the fibula to create a 2 mm gap. The rats were randomly assigned to an EA group (n=20) and a control group (n=20). In the EA group, a cathodal electrode was connected to an acupuncture needle percutaneously at the surgery site, while another acupuncture needle inserted 15 mm proximal to the surgery site was used as an anodal electrode. EA was performed 5 days a week for 6 weeks. The control group received no treatment. Some rats were killed at 3 days and 1 week after surgery and the cut end of the distal part of the fibula was surgically removed and histologically assessed. Haematoxylin and eosin (H&E) staining was used to measure total cell count and immunohistochemical staining to assess the increase in the bone morphogenetic protein 2 (BMP-2)-positive cells. The healing process was also assessed weekly after surgery via x-ray examinations. Results At each time point, total cell count showed a marked increase in the EA group (p<0.05), while BMP-2 expression showed a tendency to increase in the EA group. Radiological examination showed a marked reduction in the distance between the cut ends of the fibula in the EA group. Conclusions There was a marked increase in cell count and expression of growth factor in the EA group. These results indicate direct current EA could be useful for promoting bone healing.

Clinical effect of acupuncture on cervical spondylotic radiculopathy: results of a case series

Objective To observe the effectiveness of acupuncture applied to the cervical region of patients with upper extremity radicular symptoms due to cervical spondylotic radiculopathy (CSR). Methods 15 subjects diagnosed with CSR and with upper extremity pain and/or paraesthesiae for 13.1±18.0 months were selected. The 15 patients had 16 affected limbs and scored a total of 17 symptom scores of pain and/or paraesthesiae. All patients were treated with acupuncture once a week for 4 weeks at up to 10 sites in the cervical paraspinal region centred on the affected area. The severity of the symptoms was recorded using a visual analogue scale (VAS) and functional evaluation was conducted using a Neck Disability Index (NDI). Results A significant reduction over time was seen for both mean VAS (p<0.0001) and NDI (p<0.0001). Changes were still significant at 4-week follow-up. A 50% reduction in symptoms was scored for 15 of the 17 symptoms scored. Conclusions Favourable results were seen in nearly 90% of cases. These results show that acupuncture treatment to the cervical region may be effective as a conservative therapy for treating CSR.