Naoto Ishizaki

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.

Repeated application of low-frequency electroacupuncture improves high-fructose diet-induced insulin resistance in rats

Background Insulin resistance is frequently present in obesity and during the development of type 2 diabetes mellitus. Objective The purpose of the present study was to investigate the effect of electroacupuncture (EA) on high-fructose diet (HFD)-induced insulin resistance. Methods Male Wistar rats were fed HFD for 4 weeks and developed insulin resistance. Insulin sensitivity was assessed by clamp. The number of animals was seven, eight and seven in the control, HFD and HFD+EA groups, respectively. AMP-activated protein kinase (AMPK) and glucose transporter 4 (GLUT4) in skeletal muscle were measured by Western blotting analysis (n=7 in each group). EA stimulation was carried out 12 times over 4 weeks at an intensity of 1–3 mA and a frequency of 2/15 Hz in a conscious state without restraint. Results There was no significant difference in mean body weight and fasting blood glucose concentration between groups at the end of the experiment. The mean glucose infusion rate during the clamp was significantly lower in the HFD group than in controls (p<0.05). There was no significant difference in expression of GLUT4 in skeletal muscle in the control and each group. Phosphorylated AMPKα (Thr172) in skeletal muscle showed a significant increase immediately after the final EA stimulation when compared with the control group (p<0.05). Conclusion Repeated application of EA is capable of improving diet-induced insulin resistance, probably through activation of AMPK signalling pathways in skeletal muscle. These results suggest that repeated application of EA may have beneficial effects on diet-induced insulin resistance.

Public status and prevalence of acupuncture in Japan.

Acupuncture originated in China and is widespread throughout Asia. It is expected that a higher utilization of this remedy exists in these countries compared to Western countries. We conducted annual nationwide surveys from 2003 through 2006 on the utilization of acupuncture in Japan. Face-to-face interviews were conducted with 2000 individuals randomly chosen from the resident database. Annual utilization percentages, based on the number of respondents, from 2003 to 2006 were 6.5%, 4.8%, 6.4%, and 6.7%, respectively, while lifetime experiences determined in each surveys were estimated as 26.7, 19.4, 24.4 and 25.4, respectively. Respondents who had utilized acupuncture and/or moxibustion tended to be older than those who had no experience. Acupuncture was mainly used for musculoskeletal symptoms, and a detailed breakdown of the musculoskeletal symptoms identified in the 2005 survey showed 50.9% for low back pain, 35.9% for shoulder stiffness and 12.0% for knee pain. Reasons given for continuing therapy included the effective amelioration of symptoms, comfort of the procedure and low number of side-effects, while those who decided against continuing cited no improvement of symptoms, cost and lack of time for treatment. In conclusion, annual utilization of acupuncture and/or moxibustion was estimated at more than 6%, and the percentage of those with a lifetime experience was ∼25%, thus demonstrating the relatively higher utilization of the remedy in Japan over utilization in western countries. Application of the treatment for musculoskeletal problems and utilization by the older population were specific standouts of the use of acupuncture and/or moxibustion in Japan.

Combined standard medication and acupuncture for COPD: a case series

Background Traditional acupuncture has been used in patients with chronic obstructive pulmonary disease (COPD). However, only a few studies have been performed to determine the efficacy of this treatment. Objective To observe changes in the symptoms of COPD during acupuncture treatment in patients with COPD stratified according to the severity of the disease. Methods A prospective case series of 26 patients with dyspnoea on exertion due to COPD was followed from October 2004 to October 2008 in the Departments of Respiratory Internal Medicine, Gifu University of Medicine and Meiji University of Integrative Medicine, Japan. All participants received acupuncture treatments once a week for 10 weeks in addition to standard medication therapy. The main outcome measure was the modified Borg dyspnoea scale after the 6 min walk test (6MWT) and the secondary outcome measure was the BODE index. Results All 26 patients showed significant improvement in the Borg dyspnoea scale after 10 weeks of acupuncture treatment (from 4.02 (2.85) to 1.96 (1.97), mean difference −2.06, 95% CI −3.03 to −1.09, p=0.0002, paired t test). Improvements in the BODE index, 6MWT and oxygen saturation during exercise, which indicates better reduced dyspnoea on exertion and prognosis, were also found. Conclusion The results of this study suggest that acupuncture treatment has clinically useful effects, at least in the short term, in reducing dyspnoea on exercise in patients with COPD, particularly in those more severely affected.

Evidence in Safety Issue of Acupuncture (1)

鍼灸臨床で行われている安全性に関する知識や手順には、科学的根拠に乏しい逸話や思い込みも含まれている。鍼灸の安全性を向上させるためには、エビデンスがどれくらい蓄積しているかを整理し、吟味し、活用することが重要である。全日本鍼灸学会研究部安全性委員会では、現在までに報告されている鍼灸の安全管理に関連する研究成果をレビューする作業を開始した。2004年度に取り上げたテーマは次のとおりである : 1. 鍼灸学校における安全性教育と損害賠償の現状2. 手洗いと手指消毒法3. 施術野の消毒法4. 刺鍼から抜鍼までの操作5. 安全な刺鍼深度6. 施術環境の衛生この作業で明らかになった知識や疑問が、学校教育、日常臨床、マニュアル作成、および研究に反映されることを望んでいる。

The effect of acupuncture stimulation to the bilateral quchi points on insulin secretion.

曲池穴刺激の血清インスリン分泌への影響を調べるために, 両側曲池穴に, 1cm直刺刺入を行った置鍼刺激群, 通電刺激を加えた通電刺激群, さらには2群に対し経穴コントロールとして曲池穴より外側に1.5cm離した部位の置鍼刺激群, 通電刺激群, 無刺激群の5群に対しブドウ糖負荷試験を行い, 血糖値, 血清インスリン値を測定した。結果は両側曲池置鍼刺激群が負荷後30分において血清インスリン値が有意に高値を示し, また血清インスリン値の総和も有意に高値を示した。この事より両側曲池穴に対する置鍼刺激がインスリン分泌を亢進させることが示唆された。