Takako Matsubara

Comparative Effects of Acupressure at Local and Distal Acupuncture Points on Pain Conditions and Autonomic Function in Females with Chronic Neck Pain

Acupressure on local and distal acupuncture points might result in sedation and relaxation, thereby reducing chronic neck pain. The aim was to investigate the effect of acupressure at local (LP) and distal acupuncture points (DP) in females with chronic neck pain. Thirty-three females were assigned to three groups: the control group did not receive any stimuli, the LP group received acupressure at local acupuncture points, GB 21, SI 14 and SI 15, and the DP group received acupressure at distal acupuncture points, LI 4, LI 10 and LI 11. Verbal rating scale (VRS), Neck Disability Index (NDI), State-Trait Anxiety Inventory (STAI), muscle hardness (MH), salivary alpha-amylase (sAA) activity, heart rate (HR), heart rate variability (HRV) values and satisfaction due to acupressure were assessed. VRS, NDI, STAI and MH values decreased after acupressure in the LP and the DP group. HR decreased and the power of high frequency (HF) component of HRV increased after acupressure in only the LP group. Although acupressure on not only the LP but also the DP significantly improved pain conditions, acupressure on only the LP affected the autonomic nervous system while acupuncture points per se have different physical effects according to location.

The effect of acupressure at the extra 1 point on subjective and autonomic responses to needle insertion.

BACKGROUND: Premedication with sedatives can decrease the discomfort associated with invasive anesthetic procedures. Some researchers have shown that acupressure on the acupuncture extra 1 point is effective for sedation. We investigated whether acupressure on the extra 1 point could alleviate the pain of needle insertion. METHODS: We investigated the effect of acupressure at the extra 1 point or a sham point on needle insertion using verbal rating scale (VRS) pain scores and heart rate variability (HRV). Twenty-two healthy female volunteers were randomly allocated to two groups: the extra 1 group received acupressure at the extra 1 point, and the sham group received acupressure at a sham point. After starting the electrocardiogram record, a 27-gauge needle was inserted into the skin of a forearm. Thereafter, another needle was inserted into the skin of the other forearm during acupressure. RESULTS: Acupressure at the extra 1 point significantly reduced the VRS, but acupressure at the sham increased the VRS. Acupressure at the extra 1 significantly reduced the low frequency/high frequency ratio of HRV responding to needle insertion. CONCLUSIONS: Acupressure at the extra 1 point significantly reduced needle insertion pain compared with acupressure at the sham point. Also, acupressure at the extra 1 point significantly reduced the low frequency/high frequency ratio of HRV responding to needle insertion, which implies a reduction in sympathetic nervous system activity.

The Influence of Acupressure at Extra 1 Acupuncture Point on the Spectral Entropy of the EEG and the LF/HF Ratio of Heart Rate Variability

Acupressure applied on the Extra 1 acupuncture point results in sedation, thereby reducing bispectral index (BIS) values. Mental status and hypnotic agents influence the autonomic nervous system. We hypothesized that acupressure at the Extra 1 point would induce sedation and change sympatho-parasympathetic nerve balance. We investigated the effect of acupressure at the Extra 1 point on the EEG spectral entropy values and heart rate variability (HRV). Forty-eight volunteers (24 males and 24 females) were randomly assigned to the control or Extra 1 group. The control group received acupressure at a sham point and the Extra 1 group received acupressure at the Extra 1 point. Acupressure was applied for 5 min. The record of the EEG spectral entropy values and HRV started 5 min before acupressure and stopped 5 min after acupressure. Acupressure significantly reduced the EEG spectral entropy values in both groups, but the values of the Extra 1 group were significantly smaller than those of the control group (P < .01). Acupressure significantly decreased the LF/HF ratio of HRV in both groups (P < .05). When divided upon gender, although acupressure tended to decrease the LF/HF ratio, the ratio significantly decreased during and after acupressure only in females of the Extra 1 group (P < .05). We concluded that acupressure on the Extra 1 point significantly reduced the EEG spectral entropy in both the genders, but affected the LF/HF ratio of HRV only in females.

Effect of muscle load tasks with maximal isometric contractions on oxygenation of the trapezius muscle and sympathetic nervous activity in females with chronic neck and shoulder pain

BackgroundSympathetic nervous activity contributes to the maintenance of muscle oxygenation. However, patients with chronic pain may suffer from autonomic dysfunction. Furthermore, insufficient muscle oxygenation is observed among workers with chronic neck and shoulder pain. The aim of our study was to investigate how muscle load tasks affect sympathetic nervous activity and changes in oxygenation of the trapezius muscles in subjects with chronic neck and shoulder pain.MethodsThirty females were assigned to two groups: a pain group consisting of subjects with chronic neck and shoulder pain and a control group consisting of asymptomatic subjects. The participants performed three sets of isometric exercise in an upright position; they contracted their trapezius muscles with maximum effort and let the muscles relax (Relax). Autonomic nervous activity and oxygenation of the trapezius muscles were measured by heart rate variability (HRV) and Near-Infrared Spectroscopy.ResultsOxyhemoglobin and total hemoglobin of the trapezius muscles in the pain group were lower during the Relax period compared with the control group. In addition, the low frequency / high frequency (LF/HF) ratio of HRV significantly increased during isometric exercise in the control group, whereas there were no significant changes in the pain group.ConclusionsSubjects with neck and shoulder pain showed lower oxygenation and blood flow of the trapezius muscles responding to isometric exercise, compared with asymptomatic subjects. Subjects with neck and shoulder pain also showed no significant changes in the LF/HF ratio of HRV responding to isometric exercise, which would imply a reduction in sympathetic nervous activity.

The Effects of Exercise Therapy for the Improvement of Jaw Movement and Psychological Intervention to Reduce Parafunctional Activities on Chronic Pain in the Craniocervical Region

Apparent organic abnormalities are sometimes not identified among patients suffering from chronic pain in the craniocervical region. In some cases, parafunctional activities (PAs) are recognized. PAs are nonfunctional oromandibular activities that include jaw clenching and bruxism, but are considered as factors that contribute to craniomandibular disorders (CMDs). It is now recognized that PAs and CMDs influence musculoskeletal conditions of the upper quarter. Exercise therapy (ET) to improve jaw movement and psychological intervention (PI) to reduce PAs are useful for PAs and CMDs. We hypothesized that ET and PI would be effective for craniocervical pain without organic abnormalities.

Integration of a Kampo medicine, Nijutsuto, and Western medical treatment in the treatment of long-term frozen shoulder refractory to Western medical treatment: a case series.

Objective: Frozen shoulder is a common disorder in general orthopedic practice, characterized by spontaneous onset of pain in the shoulder and accompanied by limitation of glenohumeral movement. Treatments for frozen shoulder include shoulder exercise, manual therapy, corticosteroid injection, manipulation under anesthesia, and arthroscopic capsular release. Several patients suffer from some degree of pain and range of motion limitation for up to 10 years even when these treatments are applied. Kampo, a traditional Japanese herbal medicine based on traditional Chinese herbal medicine, has been used for the treatment of pain in Japan. Nijutsuto has been a Kampo formula used to effectively treat frozen shoulder. Methods: Thirteen patients suffering from long-term frozen shoulder refractory to Western medical treatment were administered Nijututo. Results: Almost all patients experienced sound pain relief after Nijutsuto admnistration. There were no severe side effects reported. Conclusion: Nijutsuto combined with an exercise program improved pain intensity in 13 patients with long-term frozen shoulder.

Behavior of children emerging from general anesthesia correlates with their heart rate variability

To the Editor: Children emerging from anesthesia may experience a variety of behavioral disturbances described as postoperative agitation [1]. We could easily expect some autonomic changes in these agitated children. Frequency-domain analysis of heart rate variability (HRV) is a sophisticated noninvasive tool to assess autonomic nervous system (ANS) regulation of the heart [2]. When humans are under various physical and mental stress conditions, disturbances in the ANS occur. In the present study, we calculated children’s HRV and analyzed the relationship between their behavior on emerging from anesthesia and the low frequency components (LF) to high frequency components (HF) (LF/HF) ratio of their HRV. After obtaining approval from the Ethics Committee of Aichi Medical University and written informed parental consent, we studied 28 children, aged 2–4 years, who were scheduled for removal of a nevus. Forty-five minutes before anesthetic induction, midazolam 0.5 mg kg was given orally. After arrival in the operating room at 08:15, the mothers were encouraged to sit in a straight-back chair and to hold their child during the anesthetic induction. After anesthesia was induced with 7% sevoflurane in 100% oxygen, fentanyl 1 lg kg and vecuronium 0.1 mg kg were injected intravenously to facilitate tracheal intubation. Then, plastic surgeons infiltrated the nevus with 0.25% lidocaine 5–10 ml. Anesthesia was maintained with sevoflurane (1.5%–2.5%) in 100% oxygen and fentanyl 4 lg kg without further vecuronium. On completion of the surgery, sevoflurane was discontinued and a palm-sized electrocardiographic unit (Active Tracer.AC300; GMS, Tokyo, Japan) [2] was placed on each child for continuous recording of variation in their autonomic nervous activities. When the child displayed a facial grimace, purposeful movement, and protective upper airway reflexes, and was breathing spontaneously, regularly, and adequately, and had opened their eyes, the tracheal tube was removed. We transferred the children to the recovery room and observed them for 20 min. An observer scored the child’s emergence behavior on a five-point scale: (1) obtunded with no response to stimulation; (2) asleep but responsive to movement or stimulation; (3) awake and responsive; (4) inconsolable crying; and (5) thrashing behavior requiring restraint. For 20 min in the recovery room, the observer recorded the highest level reached. Data recorded for more than 30 min in the palm-sized electrocardiographic unit were analyzed for HRV by the maximum entropy method (CHIRAM; Suwa Trust Japan, Japan). Since three children were excluded because of refusal to midazolam, 10 boys and 15 girls were included in the study; median age (range) was, 3 (2–4) years; median weight, 16 (12–22) kg; and median anesthetic time, 125 (67–194) min. The relationship between the score for emergence behavior and the LF/ HF ratio of their HRV showed a significant, positive correlation (rs = 0.6219, n = 25, p \ 0.0009) (Fig. 1). Stressful conditioning leads to the augmentation of sympathetic nerve activity, thereby influencing heart rate and blood pressure [3, 4]. Also, emotional factors are known to influence the sympathetic nervous system [5]. Thus, we believe that, in the present study, emergence from Y.-C. P. Arai (&) J. Sato T. Ushida K. Suetomi M. Nishihara T. Matsubara Multidisciplinary Pain Center, Aichi Medical University, 21 Karimata, Nagakutecho, Aichigun, Aichi 480-1195, Japan e-mail: arainon@aichi-med-u.ac.jp

Jaw Exercise Therapy and Psychoeducation to Reduce Oral Parafunctional Activities for the Management of Persistent Dentoalveolar Pain

Objective To retrospectively analyze the effects of our original combination therapy treatment on patients with nonodontogenic persistent dentoalveolar pain. Methods Twenty-one patients suffering from persistent dentoalveolar pain (nineteen females and two males; mean age ± standard deviation: 55.7 ± 19.6 years) participated in this study. They were treated with a therapy combination of jaw exercise and psychoeducation to reduce oral parafunctional activities every month. The intensity of pain in these subjects was evaluated using a numerical rating scale (NRS) before and after treatment. Results The NRSs at the baseline ranged from 5 to 10 (median, 8), from 0 to 10 (median, 2) at one month after treatment, from 0 to 10 (median, 1) at three months after treatment, and from 0 to 10 (median, 0) at the end of treatment. Pain intensity after treatment improved significantly. Conclusion There was a significant reduction in pain after our combination of therapies as nonpharmacological treatments, and therefore this treatment could be useful in the management of NPDP patients.

The Association Between Constipation or Stool Consistency and Pain Severity in Patients With Chronic Pain

Background Bacteria can influence a variety of gut functions. Some studies showed that stool consistency and constipation were associated with gut microbiome (GM) composition, and enterotype, dysbiosis. Growing evidence indicates the significant role of GM in the homeostatic function of the host body. The GM may regulate multiple neurochemical and neurometabolic pathways. Chronicity of the pain is actively modulated at the molecular to the network level by means of several neurotransmitters. The GM to some extent can affect pain perception. Objectives The current study aimed at investigating the relationship between constipation state or usual stool form and pain severity of patients with chronic pain. Methods The current study was conducted on 365 patients with chronic pain. The participants were evaluated on their stool form (the Bristol stool form scale; BSFS), constipation state (the Cleveland clinic constipation score; CCCS), body mass index (BMI), and usual pain severity (numerical rating scale; NRS). In addition, the participants were assigned into five groups according to the pain region (i e, low back and/or lower limb, whole body, neck and/or upper back and/or upper limb, head and/or face, chest and/or abdominal). Results The CCS showed a significant and positive association with the pain severity of the total patients and patients with low back and/or lower limb pain. Simultaneous multiple linear regression analyses revealed that a predictor of the pain severity was the CCS for the total patients and patients with low back and/or lower limb, whole body pain. Conclusions Constipation displayed a significant and positive association with the pain severity of the total patients and patients with low back and/or lower limb pain, whole body.

Physical Activity May Be Associated with Conditioned Pain Modulation in Women but Not Men among Healthy Individuals

Background Conditioned pain modulation (CPM), a phenomenon also known as diffuse noxious inhibitory control, is thought to be affected by various factors, including sex and level of physical activity. However, the involvement of these factors in CPM remains unclear. Methods Eighty-six healthy young subjects (M/F, 43/43) participated in this study. Participants were assessed on the basis of their mechanical pressure pain threshold (PPT), CPM response, body mass index (BMI), basal metabolic rate (BMR), and duration of moderate-to-vigorous physical activity (MVPA) over a week, using a motion counter. Response to CPM was evaluated as PPT during painful cold stimulation relative to baseline PPT. Results Men showed significantly higher baseline PPT than women; however, this difference was no longer significant after controlling for confounders. Stepwise multiple linear regression analyses revealed BMR to be a significant contributor towards baseline PPT in the entire study population. In contrast, although there were no significant contributors to CPM response among men and in the overall study group, MVPA was positively associated with CPM response among women (β = 0.397). Conclusions These results suggest that, among healthy young individuals, CPM response may be associated with moderate-to-vigorous physical activity in women but not in men.