Review Article2008-09-01

A Review of Psychosocial Predictors of Treatment Outcomes: What Factors Might Determine the Clinical Success of Acupuncture for Pain?

Felicity L. Bishop^*, George T. Lewith

2008; 1(1): 1-12 https://doi.org/10.1016/S2005-2901(09)60001-7

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This narrative review examines the psychosocial factors that might predict clinical outcomes in acupuncture for pain. Given existing evidence concerning the clinical effectiveness and safety of acupuncture in painful conditions, it is important to consider how clinicians might further improve their effectiveness. The relevant theoretical frameworks focus primarily on the patient, suggesting that their background characteristics and their beliefs about pain and acupuncture should be considered as potential predictors of outcome. The self-regulation model within health psychology helps us understand how people manage their health and integrate interventions like acupuncture into the management of their illness. This model also implies that the therapeutic relationship, in particular patients' perceptions of that relationship, is likely to be related to outcome. The empirical literature in this area is sparse. However, the findings to date do suggest that a number of psychosocial factors, in particular patients' beliefs about acupuncture, are significant predictors of treatment outcomes from acupuncture for pain. Factors related to the therapeutic relationship are also likely to be important in facilitating good clinical outcomes. We discuss the limitations of the existing studies and make recommendations for future research in this area. If we can better understand the psychosocial factors involved in acupuncture, then we should be able to enhance acupuncture treatments and improve outcomes for patients. These observations will, therefore, have potential to allow us to develop techniques that may improve clinical outcomes in the treatment of pain.

Research Article2008-09-01

The Effect of Acupuncture Therapy on Pain Perception and Coping Strategies: A Preliminary Report

Dorit Gamus^a*, Vered Meshulam-Atzmon^b, Shay Pintov^c, Rebecca Jacoby^b

2008; 1(1): 51-53 https://doi.org/10.1016/S2005-2901(09)60007-8

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The objective of the present study was to examine the effect of acupuncture on the perception of pain and coping strategies, thus focusing on the psychological aspects of pain. The study was conducted in two complementary and alternative medicine clinics of public hospitals. Forty-one patients scheduled for routine acupuncture therapy because of chronic musculoskeletal pain were recruited for the study to receive eight acupuncture treatments. Twenty-four patients completed the treatment schedule and filled two self-reported questionnaires before and after therapy: (1) Illness Perception Questionnaire—Revised (IPQ-R); and (2) Coping Strategies questionnaire (Brief COPE). A significant improvement was found in the following measures related to pain perception: timeline (chronic versus acute), treatment control, and personal control. Additionally, significant improvement was displayed in three measures related to coping strategies: positive reframing, religion, and venting. The results indicate that acupuncture therapy might be efficient in changing patient's pain perception from chronic to acute and in enhancing their sense of personal and treatment control over their pain. In addition, acupuncture therapy partially improved coping strategies. The present study provides further validation for acupuncture therapy in pain and highlights its possible role in affecting the psychological aspects of pain.

Research Article2008-09-01

Acupuncture Treatment in Geriatric Rehabilitation: A Retrospective Study

Adi Barad^a, Yair Maimon^a, Ehud Miller^a, Shifra Merdler^b, David Goldray^b, Yaffa Lerman^b, Shahar Lev-ari^a*

2008; 1(1): 54-57 https://doi.org/10.1016/S2005-2901(09)60008-X

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The main goal of geriatric rehabilitation reconditioning following an acute illness is rapid restoration of normal activity. Key elements are pain control, restoration of bowel function, sleep, appetite and general well being, alongside physical activity. The aim of this retrospective study was to assess the effect of acupuncture as an adjunct to medical and physical rehabilitation in geriatric patients. The setting was a university-affiliated large city general hospital. The participants comprised 27 consenting consecutive patients in a subacute geriatric rehabilitation department. The interventions consisted of biweekly acupuncture treatment in conjunction with medical and physical therapy. The outcome measures of pain, appetite, quality of sleep, bowel function and general well being were assessed using a 10-point Likert scale at the onset and close of treatment. The results showed that a significant post-treatment improvement was seen in pain (p=0.005), appetite (p=0.0034), bowel function (p=0.029) and general well being (p=0.0012) scores in patients' treatment when compared with pretreatment baseline scores. The “quality of sleep” score showed a trend towards improvement (p=0.073). In conclusion, acupuncture may be beneficial as an adjunctive treatment in geriatric postacute illness rehabilitation. Randomized controlled trials are needed to further assess the role of acupuncture as part of treatment management for restoring normal physical activity in geriatric patients.

Research Article2008-09-01

Vascular Responses to Manual PC6 Acupuncture in Nonsmokers and Smokers Assessed by the Second Derivative of the Finger Photoplethysmogram Waveform

José F. Rivas-Vilchis^a*, Ricardo Escorcia-Gaona^b, Jorge A. Cervantes-Reyes^b, Rubén Román-Ramos^a

2008; 1(1): 58-62 https://doi.org/10.1016/S2005-2901(09)60009-1

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BackgroundSmoking is reported to increase arterial stiffness. Indices obtained from the second derivative of digital volume pulse (SDDVP) waveform have been proposed to characterize vascular aging and arterial rigidity. PC6 (Neiguan) is a traditional acupoint in each forearm that has been shown to modify cardiovascular functioning.ObjectiveTo investigate the acute effects of manual needling with PC6 on SDDVP indices in healthy chronic smoker and nonsmoker subjects.Subjects and MethodsAging index (AI) was defined as (b – c – d – e)/a, B:A was calculated as the ratio of the absolute value for the height of the b wave (B) to that of the a wave (A), and D:A was calculated as the ratio of the absolute value for the height of the d wave (D) to that of the a wave (A). These indices derived of the wave components of SDDVP of healthy nonsmokers (n=40; 28.3±3.0 years old) vs. chronic smokers (n=30; 29.9±2.9 years old) were compared. The digital volume pulse (DVP) was obtained by measuring infrared light transmission through the finger. Of each subject, a DVP registration 20 minutes long was obtained. PC6 was stimulated unilaterally by manual needling for 5 minutes (1–6 minutes). SDDVP indices were compared in each subject in pre- vs. post-acupuncture periods (30 seconds vs. 18 minutes, respectively).ResultsAt baseline, we found significant difference in B:A between nonsmokers and smokers. Comparing pre- vs. post-acupuncture periods, B:A and D:A did not show significant differences among nonsmokers, but B:A improved significantly in smokers and AI improved significantly in both nonsmokers and smokers.ConclusionThese findings suggest that manual needling with PC6 could revert some of the deleterious effects on vascular functioning produced by chronic cigarette smoking.

Review Article2009-03-01

Acupuncture in Modern Society

Kristin VanderPloeg^a, Xiaobin Yi^b*

2009; 2(1): 26-33 https://doi.org/10.1016/S2005-2901(09)60012-1

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For at least 2,500 years, acupuncture has been an integral part of traditional Chinese medicine. However, recently as more people in western countries are diagnosed with chronic disease poorly treated with modern medical therapies, many are turning to acupuncture and other forms of alternative medical treatments. Based on the theory of harmonious flowing qi being the basis of good health, acupuncture focuses on restoring qi by manipulation of the complementary and opposing elements of yin and yang. However, in the modern medical community we struggle to with the concept of qi, given a lack of anatomic and histological evidence supporting its existence. However, with the surge in public interest in acupuncture, the scientific community begun heavy investigation of acupuncture's efficacy, as well as the physiologic basis behind it. Thus far, evidence supports the use of acupuncture in post-operative nausea and vomiting, postoperative dental pain, chronic pain conditions such as lower back pain, and possibly also such psychologic conditions as addiction. It is possible that by affecting afferent nerve signaling, acupuncture may influence the release of endogenous opioids to promote pain relief. This effect may be augmented by release of ACTH and cortisol, as well as through down-regulation of signaling through pain fibers. When treating patients who may utilize alternative forms of medicine, it is important that medical practitioners be educated in regards to the basic fundamental beliefs behind acupuncture, as well as the scientific evidence supporting its use and revealing its efficacy. The purpose of this review is to give western trained physicians exposure to history, basic knowledge and its clinical applications of acupuncture to accommodate accelerating interests in acupuncture in modern society.

Research Article2009-03-01

Investigation of Electrical Responses to Acupuncture Stimulation: The Effect of Electrical Grounding and Insulation Conditions

Yong-Heum Lee^ab, Yeon-Hang Ryu^a, Byungjo Jung^ab*

2009; 2(1): 49-55 https://doi.org/10.1016/S2005-2901(09)60015-7

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Acupuncture in Oriental medicine has been widely used as a core therapeutic method due to its minimal side-effects and therapeutic efficacy. However, the electrical response to acupuncture stimulation (ERAS) has not been clearly studied under acupuncture conditions that might affect the efficacy of acupuncture therapy. In this study, the ERAS was objectively investigated by measuring meridian electric potentials (MEPs) when the electrical grounding conditions of the operator and subject were varied, and when the insulation conditions of acupuncture needle were varied. MEPs between Sang-geoheo (ST37) and Ha-geoheo (ST39) of the Stomach Meridian (ST) were measured by stimulating Jok-samni (ST36) with an acupuncture needle. For non-insulated acupuncture stimulation (NIAS), the average MEP peak was 148.6 ± 20.6 when neither the operator nor the subject were electrically grounded, 23.1 ± 8.8 when the subject only was electrically grounded, 348 ± 76.8 when the operator only was electrically grounded, and 19.9 ± 4.7 when both the operator and the subject were electrically grounded. The MEPs presented various magnitudes and patterns depending on the electrical grounding conditions. The MEP pattern was very similar to that of the charge and discharge of a capacitor. For insulated acupuncture stimulation (IAS), the average MEP peak was 20 ± 4 in all electrical grounding conditions, which is not a significant electric response for acupuncture stimulation. In terms of electricity, this study verified that acupuncture therapy might be affected by acupuncture conditions such as (1) the electrical grounding condition of the operator and the subject and (2) the insulation condition of the acupuncture needle.

Research Article2009-03-01

Observation of Coiled Blood Plexus in Rat Skin with Diffusive Light Illumination

Vyacheslav Ogay^a, Flora Min^b, KwanHyung Kim^a, JaiSoon Kim^a, Kyung Hee Bae^c*, Sang Chul Han^c, Kwang-Sup Soh^a*

2009; 2(1): 56-65 https://doi.org/10.1016/S2005-2901(09)60016-9

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Blood plexuses are characteristic anatomical features of acupuncture points (APs). We developed an optical technique using diffusive light illumination to increase the brightened area of skin for observation of the blood plexuses in skin. We found that the blood plexuses were coiled blood vessels which came out of the perforations in the fascia of muscle. The coiled vessels could be straightened by stretching the skin. We observed a series of blood plexuses at the putative APs along the left and right kidney meridian lines in the abdominal skin of rats. In addition, the locations of the plexuses on the muscle fascia were just above the putative acupuncture muscle channels along the kidney meridians. Furthermore, immunohistochemical analysis of the skin specimens of the plexuses revealed its neurovascular bundle nature as expected from known anatomical features of the APs.

Research Article2009-03-01

Visualizing the Network of Bonghan Ducts in the Omentum and Peritoneum by Using Trypan Blue

Byung-Cheon Lee^ab, Ki Woo Kim^c, Kwang-Sup Soh^d*

2009; 2(1): 66-70 https://doi.org/10.1016/S2005-2901(09)60017-0

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A visualizing agent, Trypan blue, was found to be preferentially effective for Bonghan ducts (BHDs) and corpuscles compared to blood vessels or adipose tissues. By using it, we observed a weblike network of BHDs which was in various membrane structures, such as the peritoneum, and omenta. This network of BHDs in the membrane structures was connected to the freely movable BHDs which did not adhere to the surfaces or wrapping membranes of internal organs. In addition, tracing BHDs in adipose tissues became possible because Trypan blue does not stain adipose tissue.

Brief Report2009-03-01

Bonghan System as Mesenchymal Stem Cell Niches and Pathways of Macrophages in Adipose Tissues

Byung-Cheon Lee^ab, Kyung-Hee Bae^c, Gil-Ja Jhon^d, Kwang-Sup Soh^a*

2009; 2(1): 79-82 https://doi.org/10.1016/S2005-2901(09)60020-0

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A new technique for visualizing Bonghan ducts (BHDs) and Bonghan corpuscles (BHCs) was developed by using a vivi-staining dye, Trypan blue. The dye stains BHDs and BHCs preferentially to adipocytes so that tracking a BHD and a BHC, even inside adipose tissues, is possible. Concerning the functions of the BHD and the BHC in adipose tissues, we propose conjectures: the Bonghan system may be niches for mesenchymal stem cells, which can differentiate into adipocytes, and pathways for macrophages involved in adipogenesis.

Research Article2008-12-01

Pharmacopuncture in Dorsopathy Treatment

Lev Georgievich Agasarov^*

2008; 1(2): 110-113 https://doi.org/10.1016/S2005-2901(09)60030-3

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This work further investigates the mechanisms of pharmacopuncture based on clinical data from patients with dorsopathy at the lumbosacral level. For the first time, pharmacopuncture was analyzed from the perspective of “classical” medicine and not using homeopathic medicine preconceptions. This confirmed the benefits of the chondro-protector Alflutop. The reduction of the vaso-reflectory reactions observed in this study indicates an extension of its therapeutic uses at the expense of the pharmacopuncture reflectory mechanisms. In turn, the data obtained point the way to further study into the active mechanism of pharmacopuncture.