以痛为腧按揉法缓解腰椎间盘突出症致腰腿痛的效应

Analgesic effect on lumbar intervertebral disc protrusion-induced back-leg pain by kneading method of taking the tender point as acupoint

目的:观察以痛为腧压痛点按揉法对发作期腰椎间盘突出症所致的腰腿痛的镇痛作用,并与传统斜扳法治疗的效果进行比较。方法:采用单盲随机对照平行试验的方法,选择2003-02/2004-04在上海中医药大学附属岳阳医院推拿科住院的60例单侧型发作期腰椎间盘突出症患者,按随机数字表法将其分为压痛点治疗组和斜扳法对照组(n=30)。压痛点治疗组施用拇指按揉法于患者腰部压痛点和委中(处进行治疗;斜扳法对照组施用腰椎斜扳法。治疗均为20min/次,1次/d,7d为1个疗程,共2个疗程。治疗前后应用腰痛疗效的分级表(总分为100分,评分越低腰痛越剧烈)评估2组患者症状体征改变情况,应用目测类比评分(总分为10分,评分越高疼痛越剧烈)评估疼痛程度,并检测推拿前和推拿后1周两组血清β-内啡肽和P物质水平。结果:60例患者全部进入结果分析。①腰痛疗效积分:压痛点治疗组患者治疗后高于治疗前(64.77±4.14,40.63±2.93,P=0.01);斜扳法对照组患者治疗后也高于治疗前(60.70±5.78,42.83±3.63,P=0.0);2组治疗前后比较差异均不显著(P>0.05)。②目测类比评分:压痛点治疗组治疗后低于治疗前(4.71±0.52,8.99±0.26,P=0.0);斜扳法对照组治疗后也低于治疗前(5.59±0.80,8.94±0.27,P=0.0);2组治疗前后比较差异均不显著(P>0.05)。③血清β-内啡肽水平:治疗1周后压痛点治疗组患者高于治疗前[(55.83±5.53),(46.07±5.10)ng/L,P=0.0];斜扳法对照组患者低于治疗前[(46.50±3.72),(49.87±4.38)ng/L,P=0.15];2组治疗前后差值比较差异显著(P=0.01)。④血清P物质水平:治疗1周后压痛点治疗组患者低于治疗前[(34.73±4.98),(37.95±4.66)ng/L,P=0.01];斜扳法对照组患者高于治疗前[(42.04±4.06),(39.92±3.32)ng/L,P=0.19];2组治疗前后差值比较差异显著(P=0.01)。结论:①以痛为腧按揉法和斜扳法均能使腰椎间盘突出症患者的疼痛减轻,具有明显的镇痛作用。②以痛为腧按揉法可使腰椎间盘突出症患者血清β-内啡肽水平明显升高,血清P物质水平明显降低;而斜扳法的作用与之相反,提示两种方法治疗腰椎间盘突出症的镇痛作用机制不同。

AIM： To observe the analgesic effects of the kneading method of taking the tender point as acupoint on back-leg pain induced by lumbar intervertebral disc protrusion （LIDP） in the period of onset, and compare with that of “obliquely-polling” therapy. METHODS： Sixty inpotients with one-sided fits of LIDP from February 2003 to April 2004 were selected from the Department of Tuina, Yueyang Hospital Affiliated to Shanghai University of TCM were selected according to single-blind parallel randomized experimental method, and randomly divided into living acupoint treatment group （treatment group） and obliquepulling control group （control group ） （n=30）. Patients in the treatment group were treated with the approach of “pressing and kneading with the thumb” on the living acupoint and acupoint of Weizhong （B40）, while patients in the control group received treatment with approach of oblique pulling on the patient＇s lumbar vertebra. Patients of beth groups were treated once a day and 20 minutes each time for totally 2 courses with 7 days in one course. The efficiency scale of lumbar pain （the total score was 100 points, and the lower the score was, the severer the lumbar pain was） was used to evaluate changes in symptoms and physical signs of patients in beth groups before and after treatment. Visual Analog Scale （VAS） （the total score was 10 points, and the higher the score was the severe the pain was） was adopted to evaluate the pain. Levels of β-endorphin anti substance P were detected in patients of beth groups before Tuina and one week after Tuina. RESULTS： A total of 60 patients were involved in the analysis of results. ①Scores of efficacy of lumbar pain： the scores of patients in the treatment group were higher than those before administration [（64.77±4.14）, （40.63±2.93）, p=0.0], and the scores of patients in the control group were higher than those before treatment [（60.70±5.78）; （42.83±3.63）, p=0.0]. The differences before and after treatment between two groups were not significant （P 〉 0.05）.②VAS score： the score of treatment group after treatment was lower than that before treatment [（4.71±0.52）, （8.99±0.26）, P=0.01〈 0.05）; lower after treatment than before treatment in the control group [（5.59±0.80）, （8.94±0.27）,t=9.746, P=0.0]. There was no significant differences before and after treatment in two groups （P 〈 0.05）.③Levd of serum β-endorphin： that in patients of the treatment group was higher at one week after treatment than that before treatment [（55.83±5.53）, （46.07±5.10） ng/L,P=0.0], and that in patients of the control group was just the opposite. [（46.50±3.72）, （49.87±4.38） ng/L, P=0.15]. The comparison between the D-value of the level of serum β-endorphin of the two groups before and after treatment wasremarkable （P=0.01）.④Level of serum substance P： that in patients of the treatment group was lower at one week after treatment than that before treatment [（34.73±4.98）, （37.95±4.66） ng/L P=0.01], and that in patients of the control group was just the opposites. （42.04±4.06）, （39.92±3.32） ng/L,P=0.19]. The comparison between the D-value of the level of serum substance P of the two groups before and after treatment was remarkable （P=0.01）. CONCLUSION： ①Both of kneading method of taking the tender point as acupaint and oblique-pulling method can relieve the pain of patients with LIDP, the analgesic effects of which are significant.②Kneading method of taking the tender point as acupaint can obviously enhance the level of β-endorphin and reduce the level of substance P in patients with LIDP,while the effects of oblique-pulling method are opposite to it, which indicated that the analgesic mechanisms of two methods in the treatment of LIDP are different.