Effectivenss of electroacupuncture for skeletal muscle pain in Parkinson's disease:a Clinical randomized controlled trial

OBJECTIVE:To explore the effect of electroacupuncture on skeletal muscle pain in Parkinson's disease(PD).METHODS:A single-center randomized controlled trial was conducted with sixty patients with Parkinson's disease with skeletal muscle pain were randomly divided into electroacupuncture group and sham acupuncture control group with 30 patients each.The electric acupuncture group was treated with electric acupuncture,while the control group was treated with Park needle pseudoacupuncture.Both groups were treated 5 times a week for a total of 4 weeks,and both groups completed 20 treatments.King's Parkinson's Pain Scale(KPPS)and visual analog scale(VAS)were used before and after treatment to evaluate the pain degree of patients.Realtime shear wave elastography(SWE)and modified Ashworth score(MAS)were used to evaluate the changes of muscle tone.Parkinson's comprehensive Score Scale(MDS-UPDRS,including UPDRS Ⅱ and UPDRS Ⅲ)was used to evaluate exercise ability.Hamilton Depression Scale(HAMD)score was used to evaluate the emotional changes of patients.Spearman correlation analysis was used to explore the correlation between pain degree and muscle tone,exercise ability and emotion.RESULTS:During the study,one case fell off in the control group,and 30 cases were eventually included in the analysis and treatment group and 29 cases in the control group.After treatment,Young's modulus of biceps and quadriceps and shear wave velocity of biceps were decreased in electroacupuncture group compared with before treatment,while KPPS score,VAS score,UPDRS Ⅱ,UPDRS Ⅲ and modified Ashworth score were decreased,with statistical significance(P<0.05).There was no statistical significance in control group(P>0.05).After treatment,KPPS score,VAS score,UPDRS Ⅱ and UPDRS Ⅲ,MAS,HAMD score,Young's modulus of biceps and shear wave velocity in electroacupuncture group were significantly lower than those in control group(P<0.05).Spearman correlation analysis showed that KPPS score was positively correlated with UPDRS Ⅲ(r=0.414,P<0.05).KPPS score was positively correlated with HAMD score(r=0.576,P<0.01).CONCLUSION:Electroacupuncture therapy can effectively improve skeletal muscle pain in patients with Parkinson's disease,reduce the muscle hardness of patients,improve patients'daily life ability,and improve patients'emotional disorders.The degree of skeletal muscle pain in PD patients is correlated with motor ability and emotional disorders,but there is no significant correlation between the degree of skeletal muscle pain and the muscle tone of PD patients.

柔筋止痛针刺法治疗帕金森病伴发不同类型疼痛患者的临床观察

目的观察柔筋止痛针刺法治疗帕金森病伴发疼痛的疗效及对不同类型疼痛的治疗效果。方法将帕金森病伴发疼痛患者84例,根据Chandhur疼痛分类形式分为骨骼肌疼痛(22例)、根性疼痛(10例)、运动障碍性疼痛(34例)、不能静坐或坐立不安感导致的疼痛(14例)及其他(4例)。所有患者常规口服治疗帕金森病西药,停止服用止痛类药物,同时给予柔筋止痛针刺法治疗,采用平补平泻法,留针30min,每日1次。5次为1个疗程,共治疗2个疗程。治疗前后对不同类型疼痛患者进行中医证候评分、疼痛视觉模拟量表(VAS)评分、国王帕金森病疼痛评价量表(KPPS)评分、帕金森综合评分量表(UPDRS)评分,治疗后对84例患者评价中医证候疗效。结果84例患者中临床痊愈0例,明显进步21例,进步48例,稍有进步5例,无效10例,总有效74例,总有效率为88.1%;与治疗前比较,治疗后患者中医证候总积分、VAS评分、KPPS评分中疼痛频次和总积分、UPDRS评分均降低(P<0.05或P<0.01)。由于其他类型疼痛患者病例数较少不纳入统计分析。治疗后,帕金森病骨骼肌疼痛患者中医证候总积分、VAS评分、KPPS评分总积分及UPDRS评分均较治疗前降低(P<0.05或P<0.01);帕金森病静坐不能或坐立不安感导致的疼痛患者VAS评分、KPPS评分总积分及疼痛频次较治疗前降低(P<0.05或P<0.01),而UPDRS评分差异无统计学意义(P>0.05)。帕金森病根性疼痛、运动障碍性疼痛患者VAS评分、KPPS评分、UPDRS评分较治疗前比较差异均无统计学意义(P>0.05),但中医证候总积分差异有统计学意义(P<0.05)。结论柔筋止痛针刺法治疗帕金森病伴发疼痛具有一定的临床疗效,对于改善帕金森病骨骼肌疼痛、不能静坐或坐立不安感导致的疼痛效果更好,对根性疼痛和运动障碍性疼痛效果不明显。

“百会”“四神聪”放血对颅内低灌注模型大鼠脑微梗死及神经血管耦合功能的影响

目的探讨“百会”“四神聪”放血对颅内低灌注模型大鼠认知障碍的影响及可能作用机制。方法30只SD大鼠随机分为实验组、模型组、空白组各10只。实验组、模型组采用双侧颈总动脉结扎法建立颅内低灌注大鼠模型。实验组造模1周后开始给予“百会”“四神聪”放血,每周一、三、五放血,干预4周,共12次;模型组及空白组大鼠不做干预。各组大鼠干预4周后采用Morris水迷宫评价大鼠认知行为学改变,包括隐蔽平台实验(持续5天,记录每天逃避潜伏期时间)和空间探索实验(隐蔽平台实验结束24 h后开始,记录大鼠平台象限停留时间、平台位置穿越次数、平台象限游泳距离)。水迷宫实验完成后取大鼠脑组织进行HE染色,根据染色结果统计脑微梗死灶数量,观察脑白质损伤情况并分为0度、Ⅰ度、Ⅱ度;免疫组织化学法测定大鼠脑组织髓鞘碱性蛋白(MBP)、神经元型一氧化氮合酶(nNOS)、花生二烯酸(AA)、神经胶质抗原2(NG2)蛋白表达;ELISA法检测大鼠外周血清一氧化氮(NO)含量。结果与空白组同时间比较,模型组和实验组大鼠Morris水迷宫隐蔽平台实验第5天逃避潜伏期延长(P<0.05);与模型组同时间比较,实验组大鼠第5天逃避潜伏期缩短(P<0.05)。各组大鼠Morris水迷宫空间探索实验平台位置穿越次数、平台象限游泳距离比较差异无统计学意义(P>0.05);与空白组比较,模型组大鼠平台象限停留时间缩短(P<0.05);与模型组比较,实验组大鼠平台象限停留时间延长(P<0.05)。与空白组比较,模型组大鼠脑组织中脑微梗死灶数量增多,脑白质损伤程度分级以Ⅱ度为多,脑组织MBP、NG2、AA蛋白表达和外周血清NO含量升高(P<0.05);与模型组比较,实验组大鼠脑白质损伤程度分级以0度和Ⅰ度为主,脑组织MBP、NG2蛋白表达和外周血清NO含量降低,AA蛋白表达升高(P<0.05);与模型组比较,实验组大鼠脑微梗死灶数量有减少趋势但两组比较差异无统计学意义(P>0.05)。结论“百会”“四神聪”放血可以改善颅内低灌注模型大鼠的认知功能,减轻脑白质损伤程度,其机制可能与调节皮质神经元介导的神经血管耦合通路相关。