Effectiveness and safety of electroacupuncture analgesia in controlling intraoperative pain and hemodynamics during total thyroidectomy:A randomized controlled trial

Objective:To evaluate the effectiveness and safety of electroacupuncture in conjunction with additional medications in providing analgesia and stabilizing hemodynamic parameters during total thyroidectomy.Methods:This randomized controlled trial included 100 patients who underwent a total thyroidectomy between October 2022 and October 2023 at the Vietnam National Hospital of Acupuncture.The patients were randomized into two groups.The electroacupuncture analgesia(EA)group received EA stimulation at five acupuncture points:Hegu(LI 4),Neiguan(PC 6),Shuitu(ST 10),Quepen(ST 12),and Yifeng(SJ 17),while the control group received a bilateral superficial cervical plexus block.Primary outcomes included the level of analgesia and perioperative vital signs in both groups.Additionally,pain thresholds and serum b-endorphin levels were measured before and after electroacupuncture in the EA group.Results:Complete analgesia(Level A)was attained in 86%and 76%of the patients in the EA and control groups,respectively,with no significant difference between the two groups(P=1.00).In the EA group,the mean pain threshold after receiving EA doubled(648.7(77.4)g/s vs.305.3(45.3)g/s,P<.001),and the mean serum b-endorphin level increased by approximately 13.5 pg/mL(P<.001).All patients remained hemodynamically stable throughout the surgery.Conclusion:EA,in conjunction with additional medications that stimulate five acupuncture points,LI 4,PC 6,ST 10,ST 12,and SJ 17,was well tolerated and effectively maintained a suitable level of analgesia and hemodynamic stability during total thyroidectomy.

THE ROLE OF CONNEXIN 43 GENE IN ACUPUNCTURE ANALGESIA

Objective To and connexin 43. Methods investigate the possible relationship between the analgesic effect of acupuncture Connexin 43 gene knock-out mice were randomly divided into 4 groups： a wide type （WT） control group, a WT acupuncture group, a heterozygous （HT） control group and HT acupuncture group. Hot-plate test and writhing response induced by acetic acid were used for investigating the different analgesic effect of acupuncture on HT and WT mice. Results There was no significant difference in the basic pain threshold value between HT and WT mice （P 〉0.05）. Acupuncture could significantly increase the pain threshold value, prolong the latency period of writhing body and decrease the number of writhing body as compared with pre-acupuncture in WT and HT mice （P 〈 0.01 or P 〈 0.05）. The pain threshold, latency period of writhing and number of writhing body in HT mice were less than WT mice post-acupuncture （P〈0.05）. Conclusion Connexin 43 gene knock-out might partially inhibit the analgesic effect of acupuncture, suggesting that connexin 43 is possibly related with meridians and the effect of acupuncture.

M-CHOLINOCEPTORS IN CAUDATE NUCLEUS PARTICIPATE IN SmI ORIGINATING DESCENDING MODULATION OF PARAFASCICULARNEURONS IN ACUPUNCTURE ANALGESIA

The present study was undertaken to investigate whether M-cholinoceptors in caudate nucleus (Cd) were implicated in cortical sensorimotor area I (SmI) originating descending modulation of activities in thalamic parafascicular nuclei (Pf) in acupuncture analgesia (AA). It was found that following bilateral microinjection of atropine into Cd head electroacupuncture (EA) (n=12) or glutamate (Glu) applied at SmI (n=12) did not affect the nociceptive responses of Pf neurons (P>0. 05),while in the saline control groups EA (n=11) or Glu at SmI (n=12) obviously inhibited nociceptive responses of Pf neurons (P<0. 05). There were significant differences in the effect of EA or Glu at SmI between atropine and saline groups (ANOVA, P<0. 05). Together with our previous findings demonstrating the participation of SmI originating descending modulation of Pf neurons in AA, the present investigation indicates that M-cholinoceptors are involved in mediating SmI originating descending modulation of Pf neurons in AA.

COMBINATION OF ACUPUNCTURE ANALGESIA AND EPIDURAL BLOCK IN RENAL TRANSPLANTATION

One hundred patients undergoing renal transplantation were randomly divided into com-bined acupuncture-epidural anesthesia group (group A, points selected: Ciliao, Sanyinjiao, Taixi to-gether with Shenyu and para-incision or Zusanli; combined with small dose of epidural block) and epidural block group (group C), each 50 patients. The initial dose and total dose of local anesthetics were 5. 6 ±0. 3 ml and 13. 5±1.0ml in group A, and 14. 5±0. 4 ml and 25. 4 ±1. 2 ml in group C,respectively. There was very significant difference between the two groups (P< 0.001 ). During the operation the hemodynaminc changes were greater in group C. Ephedrine and atropine were used in 1 and 2 cases in group A, and in 9 and 5 cases in group C, respectively. The starting time of urination of the transplanted kidney was shorter in group A than in group C, being 209±25 s and 410±47 s, re-spectively (P<0.001 ). There was no significant difference in the indices of immmunologic function between the two groups. The anesthetic results in group A were evaluated according to the initial dose of epidural anesthetics. Those were excellent in 31 cases (62 % ) and good in 13 (26% ) with the ex-cellent-good rate 88 %.

SYMPATHETIC REGULATION AND ACUPUNCTURE ANALGESIA IN ARTHRITIC RATS

In the present study,6-hydroxydopamine(6-OHDA),a peripheral adrenergicdepleting agent,was used to investigate the role of sympathetic activity in nociception and pain modu-lation,which was reported with some contradictory.Acute arthritis were induced by an injection ofFruend’s adjuvant in thirty-two rats.They were divided into three groups.Natural recovery fromarthritis(redness,swelling,on-going pain and hyperalgesia)was delayed by pretreatment with an in-jection of 6-OHDA,and acupuncture at Huantiao and Shensu points could accelerate its recovery.It issuggested that sympathetic regulatory system might play an important role in natural normalizationaction and in the acupuncture-induced regulation effects.

NEIMADIAN-POINT ACUPUNCTURE AND AURICULAR-POINT PRESSING USED FOR ORTHOPAEDIC POSTOPERATIVE ANALGESIA

The authors have treated 64 cases of orthopaedic postoperative pains by Neimadian-point acupuncture and auricular-ponit pressing with satisfactory results. In this paper, therapeuticmethods, therapeutic-effect observations and typical cases are reported, and the analgetie mechanismis preliminarily explored as well.

What Does GABAergic Neurotransmission System Do in Acupuncture Analgesia?

As one of the essential components of traditional Chinese medicine, acupuncture has been accepted world-widely for its effectiveness in treating various disease and health conditions. Pain management is one of the least controversial therapeutic benefits of acupuncture treatment. To date, the mechanism underlying acupuncture analgesia remains poorly understood. In this review, roles of members of GABAergic neurotransmission system which has long been related to pain perception and modulation, in acupuncture analgesia are discussed.

EFFECT OF ACUPUNCTURE ANALGESIA ON SYNAPSFS OF NUCLEUS CENTRO—MEDIANUS OBSERVED WITH ELECTRO—MICROSCOPE

The present study was aimed at the investigation of the ultrastructuralchanges of nucleus centromedianus(CM)of nuclei intralaminares under acupuncture analge-sia.The results of the observations on 18 healthy and adult rats were as follows.1.Thesynapses of the CM belong mainly to the axodendricular synapses and also with some suc-cessive or juxtaposing synapses.2.The presynaptic sac contains a lot of round and clearvesicles,some granular vesicles also spread among clear vesicles in a few synapses.3.Theround clear synaptic vesicles of CM in the electroacupuncture analgesia(EA)group are de-creased significantly than that in the control group.It is suggested that CM plays a role inacupuncture analgesia.

RELATIONSHIP BETWEEN ACUPUNCTURE ANALGESIA AND MET-ENKEPHALIN OR DYNORPHIN

subjective: The effect of 4～5 Hz electroacupuncture (EA) on alterations of both met enkephalin (MEK) and dynorphin (Dyn) in the patient plasma or mouse spinal cord and its relation with analgesic effect were studied.Methods: In acupuncture clinic 10 patients with acute pain were treated with 4 Hz EA at Zusanli(ST 36) and/or Hegu(LI 4) acupoints for 30 min. 20 BALB/C mice were randomly divided into 2 groups: a. EA group(n=10), treated with 4～5 Hz EA at bilateral “Zusanli"(ST 36) for 15 min; b. control group(n=10) treated with no EA, but also restrained for 15 min. Before and after EA or restraining acupoints, the pain threshold of the patients or mice was detected. 10 μl of the patient plasma before and after EA and each mouse spinal cord suspension, of the 2 groups were blotted onto nitrocellulose membrane (NCM) respectively. The protein dot blot signals were detected by immunoreactivity (IR) and using Shimadu TLC Scanner and analyzed statistically. Results: The results showed that an increase in patient plasma MEK IR or Dyn IR and a decrease in mouse spinal MEK IR or Dyn IR could be detected, and the alteration of plasma or spinal MEK IR was more significant than that of plasma or spinal Dyn IR. There was a positive correlation in alteration between plasma or spinal MEK IR and plasma or spinal Dyn IR with respective parallel levels in individuals. The increased plasma MEK IR or the decreased spinal MEK IR was positively or negatively correlated with the analgesic effect, while the correlation between plasma or spinal Dyn IR and analgesic effect was insignificant. Conclusion: The results suggest that under lower frequency EA the met enkephalin may play an important role in analgesia.

WRIST-ANKLE ACUPUNCTURE FOR ANALGESIA IN TREATING SOME COMMON DISEASES IN ATHLETES

With gradual generalization of acupuncture-moxibustion therapy in developed countries, an increasing attention has been paid to its application in the athletic field. Wrist-ankle acupuncture is a kind of shallow acupuncture, by which 6 points in the wrist and ankle regions are selected and punctured for treating diseases related to individual parts of the body. It is a kind of information therapy concerning biological hologram regularities. The analgesic effects of the therapy in treating some common diseases in 64 athletes are reported as follows.

THE ROLE OF P_1-PURINERGIC RECEPTORS IN THE SPINAL MECHANISMS OF ACUPUNCTURE ANALGESIA

It has been extensively proved that electro-acupuncture elicit analgesia in bothextensive areas and local region via supraspinal structures and spinal cord.The present investigationwas to study the role of P1-purinergic receptors in the spinal mechanisms of weak electroacupuncture-induced analgesia.Leg withdrawal latency（LWL）to noxious radiant heat focused on the ankle regionwas used to assess the effects of acupuncture and that of P1-purinergic（adenosine）receptor antago-nists,theophylline and caffeine on the electro-acupuncture（EA）analgesia.EA prolonged the LWLby 16.7%±20.3%,with an after-effect lasting about 15 min.Both theophylline and caffeineblocked the EA-induced prolongation of LWL in a dose-dependent manner at the doses of 1.6-16 mg/kg.These results suggest that P1-purinegic receptor is involved in the spinal mechanisms of weak EAproduced analgesia in the rat.

Study on the mechanism of acupuncture analgesia from the perspective of psychosomatic medicine

Acupuncture is a kind of traditional Chinese therapy which has gained increased attention in recent years.It has been shown that acupuncture is effective in treating many types of pain pathologically as well as psychologically.For instance,as a promising therapy for psychiatric disorders,acupuncture is helpful to alleviate depression,reduce the adverse effects of drug treatment at the same time.It is most widely utilized for management of chronic,noncancer pain in adults.As a non-pharmaceutical measure,acupuncture has the potential to make contribution to reduction in opioid overuse.Acupuncture analgesia can be analyzed from the perspective of psychosomatic medicine,contributing to a better understanding of its mechanism and function.The mechanisms are closely related to regulation of neurotransmitters and inflammatory factors,including down-regulation of Glutamate,5-hydroxytryptamine,dopamine,Substance P,Tumor necrosis factor-α,Interleukin(IL)-1,IL-6 and up-regulation ofβ-endorphin,endogenous opioid peptide,γ-aminobutyric acid,etc.Electro-acupuncture(EA)has pain-relief effects under some specific parameter values.Low frequency EA is more commonly used in clinical practice than high frequency EA.Our study conducts a comprehensive analysis of acupuncture analgesia and discusses associated characteristics of its mechanisms.

Correlation between the cumulative analgesic effect of electroacupuncture intervention and synaptic plasticity of hypothalamic paraventricular nucleus neurons in rats with sciatica

In the present study, a rat model of chronic neuropathic pain was established by ligation of the sciatic nerve and a model of learning and memory impairment was established by ovariectomy to investigate the analgesic effect of repeated electroacupuncture stimulation at bilateral Zusanfi （ST36） and Yanglingquan （GB34）. In addition, associated synaptic changes in neurons in the paraventricular nucleus of the hypothalamus were examined. Results indicate that the thermal pain threshold （paw withdrawal latency） was significantly increased in rats subjected to 2-week electroacupuncture intervention compared with 2-day electroacupuncture, but the analgesic effect was weakened remarkably in ovariectomized rats with chronic constrictive injury. 2-week electroacupuncture intervention substantially reversed the chronic constrictive injury-induced increase in the synaptic cleft width and thinning of the postsynaptic density. These findings indicate that repeated electroacupuncture at bilateral Zusanfi and Yanglingquan has a cumulative analgesic effect and can effectively relieve chronic neuropathic pain by remodeling the synaptic structure of the hypothalamic paraventricular nucleus.

A central analgesic mechanism of acupuncture for migraine An ongoing functional MRI study

Shaoyang acupoints are the most frequently used in migraine treatment. However, the central anal- gesic mechanism remains poorly understood. Studies have demonstrated that single stimulus of the verum acupuncture in healthy subjects can induce significant connectivity or activity changes in pain- related central networks compared with sham acupuncture. However, these findings are not indicative of the central analgesic mechanism of acupuncture at Shaoyang acupoints. Thus, we recruited 100 migraine sufferers and randomly assigned them into five groups： Shaoyang uncommon acupoint, Shaoyang common acupoint, Yangming uncommon acupoint, non-acupoint control, and blank control groups. Subjects were subjected to evaluation of curative effects and functional MRI prior to and after 10 and 20 acupuncture treatments. All subjects were diagnosed by physicians and enrolled following clinical physical examination. Subjects were observed during 1-4 weeks after inclusion. At the fifth week, the first clinical evaluation and resting functional MRI were conducted. The Shaoyang uncom- mon acupoint, Shaoyang common acupoint, Yangming uncommon acupoint, and non-acupoint control grousp then were treated with acupuncture, five times per week, 20 times in total over 4 weeks. The second and third clinical evaluations and resting functional MRI screenings were conducted following 10 and 20 acupuncture treatments. The blank control group was observed during the 5 to 8 week pe- riod, followed by clinical evaluation and resting functional MRI. The aim of this study was to examine changes in brain functional activity and central networks in subjects with migraine undergoing acu- puncture at Shaoyang uncommon acupoints. This study provides a further explanation of the central analgesic mechanism by which acupuncture at Shaoyang acupoints treats migraine,

The cumulative analgesic effect of repeated electroacupuncture involves synaptic remodeling in the hippocampal CA3 region

In the present study, we examined the analgesic effect of repeated electroacupuncture at bilateral Zusanfi （ST36） and Yanglingquan （GB34） once a day for 14 consecutive days in a rat model of chronic sciatic nerve constriction injury-induced neuropathic pain. In addition, concomitant changes in calcium/calmodulin-dependent protein kinase II expression and synaptic ultrastructure of neurons in the hippocampal CA3 region were examined. The thermal pain threshold （paw withdrawal latency） was increased significantly in both groups at 2 weeks after electroacupuncture intervention compared with 2 days of electroacupuncture. In ovariectomized rats with chronic constriction injury, the analgesic effect was significantly reduced. Electroacupuncture for 2 weeks significantly diminished the injury-induced increase in synaptJc cleft width and thinning of the postsynaptJc density, and it significantly suppressed the down-regulation of intracellular calcium/ calmodulin-dependent protein kinase II expression in the hippocampal CA3 region. Repeated electroacupuncture intervention had a cumulative analgesic effect on injury-induced neuropathic pain reactions, and it led to synaptic remodeling of hippocampal neurons and upregulated calcium/calmodulin-dependent protein kJnase II expression in the hippocampal CA3 region.

Effect of wrist-ankle acupuncture on propofol dosage during painless colonoscopy:A randomized controlled prospective study

BACKGROUND The clinical advantages of painless colonoscopy can reduce the fear and discomfort of patients and increase the detection rate of diseases.Propofol has the characteristics of fast effect and short action time.It is a common choice for painless endoscopic sedation and anesthetics.However,propofol can cause severe respiratory and circulatory depression.Therefore,it is important to find a way to reduce the dose of propofol.AIM To explore the effect of wrist-ankle acupuncture on propofol dose during colonoscopy.METHODS Two hundred patients who were going to receive selective painless colonoscopy in Hebei Hospital of Traditional Chinese Medicine were selected and divided into wrist-ankle acupuncture group(WAA group,n=100)and control group(CON group,n=100).After entering the operation room,patients were given 0.025 mg/kg nabufine intravenously and propofol at the initial dose of 0.5 mg/kg.In patients who did not fall asleep,propofol(10 mg/time)was given until loss of consciousness.Prior to anesthesia,patients in WAA group were punctured by specialist in the inferior 1,2 and 3 regions according to the zoning principle of wrist-ankle acupuncture.The primary endpoint was required dose of propofol,and the secondary endpoints were the incidence of hypoxemia and hypotension.Furthermore,the following data were recorded:The operation time,wake-up time,incidence of nausea and vomiting,incidence of abdominal distention,post colonoscopy pain,examiners'satisfaction,patients'satisfaction and Borg fatigue index.This study has been registered in the Chinese Clinical Trial Registry(Registration Code:ChiCTR1900022177).RESULTS The induced dose of propofol and the total dose of propofol in WAA group were 80 mg and 110 mg,respectively,which were significantly lower than those in CON group(P<0.05).The incidences of hypoxemia and hypotension in the WAA group were 2.2%and 3.3%,respectively,significantly lower than those in the CON group(P<0.05).The incidence of abdominal distension in the WAA group was 8.8%,which was significantly lower than that in the CON group(P<0.05,28.9%).The waking time of WAA group was 3.26±0.87 min,which was significantly lower than that of CON group(6.06±0.88 min,P<0.05).CONCLUSION Wrist-ankle acupuncture can reduce the induction dose and total dose of propofol as well as the incidence of adverse reactions in painless colonoscopy without affecting the satisfaction of examiners and patients.This procedure is simple in operation and easy to promote in clinical practice.

CLINICAL STUDY ON THE TREATMENT OF UROLITHIASIS WITH ACUPUNCTURE

120 cases of urolithlasis were randomly divided into 3 groups of 40 persons each.The first group was solely treated with an improved acupuncture method,the second group was treatedwith Chinese herbal medicine,and the third group was treated with both of the above methods.Results showed that the improved acupuncture method possessed better stone-removing effect thanthe herbal medicine method and no much difference occurred between the patients treated withacupuncture and those treated with both above methods.Besides,the authors also experienced the excellentanalgesic and stone-dissolving effect of acupuncture in this study.

EFFECT OF ACUPUNCTURE STIMULATION AT SANYINJIAO (SP 6) ON CEREBRAL GLUCOSE METABOLISM IN DYSMENORRHEA PATIENTS

To study the central mechanism of acupuncture stimulation of Sanyinjiao （三阴交 SP 6） in relieving dysmenorrhea. Methods： A total of 6 dysmenorrhea volunteer patients were subjected into this study. On the first positron emission tomography （PET） scan examination, they were assigned to pseudoacupuncture group by using the acupuncture needle just to prick the skin of Sanyinjiao （SP 6） ; while on the second PET scans, they were assigned to acupuncture group by inserting the needle into the same acupoint. 18F fluorodeoxyglucose （;SF-FDG） PET of the whole brain was performed during pseudo-acupuncture and real acupuncture of Sanyinjiao （SP 6）. The acquired PET data were analyzed by using statistical parametric mapping （SPM） software to determine changes of glucose metabolism in different cerebral regions. The patient＇s pain intensity was rated by using 0-10 numerical pain intensity scale. Results： After pseudo-acupuncture stimulation of Sanyinjiao （SP 6）, no significant changes were found in the pain intensity （ P 〉0.05）, while after real-acupuncture stimulation, the pain intensity declined significantly （ P〈0.01 ）. Following acupuncture of the right Sanyinjiao （SP 6）, multiple cerebral regions involving pain were activated （increase of glucose metabolism）, including ipsilateral lenticular nucleus （globus palliclus, putamen）, ipsilateral cerebellum and insular lobe, bilateral dorsal thalamus, ipsilateral paracentral Iobule, bilateral amygdaloid bodies, contralateral substantia nigra of the midbrain, bilateral second somatosensory （S Ⅱ ） areas, ispsilateral hippocampal gyms, frontal part of the ipsilateral cingulated gyrus, and bilateral mammary bodies of the hypothalamus. In addition, fewer regions of the cerebral cortex responded with decrease of the glucose metabolism after real acupuncture.

CLINICAL STUDIES ON THE TREATMENT OF PARAPLEGIC PATIENTS' PAIN WITH ACUPUNCTURE

One hundred and eighteen cases of paraplegic and quadriplegic patients with different degree of pain were divided into groups, their pain was treated with acupuncture, drug and acupuncture combined with drug respectively. The results show that the total analgesic effect of drug group,acupuncture group and acupuncture combined with drug group are 54. 29 %, 78. 95 % and 95. 56 % respectively. There is a significant difference(P < 0.05 ) between drug and acupuncture groups, and there is an extraordinarily significant difference(P < 0. 01 ) between drug and acupuncture combined with drug groups. It suggests that the acupuncture analgesic effect on the paraplegic and quadriplegic patients is better than that of drug, and the analgesic effect of acupuncture combined with drug is the best.

ANALYSIS OF THERAPEUTIC EFFECTS OF ACUPUNCTURE ON POSTHERPETIC NEURALGIA

Acupuncture therapy was adopted in treating 17 patients suffering from postherpeticneuralgia. Local acupoint was selected as the main point and some points on the related meridians asadjunct points, which were punctured once a day, 10 successive days as a treatment course. It was re-vealed that the total effective rate was 88. 24% and 22. 22% in acupuncture group and control grouprespectively (P【0. 01). And the high effective rates were observed in the 2nd and 3rd course of thetreatment and in the patients whose courses of diseases were in one month. lt is suggested thatacupuncture was simple, physiologically moderate and effective therapy in the treatment of posther-petic neuralgia.