Exploration of the therapeutic effect and clinical outcomes of acupuncture at pain-sensitive points to treat chronic nonspecific low back pain:Application of the acupoint sensitization theory

Objectives:To investigate the clinical and therapeutic effects of acupuncture at the pain-sensitive points of patients with chronic nonspecific low back pain and optimize the acupuncture treatment for chronic nonspecific low back pain.Methods:Using the FDK 20 pressure algometer,the pain-sensitive points were probed in 30 patients with chronic nonspecific low back pain.The top 5 points that elicited the most painful reaction were selected and stimulated with an even-needling technique after deqi.The needles were retained for 30 min.TDP irradiation was concurrently administered.The treatment was administered once daily on weekdays(Monday to Friday) and discontinued for 2 days during the weekend(Saturday and Sunday).The treatment lasted for 2 consecutive weeks.The changes in the range of motion(ROM) of the lumbar vertebrae,visual analogous scale(VAS) score,and the Oswestry disability index(ODI) score of the lumbar vertebrae were assessed before treatment and after 5 and 10 treatment sessions.Results:Compared with the data before treatment,the spinal ROM increased after 5 and 10 treatment sessions in the patients with chronic nonspecific low back pain.The ROM after 10 treatment sessions was remarkably wider than that after 5 treatments,with statistical significance(all P<0.05).Compared with that before treatment,the immediate VAS score showed statistically significant reduction after 5 treatment sessions(P<0.05).Moreover,compared with the score after 5 treatment sessions,the immediate VAS score reduced after 10 treatment sessions,but without any statistical significance.After 5 and 10 treatment sessions,the ODI score was reduced in the patients and it was significantly different from that before treatment(both P<0.05).Conclusion:Acupuncture at the pain-sensitive points alleviates pain and improves lumbar vertebral function in patients with chronic nonspecific low back pain.Thus,further research is needed to confirm whether acupuncture can be a better intervention for chronic nonspecific low back pain.

Trigger points and sensitized acupoints:same book,different covers?

Acupoints and trigger points in traditional Chinese medicine represent two different minimally invasive therapy systems-based,respectively,on traditional acupuncture and dry needles.Many studies argue that trigger points and traditional acupoints are conceptually similar because they generally have identical locations on the human body.However,whether trigger points contribute to the formation of the traditional acupuncture technique is controversial.Although many relevant studies have been conducted,this controversy continues to hinder the development of both disciplines.Recently,researchers of Chinese acupuncture have proposed the“acupoint sensitization”theory,which postulates that traditional acupoints may be sensitized by diseases,environments,and therapies.This turns them into a“sensitized state.”Recent studies suggest that trigger points and sensitized acupoints share similar biological properties.To clarify the above-mentioned confusion,we reviewed relevant studies on these two concepts and attempted to analyze their relationship.In this paper,we provide a general summary of acupoint sensitization theory and sensitized acupoints.We then compare trigger points with sensitized acupoints by categorizing their similarities and differences,including location and range,pathological morphology,pain perception,surface temperature effects,and bioelectrical properties.We believe that,because trigger points and sensitized acupoints have many shared properties,they might constitute“the same book with different covers.”

Electroacupuncture at Sensitized Acupoints Relieves Somatic Referred Pain in Colitis Rats by Inhibiting Sympathetic-Sensory Coupling to Interferewith 5-HT Signaling Pathway

Objective:To investigate whether electroacupuncture(EA) at sensitized acupoints could reduce sympathetic-sensory coupling(SSC) and neurogenic inflammatory response by interfering with 5-hydroxytryptamine(5-HT)ergic neural pathways to relieve colitis and somatic referred pain,and explore the underlying mechanisms.Methods:Rats were treated with 5% dextran sodium sulfate(DSS) solution for 7 days to establish a colitis model.Twelve rats were randomly divided into the control and model groups according to a random number table(n=6).According to the Research on Rat Acupoint Atlas",sensitized acupoints and non-sensitized acupoints were determined.Rats were randomly divided into the control,model,Zusanli-EA(ST 36),Dachangshu-EA(BL 25),and Xinshu(BL 15) groups(n=6),as well as the control,model,EA,and EA+GR113808(a 5-HT inhibitor)groups(n=6).The rats in the control group received no treatment.Acupuncture was administered on 2 days after modeling using the stimulation pavameters:1 mA,2 Hz,for 30 min,with sparse and dense waves,for 14 consecutive days.GR113808 was injected into the tail vein at 5 mg/kg before EA for 10 min for 7 consecutive days.Mechanical sensitivity was assessed with von Frey filaments.Body weight and disease activity index(DAI) scores of rats were determined.Hematoxylin and eosin staining was performed to observe colon histopathology.SSC was analyzed by immunofluorescence staining.Immunohistochemical staining was performed to detect 5-HT and substance P(SP) expressions.The calcitonin gene-related peptide(CGRP) in skin tissue and tyrosine hydroxylase(TH) protein levels in DRG were detected by Western blot.The levels of hyaluronic acid(HA),bradykinin(BK),prostaglandin I2(PGI2) in skin tissue,5-HT,tryptophan hydroxylase 1(TPH1),serotonin transporters(SERT),5-HT 3 receptor(5-HT3R),and 5-HT 4 receptor(5-HT4R) in colon tissue were measured by enzyme-linked immunosorbent assay(ELISA).Results:BL 25 and ST 36 acupoints were determined as sensitized acupoints,and BL 15 acupoint was used as a non-sensitized acupoint.EA at sensitized acupoints improved the DAI score,increased mechanical withdrawal thresholds,and alleviated colonic pathological damage of rats.EA at sensitized acupoints reduced SSC structures and decreased TH and CGRP expression levels(P<0.05).Furthermore,EA at sensitized acupoints reduced BK,PGI2,5-HT,5-HT3R and TPH1 levels,and increased HA,5-HT4R and SERT levels in colitis rats(P<0.05).GR113808 treatment diminished the protective effect of EA at sensitized acupoints in colitis rats(P<0.05).Conclusion:EA at sensitized acupoints alleviated DSS-induced somatic referred pain in colitis rats by interfering with 5-HTergic neural pathway,and reducing SSC inflammatory response.

An infrared thermographic analysis of the sensitization acupoints of women with primary dysmenorrhea

OBJECTIVE:To explore the sensitization acupoints of women with primary dysmenorrhea(PD)by comparing infrared radiation temperatures between acupoints and non-acupoints.METHODS:We tested 10 acupoints of every woman with PD and healthy subjects on premenstrual,menstrual,and postmenstrual days using an infrared imaging device.The primary outcome was the absolute value of body surface temperature difference(AVTD)between the left and right sides of the same testing point.RESULTS:A total of 58 PD patients and 57 healthy volunteers completed the test from May 2016 to May 2017.Compared with the healthy group,we observed a significant reduction and increase in the AVTD in Taichong(LR3)and Sanyinjiao(SP6),respectively,during menstrual days in the PD group(P=0.01;P=0.04);while during postmenstrual days,all AVTDs of Shuiquan(KI5),Diji(SP8),and Xuehai(SP10)were diminished in the PD group(P=0.01;P=0.03;P=0.01,respectively).No significant differences in AVTD were detected at any other points or testing times.CONCLUSIONS:Compared with the healthy group,the AVTDs of Taichong(LR3),Sanyinjiao(SP6),Shuiquan(KI5),Diji(SP8),and Xuehai(SP10)at menstruationrelevant points of PD patients were sensitized,providing a reference for the selection of acupoints in the treatment of PD.

Acupuncture Enhances Signalsat Sensitized Acupoints to Elevate Pressure Pain Thresholdin Knee Osteoarthritis Patients

Objective:To observe the pressure pain threshold(PPT),skin conductance(SC)and blood perfusion(BP)of the sensitized acupoints in patients with knee osteoarthritis(KOA),and explore the mechanism of acupuncture at the sensitized acupoints for treating diseases.Methods:Eleven healthy subjects and 11 unilateral KOA patients were recruited from July 2020 to March 2021 in this study.The PPT,SC and BP of control acupoints in healthy controls,and non-sensitized and sensitized acupoints in KOA patients were measured and compared between baseline and after manual acupuncture(MA)treatment.Results:Before MA treatment,lower PPT was observed at the sensitized acupoints comparedwith non-sensitized andcontrol acupoints(P<0.05).After MA treatment,PPT at the sensitized acupoints increased significantly in KOA patients(P<0.05).Before MA treatment,there was no statistical difference in SC and BP among control,non-sensitized and sensitized acupoints(P>0.05).Compared with the control and non-sensitized acupoints,there were significant increases of SC and BP in sensitized acupoints of KOA patients after MA treatment(P<0.05 or P<0.01).Conclusion:MA at sensitized acupoints could elevate PPT of KOA patients,which may be associated with the increment of SC and BP.

肽能神经元对颈部急性炎性痛模型大鼠穴位敏化的调节作用

Objective:Pain is a health problem frequently reported in the clinical and general populations.Acupoint therapy is one of the most effective ways to treat pain;however,its mechanism remains unclear.Therefore,this study aimed to explore the relationship between distal acupoints,dorsal root ganglion(DRG)neurons,and spinal cord dorsal horn(SDH) neurons in neck acute inflammatory pain(NAIP).Methods:NAIP model rats were used to explore the relationship between acupoint sensitization and pain.Out of fourteen rats,ten rats were grouped into control and NAIP groups,five rats in control and five rats in NAIP.Mustard oil was subcutaneously injected on one side between the C4 and C7 vertebrae of the neck to establish an NAIP model.Evans blue(EB) was injected through the tail vein to detect sensitized acupoints after NAIP modeling.EB exudation in the body,Liè qūe(列缺 LU7),and Língdào(灵道 HT4) were evaluated.An immunofluorescence assay was conducted to detect the expression of calcitonin generelated peptide(CGRP),isolectin B4(IB4),and c-Fos in the dorsal root ganglion(DRG)and spinal cord dorsal medullae spinalis(CDMS).Four rats were used for the retrograde labeling of neurons of the LU7 region to the DRG and CDMS using CTB-488 and CTB-555 microinjection.Results:NAIP was shown to lead to oozing and pain sensitization in the LU7 and HT4 and increased the proportion of c-Fos^(+)/CGRP^(+)and c-Fos^(+)/IB4^(+)cells in both the DRG and CDMS.CTB-488 and CTB-555injected into the LU7 and sensitization point areas were observed in the DRG and CDMS regions of NAIP rats.Conclusions:Our study revealed that NAIP could lead to oozing and pain sensitization in the LU7 and HT4regions and that the pain point around LU7 might result from the transfer of peptidergic(CGRP-positive)and non-peptidergic(IB4-positive) neurons in the DRG and CDMS.