Factors contributing to Therapeutic Effects Evaluated in Acupuncture Clinical Trials

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Posted on 04/28/2012

This is a comprehensive look at what is known about the different types of acupuncture point stimulation.  A very nice reference article to have, and has free access to the article online.

Factors contributing to therapeutic effects evaluated in acupuncture clinical trials.
Shi GX, Yang XM, Liu CZ, Wang LP.
Trials. 2012 Apr 21;13(1):42.
Abstract ABSTRACT: Acupuncture treatment has been widely used for many conditions, while results of the increasing numbers of randomized trials and systematic reviews remain controversial. Acupuncture is a complex intervention of both specific and non-specific factors associated with therapeutic benefit. Apart from needle insertion, issues such as needling sensation, psychological factors, acupoint specificity, acupuncture manipulation, and needle duration also have relevant influences on the therapeutic effects of acupuncture. Taking these factors into consideration would have considerable implications for the design and interpretation of clinical trials.

NFL and Acupuncture

Yay. I remember reading this article when it came out but couldn't find it, it's entitled "Big Men, Little Needles." The New York Jets use acupuncture to keep strong, healthy and pain free.
So can you!!

Needling the body forces the connective tissue aroung the pin to contract stimulating blood flow and releasing endorphins, which act as powerful pain relievers. Inserting acupuncture needles also triggers the production of dopamine a chemical in the braind that plays a part in response to pleasure and pain, which is why some patients feel high afte acupuncture therapy... Not only effective in easing pain, acupuncture can also help the body overcome one of the toughest hurles to healing, inflammation.

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Interview with ME! in the Examiner

Here's a link to the interview. I wish I hadn't been so wordy and wonkish. But if the shoe fits...

Info on my practice here.

Recent Research Shows Acupuncture Useful for Kids

There have been a number of recent studies about acupuncture for children. I think the problem comes with the number of visits needed for the conditions they describe below. It's hard enough for adults to keep up with their acupuncture series, harder still for families and children. I'm board certified in Pediatrics and still think that the fit with kids and acupuncture can be tricky. (For more information about my practice, please click here.)

Most of us would say yes to anything that makes our children feel better, and expert evidence is piling up in favor of kiddie acupuncture. Recent research from the New York Eye and Ear Infirmary found that acupuncture was as effective at treating amblyopia, or "lazy eye," as eye patches. Other studies have linked acupuncture with reduced symptoms of ADHD in preschoolers and decreased crying episodes in colicky infants. And, according to a small study from doctors at Rush University Medical Center in Chicago, acupuncture may alleviate pain and nausea in kids with chronic illnesses.

Worried about the ouch factor?
"While no one likes needles, kids are often surprised at how relatively painless and helpful acupuncture can be," says Kathi Kemper, M.D., founding chair of the American Academy of Pediatrics section on complementary and integrative medicine. "The needles are tiny, and they're not hollow, so they don't tear the skin." To find a reputable provider in your area, Kemper recommends asking your child's pediatrician, who can direct you to someone specially licensed in pediatric acupuncture. You can also use the "advanced search" option at acufinder.com to find a local acupuncturist who specializes in treating kids.

Read more: http://www.sfgate.com/cgi-bin/article.cgi?f=/g/a/2011/07/26/hearstmagfamily5631726.DTL#ixzz1Vo2l8aRu

Treating High Blood Pressure in the Acupuncture Clini

This is the latest data on the patient we've been following on this blog here and here. He is maintaining control of his blood pressure very nicely in spite of the fact that he hasn't been able to exercise as much as I recommend, nor has he taken the excess weight off. But he has followed through with his monthly acupuncture and takes his herbs religiously.
I did HRV monitoring on him when he came in on Wednesday and his LFR/HFR decreased from .68 to .57.
His SD1/Sd2 went down from .39 to .29 (not a positive result)
But his Sample Entropy went from 1.11 to 1.48 which, in my opinion is the most sensitive marker.
(Brief primer: LFR/HFR stands for Low Frequency/High Frequency HRV. If this decreases, it is interpreted to mean that the stress response in decreased. So decrease in LFR/HFR=decreased stress. The other measure SD1/Sd2, is a nonlinear method, if this ratio increases =decreased stress.)
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Blood Pressure Management and Acupuncture

This is another case study. This patient had severe peripheral neuropathy in her feet when she presented to the clinic. She suspected that it was due to a statin she was taking so discontinued it. She also had blood pressure that was out of control and wanted to try another approach.
The graph below shows her Blood Pressure the week before she came in to see me. Her first visit was 6/23/2011. Her last visit was 7/11/2011. The blood pressures for those days I took in my clinic. I didn't end up seeing her after those 4 visits, but contacted her to find out how she was doing and she gave me the last three readings.
So the acupuncture helped her blood pressure, but her blood pressure also was lowered because her feet improved dramatically so she wasn't in so much pain. This obviously helped her blood pressure also. (If I can get it together, I'll try to post her HRV readings in a later post since they were fascinating also.)



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Acupuncture and the relaxation response for treating gastrointestinal symptoms in HIV patients on highly active antiretroviral therapy

I bring this study to your attention for a few reasons. It underscores the efficacy of acupuncture for gastrointestinal problems in general by addressing a serious and pernicious problem in HIV patients. The gut is highly innervated, and for that reason is actually easier to affect with acupuncture than one might think. The other interesting part of this study is that they combined the relaxation response with acupuncture to see if there was any difference and it turns out that they had a synergistic effect. The biofeedback device I use in my clinic to monitor Heart Rate Variability (HRV), a measure of the relaxation response, is designed to be used as a device for patients to learn to relax. I use it as a simple monitor, to see what happens during treatment. This makes me think I should go ahead and use it as intended, with patient participation. Who knows how much better my results would be? (For info on my practice, please click here.)

Acupuncture and the relaxation response for treating gastrointestinal symptoms in HIV patients on highly active antiretroviral therapy.
Chang BH, Sommers E.
Acupunct Med. 2011 Jun 24. [Epub ahead of print]

1VA Boston Health Care System, Boston, Massachusetts, USA.
Abstract
OBJECTIVES:

To examine the effect of acupuncture and the relaxation response (RR) for treating gastrointestinal (GI) symptoms in HIV patients who are using highly active antiretroviral therapy (HAART).
METHODS:

The authors conducted a 4-arm 2×2 double-blind randomised controlled trial in an acupuncture clinic in the USA. Sham acupuncture and health education were used as the control conditions of real acupuncture and RR elicitation, respectively. Enrolled patients were randomised to real acupuncture+RR (AR), sham acupuncture+RR (SR), real acupuncture+health education (AE) or sham acupuncture+health education (SE) study arm. Participants listened to CDs with RR-eliciting instructions or health education while receiving acupuncture intervention. Interventions were provided twice weekly for 4 weeks and once weekly for another 4 weeks. Participants used daily diaries to record GI symptom severity ratings (0-10). The authors estimated the intervention effect as the changes in symptom rating per intervention session increase using a mixed-effects regression model.
RESULTS:

A total of 130 people with HIV/AIDS who were on HAART and had persistent GI symptoms were enrolled and 115 started the study intervention. The AR group had greater intervention effects for loose stools symptoms than the other three groups (ß=-0.149, -0.151 and -0.144, p value=0.013, 0.013 and 0.018 comparing AR to AE, SR and SE, respectively). The AR group also had significant intervention effects on reducing nausea symptoms when the intervention was given twice per week (ß=-0.218, p=0.001).
CONCLUSIONS:

Our trial provided preliminary data demonstrating the potential synergistic effects of acupuncture and RR for treating GI symptoms in HIV patients on HAART.

Studying the Acupuncture Meridians: Collagen Bands and Electrical Impedance

Helene Langevin is a regular at the Society for Acupuncture Research (SAR) gatherings. Her particular interest and expertise is the actual meridians themselves, and the collagen networks that contribute to acupuncture signaling. I was unaware of this study and think it's interesting. The emphases are mine.
Electrical Impedance of Acupuncture Meridians: The Relevance of Subcutaneous Collagenous Bands

The scientific basis for acupuncture meridians is unknown. Past studies have suggested that acupuncture meridians are physiologically characterized by low electrical impedance and anatomically associated with connective tissue planes. We are interested in seeing whether acupuncture meridians are associated with lower electrical impedance and whether ultrasound-derived measures – specifically echogenic collagenous bands - can account for these impedance differences.

In 28 healthy subjects, we assessed electrical impedance of skin and underlying subcutaneous connective tissue using a four needle-electrode approach. The impedances were obtained at 10 kHz and 100 kHz frequencies and at three body sites - upper arm (Large Intestine meridian), thigh (Liver), and lower leg (Bladder). Meridian locations were determined by acupuncturists. Ultrasound images were obtained to characterize the anatomical features at each measured site. We found significantly reduced electrical impedance at the Large Intestine meridian compared to adjacent control for both frequencies. No significant decrease in impedance was found at the Liver or Bladder meridian. Greater subcutaneous echogenic densities were significantly associated with reduced impedances in both within-site (meridian vs. adjacent control) and between-site (arm vs. thigh vs. lower leg) analyses. This relationship remained significant in multivariable analyses which also accounted for gender, needle penetration depth, subcutaneous layer thickness, and other ultrasound-derived measures.

Collagenous bands, represented by increased ultrasound echogenicity, are significantly associated with lower electrical impedance and may account for reduced impedances previously reported at acupuncture meridians. This finding may provide important insights into the nature of acupuncture meridians and the relevance of collagen in bioelectrical measurements.

Andrew C. Ahn1,2*, Min Park3, Jessica R. Shaw4, Claire A. McManus5, Ted J. Kaptchuk2,6, Helene M. Langevin7

1 Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America, 2 Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America, 3 P-pro Korea Co., Ltd., Seoul, Korea, 4 AltThera Health, Boston, Massachusetts, United States of America, 5 Department of Research and Training, Spaulding Rehabilitation Hospital, Boston, Massachusetts, United States of America, 6 Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School, Boston, Massachusetts, United States of America, 7 Department of Neurology, University of Vermont, Burlington, Vermont, United States of America

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Typical Patient who comes to my Acupuncture Clinic

I thought I might start to feature some case studies of some of my patients. This patient is particularly interesting. She is in her mid sixties and came in for help with Neuropathy of her feet. Her other problems include high cholesterol and high blood pressure. It turns out that the neuropathy was made much worse by Lipitor. She finally convinced her physician to discontinue it, and she was doing better but then he put her on another statin. Her neuropathy got so intense that she couldn't walk without a cane and was crying out from the pain. She stopped it and came into the clinic to see me.
I gave her treatment for stress and for the neuropathy in her feet. I saw her for the first time on a Thursday, and by the following Monday the pain in her feet was much improved, and her blood pressure had remained below 140 systolic and below 80 diastolic. She can walk without a cane now.
Of course it is hard to tell if the acupuncture helped or if it was tincture of time being off of the statin. Similarly with the blood pressure, it might have come down with the lessening of the pain in her feet.
I will continue to treat her for both problems, at least for awhile, and try to get her blood pressure low enough that she can consider cutting back on medications.
Interestingly, she had Clostridia dificil last year. A nasty life threatening type of colitis that is usually caused by antibiotics. And sure enough, she had been treated for 6 months with antibiotics for a bladder infection. She was also diagnosed with COPD because of a dry cough, when dry cough is a typical side effect of Lisinopril, something I've seen quite a bit in my clinic. The cough went away once she discontinued the Lisinopril, COPD, um, gone.
These are the types of medical histories that make people open to alternative medicine. First, do no harm.
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Acupuncture and Menopausal Symptoms

This study was cited in the most recent issue of Acupuncture Today. It compares acupuncture with sham acupuncture with symptoms, estrogen levels and FSH levels as outcome measures. I was not aware of it, and as a study it is pretty small, but I put it up for discussion's sake. Sara Calabro, LAc, reviewed the study. She also notes that in the U.K. there was a large study of over one million postmenopausal women looking at the risks of HRT (hormone replacement therapy.) Their findings show that women who took HRT in the early stages of menopause were at higher risk of developing breast cancer than those tho took it five or more years after menopause began. Of course, HRT has also been shown to increase heart problems, stroke and blood clots. So, we can hope that one day, acupuncture will be a first line recommendation for the symptoms of menopause, it's safe and many studies confirm that it is effective. Previous posts related to menopause are here and here. (For more information about my practice, please click here.)

Acupunct Med. 2011 Mar;29(1):27-31.

The effect of acupuncture on postmenopausal symptoms and reproductive hormones: a sham controlled clinical trial.
Sunay D, Ozdiken M, Arslan H, Seven A, Aral Y. Source Department of Family Medicine, Ministry of Health, Ankara Training and Research Hospital, Kiz kulesi sokak 3/5 Gaziosmanpasa Çankaya, Ankara, Turkey. didemsunay@gmail.c

Acupuncture is commonly used to treat menopausal symptoms and other gynaecological conditions. In this study, the authors aimed to investigate whether acupuncture has an effect on menopausal symptoms and to explore whether this effect is related to changes in hormone levels. Materials and methods A total of 53 postmenopausal women were alternately assigned into two treatment groups: acupuncture (n=27) and sham acupuncture (n=26). Menopausal symptoms were assessed using the Menopause Rating Scale (MRS). The serum oestradiol, follicular stimulating hormone (FSH) and luteinising hormone (LH) levels were measured at baseline and again after the first and last sessions. The Student t test was used for normally distributed data and the Wilcoxon signed rank test for not normally distributed data. The group differences in MRS scores were assessed using non-parametric Mann-Whitney U test.

RESULTS:

After treatment, total MRS, and the somatic and psychological subscale scores were significantly lower in the acupuncture group than the sham group (all p=0.001). The severity of hot flushes was found to be significantly decreased after treatment in acupuncture group (p=0.001). In the acupuncture group LH levels were lower and oestradiol levels were significantly higher than sham group (p=0.046 and p=0.045, respectively) after treatment, but there was no difference in FSH levels.

CONCLUSION:

Acupuncture was effective in reducing menopausal complaints when compared to sham acupuncture and can be considered as an alternative therapy in the treatment of menopausal symptoms.

Nice testimonial from a patient with allergies

Just for something different, I thought I'd share with you a testimonial from a patient I've been treating for allergic rhinitis. I received it yesterday and it hopefully speaks for itself. In this particular case, I started with acupuncture alone, and then added Astra Essence, an overall tonic with astragalus to strengthen the lung, as a daily tonic.

I developed allergies to cats and dogs about 30 years ago. I tried allergy shots for a year and they did not seem to help. When I went to friends' houses, I had to take a Zyrtec or Claritin, found that the pills did not always work and also found that they made me feel drowsy and a little off -- just when I'd most like to socialize. You're not supposed to drink when you take those medications, so wine with dinner was a problem.

Over the years, the allergies seemed to be getting worse. Feeling that this was all headed in the wrong direction, I wondered whether acupuncture could help when shots and pills had not. I didn't have much to lose. Dr. Sparrow's experience with her own allergies and acupuncture sounded promising and I liked the fact that she is a trained physician.

Dr. Sparrow has a great manner and is easy to talk to. She explained that the theory is that acupuncture and herbs can help to strengthen and balance your immune system. This made sense, because the medical research links allergies to immune system response.

Most importantly, the acupuncture and herbs are working for me. After just the first few treatments, I have been able to take no pills and still go comfortably to homes of friends with cats and dogs. After a year, it's even better. Dr. Sparrow advises not to challenge one's system too much, so I am still careful but I just don't have to be as careful (or drugged) as I was before. What a relief! As a side bonus, I have not had a cold or other illness in about a year (despite a heavy air travel schedule).

To give the blog readers a break from the academics and harangues about institutionalized medicine... For more information about my practice please click here.
If you have any questions or comments about this case or others please let me know in comments!

Letter to the Economist

Just for the sake of completeness, I will post my letter to the Economist here. I didn't get it in in a timely fashion because of my last Spain trip in May, but I'll "publish" it here instead. It is in response to the Economist articles about Alternative Medicine, here and here.
Sir:I was amused and bemused by the full-throated condemnation of alternative medicine as no more than placebo in the May 21st Economist.. I can only address the acupuncture literature, since that is my area of interest and expertise. The author makes no mention whatsoever of the significant number of reputable acupuncture studies done on animals to delineate physiological pathways involved in acupuncture(no placebo there). Nor did he mention numerous fMRI studies done on acupuncture subjects, nor of the exhaustive studies performed on knee osteoarthritis nor of the extensive studies funded by the German insurance companies which lead to their including acupuncture as a covered benefit. Nor did he mention that the British NHS has recently included acupuncture as a first line treatment for back pain because “they want to fund only treatments that work.”
Placebos will always be with us both in traditional and alternative medicine, but without irony he mentions that fake surgery for the knee (it was actually arthroscopy) was no better than the real thing, but somehow never admits the obvious that surgery itself may be quite a powerful placebo. He also stated that Ernst, in debunking alternative medicine is addressing “a serious public-health problem.” “Conventional medicines must be safe and effective before licensed for sale.” In the last decade alone, Vioxx and Prozac, as the most egregious examples, were on the market for years and it took quite a bit of morbidity and mortality before the problems came to light or were even admitted.
There is nothing courageous, new, nor noteworthy in attacking alternative medicine. The fact is that acupuncture research is poorly funded, with no huge lobbying or industrial backing, since it is currently not easily scalable so remains unattractive to corporate interests. Admittedly, acupuncture’s mode of action has not been adequately explained and the results not yet entirely reproducible. The same could be said of some traditional modes of therapy. But patients seek safe treatment options, and vote with their feet. This fact alone seems to enrage some critics.


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Acupuncture in critically ill patients improves delayed gastric emptying: a randomized controlled trial.

This article combines my previous specialty, Anesthesiology and Critical Care, and Acupuncture. So for me it is doubly interesting. In addition, the results are dramatic in this study coming out of Germany, with collaboration with colleagues at Harvard. The acupuncture improved gastric emptying much more than medications, by a large margin. We don't get that kind of margins often in acupuncture research, so it's a satisfying study.
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Acupuncture in critically ill patients improves delayed gastric emptying: a randomized controlled trial.
Pfab F, Winhard M, Nowak-Machen M, Napadow V, Irnich D, Pawlik M, Bein T, Hansen E.
Anesth Analg. 2011 Jan;112(1):150-5. Epub 2010 Nov 16

Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany.
Abstract
BACKGROUND:

Malnutrition remains a severe problem in the recovery of critically ill patients and leads to increased in-hospital morbidity and in-hospital stay. Even though early enteral nutrition has been shown to improve overall patient outcomes in the intensive care unit (ICU), tubefeed administration is often complicated by delayed gastric emptying and gastroesophageal reflux. Acupuncture has been successfully used in the treatment and prevention of perioperative nausea and vomiting. In this study we evaluated whether acupuncture can improve gastric emptying in comparison with standard promotility drugs in critically ill patients receiving enteral feeding.
METHODS:
Thirty mechanically ventilated neurosurgical ICU patients with delayed gastric emptying, defined as a gastric residual volume (GRV) >500 mL for ≥ 2 days, were prospectively and randomly assigned to either the acupoint stimulation group (ASG; bilateral transcutaneous electrical acupoint stimulation at Neiguan, PC-6) or the conventional promotility drug treatment group (DTG) over a period of 6 days (metoclopramide, cisapride, erythromycin). Patients in the ASG group did not receive any conventional promotility drugs. Successful treatment (feeding tolerance) was defined as GRV <200 mL per 24 hours.
RESULTS:
.. After 5 days of treatment, 80% of patients in the ASG group successfully developed feeding tolerance versus 60% in the DTG group. On treatment day 1, GRV decreased from 970 ± 87 mL to 346 ± 71 mL with acupoint stimulation (P = 0.003), whereas patients in the DTG group showed a significant increase in GRV from 903 ± 60 mL to 1040 ± 211 mL (P = 0.015). In addition, GRV decreased and feeding balance (defined as enteral feeding volume minus GRV) increased in more patients in the ASG group (14 of 15) than in the DTG group (7 of 15; P = 0.014). On treatment day 1, the mean feeding balance was significantly higher in the ASG group (121 ± 128 mL) than in the DTG group (-727 ± 259 mL) (P = 0.005). Overall, the feeding balance improved significantly on all days of treatment in comparison with the DTG group. Patients in the DTG group did not show an increase in feeding balance until day 6.
CONCLUSIONS:

We introduce a new protocol for acupuncture administration in the critical care setting. We demonstrated that this protocol was more effective than standard promotility medication in the treatment of delayed gastric emptying in critically ill patients. Acupoint stimulation at Neiguan (PC-6) may be a convenient and inexpensive option (with few side effects) for the prevention and treatment of malnutrition in critically ill patients.

Effect of acupuncture on heart rate variability in primary dysmenorrheic women

Dysmenorrhea in layman's terms is menstrual cramps, or menstrual pain. I was not aware that dysmenorrhea had an autonomic component. They used a simple point selection and a simple cross-over design. The subjects had one month with sham acupuncture (SA) and then one month with real acupuncture (RA) or vice versa and the results were compared. They do report the changes in the HRV between sham and real acupuncture, but not whether the patients improved on a pain scale or not. So, to me, this is an interesting study because of the definitive differences in HRV measurements, but whether it would be super interesting to dysmenorrhea sufferers is questionable.

To read more about acupuncture, HRV, and my practice please click here.

Effect of acupuncture on heart rate variability in primary dysmenorrheic women.
Am J Chin Med. 2011;39(2):243-9.
Kim E, Cho JH, Jung WS, Lee S, Pak SC.

Department of Gynecology, College of Oriental Medicine, Kyung Hee University Seoul, South Korea.

Primary dysmenorrhea is a common gynecological complaint among young women that is related to an autonomic nervous system (ANS) disturbance. Acupuncture is one of several therapeutic approaches for primary dysmenorrhea, since it can modulate ANS function. The heart rate variability (HRV) parameters such as high frequency (HF), low frequency (LF) and LF/HF ratio are generally accepted tools to assess ANS activity. The purpose of this study was to investigate the effects of acupuncture applied at Hegu (LI4) and Sanyinjiao (SP6) points on HRV of women with primary dysmenorrhea during the late luteal phase. The experimental design was a crossover and patient-blinded procedure. All subjects participated in Sham (SA) and Real Acupuncture (RA) procedure, separated by one month, in a crossover sequence. The participants included 38 women (mean age 22.3 years; weight 53.8 kg; height 162.6 cm). HRV measurement was 15 min before and 15 min after an acupuncture procedure. The RA procedure was performed at two bilateral acupoints, but needles were inserted subcutaneously to the acupuncture points for the SA procedure. The RA induced a significant decrease in LF/HF ratio and a significant increase in the HF power, while SA treatment caused a significant increase only in the HF power. Manual acupuncture at bilateral acupoints of LI4 and SP6 may play a role in dysmenorrhea treatment with autonomic nervous system involvement.

Acupuncture inhibits GABA neuron activity in the ventral tegmental area and reduces ethanol self-administration

This is another study looking at alcohol self-administration, in Rats, mind you, but this one looks at the brain physiology behind acupuncture's effects. Their conclusion was "These findings suggest that DOR-mediated opioid modulation of VTA GABA neurons may mediate acupuncture's role in modulating mesolimbic DA release and suppressing the reinforcing effects of ethanol." I did a previous post looking at those tippling rodents here. They use Heart 7 as their therapeutic point, which implies that they think drinking is more related to the heart and spirit than a liver imbalance. It is close to PC 6 which has been repeatedly shown to decrease the stress response, so very thought provoking in terms of clinical utility.

(To read further about acupuncture, HRV, and my practice please click here.)

Acupuncture inhibits GABA neuron activity in the ventral tegmental area and reduces ethanol self-administration.

Yang CH, Yoon SS, Hansen DM, Wilcox JD, Blumell BR, Park JJ, Steffensen SC.

Daegu Haany University, Daegu, South Korea.
Alcohol Clin Exp Res. 2010 Dec;34(12):2137-46. doi: 10.1111/j.1530-0277.2010.01310.x. Epub 2010 Sep 22.
Abstract

BACKGROUND: Withdrawal from chronic ethanol enhances ventral tegmental area (VTA) GABA neuron excitability and reduces mesolimbic dopamine (DA) neurotransmission, which is suppressed by acupuncture at Shenmen (HT7) points (Zhao et al., 2006). The aim of this study was to evaluate the effects of HT7 acupuncture on VTA GABA neuron excitability, ethanol inhibition of VTA GABA neuron firing rate, and ethanol self-administration. A role for opioid receptors (ORs) in ethanol and acupuncture effects is also explored.

METHODS: Using electrophysiological methods in mature rats, we evaluated the effects of HT7 stimulation and opioid antagonists on VTA GABA neuron firing rate. Using behavioral paradigms in rats, we evaluated the effects of HT7 stimulation and opioid antagonists on ethanol self-administration using a modification of the sucrose-fading procedure.

RESULTS: HT7 stimulation produced a biphasic modulation of VTA GABA neuron firing rate characterized by transient enhancement followed by inhibition and subsequent recovery in 5 minutes. HT7 inhibition of VTA GABA neuron firing rate was blocked by systemic administration of the nonselective μ-opioid receptor antagonist naloxone. HT7 stimulation significantly reduced ethanol suppression of VTA GABA neuron firing rate, which was also blocked by naloxone. HT7 acupuncture reduced ethanol self-administration without affecting sucrose consumption. Systemic administration of the δ-opioid receptor (DOR) antagonist naltrindole blocked ethanol suppression of VTA GABA neuron firing rate and significantly reduced ethanol self-administration without affecting sucrose consumption.

CONCLUSIONS: These findings suggest that DOR-mediated opioid modulation of VTA GABA neurons may mediate acupuncture's role in modulating mesolimbic DA release and suppressing the reinforcing effects of ethanol.
Copyright © 2010 by the Research Society on Alcoholism.

Alcohol Clin Exp Res. 2010 Dec;34(12):2137-46. doi: 10.1111/j.1530-0277.2010.01310.x. Epub 2010 Sep 22.

Improvement of menopausal symptoms with acupuncture not reflected in changes to heart rate variability

This undercuts one of my theories that if someone's autonomics, heart rate variability (HRV) are improved with acupuncture then they are more likely to see improvement in their symptoms. In this study, the patients improved in 11 out of 12 of their symptoms from menopause, but their HRV did not change.

(To read further about acupuncture, HRV, and my practice please click here.)

Improvement of menopausal symptoms with acupuncture not reflected in changes to heart rate variability.

Wright CL, Aickin M.

School of Nursing Portland Campus, 3455 SW US Veterans Road, SN-ORD, Portland, OR 97239, USA; cwright80@hotmail.com.
Acupunct Med. 2011 Mar;29(1):32-9.
Abstract

Hypothesis Studies indicate that menopausal symptoms are relieved by acupuncture. Additional studies have suggested that acupuncture may affect heart rate variability (HRV). This paper reports a pilot study that investigated whether menopausal symptoms responded to acupuncture, and if changes in the spectral analysis of HRV, either suppression of low frequency or augmentation of high frequency bands, corresponded with symptom report. Methods/interventions 12 healthy menopausal subjects were enrolled in this feasibility study. At baseline, subjects were experiencing moderately distressing menopausal symptoms, scoring at least 22 of a possible 44 points on the Menopausal Rating Scale. 10 traditional Chinese medicine-based, protocol acupuncture treatments were administered over a 4 week period, three times a week for 2 weeks, followed by twice a week for 2 weeks. Outcome measures Menopausal Rating Scale questionnaire, 11 menopausal symptoms were evaluated on a zero to four severity scale via self-administered daily checklist for 4 weeks. Dynamic measures of HRV (autoregressive model) were captured before, during and after acupuncture at each session. Spectral analysis of the heart rate was used to compute power in the low frequency and high frequency bands, and their ratio. RESULTS: All subjects complied fully with the protocol without any reported adverse events. While all 11 symptoms showed significant improvement, and one HRV measure changed, on average over the study period, there was essentially no support for a relationship between HRV, menopausal symptom report and acupuncture intervention.

Review of Acupuncture for Infertility

From the available acupuncture literature this group concluded that acupuncture can be of benefit for fertility treatments in women with Polycystic Ovary Disease. In addition, it can increase the rate of live births during embryo transfer for invitro fertilization patients if given on the day of transfer. It can also improve sperm count and motility in males with infertility of idiopathic origin. Interestingly, they do attribute some of acupuncture's success to changes in the autonomic nervous system. So more researchers coming around to my way of thinking?

(To read further about acupuncture, HRV, and my practice please click here.)


Acupuncture in clinical and experimental reproductive medicine: a review.
J Endocrinol Invest. 2011 Feb 4. [Epub ahead of print]
Franconi G, Manni L, Aloe L, Mazzilli F, Giambalvo Dal Ben G, Lenzi A, Fabbri A.

Endocrinology Unit, S. Eugenio and CTO Hospitals, Tor Vergata University, Roma, Italy. giovanna.franconi@uniroma2.it.

Abstract

Background: Acupuncture has been used as treatment for infertility for hundreds of years, and recently it has been studied in male and female infertility and in assisted reproductive technologies, although its role in reproductive medicine is still debated. Aim: To review studies on acupuncture in reproductive medicine, in experimental and clinical settings. Methods: Papers were retrieved on PubMed and Google Scholar and were included in the review if at least the abstract was in English. Results: There is evidence of benefit mainly when acupuncture is performed on the day of embryo transfer (ET) in the live birth rate. Benefit is also evident when acupuncture is performed for female infertility due to polycystic ovary syndrome (PCOS). There is some evidence of sperm quality improvement when acupuncture is performed on males affected by idiopathic infertility. Experimental studies suggest that acupuncture effects are mediated by changes in activity of the autonomic nervous system and stimulation of neuropeptides/neurotransmitters which may be involved in the pathogenesis of infertility. Conclusions: Acupuncture seems to have beneficial effects on live birth rate when performed on the day of ET, and to be useful also in PCOS as well as in male idiopathic infertility, with very low incidence of side effects. However, further studies are necessary to confirm the clinical results and to expand our knowledge of the mechanisms involved.

Autonomic activation in insomnia: the case for acupuncture.

I hope I'll be able to get a copy of this article. If I do, I'll post again on the details. Here are the money quotes: "Acupuncture may represent a unique avenue of treatment for poor sleep by virtue of its direct effects on peripheral nerves and muscles, which, in turn, modulate autonomic tone and central activation. In this review, we summarize both basic and clinical research indicating that acupuncture exerts profound influences via a wide variety of potential neural and/or hormonal mechanisms that have great relevance for the modulation of sleep and wakefulness."
I would add that acupuncture is often helpful for a wide variety of psychological conditions because it provides that link between the physical and the mental through augmentation of the autonomic nervous system, hence decreasing stress and its related maladies.

(To read further about acupuncture, HRV, and my practice please click here.)

Autonomic activation in insomnia: the case for acupuncture.

Huang W, Kutner N, Bliwise DL. J Clin Sleep Med 2011;7(1):95-102.
Current conceptualizations of the biological basis for insomnia typically invoke central nervous system and/or autonomic nervous system arousal. Acupuncture may represent a unique avenue of treatment for poor sleep by virtue of its direct effects on peripheral nerves and muscles, which, in turn, modulate autonomic tone and central activation. In this review, we summarize both basic and clinical research indicating that acupuncture exerts profound influences via a wide variety of potential neural and/or hormonal mechanisms that have great relevance for the modulation of sleep and wakefulness. We illustrate principles of acupuncture intervention applied to cases of otherwise intractable insomnia that document successful application of this component of Traditional Chinese Medicine to the treatment of poor sleep. Our review indicates the necessity for further research in the relationship between the effects of acupuncture on insomnia and autonomic regulation, which might guide better selective use of this treatment modality for insomnia. CITATION: Huang W; Kutner N; Bliwise DL. Autonomic activation in insomnia: the case for acupuncture. J Clin Sleep Med 2011;7(1):95-102.

Tendon Pain, what works?

This article from the New York Times looks at the interesting phenomenon that sometimes occurs with tendonitis: using the injured area, even intensely, can sometimes help. I've had at least two interesting experiences with this pattern. One was in a patient who had tennis elbow. I had been treating him and after 3 visits he was much better with less swelling, but he was still aware of it. He was a pro, so needed to play and he had a particularly grueling match and his elbow was all better the next day! I also had the embarrassing situation of turning on an electrotherapeutic device without turning down the intensity first and it gave a massive shock to a patient with tennis elbow. His whole arm leapt from the table and he started yelling. I quickly turned it off. By the next day, all the bruising swelling and pain was gone. I've never had the nerve to repeat that mistake, and thank goodness that patient was my husband, but after reading this article, I wonder if more stimulation might be better than less... The theory is that you increase the blood flow and that is what is curative. I addressed the cortisone issue in this post.

To learn more about acupuncture and HRV and my practice please click here.

For Tendon Pain, Think Beyond the Needle
By JANE E. BRODY

Two time-honored remedies for injured tendons seem to be falling on their faces in well-designed clinical trials.

The first, corticosteroid injections into the injured tendon, has been shown to provide only short-term relief, sometimes with poorer long-term results than doing nothing at all.

The second, resting the injured joint, is supposed to prevent matters from getting worse. But it may also fail to make them any better.

Rather, working the joint in a way that doesn’t aggravate the injury but strengthens supporting tissues and stimulates blood flow to the painful area may promote healing faster than “a tincture of time.”

Neuro pathways involved in acupuncture decreasing Blood Pressure

This is a nice study that looks at the pathways involved in acupuncture's effect on blood pressure. I have had good results in my clinic in patients with hypertension as long as they are willing to follow through with their visits! Once their blood pressure has come down, monthly visits suffice usually with herbal supplementation.

To learn more about acupuncture, HRV, and my practice please click here.

Neural mechanism of electroacupuncture's hypotensive effects
Auton Neurosci. 2010 Oct 28;157(1-2):24-30. Epub 2010 May 5.
Neural mechanism of electroacupuncture's hypotensive effects. Li P, Longhurst JC
Department of Medicine, Susan-Samueli Center for Integrative Medicine, University of California, Irvine, California 92697, USA. pengli@uci.eduAbstract

EA at P 5-6 and S 36-37 using low current and low frequency may be able to reduce elevated blood pressure in a subset of patients (∼70%) with mild to moderate hypertension. The effect is slow in onset but is long-lasting. Experimental studies have shown that EA inhibition of cardiovascular sympathetic neurons that have been activated through visceral reflex stimulation is through activation of neurons in the arcuate nucleus of the hypothalamus, vlPAG in the midbrain and NRP in the medulla, which, in turn, inhibit the activity of premotor sympathetic neurons in the rVLM. The arcuate also provides direct projections to the rVLM that contain endorphins. Glutamate, acetylcholine, opioids, GABA, nociceptin, serotonin and endocannabinoids all appear to participate in the EA hypotensive response although their importance varies between nuclei. Thus, a number of mechanisms underlying the long-lasting effect of EA on cardiovascular function have been identified but clearly further investigation is warranted.