Autonomic Nervous System:Acupuncture and Low Back Pain

This study evaluates the autonomic nervous system (stress response) in patients with low back pain comparing electroacupuncture (10 sessions) and an antiinflammatory medication. What they found was that both groups had pain relief, but the acupuncture group more so. There was an improvement in the stress response in the acupuncture group also. (For info on my practice please click here.)

Autonomic status and pain profile in patients of chronic low back pain and following electro acupuncture therapy: a randomized control trial.
Shankar N, Thakur M, Tandon OP, Saxena AK, Arora S, Bhattacharya N.Indian J Physiol Pharmacol. 2011 Jan-Mar;55(1):25-36.
Department of Physiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi.

Pain is a syndrome characterized by several neurophysiological changes including that of the autonomic nervous system. Chronic low back pain (LBP) is a major health problem and is a frequent reason for using unconventional therapies especially acupuncture. This study was conducted to evaluate the autonomic status and pain profile in chronic LBP patients and to observe the effect of electro acupuncture therapy. Chronic LBP patients (n=60) were recruited from the Department of Orthopaedics, GTB Hospital, Delhi. Age and sex matched healthy volunteers were selected as controls (n=30). Following a written consent, LBP patients were randomly allocated into two study groups - Group A received 10 sittings of electro acupuncture, on alternate days, at GB and UB points selected for back pain, while the Group B received a conventional drug therapy in the form of oral Valdecoxib together with supervised physiotherapy. Controls were assessed once while the patients were assessed twice, before and after completion of the treatment program (3 weeks). The autonomic status was studied with non-invasive cardiovascular autonomic function tests which included E: I ratio, 30:15 ratio, postural challenge test and sustained handgrip test. Pain intensity was measured with the visual analogue scale (VAS) and the global perceived effect (GPE). Statistical analysis was performed using repeated measure's ANOVA with Tukey's test. Pain patients showed a significantly reduced vagal tone and increased sympathetic activity as compared to the controls (P<0.05 to P<0.001 in different variables). Following treatment, both the study groups showed a reduction in vagal tone together with a decrease in the sympathetic activity. There was also a considerable relief of pain in both groups, however, the acupuncture group showed a better response (P<0.01). We conclude that there is autonomic dysfunction in chronic LBP patients. Acupuncture effectively relieves the pain and improves the autonomic status and hence can be used as an alternative/additive treatment modality in these cases.

Spinal Serotonin and Electroacupuncture: University of Maryland Group

University of Maryland with another elegant study exploring the precise spinal neuro-receptors involved in electroacupuncture. They employ the model that they have used repeatedly, iwhich is to inject Freund's adjuvant into the joint space of cats hind paws. This is an irritant which mimics arthritis. They then use hind paw withdrawal latency to measure the effects of acupuncture versus control.
But don't we all know that acupuncture is just placebo??
(Information on my practice here.)

Involvement of spinal serotonin receptors in electroacupuncture anti-hyperalgesia in an inflammatory pain rat model.
Zhang Y, Li A, Xin J, Lao L, Ren K, Berman BM, Tan M, Zhang RX.
Neurochem Res. 2011 Oct;36(10):1785-92.
Center for Integrative Medicine, School of Medicine, University of Maryland, 685 W Baltimore street, MSTF Rm 8-22, Baltimore, MD 21201, USA.


We previously showed that electroacupuncture (EA) activates medulla-spinal serotonin-containing neurons. The present study investigated the effects of intrathecal 5,7-dihydroxytryptamine creatinine sulfate, a selective neurotoxin for serotonergic terminals, the 5-hydroxytryptamine 1A receptor (5-HT1AR) antagonist NAN-190 hydrobromide and the 5-HT2C receptor (5-HT2CR) antagonist SB-242,084 on EA anti-hyperalgesia. EA was given twice at acupoint GB30 after complete Freund's adjuvant (CFA) injection into hind paw. CFA-induced hyperalgesia was measured by assessing hind paw withdrawal latency (PWL) to a noxious thermal stimulus 30 min post-EA. Serotonin depletion and the 5-HT1AR antagonist blocked EA anti-hyperalgesia; the 5-HT2CR antagonist did not. Immunohistochemical staining showed that spinal 5-HT1AR was expressed and that 5-HT2CR was absent in naive and CFA-injected animals 2.5 h post-CFA. These results show a correlation between EA anti-hyperalgesia and receptor expression. Collectively, the data show that EA activates supraspinal serotonin neurons to release 5-HT, which acts on spinal 5-HT1AR to inhibit hyperalgesia.

Focus on the Cause AND the Cure

The latest dust up with the Komen foundation exposed the rank partisanship in the organization. But I hope that it will also expose the bias towards finding the "cure" the magic bullet that will take away the horror that is cancer. The Komen foundation partners with business to sell products and raise money. But somehow looking for the possible cause may anger big business. I discussed the media blackout on this topic here. This issue is far from simple, and I don't want to portray it as such. Here is an excerpt from an article by Susan Love, NYTimes. Info on my practice here.

Real Race in Cancer Is Finding Its Cause
By SUSAN LOVE, M.D.

A decision by the nation’s leading breast cancer advocacy group, Susan G. Komen for the Cure, to largely cut off financing for breast cancer screenings at Planned Parenthood set off howls of outrage last week. Once again, it seemed, political gamesmanship was jeopardizing women’s health.

The widespread anger forced Komen to reverse its decision, and it has certainly reinvigorated the women’s health movement. But the furor misses an important fact: Women have been led to believe that screening is the best prevention.

In reality, we still do not know what causes breast cancer, which means we really do not know how to prevent it, either. That has pushed us to focus on looking for cancers that are already there, a practice long based on the assumption that all cancers were the same, grew at a similar rate and were visible in the breast for a period of time before spreading. It made sense: If you could find cancers earlier, you could save lives...

We should continue to speak up when we think health care services are in jeopardy, but we cannot be satisfied with the status quo. We must move breast cancer advocacy to the next level, beyond screening for cancers that are already there, even beyond the cure, to finding the cause. That is true prevention.

Dr. Susan Love is president of the Dr. Susan Love Research Foundation in Santa Monica, Calif.

Acupuncture and Parasympathetic Activity and Enkephalins, Longhurst

Readers of this blog are familiar with Dr. Longhurst. I've blogged about his work on acupuncture and hypertension and his recent conference here, here, and here. I also mentioned how he is convinced that electro acupuncture is necessary, indeed in this study his control is manual acupuncture. This is a study looking at electro acupuncture in cats at PC 5 and 6, showing that stimulation in the neurons of the nucleus ambiguous may be responsible for the increase in parasympathetic activity induced by acupuncture. This area of inquiry is of keen interest to me since my research concerns the autonomic nervous system and acupuncture effectiveness. More info on my practice here.

Nucleus ambiguus cholinergic neurons activated by acupuncture: Relation to enkephalin.
Brain Res. 2012 Jan 12.
Guo ZL, Li M, Longhurst JC.

Acupuncture regulates autonomic function. Our previous studies have shown that electroacupuncture (EA) at the Jianshi-Neiguan acupoints (P5-P6, underlying the median nerve) inhibits central sympathetic outflow and attenuates excitatory cardiovascular reflexes, in part, through an opioid mechanism. It is unknown if EA at these acupoints influences the parasympathetic system. Thus, using c-Fos expression, we examined activation of nucleus ambiguus (NAmb) neurons by EA, their relation to cholinergic (preganglionic parasympathetic) neurons and those containing enkephalin. To enhance detection of cell bodies containing enkephalin, colchicine (90-100μg/kg) was administered into the subarachnoid space of cats 30h prior to EA or sham-operated controls for EA. Following bilateral barodenervation and cervical vagotomy, either EA for 30min at P5-P6 acupoints or control stimulation (needle placement at P5-P6 without stimulation) was applied. While perikarya containing enkephalin were observed in some medullary nuclei (e.g., raphé), only enkephalin-containing neuronal processes were found in the NAmb. Compared to controls (n=4), more c-Fos immunoreactivity, located principally in close proximity to fibers containing enkephalin was noted in the NAmb of EA-treated cats (n=5; P<0.01). Moreover, neurons double-labeled with c-Fos and choline acetyltransferase in the NAmb were identified in EA-treated, but not control animals. These data demonstrate for the first time that EA activates preganglionic parasympathetic neurons in the NAmb. Because of their close proximity, these EA-activated neurons likely interact with nerve fibers containing enkephalin. These results suggest that EA at the P5-P6 acupoints has the potential to influence parasympathetic outflow and cardiovascular function, likely through an enkephalinergic mechanism.

Genetics of the Immune System: Dr. Medzhitov

An interesting story about a Russian scientist who has studied the immune system of vertebrates. There is an innate immune system and an adaptive immune system, and he with Dr. Janeway identified the mechanism whereby the innate system triggers the adaptive one. As I've mentioned repeatedly in this blog, my hunch is that this is part of the way that acupuncture works, by triggering the body's own immune mechanisms for healing. I will excerpt some of the article here. Info on my practice here.

A Long Journey to Immune System Insights
By CLAUDIA DREIFUS

Ruslan M. Medzhitov loves scientific puzzles. And this penchant has led him to tackle some of the big questions of modern biology.

At Yale University, where he is a professor of immunology and a Howard Hughes Medical Institute investigator, Dr. Medzhitov, 45, helped make key discoveries in the workings of vertebrates’ immune systems. ..

Let’s talk about the paper by the immunologist Charles A. Janeway Jr. that changed your life. When did you learn about it?

...The only library with anything was at the Academy of Natural Sciences, and it barred nonaffiliated people from their facilities. Luckily, I had made friends with some very kind young women who worked there and who permitted me to use the library, secretly.

And it was there, one day, that I stumbled upon this three-year-old paper by Janeway, where he proposed a theory of immunity. I read it and my eyes opened up. I thought, “Now I see.”

What was in the paper?

A revolutionary idea of how the immune system worked. In vertebrates, two immune systems protect against infection. There’s the evolutionarily older system that all organisms, even plants, have — the innate immune system. There is also another system that evolved relatively recently, the adaptive immune system, which only vertebrates have. Janeway proposed that the innate system detects invading microbes, distinguishes them from everything else and signals the adaptive immune system to move against the intruder...

How did you finally prove his theory?

Our main goal was to discover the gene in the cells of the innate immune system that activates the adaptive system. That would explain how our body knows we have an infection and translates it into an immune response. It took about two years, but we found it. Today, this gene is known at the human Toll-like receptor, and it is important in immunity and in inducing inflammation.