I've been meaning to write about this interesting study that was presented at the Society for Acupuncture Research Meeting in North Carolina in March. I had met the author at previous meetings and had the opportunity to speak with him at length at the poster session. Apparently he's on his way to Harvard to do some work there. There is a center of gravity of acupuncture research starting to develop at Harvard and it's all for the good. At the epicenter is Vitaly Napadow who has done incredible work in staggering amounts on fMRI and acupuncture and other topics. He presented at the SAR also and cited my paper (had to mention that...) Turns out there is a U.C. Berkeley alum (like me),Andrew Ahn, who is headed to Harvard also who presented an interesting paper on "wavelet analysis" which is something I tried to do for awhile with my own data. Still haven't cracked that.
So I've digressed.
This study shows that acupuncture helps prevent flares of acupuncture and also the actual wheal and flare after provoked eczema. They compared verum acupuncture (VA) puncture at points Large Intestine 11, and Spleen 10 to "no acupuncture" (NA) and placebo acupuncture (PA.) Verum acupuncture significantly lowered the itching and wheal and flare associated with eczema. Details in the abstract.
Influence of acupuncture on type I hypersensitivity itch and the wheal and flare response in adults with atopic eczema - a blinded, randomized, placebo-controlled, crossover trial.
Pfab F, Huss-Marp J, Gatti A, Fuqin J, Athanasiadis GI, Irnich D, Raap U, Schober W, Behrendt H, Ring J, Darsow U.
Department of Dermatology and Allergy, Technische Universität München, Munich, Germany.
Abstract
Background: Itch is a major symptom of allergic skin disease. Acupuncture has been shown to exhibit a significant effect on histamine-induced itch in healthy volunteers. We investigated the effect of acupuncture on type I hypersensitivity itch and skin reaction in a double-blind, randomized, placebo-controlled, crossover trial. Methods: An allergen stimulus (house dust mite or grass pollen skin prick) was applied to 30 patients with atopic eczema before (direct effect) and after (preventive effect) two experimental approaches or control observation: acupuncture at points Quchi and Xuehai [verum acupuncture (VA), dominant side], 'placebo-point' acupuncture (PA, dominant side), no acupuncture (NA). Itch intensity was recorded on a visual analogue scale. After 10 min, wheal and flare size and skin perfusion (via LASER-Doppler) were measured at the stimulus site, and the validated Eppendorf Itch Questionnaire (EIQ) was answered. Results: Mean itch intensity was significantly lower in VA (35.7 +/- 6.4) compared to NA (45.9 +/- 7.8) and PA (40.4 +/- 5.8) regarding the direct effect; and significantly lower in VA (34.3 +/- 7.1) and PA (37.8 +/- 5.6) compared to NA (44.6 +/- 6.2) regarding the preventive effect. In the preventive approach, mean wheal and flare size were significantly smaller in VA (0.38 +/- 0.12 cm(2)/8.1 +/- 2.0 cm(2)) compared to PA (0.54 +/- 0.13 cm(2)/13.5 +/- 2.8 cm(2)) and NA (0.73 +/- 0.28 cm(2)/15.1 +/- 4.1 cm(2)), and mean perfusion in VA (72.4 +/- 10.7) compared to NA (84.1 +/- 10.7). Mean EIQ ratings were significantly lower in VA compared to NA and PA in the treatment approach; and significantly lower in VA and PA compared to NA in the preventive approach. Conclusions: Acupuncture at the correct points showed a significant reduction in type I hypersensitivity itch in patients with atopic eczema. With time the preventive point-specific effect diminished with regard to subjective itch sensation, whereas it increased in suppressing skin-prick reactions.
Monday, April 19, 2010
Monday, April 12, 2010
Depression in Pregnancy, Acupuncture Treatment
This is an important study in that it focuses on a patient population that could benefit greatly from a non-pharmaceutical option for treatment. It is unusual in the study design in that it uses practitioners who were "junior," meaning that they were merely administering the acupuncture so not biased by whether the point selection was appropriate or not. The depression specific acupuncture patients achieved much better results than the acupuncture non-specific patients or the massage treatment patients. This is a positive development in the acupuncture research world since many of the recent studies out of Europe have had a hard time clearly delineating the benefits of condition specific treatment versus non-specific treatment. Of note is that they consider 12 sessions a "short" trial. In day to day practice a short practice would be more around 4 visits...
Obstet Gynecol. 2010 Mar;115(3):511-20.
Acupuncture for depression during pregnancy: a randomized controlled trial.
Manber R, Schnyer RN, Lyell D, Chambers AS, Caughey AB, Druzin M, Carlyle E, Celio C, Gress JL, Huang MI, Kalista T, Martin-Okada R, Allen JJ.
Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California 94305, USA. rmanber@stanford.edu
Abstract
OBJECTIVE: To estimate the efficacy of acupuncture for depression during pregnancy in a randomized controlled trial. METHODS: A total of 150 pregnant women who met Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria for major depressive disorder were randomized to receive either acupuncture specific for depression or one of two active controls: control acupuncture or massage. Treatments lasted 8 weeks (12 sessions). Junior acupuncturists, who were not told about treatment assignment, needled participants at points prescribed by senior acupuncturists. All treatments were standardized. The primary outcome was the Hamilton Rating Scale for Depression, administered by masked raters at baseline and after 4 and 8 weeks of treatment. Continuous data were analyzed using mixed effects models and by intent to treat. RESULTS: Fifty-two women were randomized to acupuncture specific for depression, 49 to control acupuncture, and 49 to massage. Women who received acupuncture specific for depression experienced a greater rate of decrease in symptom severity (P<.05) compared with the combined controls (Cohen's d=0.39, 95% confidence interval [CI] 0.01-0.77) or control acupuncture alone (P<.05; Cohen's d=0.46, 95% CI 0.01-0.92).They also had significantly greater response rate (63.0%) than the combined controls (44.3%; P<.05; number needed to treat, 5.3; 95% CI 2.8-75.0) and control acupuncture alone (37.5%; P <.05: number needed to treat, 3.9; 95% CI 2.2-19.8). Symptom reduction and response rates did not differ significantly between controls (control acupuncture, 37.5%; massage, 50.0%). CONCLUSION: The short acupuncture protocol demonstrated symptom reduction and a response rate comparable to those observed in standard depression treatments of similar length and could be a viable treatment option for depression during pregnancy. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, www.clinicaltrials.gov, NCT00186654.
Heart Rate Variability and Acupuncture, a review
Auton Neurosci. 2010 Mar 19
Acupuncture and heart rate variability: A systematic review.
Lee S, Lee MS, Choi JY, Lee SW, Jeong SY, Ernst E.
Department of Acupuncture and Moxibustion, College of Oriental Medicine, Kyung Hee University, Seoul, South Korea.
Acupuncture has been reported to affect the autonomic system. Currently, there are no systematic reviews examining the effect of acupuncture on HRV available in the literature. Therefore, the aim of this systematic review was to summarize and critically assess the effects of acupuncture on heart rate variability. We searched the literature using 14 databases for articles published from the earliest available publications until October 2009 without language restrictions. We included randomized clinical trials (RCTs) comparing acupuncture and sham acupuncture. The risk of bias in each study was assessed using the Cochrane criteria. Twelve RCTs met all of the inclusion criteria. One RCT evaluated the effects of acupuncture in patients with minor depression or anxiety disorders and another RCT examined the effect of acupuncture on migraine patients. Another four RCTs tested the effects of acupuncture in healthy subjects who were exposed to several conditions, including mental stress, fatigue from driving, and caffeine intake. The remaining six RCTs assessed the effects of acupuncture on healthy subjects in a normal state without any stressors. Five RCTs found significant differences in HRV between patients treated with acupuncture versus those treated with sham acupuncture (controls). However, the majority of the other RCTs showed inconsistent results or did not identify significant differences in HRV spectral parameters among individuals treated with acupuncture as compared to those treated with sham acupuncture. In conclusion, sham-controlled RCTs showed variable results and no clear evidence that acupuncture has any specific effects on HRV. Therefore, more rigorous research appears to be warranted. Copyright © 2010 Elsevier B.V. All rights reserved.
Wednesday, October 21, 2009
Acupuncture, the Autonomic Nervous system and Brain Networks
This is a technical paper exploring what occurs in the brain during acupuncture and in the ensuing time period. It also looks at the difference in the brain between sham (superficial) acupuncture and verum or real acupuncture. They also correlate this activity with Heart Rate Variability, a measure of the autonomic nervous system balance. It has the added feature of citing my research study at least twice... The abstract can be found at the link, the entire paper can be downloaded from nlm also. Some excerpts of the paper follow and short discussion.
http://www.ncbi.nlm.nih.gov/pubmed/18337009?ordinalpos=12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Pain. 2008 Jun;136(3):407-18.
Acupuncture modulates resting state connectivity in default and sensorimotor brain networks
Our results demonstrate for the first time that acupuncture can enhance the post-stimulation spatial extent of resting brain networks to include anti-nociceptive, memory, and affective brain regions. This modulation and sympathovagal response may relate to acupuncture analgesia and other potential therapeutic effects.
A review of the literature suggests that acupuncture influences a diverse set of bodily organs and functions including brain processing [25, 26] and autonomic nervous system (ANS) activity [1, 44].
It has long been known that the analgesic effects of acupuncture may actually peak long after cessation of active needle stimulation [58]. ..
Furthermore, recent reports have suggested that ANS(Autonomic Nervous System) response to acupuncture (measured by heart rate variability, HRV, [49]) may be linked to clinical response for different chronic pain populations [60]. As variable peripheral ANS response to acupuncture may influence post-stimulation brain activity, we also sought to explore the relationship between acupuncture induced ANS outflow to the heart as estimated by HRV and acupuncture induced changes in RSN (Resting state network) connectivity.
We also sought to explore the relationship between acupuncture-induced autonomic modulation and subsequent change in RSN connectivity. Increased DMN (Default Mode Network) connectivity with the hippocampal formation was anti-correlated with acupuncture-induced increase in sympathetic modulation, and correlated with parasympathetic modulation. ..
Our data contribute to these results by suggesting that when acupuncture induces a sympathovagal shift toward parasympathetic, the hippocampal formation has greater connectivity with the DefaultModeNetwork, a brain network thought to subserve self-referential cognition and autobiographical memory [14]. While pain is known to modulate autonomic outflow [18], the response is typically increased sympathetic tone. However, increased hippocampal/DMN connectivity following acupuncture was associated decreased sympathetic and increased parasympathetic modulation, suggesting that acupuncture modulation of DMN connectivity may not result from classic pain-like aspects of this complex intervention. Interestingly, other groups have found that acupuncture-induced decrease of LF/HF ratio, relating a shift in sympathovagal balance toward greater parasympathetic modulation, may relate to acupuncture therapeutic effects on chronic pain [60]. Our correlative results connecting HRV metrics with enhanced DMN connectivity should to be replicated in a clinical population to investigate this possible connection with clinical efficacy...
Not that I can speak to the entirety of this complicated and excellent study, but they are exploring why acupuncture would decrease the stress response, and why it might lead to prolonged pain relief in chronic pain patients. Since chronic pain is a syndrome where the suffering of the patient is not in direct correlation to the nociceptive stimulus, it is postulated in this paper that the acupuncture sets up a new memory of sorts which requires the default mode network connectivity with certain brain regions. They showed that the acupuncture increased the connectivity of the Default Mode Network with the hippocampus, which is connected with the Autonomic Nervous System, which caused a decrease in the stress response as demonstrated by HRV (Heart Rate Variability) analysis.
In sum, this paper may show why the stress response can be lowered by acupuncture, as my own research paper suggested.
http://www.ncbi.nlm.nih.gov/pubmed/18337009?ordinalpos=12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Pain. 2008 Jun;136(3):407-18.
Acupuncture modulates resting state connectivity in default and sensorimotor brain networks
Our results demonstrate for the first time that acupuncture can enhance the post-stimulation spatial extent of resting brain networks to include anti-nociceptive, memory, and affective brain regions. This modulation and sympathovagal response may relate to acupuncture analgesia and other potential therapeutic effects.
A review of the literature suggests that acupuncture influences a diverse set of bodily organs and functions including brain processing [25, 26] and autonomic nervous system (ANS) activity [1, 44].
It has long been known that the analgesic effects of acupuncture may actually peak long after cessation of active needle stimulation [58]. ..
Furthermore, recent reports have suggested that ANS(Autonomic Nervous System) response to acupuncture (measured by heart rate variability, HRV, [49]) may be linked to clinical response for different chronic pain populations [60]. As variable peripheral ANS response to acupuncture may influence post-stimulation brain activity, we also sought to explore the relationship between acupuncture induced ANS outflow to the heart as estimated by HRV and acupuncture induced changes in RSN (Resting state network) connectivity.
We also sought to explore the relationship between acupuncture-induced autonomic modulation and subsequent change in RSN connectivity. Increased DMN (Default Mode Network) connectivity with the hippocampal formation was anti-correlated with acupuncture-induced increase in sympathetic modulation, and correlated with parasympathetic modulation. ..
Our data contribute to these results by suggesting that when acupuncture induces a sympathovagal shift toward parasympathetic, the hippocampal formation has greater connectivity with the DefaultModeNetwork, a brain network thought to subserve self-referential cognition and autobiographical memory [14]. While pain is known to modulate autonomic outflow [18], the response is typically increased sympathetic tone. However, increased hippocampal/DMN connectivity following acupuncture was associated decreased sympathetic and increased parasympathetic modulation, suggesting that acupuncture modulation of DMN connectivity may not result from classic pain-like aspects of this complex intervention. Interestingly, other groups have found that acupuncture-induced decrease of LF/HF ratio, relating a shift in sympathovagal balance toward greater parasympathetic modulation, may relate to acupuncture therapeutic effects on chronic pain [60]. Our correlative results connecting HRV metrics with enhanced DMN connectivity should to be replicated in a clinical population to investigate this possible connection with clinical efficacy...
Not that I can speak to the entirety of this complicated and excellent study, but they are exploring why acupuncture would decrease the stress response, and why it might lead to prolonged pain relief in chronic pain patients. Since chronic pain is a syndrome where the suffering of the patient is not in direct correlation to the nociceptive stimulus, it is postulated in this paper that the acupuncture sets up a new memory of sorts which requires the default mode network connectivity with certain brain regions. They showed that the acupuncture increased the connectivity of the Default Mode Network with the hippocampus, which is connected with the Autonomic Nervous System, which caused a decrease in the stress response as demonstrated by HRV (Heart Rate Variability) analysis.
In sum, this paper may show why the stress response can be lowered by acupuncture, as my own research paper suggested.
Friday, October 9, 2009
Heart Rate Variability, TENS, and Body Composition
Study from Evidence Based Complementary and Alternative Medicine September 22, 2009 done by a Taiwanese group (http://ecam.oxfordjournals.org/cgi/content/full/nep145v1) looks at obesity in postmenopausal women. They evaluated the effect of Transcutaneous Electric Acupoint Stimulation (TEAS) as a function of body composition and heart rate variability. Body composition was used as a screening test (percentage body fat >30%, waist >80cm.) The study group received TEAS twice a week for 30 minutes for 12 weeks. The control group did not receive any intervention. HRV and body composition was measured at the 4th,8th, and 12th week. Waist circumference and % body fat were significantly less than those of the control group at the 8th and 12th week. HRV increased as measured by SDNN from the 4th to the 8th week, but was no different from controls at the 12th week.
They conclude that TEAS treatment improves body composition and has a transient effect on the HRV in postmenopausal women with obesity.
Unfortunately, there was no sham TENS applied, so this is not a truly controlled study. But this study, nonetheless, raises some interesting questions. First of all, TENS is a therapy that could be applied by patients at home, which could be an incredibly convenient therapeutic help to people afflicted with obesity. It is very interesting that the HRV increased with TENS treatment, and it is impossible to know if the HRV improved because of body composition changes or vice versa. I will look forward to further studies to see if this effect can be corroborated. It should also be noted that the subjects weight did not change, only their lean mass.
They conclude that TEAS treatment improves body composition and has a transient effect on the HRV in postmenopausal women with obesity.
Unfortunately, there was no sham TENS applied, so this is not a truly controlled study. But this study, nonetheless, raises some interesting questions. First of all, TENS is a therapy that could be applied by patients at home, which could be an incredibly convenient therapeutic help to people afflicted with obesity. It is very interesting that the HRV increased with TENS treatment, and it is impossible to know if the HRV improved because of body composition changes or vice versa. I will look forward to further studies to see if this effect can be corroborated. It should also be noted that the subjects weight did not change, only their lean mass.
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