Lymph Node Dissection Not Necessary in Breast Cancer

This study came out a few weeks ago and I've been meaning to post about it just because it is of utmost interest to patients and health practitioners alike. The study finds that lymph node dissection does not improve outcomes in women with breast cancer. Lymph node dissection turns out to fall into the category of something that makes utmost sense from a logical, western medicine standpoint, but in fact does not improve outcomes. There is a tyranny of logic that states that if something makes sense, it need not be studied. But we have to remember that placebo is very powerful and we need to apply the standard of studies across all treatment modalities.

For more information about my acupuncture practice please click here.

Lymph Node Study Shakes Pillar of Breast Cancer Care
By DENISE GRADY

A new study finds that many women with early breast cancer do not need a painful procedure that has long been routine: removal of cancerous lymph nodes from the armpit.

The discovery turns standard medical practice on its head. Surgeons have been removing lymph nodes from under the arms of breast cancer patients for 100 years, believing it would prolong women’s lives by keeping the cancer from spreading or coming back...

Acupuncture HRV results vary with point choice

I do have some problems with this study, even though it does address my two favorite topics, HRV(heart rate variability-a way to monitor stress response) and acupuncture. I strongly disagree with their opening statement that there is no evidence that acupuncture has effects on HRV. There have been studies too numerous to mention on this topic, and it begs the question of why they would study the issue if there was no evidence. I also wonder why they picked an acupuncture method that is not in current practice, i.e. a single "instantaneous" puncture. I would love to hear that single point, "instantaneous" puncture is just as effective as traditional "point combination," 20 minute sessions. That would be a boon to my practice and will await more studies with an open mind. All that said, I am buoyed by the thought that some points affect HRV more than others since that may give some keys to more effective acupuncture treatment.

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

Acupuncture to Danzhong but not to Zhongting increases the cardiac vagal component of heart rate variability.
Auton Neurosci. 2011 Jan 6.
Kurono Y, Minagawa M, Ishigami T, Yamada A, Kakamu T, Hayano J.

The Oriental Medical Center, Nagoya, Aichi, Japan.
Abstract

There is currently no convincing evidence that acupuncture has any specific effects on autonomic nervous function as assessed by heart rate variability (HRV). We examined whether the stimulation of neighboring acupunctural points, Danzhong (CV17) and Zhongting (CV16) on the anterior median line of the thorax, induced different effects on HRV. In 14 healthy males, epifascial acupunctural stimulation (single instantaneous needle stimulation on the fascial surface without producing De-Qi sensation) was performed at CV17 and CV16 on different days in a clinical study utilizing a cross-over design. We found that the stimulation of CV17, but not of CV16, decreased the heart rate (P=0.01, repeated measures ANOVA) and increased the power of the high-frequency component of the HRV, an index of cardiac vagal activity (P=0.01). The low-frequency to high-frequency ratio, an index of sympathetic activity showed no significant changes for either point. Our observations could not be explained as either nonspecific or psychological/placebo effects of needle stimulation. This study provides strong evidence for the presence of a specific acupunctural point that causes the modulation of cardiac autonomic function.

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.

Static Muscle Contraction effect on Muscle Activity, Trapezius Blood Flow, and Autonomic Indices

(Warning! Long post!)
This article (see below) is of interest to me because of the monitoring of HRV (Heart rate variability, a measure of autonomic balance, or stress response) at rest and during different challenges such as cold stress test, static hand grip test, and deep breathing test. The author was kind enough to send me an unofficial copy of his/their study.
In the introduction it is pointed out that changes in muscle activity and muscle blood flow due to stress and unfavorable muscle loads are possible factors for initiation and maintenance of muscle pain through accumulation of metabolites, which stimulate nociceptive afferents. Sometimes impaired muscle circulation can accompany chronic neck pain. In previous studies fibromyalgia patients and subjects with trapezius myalgia were found to have restricted MBF (muscle blood flow) in response to acupuncture by needle stimulation in the trapezius muscle. This may be due to aberrations in the autonomic nervous system. Indeed, various studies have found evidence for ANS (autonomic nervous system) involvement in diffuse and widespread muscle pain, and fibromyalgia patients may have elevated sympathetic tone at rest. These aberrations can be exacerbated by mental stress. Less is known about localized muscle pain, such as addressed in this article.
So in a nutshell, this study found that subjects with muscle pain showed HRV results that indicated reduced basal parasympathetic activity. Their findings (which I won't go into in detail here) indicated differences in intrinsic autonomic regulation, implying sympathetic-to-parasympathetic imbalance in chronic neck-shoulder pain. What has caused this imbalance is due to chronic pain, mental stress, or deconditioning is not known.
Their conclusion was that their findings support the hypothesis of ANS involvement at systemic and local levels in individuals with chronic neck-shoulder pain.
I bring this study to your attention for a few reasons.
1. It underscores what I tell first time patients with chronic pain from musculoskeletal problems: your pain may be worse after the first and even second acupuncture session because of an increase in blood flow that liberates many of the metabolites that can be "caught" in the vicious cycle of muscle tension and reduced blood flow.
2. It reinforces my belief in using points that have been studied and shown to decrease the stress response.
3. It reinforces my belief that autonomic balance remains a key component in pain management and in turn acupuncture treatment.
4. I was not aware of the blunted response of fibromyalgia patients to needling in the trapezius, so will have to amend and add means of increasing blood flow to the area during needling in these patients.

To read more about acupuncture, autonomic nervous system and my practice please click here.



Effects of static contraction and cold stimulation on cardiovascular autonomic indices, trapezius blood flow and muscle activity in chronic neck-shoulder pain

Department of Family Medicine and Public Health Sciences,
Division of Occupational and Environmental Health, Wayne
State University, 3800 Woodward Ave., Detroit, MI, USA
e-mail: bengt.arnetz@pubcare.uu.se
D. M. Hallman B. B. Arnetz
Department of Public Health and Caring Sciences,
Uppsala University, Uppsala, Sweden
123
Eur J Appl Physiol
DOI 10.1007/s00421-010-1813-z
Systemic cardiovascular characteristics
Subjects with muscle pain showed lower SDNN and LFHRV
during rest than the control group, indicating reduced
basal parasympathetic activity. However, there was no
increase in sympathetic activity as measured by LFnorm.
This is in line with recent studies that found diminishedHRV
in FM patients (Cohen et al. 2000) and in subjects with low
back pain (Kalezic et al. 2007). No significant difference was
found in IBI, in contrast with other studies on neck–shoulder
pain (Gockel et al. 1995; Sjo¨rs et al. 2009). In the present study, differences in autonomic reactivity
were indicated in response to HGT, but not in response to
CPT and DBT, namely the BP response to HGT was lower
in the pain group. These results are in accordance with the
blunted BP responses to exercise (Andersen et al. 2010;
Gockel et al. 1995) and normal BP responses to CPT
(Acero et al. 1999) demonstrated in previous studies
amongst subjects with neck–shoulder pain. Similar results
have been reported in patients with FM (Kadetoff and
Kosek 2010; Giske et al. 2008), indicating sympathic
hyporeactivity to various stressors (Martinez-Lavin 2007).
In the present study, however, only static contraction was
sensitive for differences in systemic BP, HRV and local
MBF, suggesting an altered exercise pressor reflex in the
pain group.
However, the increased LF reactivity observed in the
pain group during HGT should be interpreted with caution
as LF oscillations are influenced by both branches of the
ANS (Berntson et al. 1997). The current findings indicated
differences in intrinsic autonomic regulation, implying
sympathetic-to-parasympathetic imbalance in chronic
neck–shoulder pain. Whether this is a consequence of
chronic pain or due to other factors, e.g. mental stress or
deconditioning, requires further investigation. It is worth
noting, however, that although MVC was lower in the pain
Relations between symptoms and autonomic function
As expected, general health scores, as assessed with the
SF-36 questionnaire were lower in the pain group compared
to the healthy controls. More important, clinical
symptoms, e.g. dizziness and sweating, were more frequently
observed in the pain group. Using correlation
coefficients, a negative relationship was found between
disability of neck pain and resting LFnorm HRV and a
positive relation between disability and LFnorm reactivity
to static contraction. This is in line with previous findings
in low back pain (Gockel et al. 2008). Furthermore, an
inverse relationship between pain intensity and resting
SDNN was seen in the present study suggesting reduced
HRV with increased pain. Results show that it is worth to
plan treatment of neck–shoulder pain, aiming to restore
ANS balance at systemic and local levels.
myalgia had decreased vasodilatation capacity in these
muscles. Similarly, patients with generalised chronic
muscle pain, e.g. fibromyalgia (FM), had reduced MBF
following dynamic and during static exercise compared to
controls (Elvin et al. 2006). FM patients and subjects with
trapezius myalgia were found to have restricted MBF in
response to acupuncture by needle stimulation in the trapezius
muscle (Sandberg et al. 2005a).
A possible mechanism seems to be aberration in the
autonomic nervous system (ANS) (Maekawa et al. 2002;
Passatore and Roatta 2006). In chronic muscle pain, sympathetic
activity due to nociceptive stimulation may cause
disturbances of blood flow regulation in the affected
muscle and enhance muscle activation. This, in addition,
may be further exacerbated by mental stress (Larsson et al.
1995; Lundberg 2002).
Results from several studies provide evidence for ANS
involvement in diffuse and widespread muscle pain
(Martinez-Lavin 2007; Okifuji and Turk 2002). The autonomic
state in FM patients is characterised as elevated
sympathetic tone at rest, and hypo-reactivity to various
stressors, e.g. orthostatic stress, mental stress and isometric
exercise (Martinez-Lavin 2007; Giske et al. 2008). In
general, signs of ANS aberrations are reflected in heart rate
variability (HRV) and blood pressure (BP).
Although ANS may be involved in chronic muscle pain
of different origins, less is known about the degree of
autonomic involvement in localised chronic muscle pain,
especially pain in the neck–shoulder region (Leistad et al.
2008). Cardiovascular markers showed signs of sympathetic
dominance among persons with neck pain (Gockel
et al. 1995), low back pain (Gockel et al. 2008; Kalezic
et al. 2007), whiplash-associated disorders (Kalezic et al.
2010; Passatore and Roatta 2006) and distal forearm pain
among office workers (Gold et al. 2004; Sharma et al.
1997). Increased resting HR was found in subjects with
trapezius myalgia, whereas stress reactivity was unaltered
(Sjo¨rs et al. 2009).
To improve prevention and treatment, more knowledge
about ANS involvement in neck–shoulder pain is needed.
Tests are required which would differentiate between those
with and without muscle pain. Preferably, adequate assessment
should include multiple tests which target d

Monitoring the Autonomic Nervous System and HRV in rats after Acupuncture

I often don't know what to make of these studies, but find them super interesting nonetheless, and somehow can't help but incorporate their findings into my practice for better or for worse. What I love about this study is that they actually saw a difference between electroacupuncture on Stomach 36 and Pericardium 6, both in pain reduction and autonomic response as measured by heart rate, LF(low frequency portion of HRV) and LF/HR (low frequency to high frequency ratio-a common measure of stress response.) They saw no reduction when using Liver 3 nor the sham, non-acupoint. I wish we had more studies like this, comparing one set of points and another. For one, it helps get away from the ever present placebo problem in research, and for two it might help inform our practice!!
The study model is 4 groups, sham point, Stomach 36, Pericardium 6, Liver 3, 9 rats in each group. They used alternating 2Hz/15Hz electro, (got to haul out my alternating device again...)
The abstract for the study follow. The emphases are mine. Poor rats...

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

Zhen Ci Yan Jiu. 2010 Oct;35(5):335-41.
[Effects of electroacupuncture of different acupoints on changes of blood pressure and autonomic nerve system after colorectal distension in rats].

Chen SP, Gao YH, Yu XC, Liu JL.
Institute of Acu-moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China.
Abstract

OBJECTIVE: To observe the influence of electroacupuncture (EA) of different acupoints on changes of mean arterial pressure (MAP), heart rate (HR) and heart rate variability (HRV) in colorectal distension (CRD) rats, so as to analyze the specificity of actions of acupoints in relieving visceral pain and regulating activities of the autonomic nerve system.

METHODS: Forty-five Wistar rats were randomized into control, Zusanli (ST 36), non-acupoint, Neiguan (PC 6) and Taichong (LR 3) groups (n = 9/group). Under anesthesia, CRD was given to the rats by using an aerostat for 5 min. EA (2 Hz/15 Hz, 2 mA) was applied to bilateral ST 36, non-acupoint (1.0 cm lateral to ST 36), PC 6 and LR 3 for 15 min, respectively. Electrocardiogram of the cervico-chest lead was recorded by using a bioelectric amplifier, and MAP recorded by using a pressure transducer and an amplifier. Low frequency and high frequency of HRV were analyzed by Chart 5.0.

RESULTS: Following CRD, the HR, MAP, LF and LF/HF levels increased significantly in all the 5 groups (P <> 0.05). Compared with the control group, 5 min and 15 min after EA ,and 10 min after ceasing EA, MAP values of ST 36 and PC 6 groups were decreased obviously (P < style="font-weight: bold;">The LF levels of both ST 36 and PC 6 groups at 5 min after EA, and those of ST 36, PC 6 and LR 3 at 15 min after EA were significantly lower than those of control group (P <> 0.05).

CONCLUSION: EA of ST 36 and PC 6 can suppress CRD-induced increase of MAP, HR and LF/HF, suggesting beneficial effects of EA in relieving visceral pain and mediating autonomic nerve system. The aforementioned effects of EA of LR 3 and non-acupoint are not obvious.