Placebo Needles Research Articles

Effect of dry needling on pain and central sensitization in women with chronic pelvic pain: A randomized parallel-group controlled clinical trial

Chronic pelvic pain (CPP) is a debilitating problem in women with clear evidence of myofascial dysfunction. It seems that Myofascial trigger points (MTrPs) contribute to the development of central sensitization (CS). This study aimed to investigate the effect of dry needling on pain and CS in women with CPP. Thirty-six women with CPP participated in this randomized controlled clinical trial and randomly assigned into three groups: dry needling group (DNG), placebo needling group (PNG) and control group (CG). The DNG received five sessions of DN using the “static needling”, the PNG received non-penetrating method, and the CG did not receive any intervention. Assessment of outcomes including central sensitization inventory (CSI), short-form McGill pain questionnaire (SF-MPQ), electroencephalography (EEG), conditioned pain modulation (CPM), salivary cortisol concentration, 7-item general anxiety disorder scale (GAD-7), pain catastrophizing scale (PCS), and SF-36 questionnaire was performed pre-intervention, post-intervention, and three months post-intervention by a blind examiner. The result showed a significant group-by-time interaction for CSI, SF-MPQ, and PCS. There was a significant decrease in CSI score in post-intervention and three-months post-intervention compare to pre-intervention in the DNG and PNG. SF-MPQ-PPI score in DNG significantly decreased post-intervention. PCS-Total score decreased significantly post-intervention in DNG and PNG. No significant group-by-time interactions were observed for other variables. EEG results showed regional changes in the activity of frequency bands in both eye closed and eye open conditions. It seems that DN can affect central pain processing by removing the source of peripheral nociception.Trial registration: Iranian Registry of Clinical Trials (IRCT20211114053057N1, registered on: December 03, 2021. https://irct.behdasht.gov.ir/search/result?query=IRCT20211114053057N1).

Effectiveness and safety of auricular acupuncture on adjuvant analgesia in patients with total knee arthroplasty: a randomized sham-controlled trial.

This study aimed to evaluate the effectiveness and safety of auricular acupuncture (AA) on postoperative analgesia, the degree of postoperative nausea, and the effect of inflammation after total knee arthroplasty (TKA). This was a single-center, placebo-controlled, randomized clinical trial. In total, 96 patients were randomly divided into an AA group with an indwelling intradermal needle (n = 48) and a sham auricular acupuncture (SAA) group with a non-penetrating placebo needle (n = 48). Intra-spinal anesthesia was adopted in both groups during surgery, and an epidural analgesic pump was implanted after surgery for 48 h. The primary outcome was the post-surgery visual analog score (VAS) of resting and movement states (at 6, 12 h and 1, 2, 3, 5, and 7 days). The secondary outcomes included additional doses of analgesic injection during the treatment, C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count on the 1st, 3rd, and 7th day after the operation, nausea on the 1st, 2nd, and 3rd day after the operation, the Hospital for Special Surgery Knee Score (HSS) on the 2nd and 12th week after the operation, and adverse events. The VAS in the AA group at 6 h, 12 h, 2, 3, and 5 days after surgery were lower than those of the SAA group (p < 0.05). Among the secondary outcomes, the total dose of additional analgesic injection after surgery in the AA group was lower than that in the SAA group (p < 0.05). The serum CRP on the 1st day after operation in the AA group was lower than that in the SAA group (p < 0.05). The degree of nausea on 2nd day after surgery in the AA group was lower than that in the SAA group (p < 0.05). There was no significant difference in other outcomes (p > 0.05). In this study, AA was shown to be an effective and safe complementary and alternative therapy for pain relief after TKA, which was able to reduce the total postoperative dose of additional painkillers, decrease serum CRP 1 day after surgery, and improve the degree of postoperative nausea. www.chictr.org.cn, ChiCTR2100054403.

Elastic acupuncture needle: a set of one-piece elastic double-blind placebo acupuncture.

The Elastic acupuncture needle, a set of clinical device used in randomized controlled trials of acupuncture is developed, which may potentially obtain the double-blind placebo control. This kind of acupuncture device consists of a real needle and a sham one (placebo needle) with a identical appearance. Either of the needle is composed of an integrated cap-type handle and needle body, and a sterile double-sided adhesive pad is designed on the bottom for fixation. A spring with miniature low profile is built in sham needle. During operation, the real needle can be normally inserted, while the sham one be retracted because of the elasticity generated by the pressure on the skin, but deqi can still be felt by patients whenever the force difference between the skin and the spring reaches a certain balance. The rubber pad designed in this acupuncture needle can simulate the "resistance" felt by operators during needle insertion so that the double blinding is actualized in terms of the appearance and sensations.

Design and testing the validity of an inexpensive and accessible sham dry needling protocol

ObjectiveTo use a simple method of needle blunting to produce a placebo dry needling protocol which is indistinguishable from the sensations felt during therapeutic dry needling. MethodsA randomised cross-over design was used to compare the perception of needle skin penetration, pain experienced and types of sensations experienced following a single placebo dry needling and a single therapeutic dry needling application. ResultsThere were no significant differences in the proportions of patients reported ability to perceive needle penetration (p = 0.646), description of needling sensations (p = 0.3) or pain rating (p = 0.405) when comparing placebo needling to therapeutic dry needling. ConclusionNeedle tip bending creates a simple, cost-effective and effective placebo needle for use in comparisons with therapeutic dry needling. This offers researchers a viable alternative to expensive and inappropriate acupuncture sham devices when conducting dry needling trials.

Protocol for double-blind RCT of acupuncture for vulvodynia

BackgroundVulvodynia, vulvar pain of unknown origin lasting at least 3 months, affects 7% of American women. Dyspareunia, its frequent companion, renders sexual intercourse virtually impossible. Although few therapies are efficacious and rapid pain relief is rarely possible, there have been no sham/placebo-controlled studies of acupuncture for vulvodynia. Aims are to: 1) determine efficacy of acupuncture for vulvodynia, 2) explore duration of the acupuncture effect. MethodsIn a pretest/posttest randomized controlled, double-blind (practitioner-patient) efficacy trial of a standardized acupuncture protocol, we will randomize 80 participants 1:1 to either penetrating needle or skin-touch placebo needle groups. Both types of needles are designed to blind both the acupuncturist and participant. Participants with vulvodynia will insert and remove a tampon as a standardized stimulus and complete primary measures of vulvar pain (pain intensity) and secondary measures of dyspareunia (Female Sexual Function Index, FSFI dyspareunia subscale score) and sexual function (FSFI total score) pretreatment, after the 10th acupuncture session, and pain measures weekly until return to pretest levels. Upon study completion control group participants will be offered 10 free real acupuncture sessions. DiscussionThis is the first multi-needle multi-session RCT using double-blind acupuncture needles as a reliable sham. We hypothesize that controlling for baseline, at posttest there will be statistically significant less vulvar pain and dyspareunia and more sexual function over five weeks in the penetrating needle group compared to the skin touch placebo group. ConclusionThis study is responsive to the need for efficacious pain management for women with vulvodynia.ClinicalTrials.gov Identifier: NCT03364127.

The effectiveness of dry needling in patients with chronic low back pain: a prospective, randomized, single-blinded study

Dry needling (DN) is a standard procedure for treating musculoskeletal disorders. However, there are no clear recommendations for using DN in low back pain (LBP). Therefore, this study aimed to assess the effectiveness of the novel DN program for reducing pain intensity and improving functional efficiency in patients with chronic LBP. A group of 40 patients with chronic LBP due to the L5-S1 discopathy were eligible and randomized into experimental (n = 20) and control (n = 20) groups. The DN program was performed for the experimental group according to the Five Regulatory Systems (FRS) concept. The control group received sham therapy using placebo needles. DN sessions were performed twice a week for 4 weeks. A single needling application lasted 60 min. Both groups received standard treatment and physical exercise of LBP for 1 month. Subjective pain was measured by a visual analog scale (VAS), functional efficiency was assessed with the Oswestry Disability Index (ODI), and the lower spine range of motion was measured with the Schober test. There were significant differences in pain reduction (VAS) in both groups (p < 0.001). The strongest analgesic effect in the DN group yielded 6.45 points immediately after the therapy, 6.2 points after 1 month, and 6 points after 3 months. The DN group scored higher VAS reduction than the control group (p < 0.001). There were significant differences in the functional state (ODI) in the experimental group (p < 0.001). There was a significant ODI decrease by 18.1 points, after 1 month by 18.9 points, and after 3 months by 17.6 points. No significant differences were found in the control group (p > 0.05). Intergroup differences were observed in the functional efficiency in ODI in all measurement time-points (p < 0.001). There were significant differences in the range of motion (Schober test) in the DN group (main effect: p < 0.001). For all measurements, differences (p < 0.001) were observed in favor of DN compared to the control. In conclusion, DN program according to the FRS concept stands for the novel treatment method supplemented by an exercise program, effectively reducing pain and improving functional efficiency in LBP patients.

Effects of Heavy Slow Resistance Training Combined With Corticosteroid Injections or Tendon Needling in Patients With Lateral Elbow Tendinopathy: A 3-Arm Randomized Double-Blinded Placebo-Controlled Study

Background: Lateral elbow tendinopathy is a disabling tendon overuse injury. It remains unknown if a corticosteroid injection (CSI) or tendon needling (TN) combined with heavy slow resistance (HSR) training is superior to HSR alone in treating lateral elbow tendinopathy. Purpose/Hypothesis: The purpose was to investigate the effects of HSR combined with either (1) a CSI, (2) TN, or (3) placebo needling (PN) as treatment for lateral elbow tendinopathy. We hypothesized that 12 weeks of HSR in combination with a CSI or TN would have superior effects compared with PN at 12, 26, and 52 (primary endpoint) weeks’ follow-up on primary (Disabilities of the Arm, Shoulder and Hand [DASH] score) and secondary outcomes in patients with chronic unilateral lateral elbow tendinopathy. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 60 patients with chronic unilateral lateral elbow tendinopathy were randomized to perform 12 weeks of home-based HSR with elastic band exercises combined with either (1) a CSI, (2) TN, or (3) PN, and at 12, 26, and 52 weeks, we assessed the primary outcome, the DASH score, and secondary outcomes: shortened version of the DASH (QuickDASH) score, pain (numerical rating scale [NRS] score), pain-free grip strength, and hypervascularization (power Doppler area). Results: A CSI, TN, and PN improved patient outcomes equally based on the DASH (Δ20 points), QuickDASH (Δ21 points), and NRS (Δ2.5 points) scores after 12 weeks. Further, after 12 weeks, a CSI also resulted in decreased hypervascularization (power Doppler area) compared with PN (Δ–2251 pixels, P = .0418). Except for the QuickDASH score (CSI increased score by Δ15 points compared with PN; P = .0427), there were no differences between the groups after 52 weeks. Conclusion: These results suggest that 12 weeks of HSR improved symptoms in both the short and the long term and that a CSI or TN did not amplify this effect. In addition, a CSI seemed to impair patient-reported outcomes compared with HSR alone at long-term follow-up. Registration: NCT02521298 (ClinicalTrials.gov identifier).

Effect of acupuncture on gut microbiota in participants with subjective cognitive decline.

A close relationship has recently been described between subjective cognitive decline (SCD) and gut microbiota disorders. Herein, we aim to investigate the effect of electroacupuncture (EA) on gut microbiota in participants with SCD.We conducted a study of 60 participants with SCD. Sixty participants were allocated to either EA group (n = 30) or sham acupuncture group (n = 30). Both groups received 24 sessions of real acupuncture treatment or identical treatment sessions using the placebo needle. Global cognitive change based on a comprehensive neuropsychological test battery was evaluated to detect the clinical efficacy of acupuncture treatment at the baseline and the end of treatment. Faecal microbial analyses were carried out after collecting stools at T0 and T12 weeks. Microbiomes were analyzed by 16S ribosomal RNA gene sequencing. Correlation analyses were performed to investigate the relationships between the changes in gut microbiota and symptom improvement.Age is a particularly important factor leading to the severity of dementia. Compared with sham acupuncture group, the number of Escherichia–Shigella in EA group decreased after treatment. The number of Escherichia–Shigella in EA group decreased after treatment compared with EA group before treatment. Bifidobacterium is positively correlated with clinical efficacy Z-score and Montreal Cognitive Assessment Scale (both P < .005).Acupuncture could improve global cognitive change among SCD participants by regulating the intestinal flora. Dysbiosis was found in the gut microbiome in SCD and partially relieved by acupuncture. Our study suggests that gut microbiota could be a potential therapeutic target and diagnostic biomarker for SCD.

The Effect of Adding Dry Needling to Physical Therapy in the Treatment of Cervicogenic Headache: A Randomized Controlled Trial.

To compare the long-term effect of adding real or sham dry needling with conventional physiotherapy in cervicogenic headache. A randomized controlled trial. Physiotherapy Clinic, Rouhani Hospital of Babol University of Medical Sciences, Iran. Sixty-nine patients with cervicogenic headache. Patients were randomly assigned into a control group (n = 23) receiving conventional physical therapy; a dry needling group (n = 23) receiving conventional physical therapy and dry needling on the cervical muscles; placebo needling group (n = 23) receiving conventional physical therapy and superficial dry needling at a point away from the trigger point. The primary outcome was the headache intensity and frequency. Neck disability, deep cervical flexor performance, and range of motion were secondary outcomes. Outcomes were assessed immediately after treatment and 1, 3, and 6 months later. Sixty-five patients were finally included in the analysis. Headache intensity and neck disability decreased significantly more in the dry needling compared to sham and control groups after treatment and during all follow-ups. The frequency of headaches also reduced more in the dry needling than in control and sham groups, but it did not reach statistical significance. Higher cervical range of motion and enhancement of deep cervical flexors performance was also observed in the dry needling compared to sham and control groups. Dry needling has a positive effect on pain and disability reduction, cervical range of motion, and deep cervical flexor muscles performance in patients with cervicogenic headache and active trigger points, although the clinical relevance of the results was small. The trial design was registered in the Iranian Registry of Clinical Trials (www.irct.ir, IRCT20180721040539N1) before the first patient was enrolled.

Effectiveness of Traditional Acupuncture in Reducing the Severity of Hot Flashes Reported by Breast Cancer Patients

<h3>Purpose/Objective(s)</h3> Breast cancer patients often experience hot flashes (HF) and other vasomotor symptoms that negatively impact their quality of life. Patients inclined to an integrative approach may seek alternatives to prescription drugs for managing the intensity and frequency of HF. In the literature, the benefit of acupuncture in reducing HF has been variably reported, and reasoned for having some degree of placebo effect. The goal of our randomized study is to compare the efficacy of traditional acupuncture (TA) to sham acupuncture (SA) in reducing the severity of HF in female patients with breast cancer. <h3>Materials/Methods</h3> In this IRB approved study, breast cancer patients that experienced > 10 episodes of HF/ week were randomly assigned to receive either TA or SA. The technique of SA used the validated Streitberger placebo needles. The protocol for patient sessions in the TA and SA groups was the same, twice a week sessions for 5 weeks followed by once a week session for 4 weeks, and additional one-month follow up. All patients completed the MenQOL survey on HF at baseline, end of treatment, and at one-month follow up. In this analysis, patient reported MenQOL scores were categorized as 0 = not bothered at all, 1-2 = mildly bothered, 3-4 = moderately bothered, and 5-6 = extremely bothered. <h3>Results</h3> Based on patients prospectively recorded weekly hot flash diary, 54 breast cancer patients were identified as experiencing > 10HF/week. These patients were randomly assigned and prospectively treated as follows: 28 patients received TA and 26 patients received SA. The median age of the study population was 55 years. Seven women withdrew from study before the scheduled acupuncture. At baseline, 100% of patients receiving TA reported MenQOL scores of moderately to extremely bothered by HF. The incidence of this severity dropped to 77.3% at the end of treatment, and further dropped to 72.7% at their one-month follow up. In the SA group, 90% of patients at baseline reported MenQOL scores of moderately to extremely bothered by HF. The incidence of this severity dropped to 78.6% at the end of treatment, but reversed with an increase to 93.8% at their one- month follow up, similar to their baseline pre-SA scores. Further, based on the scores of the MenQOL on HF we observed that TA was most effective for patients reporting highest MenQOL scores (5-6) i.e., extremely bothered by HF. In this subset of patients, TA resulted in a 41% reduction of extremely bothersome HF symptoms. <h3>Conclusion</h3> Our data shows that acupuncture has a therapeutic role in managing HF without a confounding placebo effect. This is an excellent alternative for treating breast cancer patients who are wary of taking medical management for reducing symptoms of HF. Further research is needed on assimilating a collaborative integrative oncology approach in the multidisciplinary management of breast cancer.

Effect of electroacupuncture on small airway function in patients with stable chronic obstructive pulmonary disease

To observe the regulatory effect of electroacupuncture (EA) on small airway function and exercise tolerance in patients with stable chronic obstructive pulmonary disease (COPD). A total of 62 patients with stable COPD were randomized into an observation group (31 cases, 1 case dropped off) and a control group (31 cases, 5 cases dropped off). On the base of routine medication and aerobic exercise, the patients of the two groups all received EA at Danzhong (CV 17), Rugen (ST 18), Guanyuan (CV 4), Zhongwan (CV 12), Tianshu (ST 25) and Yingchuang (ST 16). In the observation group, filiform needles were used and inserted perpendicularly, 3 mm in depth. In the control group, the placebo needling method was performed, in which the needle was not inserted through skin at each point. In both groups, electric stimulation with low-frequency electronic pulse instrument was exerted, with continuous wave, 2 Hz in frequency, lasting 30 min each time in the two groups. The treatment was given once every other day, 3 times a week, for 14 treatments totally. Before and after treatment, the following indexes were compared in patients between the two groups, i.e. the lung function indexes (forced expiratory volume in first second [FEV1], forced vital capacity [FVC], the ratio of FEV1 to FVC [FEV1/FVC], maximal voluntary ventilation [MVV], the percentage of maximal expiratory flow [MEF] at 25% of FVC exhaled [MEF25], MEF50 and MEF75 in predicted value), cardiopulmonary exercise test indexs (metabolic equivalent [METS], oxygen uptake per kg body weight [VO2/kg], minute ventilation [VE], the percentage of oxygen pulse [VO2/HR] in predictd value, maximal minute ventilation [VEmax], ventilatory equivalent for oxygen [VE/VO2], ventilatory equivalent for carbon dioxide [VE/VCO2]), 6-minute walk distance (6MWD), the total score of COPD assessment test (CAT), the modified British Medical Research Council (mMRC) score and COPD comprehensive grade. After treatment, FVC%, MVV%, MEF75%, MEF50%, VO2/kg%, METs%, VEmax, VO2/HR%, 6MW and the total CAT score were all improved as compared with those before treatment in the observation group (P<0.05, P<0.01). After treatment, MEF75% and the total CAT score were reduced as compared with those before treatment in the control group (P<0.05). After treatment, MVV%, MEF50%, VO2/kg%, METs%, VEmax and 6MWD in the observation group were all better than those in the control group (P<0.05, P<0.01). Electroacupuncture can improve the respiratory function and exercise tolerance in COPD patients through removing small airway obstruction and increasing ventilation.

Immediate Effects of Dry Needling on the Autonomic Nervous System and Mechanical Hyperalgesia: A Randomized Controlled Trial.

Background: Dry needling (DN) is often used for the treatment of muscle pain among physiotherapists. However, little is known about the mechanisms of action by which its effects are generated. The aim of this randomized controlled trial was to determine if the use of DN in healthy subjects activates the sympathetic nervous system, thus resulting in a decrease in pain caused by stress. Methods: Sixty-five healthy volunteer subjects were recruited from the University of Alcala, Madrid, Spain, with an age of 27.78 (SD = 8.41) years. The participants were randomly assigned to participate in a group with deep DN in the adductor pollicis muscle or a placebo needling group. The autonomic nervous system was evaluated, in addition to local and remote mechanical hyperalgesia. Results: In a comparison of the moment at which the needling intervention was carried out with the baseline, the heart rate of the dry needling group significantly increased by 20.60% (SE = 2.88), whereas that of the placebo group increased by 5.33% (SE = 2.32) (p = 0.001, d = 1.02). The pressure pain threshold showed significant differences between both groups, being significantly higher in the needling group (adductor muscle p = 0.001; d = 0.85; anterior tibialis muscle p = 0.022, d = 0.58). Conclusions: This work appears to indicate that dry needling produces an immediate activation in the sympathetic nervous system, improving local and distant mechanical hyperalgesia.

Anti-spastic effect induced by waggle needling correlates with KCC2-GABAA pathway in post-stroke spasticity rats

Although clinical efficacy of waggle needling has been confirmed, therapeutic mechanisms still remain poorly understood. Reduction of GABA was involved in the etiology of spasticity. Recently, accumulated evidences suggest that the inhibitory effect of GABA is determined by low intracellular chloride concentration, which is predominantly mediated by KCC2. This study was designed to investigate whether KCC2-GABAA pathway was involved in the mechanism underlying acupuncture intervention in rats with middle cerebral artery occlusion (MCAO). Three days after modeling, the rats received waggle needling, routine needling and placebo needling for 7 consecutive days. After treatment, the muscle spasticity, motor function and infarct volumes were tested. KCC2 and GABAAγ2 levels were detected via western blotting, RT-PCR and immunofluorescence. KCC2 antagonist and agonist were administered after the last intervention. We found that acupuncture, particularly waggle needling, could remarkably alleviate muscle spasticity, reverse motor deficits and reduce cerebral infraction in MCAO rats, possibly due to its effects on up-regulating expressions of KCC2 and GABAAγ2 in the cortical infarct regions. However, the effects were blocked by KCC2 antagonist. In summary, this study suggests that improvements in muscle spasticity and motor function induced by waggle needling correlates with the activation of KCC2-GABAA pathway.

Effectiveness of Dry Needling versus Placebo on Gait Performance, Spasticity, Electromyographic Activity, Pain, Range-of-Movement and Quality of Life in Patients with Multiple Sclerosis: A Randomized Controlled Trial Protocol.

Dry needling (DN) is an emerging technique commonly used in neurological and musculoskeletal pain conditions, but there have been no previous studies in patients with multiple sclerosis (pwMS). This trial aims to assess the efficacy of deep DN, compared with sham placebo DN, on gait performance, spasticity level, pain, electromyographic activity, range-of-movement (ROM) and quality of life in pwMS. Forty adults with MS were randomly assigned to one study group. The DN group will undergo 2 sessions (once per week) using DN over the rectus femoris (RF) and gastrocnemius medialis (GM) muscles at the lower extremity with higher spasticity. The placebo group will receive the same protocol using a sham placebo needle (Dong Bang needle). Outcome measures will include gait performance, using the GaitRite® system, spasticity level with the Modified Ashworth Scale, superficial electromyographic activity of RF and GM, pain (pressure algometer), ROM (goniometer), and quality of life (Musiqol). This study is the first investigating the short-term effect of DN, compared with placebo, in pwMS, and taking into account the possible changes in the electromyographic activity of the lower limb. Therefore, the results may help to understand the suitability of using this technique in the clinical setting for this population. Trial registration: ACTRN12619000880145.

Eficacia de la punción seca en la discapacidad, umbral de dolor a la presión y movilidad del Síndrome de Dolor Miofascial de hombro en pacientes con Lesión Medular: Estudio piloto, ensayo clínico controlado aleatorizado

El dolor de hombro en pacientes con lesión medular es una de las patologías más prevalentes, en especial por el uso de dispositivos de ayuda para la movilidad, ya que la articulación inicialmente está preparada para otras funciones, y es una articulación muy móvil con poca estabilidad, por lo que suele frecuentemente lesionarse. El objetivo de este estudio es ver si una técnica de punción seca utilizada en estos pacientes es eficaz en la discapacidad (DASH) de dicha muestra. En ese estudio piloto, aleatorizado y controlado simple ciego, se utiliza la técnica de punción seca de entrada y salida rápida de Hong sobre un punto gatillo activo músculo infraespinoso en el grupo experimental y se compara con un grupo control que recibió un tratamiento de aguja placebo. Las variables que se usan en este estudio son: DASHe (Disabilities of the Arm, Shoulder and Hand versión en español), cuestionario McGill del dolor, SPADIe (Shoulder Pain And Disability Index en español) que se evaluaron antes y una semana después de la intervención, y dolor al umbral de presión y rango de movimiento del hombro de rotación interna y aducción horizontal que se evaluaron antes, inmediatamente después y a la semana de la intervención. Se llevó a cabo un análisis estadístico mediante el programa SPSS 22.0, del cual se obtuvieron, tras la homogeneidad de la muestra, que no había diferencias significativas en ninguna de las variables, a excepción del umbral del dolor a la presión tras una semana entre los grupos de estudio. La punción seca utilizada en el síndrome de dolor miofascial de hombro en pacientes con lesión medular parece eficaz para aumentar el umbral del dolor a la semana de tratamiento. Se necesita realizar un estudio con ampliación del tamaño muestral para determinar la efectividad de la intervención.

Electroacupuncture-induced plasticity between hand and face representations in the motor cortex in healthy subjects

To observe the plasticity between hand and face representations of the motor cortex of healthy volunteers after electroacupuncture(EA) at Hegu(LI4), so as to provide a scientific basis for the theory of "Hegu is indicated for orofacial problems". Using a cross-over design (self-controlled study), 10 healthy volunteers were randomly assigned to an acupuncture group and a sham acupuncture group (two-weeks wash-out period between the two groups). Subjects in the acupuncture group received EA stimulation (2 Hz, 0.5 to 1 mA, 30 min) at LI4 on their left hands. Adhesive pads sticked on the left hands of subject in the sham acupuncture group, thus, the placebo needle provided participants with a similar appearance to that in the acupuncture group but no skin penetration, and the placebo needles were connected to an EA device with a broken wire inside. Using transcranial magnetic stimulation technology, the motor evoked potentials (MEPs) of the first dorsal interosseous muscle and the orbicularis oculi muscle in hand and face representations in the contralateral motor cortex were recorded before and after EA and sham EA, and the total amplitude, effective stimulation area and center of gravity of MEPs were calculated. Compared with that before intervention, for acupuncture group, the total amplitude of MEPs in hand representation in the contrala-teral motor cortex was significantly increased(P<0.05),while the total amplitude of MEPs in face representation was significantly decreased (P<0.05). The effective stimulation area in hand representation was significantly increased(P<0.01), and there was no difference in face representation(P>0.05). The difference in the center of gravity of the X-axis in hand representation was statistically significant (P<0.05)，with the center of gravity moved an average of 0.6 cm to the outside, and there was no difference in face representation (P>0.05). There was no difference in the center of gravity of the Y-axis in hand and face representations(P>0.05). For sham acupuncture group, there were no differences in total amplitude of MEPs, effective stimulation area and the center of gravity in hand and face representations (P>0.05). EA at LI4 can induce plasticity between the hand and face representations of the motor cortex in healthy volunteers (exciting the hand representation of the motor cortex, while inhibiting the motor cortex representation), which provides a scientific basis for treating facial and mouth diseases by acupuncture at LI4 and the theory of selecting acupoints of the corresponding meridian distal to the disease location.

Acupuncture for Relief of Gag Reflex in Patients Undergoing Transoesophageal Echocardiography-A Protocol for a Randomized Placebo-Controlled Trial.

Background: Gagging during transesophageal echocardiography examination (TEE) can be distressing and even dangerous for patients. The needling of acupuncture point CV24 was described to be effective in reducing the gag reflex during TEE in patients with ischemic stroke or transient ischemic attack. Methods: We describe a proposal for a prospective, randomized, patient, practitioner and assessor-blinded, single-center trial with two arms/groups; real acupuncture will be compared to placebo acupuncture. A total of 60 (30 per group) patients scheduled for elective TEE in order to exclude a cardiac embolic source, endocarditis or for valve failure evaluation will be recruited according to patients’ selection criteria and receive either indwelling fixed intradermal needles at acupoints CV24 and bilateral PC6 or placebo needles at the same areas. Patients, the practitioners who will perform the TEE procedure, and the assessor of the outcome measures will be unaware of the group’s (real or placebo) allocation. Results: The primary outcome is the intensity of gagging, measured using verbal rating scale (VRS-11) from 0 = no gagging to 10 = intolerable gagging. Secondary outcomes include the incidence of gagging, the use of rescue medication, patients’ satisfaction with relief of unwanted side effects during TEE procedure, success of patients’ blinding (patients’ opinion to group allocation), heart rate and oxygen saturation measured by pulse oxymetry. Conclusions: To study the effects of acupuncture against gagging during TEE, we test the needling of acupoints CV24 and PC6 bilaterally. A placebo acupuncture is used for the control group. Trial registration number: NCT NCT0382142.

The selection of dermatomes for sham (placebo) acupuncture points is relevant for the outcome of acupuncture studies: a systematic review of sham (placebo)-controlled randomized acupuncture trials.

Many randomized controlled trials (RCTs) of acupuncture reveal no significant differences between acupuncture and so-called placebo acupuncture. There is a strong tendency to replace the term "placebo" by the term "sham," because any needling stimulates a certain physiological response. However, neither concept accounts for the great diversity of results in RCTs comparing verum acupuncture and sham (placebo) acupuncture. Some trials have shown little or no difference, while other studies have found statistically significant differences. Verum acupuncture and sham (placebo) acupuncture may achieve similar results to the extent that they share active constituents. We identified these common active constituents as dermatomes: the segmental structure of the human body. In our study, we tested the hypothesis that the more verum and sham (placebo) acupuncture share the same dermatomes, the closer the clinical outcomes will be, and vice versa. All major databases were searched for RCTs that tested acupuncture versus sham (placebo) acupuncture. The dermatome charts of Hansen and Schliack were used to verify verum and sham (placebo) needling locations. Reported clinical outcomes were assessed in relation to the percentage of overlap between the dermatomes stimulated by acupuncture and sham (placebo) acupuncture. Our literature search yielded a total of 1738 references. Thirty-four studies met the inclusion criteria. The effects of sham (placebo) acupuncture varied according to the dermatomes stimulated: high overlap with those stimulated by verum acupuncture resulted in almost identical efficacy, while low overlap resulted in significant differences in efficacy. Clinical outcomes were similar when verum acupuncture and sham (placebo) acupuncture shared the same dermatomes (p < 0.01). The findings of this review confirm our hypothesis. Acupuncture studies that employed verum and sham locations on overlapping dermatomes helped to create a mediocre to negative picture of acupuncture's efficacy. The segmental structure of the body with its interconnected reflex system offers an additional neurophysiological explanation for the effectiveness of acupuncture applied to structures segmentally innervated by the spinal and visceral nervous system. Further comparative acupuncture studies should be based on knowledge of segmental anatomy. In testing verum acupuncture versus sham acupuncture, the chosen sham acupuncture needling locations should be situated on non-overlapping dermatomes.

Comparative study of treatment interventions for patellar tendinopathy: a protocol for a randomised controlled trial

IntroductionPatellar tendinopathy is a degenerative disease of the patellar tendon, which affects athletes from a variety of sports, and is especially predominant in sports involving high-impact jumping. The aim of...

Analgesia mediated by stress: Possible antalgic mechanism of the dry needling technique

Abstract Introduction and Aim One of the possible mechanisms of action of dry needling is stress-induced analgesia, produced by the activation of the sympathetic nervous system (SNS). Cortisol is a steroid hormone, which is considered to be the most representative indicator of physiological states that are altered after a stressful stimulus. Although studies of other invasive techniques exist which measure the cortisol levels, no studies on dry needling have been found which gather this stress indicator. Thus, the aim of this study was to determine the changes produced in the levels of cortisol concentration in saliva after the application of the dry needling technique. Material and Methods Sixty-two healthy volunteer subjects participated in this randomized controlled single blinded trial performed at the University of Alcalá. Participants were randomly distributed into two intervention groups: deep dry needling (n = 33) and placebo needling (control) (n = 32). The saliva samples were gathered prior to the intervention and 3 minutes after finalization of the same. The level of cortisol in saliva was determined in a laboratory by performing a solid phase enzyme immunoassay using the ELISA® kit. Statistical significance was set at p &lt; 0.05. The differences between both groups were compared based on the percentage of change between the initial level and at three minutes via the Student's t-test for independent samples, estimating the effect size via the Cohen's d test. Results An increase of the levels of cortisol in saliva of 11.27% ± 4.76 was observed after the deep dry needling; in the group of placebo needling, an increase of 1.51% ± 3.08 was observed. However, when comparing both groups, no statistically significant differences were obtained (p = 0.920), with an effect size of d = 0.42. Conclusions The dry needling technique leads to an increase in the release of cortisol, one of the hormones involved in the sympathetic-excitatory relationship. This could be related to one of the possible effects of this invasive procedure with mechanisms of stress-induced analgesia. However, further studies are required to deepen our knowledge on the plausible physiological effects which support the application of the dry needling technique.