Acupuncture stimulates brain metabolism in dementia patients

CM NEWS – Needling specific acupoints may help patients with dementia, a recently published study shows. The acupoint combo seems to increase cerebral glucose metabolism in the brain, as indicated by cerebral functional imaging.

The study has been published in the January 2007 issue of the Journal of Acupuncture and Tuina Science. Chinese researchers observed the effects of needling three acupoints – Baihui (百會, Hundred Convergences; GV 20), Shuigou (水溝, Water Trough; GV 26) and Shenmen (神門, Spirit Gate; HT 7) – and their effects on cerebral glucose metabolism in patients with vascular dementia.

25 patients with vascular dementia were divided into 5 groups (Group A, B, C, D and E) randomly. Patients in the Group A were treated by needling routine acupoints for hemiplegia (paralysis in the vertical half of a patient’s body), which are acupoints of the three “yang meridians” of the hand and foot.

In addition to the “routine acupoints”, Group B patients received acupuncture to Baihui (GV 20); Group C to Shuigou (GV 26), Group D to Shenmen (HT 7), and Group E to Baihui (GV 20), Shuigou (GV 26), and Shenmen (HT 7).

All the patients were examined by Positron Emission Tomography (PET) to detect cerebral glucose metabolism in the bilateral frontal lobes (orbital gyri), parietal lobes, temporal lobes (hippocampus and hippocampal gyrus), occipital lobes, thalamus, lentiform nucleus, caudate nuclei, cingulate gyms and cerebellum before treatments and after treatments.

Why checking on cerebral glucose metabolism? Studies have linked dementia with the slowing of glucose metabolism in certain parts of the brain. One study indicated that patients with frontotemporal dementia not only showed significant metabolic deficits primarily in frontal cortical areas, but also in the caudate nuclei and the thalami. These findings demonstrate that the clinical progression in patients with frontotemporal dementia is accompanied by a region-specific decline in cerebral glucose metabolism.

Another study found that patients with multi-infarct dementia (MID) had significantly lower glucose metabolism in all the grey matter regions measured and were also characterized by more individuality in metabolic pattern.

The present study shows that after needling the routine acupoints for hemiplegia, glucose metabolism increased in lentiform nucleus and temporal lobe; and:

* patients with Baihui (GV 20) needled showed increased glucose metabolism in the frontal lobe, temporal lobe and lentiform nucleus.
* patients with Shuigou (GV 26) needled showed increased glucose metabolism in the frontal lobe, thalamus and lentiform nucleus;
* patients with Shenmen (HT 7) needled got more glucose metabolism in the parietal lobe and lentiform nucleus;
* patients who recieved needling to all these three acupoints has higher glucose metabolism in the frontal lobe, temporal lobe, thalamus and lentiform nucleus.

The results suggest that needling Baihui (GV 20), Shuigou (GV 26) and Shenmen (HT 7) affect glucose metabolism in different functional regions of the brain. In other words, the three acupoints are closely correlated to different functional regions of the brain.

Placebo effect may be at play in acupuncture studies: analysis

Reuters Health – Acupuncture can bring some relief to people with knee arthritis, but the benefits may be at least partly from a placebo effect, a new research review suggests.

In an analysis of 9 clinical trials from the past 15 years, researchers found that acupuncture generally seemed to improve knee arthritis sufferers’ pain and stiffness in the short term. The patients had osteoarthritis, a degenerative joint disease associated with age, as opposed to arthritis associated with an autoimmune disorder.

However, a closer look showed that the benefits were limited to trials that compared acupuncture with doing nothing or with “usual care,” such as anti-inflammatory medication.

In trials that compared acupuncture with “sham” acupuncture, on the other hand, there was no clear evidence that the real therapy was more effective.

Sham acupuncture is accomplished by using non-penetrating needles, or inserting needles only into the superficial layer of skin, at random sites rather than the specific points used in real acupuncture. In studies that evaluated electro-acupuncture, the sham version involved phony electrodes and “mock” electrical stimulation of acupuncture points.

The point is to keep study participants from knowing whether they were receiving the real or the placebo treatment. This helps separate the specific effects of a therapy from any placebo effects — where people feel better simply because they believe they’ve been treated.

The new findings suggest that the benefits of acupuncture for knee arthritis are at least partly due to patients’ expectations, the study authors report in the Annals of Internal Medicine.

However, that doesn’t mean acupuncture is not worthwhile, according to the researchers, led by Eric Manheimer of the University of Maryland School of Medicine in Baltimore.

Research does suggest that acupuncture has a “genuine biological effect,” and there was evidence in some studies that the real therapy resulted in somewhat better short-term effects than sham acupuncture, the researchers note.

For their study, Manheimer and his colleagues combined the results of nine clinical trials conducted in Europe, the U.S. and Thailand. The trials included a total of more than 3,500 subjects.

Each trial included a patient group that received acupuncture for knee arthritis, as well as a “control” group. In some studies, control patients were placed on a waiting list for acupuncture, while in others they received some standard therapy that acupuncture patients did not. Control patients in other studies received sham acupuncture.

In general, the Manheimer’s team found, only studies that pitted acupuncture against doing nothing, or against standard care, showed clear benefits. The results of the sham-controlled trials were too mixed to show any benefits, according to the researchers.

The investigators do not, however, dismiss the potential benefits of acupuncture for knee arthritis. Indeed, they note, a possible explanation for the mixed results is that sham acupuncture had some actual biological effects.

Given the overall safety of acupuncture, the researchers conclude, patients can still consider it as one option in a “multidisciplinary approach” to treating knee arthritis.

World’s largest conference on acupuncture to convene in China

Xinhua – More than 1,500 acupuncturists from nearly 30 countries and regions will gather in Beijing this October, to discuss the future of traditional Chinese medicine.

From Oct. 20 to 22, the acupuncturists will attend an academic forum for the 20th anniversary of the World Association of Acupuncture. The forum, with the theme of “acupuncture: looking back and looking forward”, will have eight sub-forums on topics like education, the evolution of acupuncture and needle therapy practise and assessment.

An exhibition of new methods and technologies in the field will also be held.

Deng Liangyue, chairman of the World Association of Acupuncture, said the association had successfully held six forums on acupuncture in China, Japan, the United States, France and the Republic of Korea over the past 20 years. With efforts from acupuncturists worldwide, needle therapy has spread to the four corners of the earth.

So far, more than 140 countries and regions have adopted acupuncture treatment. Traditional Chinese medicine represented by needle therapy is accepted and welcomed by mainstream society in many countries.

Statistics from the World Association of Acupuncture show there are about 100,000 people engaged in acupuncture services in Japan. 29 percent of Tokyo’s residents have received acupuncture treatment at least once. More than five million European patients choose needle therapy every year.

Acupuncture, one of the oldest traditional Chinese therapies, can not only help people give up smoking, but also cure sterility and even drug addiction. For poor people, it is a low-cost and easily accessible medical resource.

Acupuncture offers long lasting relief to migraines

CM NEWS – Acupuncture has been proved to provide effective and persistent relief of migraine headaches, according to a new study in Italy.

To check the effectiveness of a true acupuncture treatment according to traditional Chinese medicine (TCM) in migraine without aura, researchers of the Department of Medico-Surgical Specialities of University of Padua in Italy compared true acunpuncture to a standard mock acupuncture protocol, an accurate mock acupuncture healing ritual, and untreated controls.

“Migraine prevalence is high and affects a relevant rate of adults in the productive phase of their life,” says the study to be published in the journal Headache.

“Acupuncture has been increasingly advocated and used in Western countries for migraine treatment, but the evidence of its effectiveness still remains weak. A large variability of treatments is present in published studies and no acupoint selection according to TCM has been investigated so far; therefore, the low level of evidence of acupuncture effectiveness might partly depend on inappropriate treatment.”

In the study, the patients were divided into the following 4 groups:
(1) group TA, treated with true acupuncture (according to TCM) plus Rizatriptan; (N=32)
(2) group RMA, treated with ritualized mock acupuncture plus Rizatriptan; (N=30)
(3) group SMA, treated with standard mock acupuncture plus Rizatriptan; (N=31)
(4) group R, without prophylactic treatment with relief therapy only (Rizatriptan); (N=39)

What is Rizatriptan? Rizatriptan is used to treat the symptoms of migraine headaches (severe, throbbing headaches that sometimes are accompanied by nausea and sensitivity to sound and light). Rizatriptan is in a class of medications called selective serotonin receptor agonists. It works by narrowing blood vessels in the brain, stopping pain signals from being sent to the brain, and stopping the release of certain natural substances that cause pain, nausea, and other symptoms of migraine. Rizatriptan does not prevent migraine attacks.

The MIDAS Questionnaire was administered before treatment, at 3 and 6 months from the beginning of treatment, and the MIDAS Index (MI) was calculated. Rizatriptan intake was also checked in all groups of patients at all three time intervals. All patients had moderate to severe with no significant intergroup differences before treatment.

What is MIDAS Questionnaire? MIDAS is a questionnaire that measures headache-related disability simply and easily by counting the number of days of lost and limited activity due to migraine. Activities are classed into three areas:

* Paid work and education (school / college)
* Household work (unpaid work such as housework, shopping and caring for children and others)
* Family, social and leisure activities

Migraine sufferers count the number of days on which they missed out on these activities because of their migraine in the previous 3 months. Also, they count the number of days where their productivity was at most half as normal in paid and household work. The overall MIDAS score is reached by summing the answers to these five questions, and is scored in the number of days.

Group TA and RMA were evaluated according to TCM as well; then, the former was submitted to true acupuncture and the latter to mock acupuncture treatment resembling the same as TA. The statistical analysis was conducted with factorial ANOVA and multiple tests with a Bonferroni adjustment.

Results show that the migraines improved in all patients after 3 months and 6 months of treatment. However, those treated with true acupuncture plus Rizatriptan showed a significant improvement at both 3-month and 6-month treatments than with Rizatriptan only.

The researchers thus conclude that true acupuncture was the only treatment able to provide a steady outcome improvement in comparison to the use of only Rizatriptan, while Rizatriptan plus mock acunpuncture showed a transient placebo effect after 3 months into treatment.

Electric acupuncture helps insomnia

CM NEWS – Using electric acupuncture to needle 4 “extraordinary” acupoints on the top of the head might have impressive effect on treating insomnia, a recent study indicates.

Researchers at the Shandong Provincial Hospital in China evaluated the clinical therapeutic effect of electric acupuncture at a set of 4 acupoints Sishencong (EX-HN 1, “Four Brightening Spirits”, 四神聰) on insomnia.

What is electric acupuncture? Electric acupuncture, the application of a pulsating electrical current to acupuncture needles as a means of stimulating the acupoints, was developed in China as an extension of hand manipulation of acupuncture needles around 1934.

The procedure for electric acupuncture is to insert the acupuncture needle as would normally be done, attain the qi reaction by hand manipulation, and then attach an electrode to the needle to provide continued stimulation. The benefits of using electrical stimulation are:

1. It substitutes for prolonged hand maneuvering. This helps assure that the patient gets the amount of stimulation needed, because the practitioner may otherwise pause due to fatigue. Electric acupuncture may also help reduce total treatment time by providing the continued stimulus. During electric acupuncture, the practitioner can attend to other patients.
2. It can produce a stronger stimulation, if desired, without causing tissue damage associated with twirling and lifting and thrusting the needle. Strong stimulation may be needed for difficult cases of neuralgia or paralysis.
3. It is easier to control the frequency of the stimulus and the amount of stimulus than with hand manipulation of the needles.

electric acupuncture penIn this study, 276 patients were randomly assigned to 2 groups, 138 in each group. The treatment group received electric acupuncture at Sishencong, and the control group with oral administration of Tianmeng Capsule (甜夢膠囊, or “Sweet Dream Capsule”, which is a all herb product for treating mild insomnia).

The treatment course for both groups was 3 weeks. The quality and related parameters of sleep before and after treatment were evaluated with a multi-channel sleep detector. The results showed that quality of sleep was improved in both groups after treatment.

What are Sishencong acupoints? Sishencong are the four points located one inch respectively lateral, anterior and posterior to Baihui (GV 20). Sishencong belongs to extraordinary acupoints (經外奇穴) located at the central crossing points of the vertex, the front and the back points are located on the track of Dumai (Du meridian, 督脈) and the left and right points are near the track of Bladder Meridian.

Literature shows that mild acupuncture stimulation of Sishencong has been used to treat tension insomnia.

Traditionally, Sishencong was used to treat headache, dizziness, insomnia, forgetfulness and other anxiety related conditions. In modern applications, Sishencong is related to treatments of vascular headaches, cerebrovascular diseases, hypertension, hyperactivity, vascular dementia etc.

However, the improvement in the electric acupuncture group was superior to that in the control group. The researchers suggest that needling Sishencong with electric acupuncture has obvious effect on insomnia.

Possible explanations

One study on the effect of needling Sishencong on mice shows that the acupuncture significantly increase nitric oxide synthase (NOS) activity and nitric oxide (NO) content in the brain. A growing body of evidence suggests that nitric oxide (NO) may play a role in the circadian and homeostatic processes of sleep regulation

In another study by a group of Taiwanese researchers revealed that the sensitivity of spontaneous barorecepor reflex was improved by acupuncture at Sishencong points.

What is baroreflex? In cardiovascular physiology, the baroreflex or baroreceptor reflex is one of the body’s homeostatic mechanisms for maintaining blood pressure. It provides a negative feedback loop in which an elevated blood pressure reflexively causes blood pressure to decrease; similarly, decreased blood pressure depresses the baroreflex, causing blood pressure to rise.

Sishencong acupuncture might be able to simultaneously enhance cardiac vagal activity and suppress cardiac and vascular sympathetic activities in humans. It also augments the sensitivity of baroreflex. The result can explain the therapeutic mechanism on tension insomnia by acupuncture at Sishencong points.

Acupuncture eases chronic low back pain

Acupuncture can help people with chronic low back pain feel less bothered by their symptoms and function better in their daily activities, according to the largest U.S. randomized trial of its kind, published in the May 11, 2009 Archives of Internal Medicine. But the SPINE (Stimulating Points to Investigate Needling Efficacy) trial raises questions about how the ancient practice actually works.
Compared to the group that got usual care, results were similar for all three of the SPINE trial’s acupuncture groups: individualized, standardized, and simulated (without going through skin). Of the people who got any kind of acupuncture, an extra one in five were functioning significantly better at the end of the seven-week treatment—and an extra one in eight were still functioning better at one year.

“This study suggests that acupuncture is about as effective as other treatments for chronic back pain that have been found helpful,” said SPINE trial leader Daniel C. Cherkin, PhD, a senior investigator at Group Health Center for Health Studies in Seattle. “But we found that simulated acupuncture, without penetrating the skin, produced as much benefit as needle acupuncture—and that raises questions about how acupuncture works.”

The SPINE trial included 638 adult patients at two nonprofit health plans: Group Health Cooperative in Seattle and Northern California Kaiser Permanente in Oakland. They all rated the “bothersomeness” of their chronic low back pain as at least a 3 on a 0-to-10 scale. None of them had received acupuncture before. They were randomly assigned to one of four groups:

* Individualized needle acupuncture, involving a customized prescription for acupuncture points from a diagnostician
* Standardized needle acupuncture, using a single prescription for acupuncture points on the back and backs of the legs, which experts consider generally effective for chronic low back pain
* Simulated acupuncture on those same standardized points, mimicking needle acupuncture but instead of a needle using a toothpick in a needle guide tube without penetrating the skin
* Usual care, which is the standard medical care they would have gotten anyway—and that all patients in all groups received

Everyone in the three acupuncture groups (individualized, standardized, or simulated) was treated twice a week for three weeks, and then weekly for four weeks. At eight weeks, half a year, and one year, researchers measured back-related dysfunction and how much symptoms bothered patients.

The SPINE team found that at eight weeks all three acupuncture groups were functioning substantially better, while the group getting only usual care was functioning only slightly better. Dysfunction scores improved significantly more for all three acupuncture groups than for the usual care group. These benefits lasted for a year, although they waned over time.

Notably, the outcomes for groups that received the needle and simulated forms of acupuncture did not differ significantly. So, although acupuncture effectively treated low back pain, that therapeutic benefit seemed to require neither tailoring acupuncture needle sites to an individual patient nor inserting needles into the skin.

“We don’t know precisely why people got back pain relief from the simulated acupuncture,” said Cherkin’s co-author Karen J. Sherman, PhD, MPH, a senior investigator at Group Health Center for Health Studies. “Historically, some types of acupuncture have used non-penetrating needles. Such treatments may involve physiological effects that make a clinical difference.” Or it might be all about the mind-body connection, she said: “Maybe the context in which people get treatment has effects that are more important than the mechanically induced effects.”

Western medicine does not have highly effective medical treatments for chronic back pain, Cherkin said. Back pain is the number-one reason that Americans use complementary and alternative medicine (CAM), including acupuncture.

The National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, funded the SPINE trial.

“The findings of this research show that acupuncture-like treatments, including simulated acupuncture, can elicit positive responses,” said Josephine P. Briggs, MD, director of NCCAM. “This adds to the growing body of evidence that something meaningful is taking place during acupuncture treatments outside of actual needling. Future research is needed to delve deeper into what is evoking these responses.”

Cherkin and Sherman’s SPINE trial co-authors were Richard A. Deyo, MD, MPH, of Oregon Health & Science University in Portland; Partap S. Khalsa, DC, PhD, of NCCAM’s Division of Extramural Research; Andrew L. Avins, MD, MPH, Luisa Hamilton, MD, and Alice Pressman, MS, of NorthernCalifornia Kaiser Permanente in Oakland; William E. Barlow, PhD of Cancer Research and Biostatistics and Group Health Center for Health Studies; and Laura Ichikawa, MS, Janet H. Erro, RN, MN, Kristin Delaney, MPH, and Rene Hawkes of Group Health Center for Health Studies.