Zhongguo Zhen Jiu. 2013 Jul;33(7):668-72.
[Discussion on the regular of acupoint selection of acupuncture and moxibustion for lumbar disc herniation during recent 10 years].
[Article in Chinese]
Li JB1, Xiong QL, Qu SK, Qi F, Zhang L, Wang Q, Bao K, Li FB.
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Abstract
By taking "lumbar disc herniation", Chinese medicine", "acupuncture and moxibustion" as key words Chinese articles about acupuncture for lumbar disc herniation in recent 10 years were searched in three major Chinese databases of Wan fang database, VIP database and CNKI. Totally 546 relative articles were retrieved. After the elimination of invalid articles, 173 were included as valid articles with 49 main acupoints. The hierarchical clustering statistical method was used to analyze the possible rules among the former 20 acupoints. It turned out that there were 10 most common used acupoints on Bladder Meridian [Geshu (BL 17), Xiaochangshu (BL 27), Shenshu (BL 23), Dachangshu (BL 25), Pangguangshu (BL 28), Guanyuanshu (BL 26), Weizbong (BL 40), Zhibian (BL 54), Chengshan (BL 57), Kunlun (BL 60)], 2 on Gallbladder Meridian [Huantiao (GB 30), Yanglingquan (GB 34)], 2 on Governor Vessel [Yaoyangguan (GV 3), Shuigou (GV 26)], 2 on Stomach Meridian [Zusanli (ST 36), Juliao (ST 3)], 2 on Spleen Meridian [Sanyinjiao (SP 6), Xuehai (SP 10)], and the rest were extra points (Huatuo Jiaji) and Ashi points, so a conclusion could be drawn that the most common used acupoints were Bladder Meridian acupoints and supplemented by Gallbladder Meridian, Governor Vessel, Stomach Meridian, Spleen Meridian, extra points and Ashi points. The selected acupoints were most located on the lumbosacral region, leg and fewer located on the face, back and local part.




Zhongguo Zhen Jiu. 2013 Jul;33(7):605-8.
[Observation on the therapeutic effect of lumbar disc herniation treated with different acupuncture therapies].
[Article in Chinese]
Wang YL.
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Abstract
OBJECTIVE:
To observe the differences in the clinical therapeutic effects on lumbar disc herniation among warm needling therapy, electroacupuncture therapy and common acupuncture therapy.
METHODS:
One hundred and thirty-six cases of lumbar disc herniation were randomized into a warm needling group (46 cases), an electroacupuncture group (45 cases) and a common acupuncture group (45 cases). The points were the same in the three groups. The main points were Shiqizhui (EX-B 8), Yaoyangguan (GV 3), Huantiao (GB 30), Yanglingquan (GB 34), Jiaji (EX-B 2) (corresponding tender points). In the warm manipulation group, the warm and dredging manipulation was adopted. In the electroacupuncture group, G6805- II electric acupuncture apparatus was attached. In the common acupuncture group, only common needling therapy was applied without any specific manipulation supplemented. In all of the three groups, the treatment was given once every two days, 10 treatments made one session. After one session of treatment, the comprehensive assessment score of the chief symptoms and physical signs, VAS score and the clinical efficacy were compared among the three groups.
RESULTS:
The score of the chief symptoms and physical signs and VAS score after treatment were all reduced as compared with those before treatment in all of the three groups, indicating the statistically significant differences (P < 0.05). All of the three therapies could relieve the chief symptoms and physical signs of lumbar disc herniation. After treatment, the total effective rate was 89.1% (41/46) in the warm manipulation group, 88.9% (40/50) in the electroacupuncture group and 71.1% (32/45) in the common acupuncture group. The efficacies were not different apparently between the warm manipulation group and the electroacupuncture group (P > 0.05). The efficacies in the warm manipulation group and the electroacupuncture group were all superior to the common acupuncture group (P < 0.05).
CONCLUSION:
The efficacies of the warm and dredging manipulation and the electroacupuncture therapy are superior to the common acupuncture therapy in the treatment of lumbar disc herniation.




Acupunct Med. 2014 Jun;32(3):236-41. doi: 10.1136/acupmed-2013-010489. Epub 2014 Feb 24.
Immediate effects of electroacupuncture and manual acupuncture on pain, mobility and muscle strength in patients with knee osteoarthritis: a randomised controlled trial.
Plaster R1, Vieira WB1, Alencar FA1, Nakano EY2, Liebano RE1.
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Abstract
OBJECTIVE:
To compare the immediate effects of electroacupuncture and manual acupuncture on pain, mobility and muscle strength in patients with knee osteoarthritis.
METHODS:
Sixty patients with knee osteoarthritis, with a pain intensity of ≥2 on the pain Numerical Rating Scale, were included. The patients were randomised into two groups: manual acupuncture and electroacupuncture. Pain intensity, degree of dysfunction (Timed Up and Go (TUG) test), maximal voluntary isometric contraction and pressure pain threshold were assessed before and after a single session of manual acupuncture or electroacupuncture treatments.
RESULTS:
Both groups showed a significant reduction in pain intensity (p<0.001) and time to run the TUG test after the acupuncture treatment (p=0.005 for the manual acupuncture group and p=0.002 for the electroacupuncture group). There were no differences between the groups regarding pain intensity (p=0.25), TUG test (p=0.70), maximum voluntary isometric contraction (p=0.43) or pressure pain threshold (p=0.27).
CONCLUSIONS:
This study found no difference between the immediate effects of a single session of manual acupuncture and electroacupuncture on pain, muscle strength and mobility in patients with knee osteoarthritis.
TRIAL REGISTRATION NUMBER:
RBR-9TCN2X.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.




J Neurosci. 2014 Mar 12;34(11):3924-36. doi: 10.1523/JNEUROSCI.3155-13.2014.
Functional network architecture predicts psychologically mediated analgesia related to treatment in chronic knee pain patients.
Hashmi JA1, Kong J, Spaeth R, Khan S, Kaptchuk TJ, Gollub RL.
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Abstract
Placebo analgesia is an indicator of how efficiently the brain translates psychological signals conveyed by a treatment procedure into pain relief. It has been demonstrated that functional connectivity between distributed brain regions predicts placebo analgesia in chronic back pain patients. Greater network efficiency in baseline brain networks may allow better information transfer and facilitate adaptive physiological responses to psychological aspects of treatment. Here, we theorized that topological network alignments in resting state scans predict psychologically conditioned analgesic responses to acupuncture treatment in chronic knee osteoarthritis pain patients (n = 45). Analgesia was induced by building positive expectations toward acupuncture treatment with verbal suggestion and heat pain conditioning on a test site of the arm. This procedure induced significantly more analgesia after sham or real acupuncture on the test site than in a control site. The psychologically conditioned analgesia was invariant to sham versus real treatment. Efficiency of information transfer within local networks calculated with graph-theoretic measures (local efficiency and clustering coefficients) significantly predicted conditioned analgesia. Clustering coefficients in regions associated with memory, motivation, and pain modulation were closely involved in predicting analgesia. Moreover, women showed higher clustering coefficients and marginally greater pain reduction than men. Overall, analgesic response to placebo cues can be predicted from a priori resting state data by observing local network topology. Such low-cost synchronizations may represent preparatory resources that facilitate subsequent performance of brain circuits in responding to adaptive environmental cues. This suggests a potential utility of network measures in predicting placebo response for clinical use.




Effects of Wonli Acupuncture Procedure in Patients with LSS: A Clinical, Retrospective Study
Geon-Mok Lee, 1 ,* Eun-Yong Lee, 2 Jong-Hyun Han, 3 Kyong-Ha Cho, 1 Se-Rin Kang, 1 and Sang-Hoon Yoon 1
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Abstract
Background. Lumbar spinal stenosis (LSS) is a disease with increasing prevalence due to prolongation of average life span. Despite various treatment methods, many limitations remain unsolved. Objective. We are reporting cases of patients who have been treated with Wonli Acupuncture, a method of treating LSS by directly approaching the intervertebral foramen and interlaminar space with acupuncture needles different from those used in original acupuncture. Methods. A total of 82 patients with LSS were treated with Wonli Acupuncture, and out of those, 47 patients without exclusion criteria were selected for the following research. We compared the pretreatment VAS and ODI scores based on 1-year follow-up measurements. Results. The ODI value dropped by 15.3 ± 24.8 on average (from 35.2 ± 19.9 at the baseline to 19.8 ± 20.6 at the reading) (P < 0.01) and the average VAS also dropped by 19.2 ± 37.2 (from 60.7 ± 23.1 at baseline to 41.5 ± 31.9 at the reading) (P < 0.01). Conclusions. Wonli Acupuncture was found to have clinical efficacy for lumbar spinal stenosis.




Int J Community Based Nurs Midwifery. 2014 Apr;2(2):112-20.
The Effect Dry Cupping Therapy at Acupoint BL23 on the Intensity of Postpartum Low Back Pain in Primiparous Women Based on Two Types of Questionnaires, 2012; A Randomized Clinical Trial.
Akbarzadeh M1, Ghaemmaghami M2, Yazdanpanahi Z2, Zare N3, Azizi A4, Mohagheghzadeh A4.
Author information


Abstract
BACKGROUND:
Continuous low back pain is associated with the symptoms of the pregnancy period. In spite of the improvement of low back pain within 6 months after the delivery, some women may develop chronic problems. This study aimed to investigate the effect of dry cupping therapy at BL23 point on the intensity of low back pain in primiparous women. 
METHODS:
In the present randomized clinical trial, 100 samples were randomly allocated to either the cupping therapy or the control group (each containing 50 subjects). Cupping therapy was performed for 15-20 minutes every day up to 4 consecutive times. Visual Analogue Scale (VAS) and short-form McGill pain questionnaire were completed by the two groups before the intervention and immediately, 24 hours, and 2 weeks after that. Then, the data were entered into the SPSS statistical software (v. 16) and analyzed using chi-square test and repeated measures ANOVA.
RESULTS:
According to VAS, the mean intensity of low back pain in the cupping therapy group decreased from 7.8±2.7 before the intervention to 3.7±1.8, 2.5±1.7, and 1.4±1.4 immediately, 24 hours, and 2 weeks after the intervention, respectively. Besides, these measures were respectively obtained as 31.8±10.8, 9.0±6.7, 7.5±6.6, and 3.6±4.1 in the short-form McGill pain questionnaire. According to repeated measures ANOVA, a significant difference was observed among the various stages of follow-up (P=0.01).
CONCLUSION:
The study results showed cupping therapy to be effective in sedation of pain. Thus, it can be used as an effective treatment for reducing the low back pain.
TRIAL REGISTRATION NUMBER:
2013072611944N3.




J Bone Joint Surg Am. 2006 Jul;88(7):1589-95.
Important demographic variables impact the musculoskeletal knowledge and confidence of academic primary care physicians.
Lynch JR1, Schmale GA, Schaad DC, Leopold SS.
Author information


Abstract
BACKGROUND:
Although most musculoskeletal illness is managed by primary care providers, and not by surgeons, evidence suggests that primary care physicians may receive inadequate training in musculoskeletal medicine. We evaluated the musculoskeletal knowledge and self-perceived confidence of fully trained, practicing academic primary care physicians and tested the following hypotheses: (1) a relationship exists between a provider's musculoskeletal knowledge and self-perceived confidence, (2) demographic variables are associated with differences in the knowledge-confidence relationship, and (3) specific education or training affects a provider's musculoskeletal knowledge and clinical confidence.
METHODS:
An examination of basic musculoskeletal knowledge and a 10-point Likert scale assessing self-perceived confidence were administered to family practice, internal medicine, and pediatric faculty at a large, regional, academic primary care institution serving both rural and urban populations across a five-state region. Subspecialty physicians were excluded. Individual examination scores and self-reported confidence scores were correlated and compared with demographic variables.
RESULTS:
One hundred and five physicians participated. Ninety-two physicians adequately completed the musculo-skeletal knowledge examination. Fifty-nine (64%) of the ninety-two physicians scored < 70%. Higher examination scores were associated with male gender (p = 0.01) and participation in a musculoskeletal course (p = 0.009). Practitioners who took elective courses demonstrated higher scores compared with those who took required courses (p = 0.014). Greater musculoskeletal confidence was associated with the number of years in clinical practice (p = 0.045), male gender (p = 0.01), residency training in family practice (p < 0.00001), and prior participation in a musculoskeletal course (p = 0.0004). Physicians demonstrated greater confidence with medical issues than with musculoskeletal issues (mean confidence scores, 8.3 and 5.1, respectively; p < 0.00001). Higher scores for musculoskeletal knowledge correlated significantly with increasing levels of musculoskeletal confidence (r = 0.416, p < 0.0001).
CONCLUSIONS:
Although a large proportion of primary care visits are for musculoskeletal symptoms, the majority of primary care providers tested at a large, regional, academic primary care institution failed to demonstrate adequate musculoskeletal knowledge and confidence. Further characterization of the relationship between knowledge and confidence and its association with demographic variables might benefit the education of musculoskeletal providers in the future.



Aust N Z J Med. 1991 Jun;21(3):303-6.
The musculo-skeletal examination: a neglected clinical skill.
Ahern MJ1, Soden M, Schultz D, Clark M.
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Abstract
One hundred and sixty-six patients admitted to general medical wards of a teaching hospital were examined on the day of discharge to determine whether they had been assessed for musculoskeletal disorders during their admission. Of these patients, 54.8% had musculo-skeletal symptoms with 17.5% having a significant rheumatological disorder which had been ignored. A history of musculo-skeletal symptoms was recorded in 40.4% of all patients and the examination in only 14.5%. This contrasted with the documentation of the cardiovascular (99.4%), respiratory (100%), gastrointestinal (97.6%) and central nervous (53%) systems' examination. Eighty per cent of symptomatic patients received either no treatment for their rheumatic disorder, or treatment that we regarded as suboptimal or inappropriate. Musculo-skeletal symptoms are common in patients admitted to medical wards, but are being inadequately assessed or at worst ignored. The omission of the musculo-skeletal system examination, in contrast to the almost universal inclusion of other systems' examination, demands correction. Undergraduate and postgraduate training programmes require re-evaluation. The implications of these findings are discussed.




Biomedicine (Taipei). 2014;4:13. Epub 2014 Aug 2.
Needling therapy for myofascial pain: recommended technique with multiple rapid needle insertion.
Chou LW1, Hsieh YL2, Kuan TS3, Hong CZ4.
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Abstract
Myofascial trigger point (MTrP) is a major cause of muscle pain, characterized with a hyperirritable spot due to accumulation of sensitized nociceptors in skeletal muscle fibers. Many needling therapy techniques for MTrP inactivation exist. Based on prior human and animal studies, multiple insertions can almost completely eliminate the MTrP pain forthwith. It is an attempt to stimulate many sensitive loci (nociceptors) in the MTrP region to induce sharp pain, referred pain or local twitch response. Suggested mechanisms of needling analgesia include effects related to immune, hormonal or nervous system. Compared to slow-acting biochemical effects involving immune or hormonal system, neurological effects can act faster to provide immediate and complete pain relief. Most likely mechanism of multiple needle insertion therapy for MTrP inactivation is to encounter sensitive nociceptors with the high-pressure stimulation of a sharp needle tip to activate a descending pain inhibitory system. This technique is strongly recommended for myofasical pain therapy in order to resume patient's normal life rapidly, thus saving medical and social resources.




Eur J Pain. 2015 Feb 17. doi: 10.1002/ejp.671. [Epub ahead of print]
Local and distant acupuncture points stimulation for chronic musculoskeletal pain: A systematic review on the comparative effects.
Wong Lit Wan D1, Wang Y, Xue CC, Wang LP, Liang FR, Zheng Z.
Author information

  • 1School of Health Sciences, and Health Innovations Research Institute, RMIT University, Bundoora, Vic., Australia.
Abstract
One in four people suffers from chronic musculoskeletal pain (CMP). Acupuncture points stimulation is increasingly used for pain relief for CMP. Commonly, a combination of local and distant points is used. However, the difference between the effects of local and distant point stimulation is unknown. This systematic review aimed to determine if there was a difference in effects between stimulating local and distant points, and the combination of both when compared with either alone. English and Chinese electronic databases were searched to identify randomized controlled trials, where local or distant points were stimulated in adults with CMP. Pain intensity was the primary outcome measure. Nineteen were included in the qualitative analysis and 15 in the meta-analysis. Local and distant point stimulation was more effective than their respective controls in pain reduction immediately after treatment. Three studies directly compared the stimulation of local and distant points and found no significant difference between the two. No studies compared combined local and distant point stimulation with either alone. Subgroup analyses showed that, local tender point stimulation was more effective than local acupuncture points. Local and distant point stimulation induces similar degree of acupuncture analgesia. The benefit of combining local and distant point stimulation is unknown. However, subgroup analyses suggested that local tender points could be important in the treatment of CMP for short-term pain relief.



Knuckle Cracking and Hand Osteoarthritis

+

Author Affiliations

  • From the Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (KD); the Department of Radiology, National Naval Medical Center, Bethesda, MD (MO); and the Madigan Army Medical Center, Tacoma, WA (RO).
  • Corresponding author: Kevin deWeber, MD, FAAFP, USUHS, Dept. FAP, 4301 Jones Bridge Road, Bethesda, MD 20814 (E-mail: kdeweber@usuhs.mil).

 
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Abstract

Background: Previous studies have not shown a correlation between knuckle cracking (KC) and hand osteoarthritis (OA). However, one study showed an inverse correlation between KC and metacarpophalangeal joint OA.
Methods: We conducted a retrospective case-control study among persons aged 50 to 89 years who received a radiograph of the right hand during the last 5 years. Patients had radiographically proven hand OA, and controls did not. Participants indicated frequency, duration, and details of their KC behavior and known risk factors for hand OA.
Results: The prevalence of KC among 215 respondents (135 patients, 80 controls) was 20%. When examined in aggregate, the prevalence of OA in any joint was similar among those who crack knuckles (18.1%) and those who do not (21.5%; P = .548). When examined by joint type, KC was not a risk for OA in that joint. Total past duration (in years) and volume (daily frequency × years) of KC of each joint type also was not significantly correlated with OA at the respective joint.
Conclusions: A history of habitual KC—including the total duration and total cumulative exposure—does not seem to be a risk factor for hand OA.


J Altern Complement Med. 2016 Oct 18. [Epub ahead of print]
Pattern Differentiation of Lateral Elbow Pain in Traditional Chinese Medicine: A Systematic Review.
Gadau M1, Zhang SP1, Yip HY1, Yeung WF2, Bian ZX1, Lu AP1, Zaslawski C3.
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Abstract
BACKGROUND:
Traditional Chinese Medicine (TCM) uses a sophisticated diagnostic system called pattern differentiation, which allows for the tailor-made treatment of individuals.
OBJECTIVE:
This study aimed to identify the commonly used TCM patterns for lateral elbow pain (LEP), as well as the clinical features associated with these patterns.
METHOD:
Journal literature in 15 major Chinese and English databases and textbooks from five medical libraries as well as Chinamaxx were reviewed.
RESULTS:
Five hundred and fifty-five full-text journal articles, as well as 465 textbooks, were retrieved for further assessment, but only eight studies and seven books that mentioned LEP patterns could be identified and included in this study. The top four patterns that were identified were the wind-cold-dampness pattern, the qi stagnation and blood stasis pattern, the dual deficiency of qi and blood pattern, and the retained dampness-heat pattern, each of which was associated with unique features that were made up of distinct signs and symptoms.
CONCLUSIONS:
The unique features identified for each of the major patterns might be the key to understanding TCM individualized treatment based on pattern differentiation. Furthermore, the approach taken in studying TCM pattern of LEP may also be useful for studying the TCM patterns of other musculoskeletal conditions.