I love the article below (** use find to find it below this main post) from 2014 from Scientific America Mind about Acupuncture. It is hysterical. I would most like to meet Dr. Hall and pharmacist David Colquhoun, who appears to be a true Brit & very cynical. The consensus back then was that there was little to no scientific proof acupuncture works.

In 2020, I still see many patients who “swear” acupuncture works for various pains. I did post in 2017 about why acupuncture likely works given the stimulation of the fascial plain surrounding muscles and the piezoelectricity inherent to the fascial plane.
https://drcremers.com/2017/04/myofascial-pain-syndrome-and-science.html

As discussed in that old post, part of the issue in proving acupuncture works involves the subjective nature of quantifying “pain” and all that means.

Recently a patient who was having life-debilitating severe dry eye pain (10 out of 10) began a series of treatments with Intense Pulse Light. He improved significantly as the meibomian gland oil was expressed over many sessions and went from “toothpaste secretions” to “olive oil.” But he seemed to hit a wall where he could not get more pain relief (the best was 5 out of 10 eye pain). He saw a very good acupuncturist who appears to have helped with the pain even more.

There is no way to tell if his relief was from the IPL’s long term effect or if it is from acupuncture, but he is significantly better with IPL plus acupuncture. Of course, this is only 1 story (1 case), but it is interesting to me as a surgeon as we do have some patients who do not get to a “no-pain” state, and we do want our patients to have ZERO pain.

It will take years and millions of dollars to prove definitely acupuncture works for general conditions and even more time and money to prove it helps with dry eye. Still, it is interesting to think of the causes of chronic eye pain and to treat the whole person and all the factors involved.

There are many articles looking to prove the effectiveness of acupuncture as it does appear to help many patients.

This is the name of the acupuncturist my patient really loved:

Dr. Denise
Hoffecker , using herbs and accupuncture for relief of allergies. Patient has
been feeling improvement with itching

Below is the best recent article I could find which has more objective proof acupuncture works. It is in an “ok” journal and the authors do not appear to have a financial interest.

Most papers on acupuncture have been published in low-impact journals and may have authors who have a conflict of interst in proving accupunture works (see other references *** below)

ORIGINAL RESEARCH

Open Access

Changes in resting‐state functional connectivity in nonacute sciatica with acupuncture modulation: A preliminary study

First published: 10 January 2020

https://doi.org/10.1002/brb3.1494

Abstract

Aims

To investigate the functional connectivity (FC) in nonacute sciatica and the neuronal correlation of acupuncture analgesia.

Methods

A prospective study employing resting‐state functional magnetic resonance imaging was conducted. Twelve sciatica patients were enrolled to receive six or 18 acupoints of acupuncture treatment twice a week for 4 weeks. Regional homogeneity (ReHo) and seed‐based FC were performed.

Results

Regional homogeneity analysis demonstrated a greater alteration in the right posterior cingulate cortex (PCC) during the pre‐acupuncture phase than during the postacupuncture phase. Compared to that of healthy controls, the PCC‐seeded FC (default mode network, DMN) of sciatica patients exhibited hyperconnectivity of PCC‐FC with the PCC‐bilateral insula, cerebellum, inferior parietal lobule, right medial prefrontal cortex, and dorsal anterior cingulate cortex during the pre‐acupuncture phase as well as hypoconnectivity of PCC‐FC with the right cerebellum, left precuneus, and left dorsal medial prefrontal cortex during the postacupuncture phase. Correlation analysis between PCC‐seeded FC and behavior measurements revealed a positive association with the duration of sciatica in the right inferior parietal lobule prior to acupuncture treatment.

Conclusions

Acupuncture in chronic sciatica patients is associated with normalized DMN activity and modulation of descending pain processing. The changes in the subclinical endophenotype of brain FC after acupuncture treatment may provide clues for understanding the mechanism of acupuncture‐mediated analgesia in chronic pain.

1 INTRODUCTION

Sciatica is a common chronic pain disorder, typically presenting as low back or gluteal pain that may radiate to one leg, with motor or sensory complaints (Peul et al., 2007; Valat, Genevay, Genevay, Marty, Rozenberg, & Koes, 2010). A measurement of the global burden of disease revealed that low back pain is the leading cause of daily disability, and sciatica is one of the most common variations of low back pain (Andersson, Pope, Frymoyer, & Snook, 1991; Murray & Lopez, 2013). The prevalence of sciatica varies from 1.6% up to 43% in the population aged 20 years and older, highlighting its ununified diagnostic criteria and complex manifestations (Deyo & Tsui‐Wu, 1987; Videman et al., 1984).

A systemic review and meta‐analysis of drugs for pain relief of sciatica reported that management of sciatica in primary care is still unclear (Pinto et al., 2012), and the effectiveness of physical therapy, bed rest, manipulation, or medication could not be concluded from previous literature (Luijsterburg et al., 2007). Network meta‐analyses comparing the clinical effectiveness of management strategies for sciatica demonstrate that for overall outcomes, there is a statistically significant improvement following disk surgery, epidural injections, nonopioid analgesia, manipulation, and acupuncture (Lewis et al., 2015).

Chronic pain is a complex negative experience that engages multiple regions of the brain (Apkarian, Baliki, Baliki, & Geha, 2009). Chronic sciatica is classified as either persistent or multiple acute recurrences (Atlas & Nardin, 2003). Therefore, pain‐induced disability may affect sciatica patients. The key pathway of pain indicates the transmission of nociception to our brain. Many functional magnetic resonance imaging (fMRI) studies have identified that chronic pain may cause changes in the brain (May, 2008).

A recent study indicated that the interaction between large‐scale brain networks could be dynamically changed in patients with chronic pain (Kucyi & Davis, 2015). The default mode network (DMN) is a crucial brain network composed of regions including the posterior cingulate cortex/precuneus (PCC/PCu), medial prefrontal cortex (mPFC), inferior parietal cortex, inferior temporal cortex, and hippocampal cortex (Buckner, Andrews‐Hanna, Andrews‐Hanna, & Schacter, 2008). The DMN typically exhibits more activity during rest than during task engagement (Raichle, 2015). DMN alterations have been reported in numerous neuropsychiatric diseases and chronic pain disorder (Baliki, Mansour, Mansour, Baria, & Apkarian, 2014; Farmer et al., 2011). Aberrant functional connectivity (FC) of the DMN may also contribute to spontaneous neuropathic pain (Cauda et al., 2009).

Resting‐state fMRI (rsfMRI) findings showed that acupuncture may modulate the FC of the brain (Chen et al., 2015; Jia et al., 2015; Shi et al., 2015). Acupuncture may achieve its therapeutic effect on knee osteoarthritis pain by modulating FC between the right frontoparietal network, executive control network (ECN), and descending pain modulatory pathway (Chen et al., 2015). In an acute experimental low back pain study, compared with the baseline, the pain state had higher regional homogeneity (ReHo) values in the pain matrix, limbic system, and DMN; acupuncture produced broad deactivation in the brain, including the limbic system, pain status, and DMN (Shi et al., 2015). The central pain relief mechanism of acupuncture is being increasingly elucidated in recent years. A meta‐analysis of 149 studies revealed greater deactivation in the subgenual anterior cingulate, subgenual cortex, amygdala/hippocampal formation, ventromedial PFC, nucleus accumbens, and PCC during acupuncture (Huang et al., 2012). A review article on brain FC network studies proposed that acupuncture effects may increase FC of DMN and sensorimotor network with pain, as well as affective and memory‐related brain regions (Cai, Shen, Shen, Wang, & Guan, 2018).

We hypothesized that if acupuncture therapy is effective for pain relief in nonacute/chronic sciatica, changes in the activity of a key network related to acupuncture modulation, such as the DMN, may be observed (Dhond, Yeh, Yeh, Park, Kettner, & Napadow, 2008). ReHo analysis is used to estimate the local coherence of spontaneous brain activity (Zang, Jiang, Jiang, Lu, He, & Tian, 2004). ReHo seed‐based FC analysis may bypass seed‐selection ambiguity and improve the sensitivity in detecting FC of the DMN or task‐positive network (Yan et al., 2013). Further, changes in ReHo can measure the local FC, which can be used to detect brain regions with abnormal local FC caused by lesions (Jiang & Zuo, 2016). In the present study, we performed seed‐based FC analysis based on the ReHo method to explore the activity patterns of the DMN in sciatica patients compared with healthy controls, and the central analgesic effect of acupuncture in treating chronic sciatica.

2 METHODS

2.1 Participants

Subjects who met the inclusive and diagnostic criteria were recruited for this study via the outpatient department. Twelve patients and 15 healthy people were recruited. Informed consent was obtained from all individual participants included in the study, and the study was approved by the Institutional Review Board of Taipei Veterans General Hospital.

All patients who met the following inclusion criteria were screened: (a) 35–85 years old, (b) low back or gluteal pain radiating into one leg, and (c) pain duration of at least 2 weeks. Exclusion criteria were (a) known or suspected serious spinal pathology (e.g., cauda equina syndrome or spinal fracture), (b) pregnant or breast‐feeding women, (c) scheduled or being considered for spinal surgery or interventional procedures for sciatica during the 8‐week treatment period, (d) administration of sedative or analgesic drugs within 24 hr before the fMRI scan, (e) comorbidities of systemic malignancy, bleeding tendency, rheumatic arthritis, and other known autoimmune diseases, (f) focal neurological deficits with progressive or disabling symptoms, (g) history of receiving acupuncture treatment in the past 1 month, (h) contraindications for acupuncture or MRI, (i) visual analog scale <3, and (j) low back pain without sciatica.

In addition to inclusion and exclusion criteria, the patient’s diagnosed sciatica met at least two of the following items: (a) radicular pain in the L4, L5, or S1 dermatome; (b) physical examination consistent with radicular pain, motor or sensory neurological findings, or decreased reflex in the L4, L5, or S1 nerve root distribution; (c) positive straight‐leg‐raising test; (d) increased leg pain on coughing, sneezing, or straining; and (e) MRI demonstrating a unilateral disk herniation impinging on the L4, L5, or S1 nerve root (Table 1).

Table 1. Demographic data at baseline and after acupuncture modulation

Characteristics	Before acupuncture (n = 12)	After acupuncture (n = 12)	p‐Value
Gender (M/F)	6/6	6/6	—
Age (years)	61.42 ± 14.84	—	—
Duration (months)	20.75 ± 16.44	—	—
Side (right/left)	6/6	—
VAS	5.42 ± 1.83	3.92 ± 1.83	.032*
SBI	11.83 ± 5.37	9.42 ± 4.10	.287
RDQS	10.75 ± 4.85	7.17 ± 5.04	.036*
WHOQOL‐BREF, total	53.19 ± 9.48	52.68 ± 8.28	.827
Physical	12.68 ± 2.54	13.34 ± 1.87	.388
Psychological	13.17 ± 2.55	12.91 ± 2.07	.651
Social	13.58 ± 3.09	12.83 ± 3.46	.298
Environmental	13.67 ± 2.61	13.41 ± 1.92	.660

Note

Data are presented as mean ± SD and were compared using independent t test (continuous variables).
Abbreviations: RDQS, Roland Disability Questionnaire for Sciatica; SBI, Sciatica Bothersomeness Index; VAS, visual analog scale; WHOQOL‐BREF, the World Health Organization Quality of Life in the Brief Edition.
* p < .05; **p < .01.

2.2 Study design

A prospective observational study was performed. The study comprised two arms: an acupuncture group and a healthy control group. Prior to acupuncture treatment (week 0, baseline) and after 4 weeks of treatment (eight sessions), rsfMRI scans were obtained. The total observation period in this study was 4 weeks for each patient. All patients received brain fMRI and behavioral scales twice (at baseline and 4 weeks after acupuncture treatment). The healthy individuals received one fMRI and behavior scale only, without any intervention.

We reviewed previous acupuncture treatment for sciatica in MEDLINE (PubMed) since 1970 and selected acupoints that were effective for treatment (Liu & Chen, 2017). We chose to use a combined acupoint treatment strategy, considering that treatment using acupoint combinations may achieve a synergistic effect in the brain (Zhang et al., 2019, 2016). All patients with sciatica received either six or 18 acupoints of manual acupuncture. The six acupoints were Shenshu (BL 23), Huantiao (GB 30), Weizhong (BL 40), Yanglingquan (GB 34), Kunlun (BL 60), and Xuanzhong (GB 39). The eighteen acupoints were Shenshu (BL 23), Dachangshu (BL 25), Xiaochangshu (BL 27), Huantiao (GB 30), Yinmen (BL 37), Zhibian (BL 54), Chengfu (BL 36), Fengshi (GB 31), Weizhong (BL 40), Zusanli (ST 36), Yanglingquan (GB 34), Yinlingquan (SP 9), Feiyang (BL 58), Sanyinjiao (SP 6), Xuanzhong (GB 39), Kunlun (BL 60), Taixi (KI 3), and Shenmai (BL 62). The acupoints selected were primarily in the BL and GB meridians, plus the governing vessels and KI meridians, which may nourish the patient’s qi, based on the theory of Traditional Chinese Medicine (Qin, Liu, Liu, Wu, Zhai, & Liu, 2015).

2.3 Intervention

The assessment of sciatica was conducted by a neurologist with 20 years of experience in neurology. Acupuncture treatment was administered by a qualified acupuncturist who has been practicing in the Department of Traditional Chinese Medicine for over 15 years.

Sterile, disposable, 0.3 × 40 mm or 0.35 × 50 mm (diameter × length) stainless steel needles (Ching Ming Medical Device Co) were used. Needles were only used once and were generally inserted to a depth of 5–30 mm, depending on the acupuncture point. Insertion was followed by manual stimulation to elicit the “de qi” sensation. Needles were retained in position for 20 min of acupuncture treatment. The acupuncture treatment was provided twice weekly for 4 weeks in both groups (i.e., eight treatments in total).

2.4 Clinical outcome measures

The primary outcome was the 100‐mm visual analog scale (VAS) for sciatica, measured at baseline and week 4. The pain scores ranged from 0 to 10; higher values represented worse outcomes. The patients were asked to rate their average leg pain over the last 24 hr with 0 representing “no leg pain” and 10 representing the “worst pain imaginable” (Collins, Moore, Moore, & McQuay, 1997; Huskisson, 1974).

The major secondary outcome was the Roland Disability Questionnaire for Sciatica (RDQS; Kim, Guilfoyle, Seeley, & Laing, 2010; Roland & Morris, 1983) measured at baseline and week 4 to assess functional disability (score 0: no disability; score 24: most disability); higher values represent worse outcomes. Sciatica Bothersomeness Index (SBI) was introduced to rate leg pain, as well as other bothersome symptoms such as paresthesia and weakness (score 0: not bothersome; score 24: extremely bothersome). Higher symptom scores were associated with higher emotional distress and lower physical function (Grovle et al., 2010; Grovle, Haugen, Haugen, Natvig, Brox, & Grotle, 2013). Further, the World Health Organization Quality of Life in the Brief Edition (WHOQOL‐BREF) was scored at baseline and week 4 for evaluating medical outcomes and quality of life; higher scores indicate better quality of life. There were four subscales: (a) physical health, score 4–20; (b) psychological, score 4–20; (c) social relationships, score 4–20; and (d) environment, score 4–20. The total score had a minimum of 8 and maximum of 80; higher values represent better outcomes (Yao & Wu, 2005).

2.5 Image acquisition

Resting‐state fMRI scans were obtained from each group at baseline and after 4 weeks of treatment to detect the regional features of spontaneous brain activity. Resting‐state fMRI was performed with a 3.0‐Tesla scanner (Discovery MR750; GE Healthcare) and 12‐channel head coil. Echo‐planar imaging was used for the rsfMRI scans (repetition number = 200 for conventional echo‐planar imaging; dummy scan = 5; repetition time/echo time = 2,000/30 ms; flip angle = 90°; matrix size = 64 × 64 × 40; and slice number = 40, slice thickness 3 mm, and field of view = 230 × 230 mm2). With eye fixation after correction of visual acuity, the baseline study of resting brain was obtained with (a) 5‐min sensory deprivation after explaining the resting condition to subjects and (b) subject’s response at the end of the scan, verifying their state of consciousness. An online real‐time analysis of head motion, using the methods modified from Analysis of Functional Neuroimaging (NIMH), ensured the quality of fMRI images with head translation <1 mm and head rotation <0.5° within each session. Studies of head motion exceeding the motion criteria were repeated or rejected from data analysis. Structural MRI studies included (1) 3D magnetization‐preparation T1‐weighted structural image (repetition time/echo time/inversion time = 8.2/3.2/450 ms, flip angle = 12°, matrix size = 256 × 256 × 176, field of view = 230 × 230 mm2, voxel size = 0.9 × 0.9 × 0.9 mm3). The total scan time of the rsfMRI was approximately 13 min. Head cushions and earplugs were provided to reduce head motion and noise. During the fMRI examination, the patient’s vital signs such as heart rate, O2 saturation, and respiratory rate were monitored and recorded.

2.6 Analysis of resting‐state functional MRI data

2.6.1 Image preprocessing

Preprocessing was performed using the Data Processing Assistant for Resting‐State fMRI V2.3 basic edition (State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, China; Chao‐Gan & Yu‐Feng, 2010) with Statistical Parametrical Mapping 8 (SPM8; Wellcome Trust Center for Neuroimaging, University College London, London, UK) in MATLAB 2014a (The MathWorks, Inc.). Functional image data were corrected for any head movements using SPM‐realign, a linear transformation procedure. We coregistered structural data with SPM coregister and normalized it to the Montreal Neurological Institute (MNI) space using a standard MNI template (SPM‐normalize) and then smoothed it with SPM‐smooth methods.

2.6.2 Imaging postprocessing: ReHo analysis

ReHo was used for data‐driven and regions of interest as seed‐base analysis. ReHo maps were created by the following analysis (Zang et al., 2004): The resulting time series in each voxel was then linearly detrended and band‐pass‐filtered (0.01–0.08 Hz) to extract the low‐frequency oscillations. The following nuisance variables were regressed out: (a) the six head movement parameters computed based on rigid body translation and rotation during the realignment in SPM8; (b) the mean signal within the lateral ventricles of cerebrospinal fluid; and (c) the mean signal within a deep white matter region (centrum ovale). Brain activity was activated in clusters or contiguous voxels. ReHo maps were generated by calculating Kendall’s coefficient of concordance of the time series between a given voxel with its nearest neighbors (26 voxels) in a voxel‐wise manner. The ReHo maps were spatially smoothed using a 3D Gaussian kernel of 8 mm full‐width at half‐maximum. For standardization purposes, each individual subject’s ReHo map was divided by its own global mean. The peaks of significant clusters were then selected as the ReHo‐based seeds.

2.6.3 Functional connectivity analysis of ReHo‐based seeds

The preprocessing of the FC analysis protocol was the same as that of the ReHo analysis, except that the images were (a) coregistered to individuals’ anatomical image and then normalized to the standard T1 MNI template; (b) spatially smoothed using a 3D Gaussian kernel of 8 mm full‐width at half‐maximum; and (c) treated with the global mean signal for additional nuisance variables. Because the global signal regression may cause a negative shift in the distribution of correlations (Fox, Zhang, Zhang, Snyder, & Raichle, 2009; Murphy, Birn, Birn, Handwerker, Jones, & Bandettini, 2009), a positive mask was implemented to address positive connectivity only. The seeded regions that were selected for FC analysis were those wherein the ReHo significantly differed in the between‐group (compared with controls) and within‐group (before and after treatment) comparisons. The mean time‐series activity was extracted within the 3‐mm‐radius spherical ReHo‐seeded regions. The individual FC maps were computed by Pearson’s correlation coefficient (r) between the seeds and the related brain regions. After calculating the correlation between the reference time course and the time course of each voxel in the brain, r‐values were converted into z‐values using Fisher’s r‐to‐z transformation to normalize the distribution. The FC was considered significant if the family‐wise error level was p < .05 at the voxel level.

2.7 Statistical analysis

2.7.1 Demographic and behavior data

SPSS statistical package program (version 19.0; SPSS Inc.) was used. The significance level used for the statistical analysis with two‐tailed testing was 5%. Continuous variables were presented as means ± standard deviation with 95% confidence intervals (CI). Categorical variables were described as n (%). Treatment effects such as 100 mm VAS, SBI, RDQS, and WHOQOL‐BREF, measured at baseline and week 4, were evaluated using a paired t test for within‐group analysis.

2.7.2 Image data: ReHo and ReHo‐seeded FC

One‐sample t tests were performed to derive group maps of FC (ReHo‐seeded FC), paired t tests were performed to compare the changes in FC before and after acupuncture in patients with sciatica, and independent‐sample t tests were performed to compare changes in FC in the patients with sciatica and healthy controls. A cluster‐corrected p < .05 (family‐wise error correction) level was used as the threshold for statistical significance.

2.7.3 Correlation analyses

Between ReHo‐seeded FC and behavior, data were analyzed using a one‐sample t test to examine the correlation between behavior inventories (VAS, SBI, and RDQS) and baseline in patients with sciatica. Two‐sample t tests were conducted to determine the correlation between behavior inventories and ReHo‐seeded FC in the acupuncture group for the condition of before and after treatment, respectively. Significance was set at the uncorrected voxel level p < .005, followed by the family‐wise error‐corrected cluster level p < .05.

3 RESULTS

3.1 Baseline information and demographic data

Twelve patients (six male) completed the study. Each patient received two fMRI scans (one at baseline and one after eight sessions of acupuncture at 4 weeks). The average ages of patients were 61.42 ± 14.84 years. The mean disease duration was 20.75 ± 16.44 months. Six patients had right sciatica, and six patients had left sciatica. The mean VAS, SBI, RDQS, and total WHOQOL‐BREF at baseline were 5.42 ± 1.83, 11.83 ± 5.37, 10.75 ± 4.85, and 53.19 ± 9.48, respectively (Table 1).

3.2 Measurements of pain and quality of life

There were significant differences between before and after acupuncture treatment with regard to VAS and RDQS (p = .032 and .036, respectively). However, there were nonsignificant changes observed in SBI and WHOQOL‐BREF after acupuncture treatment (Table 1 and Figure 1).

Figure 1

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Behavior scales before and after acupuncture treatment. Acup, acupuncture; RDQS, Roland Disability Questionnaire for Sciatica; SBI, Sciatica Bothersomeness Index; VAS, visual analog scale. *p < .05

3.3 Intra‐ and interregional connectivity of ReHo

For the major effect of pain for sciatica, between‐group comparison of the pretreated sciatica group and the healthy controls exhibited greater ReHo alternation in the left PCC. For the effect of treatment (within‐group analysis), there was a greater ReHo alteration (Sciaticapretreatment − Sciaticapost‐treatment) in the coordinate (3, −54, 21; BA 23), which is in the region of the PCC/PCu, according to the MNI template. Compared with healthy controls, patients after acupuncture treatment had increased ReHo alternation in the right precentral gyri (BA 4; Table 2 and Figure 2).

Table 2. Comparison of groups: Between‐ and within‐group differences in regional homogeneity

Contrast	Region	BA	Size	t score	Coordinate
Contrast	Region	BA	Size	t score	x	y	z
Effect of sciatica (between groups)
HC > Pretreat	NS
Pretreat > HC	PCC	23	450	9.94	−9	−42	30
Effect of treatment
Between groups
Post‐treat > HC	Precentral gyri	4	193	7.66	24	−21	51
HC > Post‐treat	NS
Within groups
Pretreat > Post‐treat	PCC/PCu	23	381	5.21	3	−54	21
Post‐treat > Pretreat	NS

Note

Peak coordinates refer to Montreal Neurological Institute space. Significance was set at the uncorrected voxel level p = .005, followed by the family‐wise error‐corrected cluster level p = .05.
Abbreviations: BA, Brodmann area; HC, healthy control group; NS, nonsignificant; PCC, posterior cingulate cortex; Post‐treat, group with sciatica after an acupuncture treatment; Pretreat, group with sciatica before acupuncture treatment.

Figure 2

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Statistic maps in ReHo analysis of between‐group and between‐phase comparisons. (a) Comparison of patient groups between the pretreated and post‐treated phases. Comparison of the post‐treated sciatica group with the healthy group, showing ReHo in PCC (b) and right precentral gyrus (marked with yellow circle) (c). HC, healthy control; PCC, posterior cingulate cortex; Post‐treated, patients with sciatica after acupuncture treatment; PreCG, precentral gyrus; Pretreated, patients with sciatica before acupuncture treatment; ReHo, regional homogeneity. *Significant differences in between‐phase comparisons, **p < .01

3.4 Interregional FC

We used ReHo results of PCC (x = 3, y = −54, z = 21) as a region of interest (ROI) to examine changes in PCC‐seeded interregional FC. The PCC‐seeded FC exhibited a characteristic DMN pattern of FC in the sciatica and healthy groups (Figure 3a,b). The patterns of DMN and its anticorrelation were visibly different in sciatica patients before and after acupuncture. In addition, the pattern of DMN in the sciatica group with acupuncture treatment was closer to the pattern of the healthy group. When between‐group PCC‐seeded FC maps were compared, there was no significant difference found between the pretreatment sciatica group and the healthy controls. However, after acupuncture treatment, compared to the controls, the sciatica group exhibited hyperconnectivity between PCC‐seeded FC with bilateral insula, bilateral inferior parietal lobules, bilateral cerebellum, right orbitofrontal cortex (OFC, BA 10), and left dorsal anterior cingulate cortex (dACC, BA 32) and exhibited hypoconnectivity between PCC‐seeded FC and left PCu, dmPFC, and cerebellum. In the within‐group analysis, patients in the pre‐acupuncture phase exhibited hyperconnectivity between PCC‐seeded FC and the PCC itself (BA 23; Table 3 and Figure 3).

Figure 3

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PCC‐seeded FC patterns in the sciatica and healthy groups. DMN of the sciatica group in the pretreated phase (a), post‐treated phase (b) and healthy group (c). Hypoconnectivity between PCC‐seeded FC and left PCu, dmPFC, and cerebellum of the sciatica group after an acupuncture treatment, compared with controls (d, e). Hyperconnectivity with bilateral insula (Ins, marked with a yellow circle in the right), right OFC (f), bilateral IPL (marked with a yellow circle in the right) (g), left dACC (h), and bilateral cerebellum (i). dACC, dorsal anterior cingulate cortex; DMN, default mode network; dmPFC, dorsomedial prefrontal cortex; FC, functional connectivity; Ins, insula; IPL, inferior parietal lobe; OFC, orbitofrontal cortex; PCC, posterior cingulate cortex; PCu, precuneus

Table 3. Analysis of effects of between‐group and within‐group differences in regional homogeneity (ReHo) seed‐based functional connectivity

Contrast	Region	BA	Size	t score	Coordinate
Contrast	Region	BA	Size	t score	x	y	z
Right ReHo seed (3,−54,21)
Effect of sciatica (between groups)
HC > AC pre	NS	—	—	—	—	—	—
AC pre > HC	NS
Effect of acupuncture treatment
Between groups
AC post > HC	Insula, right	13	672	7.33	39	12	3
	Insula, left	13	604	6.56	−51	6	3
	OFC, right	10	268	5.27	30	51	6
	IPL, left	40	301	6.34	−54	−42	39
	IPL, right	40	217	6.18	48	−33	33
	dACC	32	318	5.07	12	15	36
	Cerebellum, fusiform, R	—	165	5.83	39	−57	−21
	Cerebellum, fusiform, L	—	486	5.07	−33	−66	−18
AC post < HC	PCu, left	31	1,247	10.56	−3	−60	21
	dmPFC, left‐	9	763	5.00	−15	54	39
	Cerebellum, tonsil	—	222	5.53	6	−54	−48
Within groups
AC pre > AC post	PCC/PCu, left	23	234	5.69	0	−30	27
AC post > AC pre	NS	—

Note

Peak coordinates refer to Montreal Neurological Institute space. The significance threshold was set at the uncorrected voxel level p = .005, followed by the family‐wise error‐corrected cluster level p = .05.
Abbreviations: AC, group of sciatica with acupuncture; dACC, dorsal anterior circulate cortex; dmPFC, dorsomedial prefrontal cortex; HC, group of healthy controls; IPL, inferior parietal lobule; NS, nonsignificant; OFC, orbitofrontal cortex; PCC, posterior cingulate cortex; PCu, precuneus; post, post‐treatment; pre, pretreatment.

3.5 Correlation analysis between the FC map and behavior measurements

The PCC‐seeded FC was positively correlated with pain duration in the right inferior parietal lobule (IPL) (BA 40; [39, −60, 39]) at baseline (Figure 4). However, PCC‐seeded FC was not significantly correlated with other behavior scores at baseline. After acupuncture treatment, there was no significant correlation between PCC‐FC and any behavior scales.

Figure 4

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Correlation between the posterior cingulate cortex (PCC)‐seeded functional connectivity (FC) and behaviors in different conditions of sciatica patients

4 DISCUSSION

This preliminary study assessed the clinical effect of acupuncture in treating sciatica and proposed whether acupuncture targeted certain regions of the brain in nonacute/chronic sciatica patients. Through our study, acupuncture may achieve pain relief and resolve disability in patients with sciatica. Seed‐based FC derived from ReHo‐contrast analysis may provide a clue for understanding the central mechanism of acupuncture modulation. We demonstrated that PCC/PCu was a pivotal hub in sciatica treatment with acupuncture. Furthermore, using PCC as an ROI for seed‐based FC whole‐brain analysis, we observed that DMN may play a crucial role in the central analgesic effect of acupuncture. The changes of PCC‐seeded DMN through acupuncture modulation were mainly located in pain‐processing regions such as the bilateral insula, cerebellum, IPL, right mPFC, and dACC. In ReHo, whole‐brain analysis revealed that the precentral gyrus was related to acupuncture modulation. Finally, correlation analysis between PCC‐seeded FC and behavior measurements revealed a positive association with the duration of sciatica in the right IPL prior to acupuncture treatment.

The present findings demonstrate that the nonacute/chronic sciatica group had greater PCC ReHo values than did the healthy control and postacupuncture groups. Higher ReHo values have been reported in several areas of the pain‐related brain network (Shi et al., 2015; Zhao et al., 2013). The PCC in the pain network is altered in chronic pain (Hemington, Wu, Kucyi, Inman, & Davis, 2016; Loggia et al., 2013). The first study of acupuncture on the DMN of healthy individuals indicated that the immediate effect of acupuncture may increase FC of the DMN to pain and affective memory‐related regions of the brain (Dhond et al., 2008). Our findings further addressed that the PCC/PCu was not only an important hub in the DMN and the relevant pain network, but also played a role in the central effect of repeated acupuncture in treating sciatica. In addition, compared with the healthy group, the postacupuncture sciatica group had significantly higher ReHo in the right precentral gyrus. This result is consistent with a previous meta‐analysis study that reported that verum acupuncture stimuli may affect the precentral gyrus relative to resting conditions (Huang et al., 2012). The findings are also consistent with a prior migraine study that reported the precentral gyrus FC of migraine patients was significantly increased after acupuncture treatment (Li et al., 2015). These results suggest that acupuncture may engage in descending pain modulatory systems (DPMS) and the DMN for central analgesia.

Furthermore, we selected PCC based on the contrast of the ReHo map as a ROI to examine the effect of acupuncture analgesia on the DMN. The PCC/PCu plays a crucial role in the DMN (Fransson & Marrelec, 2008). Our results further emphasize that the PCC/PCu is also a key brain region for acupuncture‐treated nonacute/chronic sciatica. The DMN is associated with self‐processing, attention, and memory (Buckner et al., 2008, 2005; Spreng & Grady, 2010) and contributes to acute and chronic pain (Alshelh et al., 2018). However, the exact effects of acupuncture on the DMN for pain relief are unclear. Disruption of the resting state of the DMN in PCC‐FC in the precuneus region has recently been reported in patients with chronic orofacial neuropathic pain (Alshelh et al., 2018). In the present study, there was greater PCC/PCu FC in the sciatica group prior to acupuncture treatment compared to after acupuncture treatment (Figure 3a,b). In addition, compared with the controls, the acupuncture‐treated sciatica group exhibited hyperconnectivity of PCC‐FC in the bilateral insula, bilateral IPL, bilateral cerebellum, right OFC, and left dACC (Figure 3h,i). The changes in resting‐state FC after acupuncture modulation shed light on the central analgesic effect of acupuncture and indicate that these effects may target the DMN and strengthen its connection to pain‐processing areas. An earlier study regarding FC and acupuncture reported that manual acupuncture may reduce activity in pain‐processing regions of the brain in a healthy population during nociceptive stimulation (Hui et al., 2000). A rsfMRI study revealed that the baseline of patients with chronic lower back pain demonstrated greater DMN connectivity to the ACC, left IPL, and right insula, and FC of DMN‐right insula may positively correlate with clinical pain (Loggia et al., 2013). The above regions are consistent with the brain areas affected by acupuncture that were identified in our study. In addition to bilateral insula and bilateral IPL, the patients receiving acupuncture had greater PCC‐seeded FC to the right OFC and dACC, implicating that the analgesic effect of acupuncture may involve emotion, cognition, and reward circuits of the brain (Kringelbach, 2005; Navratilova & Porreca, 2014; Stevens, Hurley, Hurley, & Taber, 2011). Stronger interregional FC between DMN and mPFC was observed in primary dysmenorrhea and migraine patients compared to controls (Coppola et al., 2018; Wu et al., 2016). Similar findings were observed in our study based on visual inspection (Figure 3a). Patients receiving acupuncture treatment had hypoconnectivity of the PCC‐FC to right dmPFC (substrate of ECN network), suggesting that acupuncture could seemingly disintegrate the maladaptive FC between DMN and ECN network for central analgesia through the DPMS (Chen, Spaeth, Spaeth, Retzepi, Ott, & Kong, 2014), alleviating pain rumination (Kucyi et al., 2014; Figure 3b,d,e).

The DMN may be reorganized by chronic pain and exhibits maladaptive connectivity in different types of chronic pain (Baliki et al., 2014). In addition, the cross‐network interaction between the DMN and salience network has been observed in chronic pain. Patients with chronic pain showed less anticorrelated FC between the DMN and salience network compared with that of healthy controls (Hemington et al., 2016). In the present study, the anticorrelation of PCC‐seeded DMN in sciatica patients of pre‐acupuncture was not significantly different than that of healthy controls (Figure 3a,c). However, acupuncture‐treated patients demonstrated global deactivation in the DMN and activation of its anticorrelation (Figure 3b), which is consistent with the results from a task fMRI study demonstrating that acupuncture may mobilize the brain’s default mode and its anticorrelated network in healthy controls (Hui et al., 2009). Furthermore, correlation analysis revealed that the PCC‐FC of patients with nonacute sciatica was positively correlated with pain duration in the IPL. This result is similar to previous research on pain scores in chronic pain patients with ankylosing spondylitis which were positively correlated with PCC‐FC with the right temporal junction (Hemington et al., 2016). Collectively, these findings suggest that disrupted DMN–salience network cross‐network connectivity is a major functional aberration in chronic sciatica patients.

There are several limitations to the current study. First, the number of subjects recruited was relatively small, and there was nonsignificant improvement in the quality of life. However, despite the small number of the patients, those treated with acupuncture obtained significantly improved pain relief and decreased disability due to sciatica. Second, we cannot exclude the possibility of a natural course of the disease of the patients. Nevertheless, all twelve patients have received contemporary Western medicine but did not attain a satisfactory therapeutic effect. Furthermore, even sham needles have a placebo effect (Lund, Naslund, Naslund, & Lundeberg, 2009). The therapeutic effects of acupuncture continue over time and cannot be elucidated only in terms of placebo effects (Egorova, Gollub, Gollub, & Kong, 2015; Vickers et al., 2018). We wanted to observe the modulated effect of acupuncture in sciatica treatment; therefore, there was no sham acupuncture group in the present study. Nonetheless, we would like to refine the study design to include a nonacupoint acupuncture group to complete the main trial.

5 CONCLUSIONS

In summary, the present study suggests that acupuncture treatment may relieve pain in sciatica patients and normalize its modulation in the relevant brain areas, especially the DMN and DPMS. The endophenotypic changes in brain FC based on acupuncture modulation may provide clues to understand the mechanisms underlying the analgesic effects of acupuncture on chronic pain. Acupuncture may promote robustness in the system (Xu et al., 2018) and normalize the disrupted cross‐network connectivity in chronic pain patients, which could be a useful treatment strategy. More comprehensive, larger‐scale, and randomized controlled studies are necessary to verify these effects.

ACKNOWLEDGMENTS

We sincerely thank the patients and healthy subjects for their participation in this study. We also thank colleagues from the Integrated Brain Research Unit, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, for providing insight and expertise that greatly assisted the research. This work was financially supported by the Brain Research Center, National Yang‐Ming University from The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan. This work was particularly supported by “Development and Construction Plan” of the School of Medicine at National Yang‐Ming University (107F‐M01‐07M32). This work was supported by the Lotung Poh‐Ai Hospital, Lo‐Hsu Foundation grant (Ilan, Taiwan; Grant No. 10605‐E235), and the Taipei Veterans General Hospital (Taipei, Taiwan; Grant No. V107C‐058).

CONFLICT OF INTEREST

The authors declare that they have no conflict of interest.

——-

****References & Old post link below

2020 Jan 15. doi: 10.1007/s12178-020-09608-0. [Epub ahead of print]

Dry Needling as a Treatment Modality for Tendinopathy: a Narrative Review.

Stoychev V1,2, Finestone AS3, Kalichman L4.

Author information

Abstract

PURPOSE OF REVIEW:

Tendinopathy describes a combination of pain, swelling, and impaired performance of the tendon and around structures. There are various treatment options for tendinopathy with unclear efficacy. Dry needling involves inserting needles into the affected tendon, and it is thought to disrupt the chronic degenerative process and encourage localized bleeding and fibroblastic proliferation. The purpose of this review is to review the use of dry needling as a treatment modality for tendinopathy.

RECENT FINDINGS:

The effectiveness of dry needling for treatment of tendinopathy has been evaluated in 3 systematic reviews, 7 randomized controlled trials, and 6 cohort studies. The following sites were studied: wrist common extensor origin, patellar tendon, rotator cuff, and tendons around the greater trochanter. There is considerable heterogeneity of the needling techniques, and the studies were inconsistent about the therapy used after the procedure. Most systematic reviews and randomized controlled trials support the effectiveness of tendon needling. There was a statistically significant improvement in the patient-reported symptoms in most studies. Some studies reported an objective improvement assessed by ultrasound. Two studies reported complications. Current research provides initial support for the efficacy of dry needling for tendinopathy treatment. It seems that tendon needling is minimally invasive, safe, and inexpensive, carries a low risk, and represents a promising area of future research. In further high-quality studies, tendon dry needling should be used as an active intervention and compared with appropriate sham interventions. Studies that compare the different protocols of tendon dry needling are also needed.

2. There is no way to tell if the authors have a financial interest in below article on Pubmed nor to access the full article at Johns Hopkins’ Medical system without asking the librarian to find it. Likely the authors do have a financial interest but the abstract is intriguing.

2020 Jan 16:acupmed2017011395. doi: 10.1136/acupmed-2017-011395. [Epub ahead of print]

Electroacupuncture reduces fibromyalgia pain by downregulating the TRPV1-pERK signalling pathway in the mouse brain.

Hsu HC1, Hsieh CL2,3, Lee KT2, Lin YW1,2,4,5.

Author information

1: College of Chinese Medicine, School of Post-Baccalaureate Chinese Medicine, China Medical University, Taichung.
2: College of Chinese Medicine, Graduate Institute of Acupuncture Science, China Medical University, Taichung.
3: College of Chinese Medicine, Graduate Institute of Integrated Medicine, China Medical University, Taichung.
4: Master’s Program for Traditional Chinese Veterinary Medicine, Chi Institute of Traditional Chinese Veterinary Medicine, Reddick, Florida, USA.
5: Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung.

Abstract

BACKGROUND:

Acupuncture has been clinically recommended as a method of pain relief by the World Health Organization and is widely used by medical doctors. Fibromyalgia (FM) pain has a complex physiological and psychological origin and can be pharmacologically treated with duloxetine, milnacipran and pregabalin. However, these drugs produce undesirable side effects, such as headaches, nausea and diarrhoea. Acupuncture may serve as an effective alternative treatment for pain relief with few side effects.

AIMS:

We hypothesised that acupuncture would reduce FM pain by influencing transient receptor potential cation channel subfamily V member 1 (TRPV1) and the downstream phosphorylated extracellular signal-regulated kinases (pERK), which are located in the central thalamus, amygdala and cortex.

METHODS:

A FM mouse model was established by injecting two doses of acid saline into 32 female C57/B6 mice. The mice were then assigned to different subgroups (n=8 each) and treated with electroacupuncture (EA) or EA sham control. TRPV1 and pERK expression levels were measured using Western blotting and immunohistochemistry.

RESULTS:

Our results demonstrated that the expression of TRPV1 and pERK in the thalamus, amygdala and somatosensory cortex was normal in the control mice, but significantly increased in FM mice; these FM-induced changes in expression were attenuated by EA.

CONCLUSION:

Our data suggest that EA can reverse the central sensitisation of the TRPV1-ERK signalling pathway in the mouse brain. Thus, our findings provide mechanistic evidence supporting the potential therapeutic efficacy of EA for treating FM pain.

2020 Jan 10;10:2. doi: 10.1186/s40945-019-0071-6. eCollection 2020.

Electrical interferential current stimulation versus electrical acupuncture in management of hemiplegic shoulder pain and disability following ischemic stroke-a randomized clinical trial.

Eslamian F1, Farhoudi M2, Jahanjoo F3, Sadeghi-Hokmabadi E4, Darabi P5.

Author information

Abstract

BACKGROUND:

Hemiplegic Shoulder Pain (HSP) is among common complications occurring after stroke leading to disability. This study was conducted to compare the effects of electrical Interferential Current stimulation (IFC) and Electrical Acupuncture (EAC) on pain intensity, range of motion, and functional ability in patients with HSP and also comparing the two modalities regarding improvement of above indices.

METHODS:

In this randomized clinical trial, 46 patients with HSP caused by ischemic stroke were recruited and assigned into 2 groups. Conventional exercise trainings were applied for both groups. Group A received additional IFC with medium frequency of 4000 HZ, and Group B received additional EAC two times a week for a total of 10 sessions. Pain severity, daily function, and shoulder Range of Motion (ROM) were evaluated using Visual Analogue Scale (VAS), Shoulder Pain and Disability Index (SPADI), and goniometry, respectively before and 5 weeks after the treatment.

RESULTS:

Both groups showed relative improvement in pain severity, SPADI score, and its subscales, and also active and passive shoulder ROM after the treatment. However, IFC group compared to EAC group had higher mean changes of active ROM in abduction (28.00 ± 3.81 vs. 12.25 ± 2.39) and functional subscale of SPADI (11.45 ± 1.88 vs. 5.80 ± 1.66) after the treatment. On the contrary, EAC group showed higher percentage of VAS changes (46.14 ± 6.88 vs. 34.28 ± 5.52), indicating better pain improvement compared to IFC group. Other parameters did not show significant difference between two groups.

CONCLUSION:

Both IFC and EAC caused short term improvement in functional state, increased motion, and decreased pain in patients with HSP. Although pain control was more evident in acupuncture group, IFC resulted in better effects on function and active ROM of abduction, and seems to have higher efficacy.

TRIAL REGISTRATION:

This clinical trial was registered in the Iranian Registry of Clinical Trials at 2016-07-16 with a registry number of IRCT201602153217N10.

This paper is intersting & was viewable on Pubmed

Acupuncture, a traditional eastern medical therapy with a long history, is one of the most popular complementary and alternative therapies in western countries, with increasingly potent evidence that it can treat obesity [13]. A systematic review indicates that acupuncture is effective in the treatment of obesity [14], as well as its related IR [15]. In addition, nutritional satisfaction and anorexia are the most pronounced proprioceptions after treatment with acupuncture [16], but the inherent mechanisms of these phenomena have not been revealed and therefore need more investigation.

2020 Jan 14:1-18. doi: 10.1159/000503752. [Epub ahead of print]

Acupuncture Targeting SIRT1 in the Hypothalamic Arcuate Nucleus Can Improve Obesity in High-Fat-Diet-Induced Rats with Insulin Resistance via an Anorectic Effect.

Shu Q1,2, Chen L3,2, Wu S3,2, Li J3,2, Liu J3,2, Xiao L2,4, Chen R5, Liang F6,7.

Author information

Abstract

OBJECTIVE:

To investigate the anorexigenic and anti-obesity effectiveness of electroacupuncture (EA) on high-fat-diet-induced (HFDI) obese rats with insulin resistance (IR) and to reveal the possible mechanisms of EA affecting SIRT1 (silent mating type information regulation 2 homolog 1) in the central nervous system (CNS).

METHODS:

We divided 60 rats into 6 groups. All interventions, including EA and intracerebroventricular administration, were performed after 8 weeks of model establishment. We tested obesity phenotypes like body weight (BW) gain; food intake; and IR levels including glucose infusion rate, intraperitoneal insulin tolerance test (IPITT), and intraperitoneal glucose tolerance test (IPGTT) during treatment. We detected protein expression and microscopic locations in hypothalamic SIRT1, the transcription factor FOXO1 (forkhead box protein O1), acetylated FOXO1 (Ac-FOXO1), pro-opiomelanocortin (POMC), and neuropeptide Y (NPY) via Western blotting and immunofluorescence, and monitored gene expression by real-time polymerase chain reaction.

RESULTS:

Like the SIRT1 agonist, EA suppressed BW gain and IR levels in obese rats, but this was only partially blocked by the SIRT1 antagonist. EA could upregulate protein expression of hypothalamic SIRT1 and downregulate the acetylation level of FOXO1 in the hypothalamic arcuate nucleus (ARC), which decreased gene expression of NPY and increased that of POMC. The agonist targeted the hypothalamic SIRT1 gene, unlike EA, which targeted posttranscriptional regulation.

CONCLUSION:

EA could improve obesity in HFDI rats with IR via its anorectic effect. This effect targeted posttranscriptional regulation of the SIRT1 gene, which induced upregulation of ARC FOXO1 deacetylation and mediated the gene expression of POMC and NPY.

2020 Jan 11:acupmed2016011314. doi: 10.1136/acupmed-2016-011314. [Epub ahead of print]

Acupuncture and moxibustion stimulate fibroblast proliferation and neoangiogenesis during tissue repair of experimental excisional injuries in adult female Wistar rats.

Alonso HR1, Kuroda FC1, Passarini Junior JR1, Quispe Cabanillas JG1, Mendonça FAS1, Dos Santos GMT1, de Aro AA1, do Amaral MEC1, Marretto Esquisatto MA1.

Author information

1: Biomedical Sciences Graduate Program, Hermínio Ometto University Center, Araras, Brazil.

Abstract

OBJECTIVE:

To investigate the effects of acupuncture and moxibustion on the repair of excisional skin injuries on the back of adult female Wistar rats.

METHODS:

90 animals were divided into three groups: C, control; A, acupuncture treatment (needled at traditional acupuncture points BL13, BL17 and ST36); M, moxibustion treatment (overlying same traditional acupuncture points). They were euthanased on days 7, 14 and 21 after injury for removal and preparation of tissue for analysis.

RESULTS:

The treated groups (A and M) showed no changes regarding the structural analysis relative to the control (C) group. The total number of fibroblast cells in the A and M groups were significantly higher than those in the C group on days 14 and 21. The number of granulocytes was significantly less in the A and M groups compared with the C group on days 14 and 21. The total number of newly formed vessels increased on day 21 and was significantly higher in the A and M groups. The amount of birefringent collagen fibre detected on day 21 was significantly higher in the C group. The amount of glycosaminoglycan and hydroxyproline was similar between the groups. The amount of collagen I did not differ between the groups in any period, despite the increased amount detected over time. The amount of type III collagen did not differ between the groups but the detected amount decreased over the course of the experiment. The amount of transforming growth factor β1 (TGF-β1) and vascular endothelial growth factor (VEGF) in the A and M rats was similar but inferior to C rats across all experimental periods.

CONCLUSIONS:

Acupuncture and moxibustion stimulated fibroblast proliferation and neoangiogenesis, and extended the period of collagen fibre reorganisation in the repair of excisional injuries in adult female rats.

2020 Jan 15:1-11. doi: 10.1080/01612840.2019.1663567. [Epub ahead of print]

Getting Well Is More Than Gaining Weight – Patients’ Experiences of a Treatment Program for Anorexia Nervosa Including Ear Acupuncture.

Olsson A1, Landgren K2.

Author information

Abstract

This study illuminates how 25 in-patients who were treated for anorexia nervosa in a highly specialized clinic for eating disturbances in Sweden experienced the treatment program. The program included structured eating, medication, restrictions in physical activity and supportive dialogues. Patients were also offered semi-standardized NADA ear acupuncture as a complement to relieve stress, anxiety and tension. In total, 46 interviews were analysed qualitatively using latent content analysis. The results showed how participants strived with their slow transition towards recovery. The novelty of integrating acupuncture in psychiatric treatment makes this study interesting. Acupuncture was experienced to relieve anxiety and somatic symptoms through the whole process. Further research is needed to evaluate the effect of acupuncture on the patient’s subjective sense of well-being when used as an adjunct to usual care.

2019 Dec 17;2019:7978180. doi: 10.1155/2019/7978180. eCollection 2019.

Effect of an Acupuncture Technique of Penetrating through Zhibian (BL54) to Shuidao (ST28) with Long Needle for Pain Relief in Patients with Primary Dysmenorrhea: A Randomized Controlled Trial.

Wang H1, Cao Y2, Jin X1, Yan M1, Wang J2, Li R2, Ji L1.

Author information

1: Shanxi University of Traditional Chinese Medicine, Jinzhong, Shanxi, China.
2: The Third Teaching Hospital of Shanxi University of Traditional Chinese Medicine, Taiyuan, Shanxi, China.

Abstract

BACKGROUND:

Primary dysmenorrhea (PD) is the commonest gynecological disorder in young women of reproductive age, and there is not always satisfactory relief of pain treated by common medications. Therefore, acupuncture has been used as an alternative therapy to relieve the symptoms of PD. In clinical practice, a penetrating method of acupuncture with long needle has been shown to be particularly effective for improving primary dysmenorrhea. This study was conducted to evaluate the effectiveness of this technique for pain relief in patients with primary dysmenorrhea as compared with a conventional pain medication.

METHODS:

The present study is a perspective, randomized, ibuprofen-controlled trial. Sixty-two eligible participants were randomly assigned in a 1 : 1 ratio to receive either acupuncture treatment or ibuprofen administration. The treatment lasted for three menstrual cycles for both groups. The primary outcome was the intensity of menstrual pain measured by using the visual analogue scale at the completion of treatment. Secondary outcomes included the severity of symptoms associated with menstrual pain, responder rate, and safety of acupuncture treatment. The clinical outcomes were measured on each menstrual cycle at baseline, treatment course (3 cycles), and follow-up period.

RESULTS:

Sixty-four patients of primary dysmenorrhea were recruited, and 62 subjects were included in the final analysis. At trial completion, acupuncture was shown to be associated with a significantly lower pain intensity and decreased symptom severity of primary dysmenorrhea as compared with ibuprofen (p < 0.05). A significantly higher responder rate was found in the acupuncture group as compared with the control group (p < 0.05). No serious adverse events were reported by patients in either group.

CONCLUSIONS:

The penetrating method of acupuncture with long needle may be an effective and safe therapy for pain relief in patients with primary dysmenorrhea. This trial was registered with the Chinese Clinical Trial Registry (ChiCTR-IOR-17012621).

2020 Jan 14;21(1):77. doi: 10.1186/s13063-019-3875-5.

Efficacy of compatible acupoints and single acupoint versus sham acupuncture for functional dyspepsia: study protocol for a randomized controlled trial.

Guo L1, Huang X2, Ha LJ3, Zhang JZ4, Mi J5, Sun PH6, Han XY7, Wang Y3, Hu JL3, Wang FC3, Li T8.

Author information

1: Department of Acupuncture and Moxibustion, Changchun University of Chinese Medicine, Changchun, 130117 China. Department of rehabilitation, Changchun hospital of traditional Chinese medicine, Changchun, 130022, China.
2: Jilin Ginseng Academy, Changchun University of Chinese Medicine, Changchun, 130117, China.
3: Department of Acupuncture and Moxibustion, Changchun University of Chinese Medicine, Changchun, 130117, China.
4: Department of Disease Prevention, First Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, 130021, China.
5: Department of Endocrinology, First Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, 130021, China.
6: Department of Epidemiology and Health Statistics, School of Public Health, Jinlin University, Changchun, 130021, China.
7: DDepartment of pharmacy, Changchun University of Chinese Medicine, Changchun, 130021, China.
8: Department of Acupuncture and Moxibustion, Changchun University of Chinese Medicine, Changchun, 130117, China. litie1999@126.com.

Abstract

BACKGROUND:

Acupoint selection is a key factor in the treatment of diseases and has not been well studied. The aim of this trial is to explore the differences in efficacy between compatible acupoints and a single acupoint for patients with functional dyspepsia (FD).

METHODS:

This randomized controlled trial will be conducted in the First Affiliated Hospital of Changchun University of Chinese Medicine in China. Two hundred and sixteen FD patients will be randomly assigned to the compatible acupoints group, single acupoint group, or sham acupuncture group. This trial will include a 1-week baseline period, a 4-week treatment period, and a 4-week follow-up period. During the 4-week treatment period, patients will receive 20 sessions of acupuncture (weekly cycles of one session per day for 5 consecutive days followed by a 2-day break). The primary outcome will be a change in the Nepean Dyspepsia Life Quality Index from baseline to after the 4-week treatment period. Secondary outcome measures will include the dyspeptic symptom sum score, Overall Treatment Effect questionnaire, and 36-item Short Form survey. Adverse events also will be recorded. Ultraweak photon emission and metabolomics tests will be performed at baseline and at the end of treatment to explore the mechanisms of the differences between compatible acupoints and a single acupoint.

DISCUSSION:

The results of this trial will allow us to compare the difference in efficacy between compatible acupoints and a single acupoint. The findings from this trial will be published in peer-reviewed journals.

2017 Cremers Blog Post on Acupuncture

Myofascial Pain Syndrome and the Science behind Acupuncture: Does Acupuncture and Massaging work?

Many people have pain from time to time in different parts of the body. Physical pain is a universal issue. Some people have severe chronic pain. This can be very frustrating as there is often no way to “objectively measure” pain and thus some doctors will dismiss issues of pain if there is no way to definitively diagnose a cause or if there are no treatments that help.

Once such chronic pain condition is Myofascial Pain Syndrome.

Myofascial Pain Syndrome

Myofascial pain syndrome is a chronic pain disorder that can be very frustrating for patients and physicians alike. In myofascial pain syndrome, pressure on sensitive points in your muscles (trigger points) causes pain in seemingly unrelated parts of your body, which is called referred pain.

Myofascial pain syndrome typically occurs after a muscle has been contracted repetitively. This can be caused by repetitive motions used in jobs or hobbies or by stress-related muscle tension.

While nearly everyone has experienced muscle tension pain, the discomfort associated with myofascial pain syndrome persists or worsens and is usually chronic.

Sometimes myofascial pain syndrome will come and go and cause unusual “other” symptoms, such as periodic dropping of the eyelid, headaches, and migraines.

Treatment options for myofascial pain syndrome include:

1. Massaging: by hand or with electric massager you can buy for cheap on Amazon

2. TENS unit: TENS stands for (Transcutaneous Electrical Nerve Stimulation). which are predominately used for nerve-related pain conditions (acute and chronic conditions). TENS machines works by sending stimulating pulses across the surface of the skin and along the nerve strands. The stimulating pulses help prevent pain signals from reaching the brain.Tens devices also help stimulate your body to produce higher levels of its own natural painkillers, called “Endorphins”.

3. Physical therapy

4. Trigger point injections.

5. Acupuncture

6. Pain medications and relaxation techniques also can help: but avoid pain meds that become addictive.

7. A recent patient told me about a specialist in this area below: Dr. Michael T. Singer

Science behind Acupuncture:
Does Acupuncture and Massaging Work?

The short answer is yes.

But it is very interesting as to why it works.

For years, the science community was skeptical about such treatments: do they really worked with pain or is it a placebo effect.

Now we know they do work with pain and other conditions, and more is understood on why it works.

See below.

First the pizoelectricity of the body is an important part of feeling normal and not having pain. These crytals in the pineal gland of the body show pizoelectricity.

2002 Oct;23(7):488-95.

Calcite microcrystals in the pineal gland of the human brain: first physical and chemical studies.

Baconnier S1, Lang SB, Polomska M, Hilczer B, Berkovic G, Meshulam G.

Author information

Abstract

A new form of biomineralization has been studied in the pineal gland of the human brain. It consists of small crystals that are less than 20 microm in length and that are completely distinct from the often observed mulberry-type hydroxyapatite concretions. A special procedure was developed for isolation of the crystals from the organic matter in the pineal gland. Cubic, hexagonal, and cylindrical morphologies have been identified using scanning electron microscopy. The crystal edges were sharp whereas their surfaces were very rough. Energy dispersive spectroscopy showed that the crystals contained only the elements calcium, carbon, and oxygen. Selected area electron diffraction and near infrared Raman spectroscopy established that the crystals were calcite. With the exception of the otoconia structure of the inner ear, this is the only known nonpathological occurrence of calcite in the human body. The calcite microcrystals are probably responsible for the previously observed second harmonic generation in pineal tissue sections. The complex texture structure of the microcrystals may lead to crystallographic symmetry breaking and possible piezoelectricity, as is the case with otoconia. It is believed that the presence of two different crystalline compounds in the pineal gland is biologically significant, suggesting two entirely different mechanisms of formation and biological functions. Studies directed toward the elucidation of the formation and functions, and possible nonthermal interaction with external electromagnetic fields are currently in progress.

Second, the fascial plane (the tissue wrapping all the muscles of the body show pizoelectricity.
Acupuncture and massaging directly stimulate the fascial plane.

Basic science is trying to find out exactly how acupunture helps pain issues on the molecular issue.

For one, I know that if I massage certain pressure points on my shoulders around the trapezius muscle when I feel I am getting a cold or flu, I can avoid getting sick (if I also take a Cold Eeze zinc lozenge. I have noticed the same for my kids: if I massage the trapezius muscle in certain areas so it hurts (I and they feel abnormal pain in this area when getting sick which usually is not painful), I can help them decrease the days they are sick or avoid the cold. I have also bogged about the pressure points I use on myself and my kids to get rid of a headache: the trapezius muscle area, the neck muscles, and the superior orbital notch (and drinking alot of water): works every time. Is it the extra water I make the kids or myself drink or the massaging, I do not know: likely both. But it works for us and we never use pain meds for headaches.

I hate “non-scientific” 1 person case reports. But since it has been years not that I have been noticing this and now I see it helping my family, I will briefly mention it here. I have become a believer in the pizoelectric properties of the fascial planes around muscles and the ability to stimultate these planes to avoid and remove pain in other parts of the body and even help attack viruses (that is a big jump, scientifically, I know.)

Sandra Lora Cremers, MD, FACS

. 2011; 4(4): 1–6.

Published online 2011 Dec 31.

PMCID: PMC3242643

Fascia Research from a Clinician/Scientist’s Perspective

Thomas W. Findley, MD, PhD

Go to:

INTRODUCTION

Fascia research. What is all the buzz about? Why is there yet another international fascia congress in Vancouver, March 28–30, 2012, and why should we manual therapists attend? (Yes, I mean “we”). I am a physician in physical medicine and researcher who is crazy enough about research to have obtained my PhD during my residency program. As my wife will verify, I live, breathe, and dream research and, according to my mother, at age three I stood still for 45 minutes in the warmth of the winter sunlight streaming in through our dining room window, holding a jar of honey, proclaiming “I doing exerment [experiment]”. The budding scientist in me was studying changes in the viscosity of a fluid with application of heat. I am still doing much the same thing 60 years later. However, I also am a manual therapist with a half-time clinical practice as a Certified Advanced Rolfer™.

I experienced Rolfing® Structural Integration in 1970, before attending medical school, and have carried the perspective on fascia developed by Dr Rolf throughout my career. Thirty years ago, I studied the clinical practice and scientific basis of muscle strengthening, exercise, stretching, heat, and other therapeutic modalities that are still used in my medical specialty today. Then our resident didactic lectures got to connective tissues. From the research standpoint, all we knew was that, if you heated a rat tail, you could stretch it. I eagerly absorbed the clinical experience of my teachers, learning procedures for dealing with connective tissues developed during the polio era; but my body knew there was more.

Fast-forward 20 years. As director of Research at Kessler Institute for Rehabilitation in New Jersey, I earned the trust of the hospital leaders, who were confident that I knew my material thoroughly and well, even though they also recognized that they had no real hope of understanding it. From that vantage point, I convinced them to sponsor a training program in structural integration at the hospital in 1991, for myself and other physical therapists. The therapists began using these techniques with the traditional rehabilitation patients with good results – even publishing them(1). I stayed in my research tower, except to use my bodywork training when faced with the challenge of getting Christopher Reeve off his ventilator (you can see some details in his remake of the Hitchcock thriller Rear Window). Even becoming a professor at UMDNJ School of Osteopathic Medicine did not dislodge me from my research perch. When I had the opportunity in 2000 for a sabbatical from my academic position, however, I did not write a book or do a new research project or visit a research laboratory. I chose to expand my horizons by setting up a clinical practice as a bodywork practitioner, and have maintained a half-time practice as an Advanced Rolfer ever since. In this editorial, I will join the ranks of my fellow manual therapy practitioners and give you my clinical perspective on the upcoming fascia research congress.

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DISCUSSION

The fields of acupuncture, massage, structural integration, chiropractic, and osteopathy all present clinical hypotheses with fascia as a central theme. Yet many practitioners are unaware of the scientific basis for evaluating such hypotheses, and few know of the sophistication of current laboratory research equipment and methods. I will fill in some of these details, to give a flavor of what to expect at the next fascia congress. The hallmark of the fascia congress is interaction between clinicians and scientists, which is reflected in its theme: Fascia Research–What Do we Notice and What Do we Know—continuing the clinician–scientist dialogue. Particular effort is being made to incorporate clinical translation immediately following scientific presentations, and vice versa. We planned for time after each keynote to do this in Amsterdam in 2009, but then we received some incredibly exciting abstracts which were given those time slots instead. That was one reason, among many, to choose the Massage Therapists’ Association of British Columbia to be the host—to make sure the science is translated into relevant concepts for the clinician.

I publicly admit that I was overwhelmed by the first congress, and similarly by the second. Both my clinical side and my research side had difficulty digesting all the material, so I watched the DVD recordings again, and again, and again. To be generous, I now understand perhaps half of what was presented. I went through probably 2000 recent papers on fascia to select a few outstanding ones for the 2012 program book, and it took me two hours to really understand one diagram from one paper selected—and this was after I had already used that diagram in a summary talk I gave on fascia research. The good news for you, my readers, is that I can now explain this material to you in ways that make sense to my clinical half. This editorial comes out of a four-hour workshop I recently gave at the AMTA national convention.

It’s All Connected

We all know the children’s song “the hip bone’s connected to the thigh bone …”. Anatomy texts show these bony connections and two joint muscles such as the gastrocnemius, but they don’t show the whole picture. I have a simple clinical demonstration of fascial continuity extending from the occiput to the calcaneus that I show medical students. It is quite simple. Sit in your chair with your knees bent and dorsiflex your ankle. Now stand up and do the same thing. It does not move as far—and we know why. The gastrocnemius extends across both the ankle and the knee. Now take that leg and with the knee straight, put it on the table in front of you. The foot moves less. Now bend your trunk forward. Even less motion. Next, drop your head. Now you can really feel tightness in your calf. This demonstrates just one simple fascial connection, the back-line, but the fascial connections throughout the body are far, far more intricate.

We find that muscles hardly ever transmit their full force directly via tendons into the skeleton, as is usually suggested by our textbook drawings. Rather, they distribute a large portion of their contractile forces onto fascial sheets. In some muscles (for example the Gluteus maximus), 85% of the fibers go to the distal fascia (in this case the Fascia lata) rather than to the theoretical muscle insertion. Muscles also transmit forces laterally to neighboring muscles; in some cases (measured in the rat leg), almost 50% of the muscle-generated force goes laterally rather than to the muscle tendon(). These forces go to synergistic partners, as well as cross the limb to antagonistic muscles. Thereby they stiffen not only the respective joint, but may even affect regions several joints away. The simple questions from musculoskeletal textbooks regarding “which muscles” are participating in a particular movement cannot be simply answered. Muscles are not separate individual functional units, no matter how much the textbook authors and your anatomy instructors want them to be. Rather, most motions are generated by many individual motor units, which are distributed over some portions of one muscle, plus other portions of other muscles. The tensional forces of these motor units are then transmitted to a complex network that converts them into the final body movement. While these pathways have been studied in the extremities where muscles cross one or two joints, there is little information on whether the same principles apply in the trunk, as well. However, the next fascia congress will show anatomic pictures of minute fascial strands between muscles in the neck which may well be myofascial connections. The program book for the 2009 congress shows tiny fibers extending from the muscle to pull open the nitric oxide receptors on the arterioles and, thus, immediately increase blood flow to that muscle(3).

It rapidly gets very complicated. There are nerves in the motor cortex of the brain which directly communicate with muscles via a single synapse in the spinal cord. Fortunately, we do not have to use these often, or we would spend forever figuring out how to move. We have patterns of movement which we are born with, and others which we learn through repetition, and we generally rely on these automatic patterns to accomplish our daily activities. Remember how many months it took you to learn how to walk the first time? You may not, but your parents do. And we don’t ordinarily forget these patterns, even after many years of disuse. How many of us have forgotten how to ride a bicycle? If you have a stroke which interferes with movement patterns, learning to walk the second time around goes quicker.

Many years of scientific studies have begun to probe the nature of movement, and the last fascia congress was held in a school of movement science. The individual motor units used for a particular movement depends on the force required—if more force is required, motor units with larger numbers of muscle fibers are used. If the motion requires less force, smaller units are used. Furthermore, there is a rotational system so that the motor units you use at any particular moment in time get a brief rest and other ones of similar size take over briefly(). Similarly, if you encounter unexpected resistance part way through performing a motion, more motor units are automatically brought to bear. This “sharing the load” function happens without our conscious awareness.

At the 2007 Fascia Research Congress in Boston, Dr Gracovetsky showed us that in the lumbar spine the load is shared between muscles and fascia(). If the load were always on the muscles, they would fatigue; if it were always on the fascia, they would stretch out. Moving back and forth between the two allows the body to make use of the best characteristics of both. We find that fascial stiffness and elasticity also play a significant role in many ballistic movements of the human body. How far you can throw a stone, how high you can jump, and how long you can run depend not only on the contraction of your muscle fibers, but also to a large degree on how well the elastic recoil properties of your fascial network are supporting these movements. This is graphically illustrated by the double-amputee Oscar Pistorius, whose entrance into the 2008 summer Olympics was blocked because it was thought that his spring-like artificial legs gave him an unfair advantage over able bodied runners. It turns out they didn’t—fascia is even better!

We are not just talking about fascial connections between muscles, bones, ligaments, and other large body structures. These fascial connections reach to the very interior of the cell, all the way to the nucleus. The scientific progress in documenting these connections has been truly amazing. As lead speaker in 2007, Dr Ingber showed us how the slightest touch on a cell surface with a micropipette caused the nucleus to immediately expand and begin DNA transcription(6). The older models of the cell regarded it as a formless water balloon. Dr Ingber showed that, instead, the cell is built more like a tent with poles bearing compression and guy wires under tension, following the principles of tensegrity. He showed us that the microtubules in the cell are the equivalent of the tent poles, and the actomyosin filaments are the guy wires. The living cell is a mechanical structure with a force balance between compression-bearing microtubules and tension-bearing bundles of actomyosin filaments. The tent pegs are the integrin receptors. The cells are anchored to the extracellular matrix by clusters of integrin receptors, which connect extracellular proteins and filaments to intracellular filaments, the actin-associated molecules. These integrin receptors also serve to sense physical forces outside the cell and transmit that information through mechanical connections throughout the cell to the nucleus, as well as to multiple locations in the cell. This cytoskeleton provides both mechanical structure and direction to biochemical reactions within the cell. The cell can thus convert external mechanical signals into internal biochemical reactions(). In a similar fashion, development of the embryo is strongly influenced by the mechanical environment of the cell and is guided by this extra- and intracellular fascial network().

Use of the experimental methods recently developed may allow us to explore the effects of externally applied forces that create repetitive stress disorders or assist in manually applied therapies. Many clinical therapies use externally applied forces based on empirical observations (some ancient), but rarely if ever are these treatments anchored in the biomechanical environment of the cell. Recent developments in medical diagnostic imaging may allow direct observation of this biomechanical context.

Dr Frederick Grinnell is doing some very important work at the cellular level, yet when he was invited to be a keynote speaker at the 2007 fascia congress he did not understand why his work was so important, despite his receiving Rolfing bodywork for many years. I had to explain the potential clinical meaning of his science and then he enthusiastically agreed. If we remain at the cellular level for a moment, we can look at the primary cell in fascia, the fibroblast. We find that fibroblasts synthesize, organize, and remodel collagen, depending on the tension between the cell and the extracellular matrix. In the 2007 Fascia Congress, Dr Grinnell showed so elegantly that at low tension from outside the cell, the fibroblast is in a resting state with low synthesis of collagen matrix(9). When placed in a high tension matrix the fibroblasts increase their collagen synthesis and cell proliferation. The fibroblasts appear quite different in these two states. In low tension, they have a small cell body with dendritic extensions connected to other cells by gap junctions. In high tension matrix, the fibroblasts assume a larger cell body of lamellar shape. An individual fibroblast can change back and forth between these two cell morphologies. By looking in the microscope at the fibroblast, from the size of the cell body one can infer the tension placed on the cell: the higher the tension, the larger the cell body. This change in cell body size affords the opportunity for measuring at the cellular level the effects of therapies designed to change fascial tension.

Each fibroblast can remodel nearby collagen matrix, and this local remodeling can spread throughout the matrix to result in large scale matrix contraction. By exerting traction on the matrix, the fibroblast can either cause motion of the collagen or movement of the fibroblast through the matrix(). Fibroblasts produce and degrade matrix proteins, with an indirect effect on matrix stiffness. They can also differentiate into myofibroblasts, which can contract and increase matrix tension. By changing shape, the fibroblast can affect stiffness and viscosity of connective tissue within minutes, consistent with the mechanotransduction model of microtubule network expansion and actomyosin generated tension proposed by Ingber(). The fibroblast may also remodel cell matrix contacts in the direction of tissue stretch to reduce tension(). Does the fibroblast just respond to the mechanical forces around it, or is it a primary force for directing growth and adaptation? Either way, it is a key player in the fascial orchestra, and perhaps it is the conductor.

And Therapies Actually Do Something

Using these new techniques for imaging the fibroblast, at the first congress in 2007 Drs Standley(12) and Langevin(13) showed the cellular effects of manual therapy, acupuncture, and yoga-like stretching. And they continued with new findings from their research, which they presented at the second Fascia Congress in Amsterdam in 2009(,15). Connective tissue actively regulates matrix tension in response to stretch as a normal, dynamic physiological process. Understanding how cells respond to forces can lead to potential new treatments and refinements on existing ones.

And there’s more . . . several new areas will be presented in the 2012 fascia congress. Some of this research is not new, it is more than ten years old, yet we are just appreciating its application.

The deep fascia is a highly vascular structure with a superficial and a deep layer, each with an independent rich vascular network of capillaries, venules, arterioles, and lymphatic channels. The presence of mast cells in deep fascia suggests a protective role similar to other connective tissues. The deep layer has few elastin fibers but does have myofibroblasts, suggesting contractile ability. Any active contraction would need to be controlled by a nerve supply and, indeed, one finds myelinated and unmyelinated nerve axons and Schwann cells in these deep fascial layers. The deep fascia is not just a tough barrier structure of collagen and elastin, but is a metabolically active vascular layer which provides gliding and protective functions(). Deep fascia has parallel longitudinal collagen bundles and rudimentary elastic laminae, giving it both high tensile strength and elasticity. At the junction between the deep fascia and the muscle, without any special secretory cells, the fascia is able to maintain a lubricating layer of hyaluronic acid (hyaluronan) which, like a hydraulic fluid, allows sliding between the fascia and neighboring muscle. However, when the epimysium is disrupted in surgery, overlying fascia does not remain distinct and does not create a gliding layer over the scar(). More recent findings show that while hyaluronic acid is a lubricant, breakdown products of this large molecule are themselves tissue irritants(), and fragments from collagen, elastin, and laminins in the extracellular matrix also modulate activities of inflammatory cells().

This layer of hyaluronan is 100–200 microns thick. The architecture of the fascia allows continuity of nerves, blood, and lymph vessels between the sliding tissues. With trauma to the muscle, the overlying fascia no longer produces the sliding layer of hyaluronan. Restoring this natural sliding mechanism becomes the next task for the manual therapist.

I was a car mechanic before I went to medical school, and learned that my hands could detect valve clearances with an accuracy of one thousandth of an inch (that equals 25 microns). I would lie on my back, reach up around the engine on the old air-cooled VWs, pop off the valve cover, and wiggle the rocker arm to check the valve clearances. From time to time, I would go through the effort of squeezing in a feeler gauge to check what my fingers were telling me. To put this in perspective, a red blood cell is 8 microns in diameter and a sheet of paper is about 75 microns. Most of us can tell the difference between 75 and 150 microns, for example when we turn the page on a magazine and accidentally get two at a time. I am convinced that feedback from the clinician’s hands can guide manual therapy, although we don’t yet have the bodywork equivalent of the mechanics feeler gauge to check our perceptions. The newer musculoskeletal ultrasound imaging machines are beginning to have sufficient resolution to see a hyaluronic acid layer of 100–200 microns (MRI resolution is about 300 microns). I have tested the ultrasound machine I use in my clinical practice. It can measure thickness with an accuracy of almost 50 microns in my research projects when I insert objects into mozzarella cheese, but I can’t consistently see the hyaluronic acid layer in humans yet. My hands are still better.

References:

1. Dr. Michael T. Singer is a board-certified Diplomate of the American Board of Prosthodontics (1983) and the American Board of Orofacial Pain (1996). Dr. Singer is board certified in the specialties of Prosthetic Dentistry, and Orofacial and Maxillofacial Prosthodontics; his practice specializes in the treatment of the full range of facial and oral pain disorders and in the restoration of facial structures lost to cancer, trauma, and birth defects. He has over 30 years of clinical experience treating patients and consulting in a broad range of interdisciplinary cases.

Dr. Singer graduated from Northwestern University Dental School in 1974 as well as the Walter Reed Army Medical Center Prosthetic program. He is also a graduate of the Bethesda Naval Dental School program in Maxillofacial Prosthodontics and the University of Minnesota Orofacial Pain graduate program. He subsequently served in the Army at Walter Reed Army Medical Center in Washington, D.C. During his career there, he became a highly trained officer in the United States Army Dental Corps, completing 4 residency programs in 6 years of postdoctoral study:

General Dentistry Residency
Prosthodontic Residency
Maxillofacial Prosthodontics Residency
Orofacial Pain Residency

At Walter Reed, Dr. Singer was Chief of the Orofacial Pain and the Maxillofacial Prosthodontics Clinic. He retired from the Army and Walter Reed Army Medical Center in 1997 with the rank of Colonel.

Dr. Singer entered private practice in 1997. He also holds a position as a Clinical Instructor in the Advanced Prosthodontics Program at the University of Maryland Dental School, where he has taught since 1997.

Dr. Singer provides prosthetic restoration to patients with an advanced and/or complex temporomandibular disorder as well as to those with a severely compromised dentition. Clinically, his special interests include prosthodontics, maxillofacial prosthodontics, and orofacial pain.

A member of the faculty of the University of Maryland Dental School graduate department of Prosthodontics, Dr. Singer has lectured to dentists and physicians across the United States. He is a featured speaker for the American Academy of Pain Management.

http://www.michaelsingerdds.com/about_michael_singer.html

2. This is controversial but very interesting. While I do not believe at all that wearing any crystals help with anything: have never seen any worthwhile study to indicate they help, the pineal gland does have very interesting properties that need to be explored more.

https://physics.knoji.com/the-piezoelectric-effect-and-the-pineal-gland-in-the-human-brain/

The Piezoelectric Effect and the Pineal Gland in the Human Brain

Debbie Edwards

Learn how electromagnetic energy affects the Pineal Gland in the human body and how the Calcite Micro-crystals respond and reproduce electromagnetic energy.

As we explored the Piezoelectric effect through my other article pertaining to Quartz Crystal in which we described the Piezoelectric effect as electricity resulting from pressure, which holds an accumulated electric charge as a solid material, in this article we are going to further explore how this effect pertains to the Pineal Gland inside the human brain.
In this article we will be exploring how the Piezoelectric effect relates to the human brain and electromagnetic energies within and outside the human body that pertain to extra sensory perception and energetic sensitivity, especially during exercises that focus on enhancing the electromagnetic response through meditation, dreams and environmental stimulation. In metaphysical literature, the Pineal Gland has been described as the “seat of the soul”, the “third eye”, and “Brow Chakra (Ajna Chakra). The reference to being the “third eye” is quite ironic considering the anatomy of the Pineal Gland has a lens, cornea and retina as does the actual eye.
Physiologically, the Pineal Gland is a pine cone shaped gland of the endocrine system that is approximately the size of a raisin, and is responsible for producing Melatonin which influences sexual development and regulates the sleep cycles in the human brain and body. More specifically, the Pineal gland is responsible for converting Serotonin into Melatonin and is the only gland in the body that does so. It is the first distinguishable gland present in the brain and is recognizable within three weeks gestation of fetal development.

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Inside the Pineal Gland are Calcite Micro Crystals consisting of Calcium, Carbon and Oxygen that produce bioluminescense; a “cold” light that produces light without heat, ranging in the blue-green light spectrum. In deep sea marine life that uses bioluminescense in the same way, we can look forward to more emphasis on developing the Pineal Gland for transparency within the cellular tissue of the human body. For example, there have been ongoing studies in labs with animals such as rats in which bioluminescent imaging is able to detect cancer or abnormal cell growth in comparison with thermal imaging that makes the study and conclusions more efficient and precise.

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The Calcite Micro-crystals are said to have their own Piezoelectric effect that is responsive to electromagnetic energies outside the physical body, and can also produce it’s own electromagnetic energy. A new form of bio-mineralization has been studied in the human Pineal Gland using scanning electron microscopy and energy dispersive spectroscopy.
A study conducted in Israel by the Department of Chemical Engineering through the Ben-Gurion University of the Negev in Sheva, these tiny micro-crystals were noted to have a texture that may be noncentrosymmetric because of the structural organization of the sub-unit, even though the single crystals do have a center of symmetry which gives one reason in which the crystals are considered Piezoelectric, similar to the calcite crystals inside the inner ear. Among many results, it is discovered that the calcite micro-crystals would have piezoelectric properties with excitability in the frequency range of mobile communications which brings into question the entire spectrum of energy waves we encounter every day that could, in the long term, create morphological change on cellular membranes of related cells.
What this means is that any energies that produce an electromagnetic response in relation to the Pineal gland could alter energy patterns within the body and brain from the central nervous system to sexual function, sleep cycles or sleep deprivation and hypersensitivity to electromagnetic stimulation through one’s environment.

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Discovering the alteration that electromagnetic frequency waves of energy has on the Pineal Gland is not new to science, Metaphysicians or spiritualists.
According to author Preston B. Nichols who wrote The Montauk Project copyright © 1992, states that in the 1960’s, military personnel of the Air Force were working on the Sage Radar project on a decommissioned base, Montauk. It was reported that by changing the pulse duration and frequency of the radar that used a middle infrared band of energy waves, they could change the general mood of the people on the base.
Results of stronger pulses of infrared energy waves on the brain, and especially the Calcite Micro-crystals in the Pineal Gland are:

Sleepiness
Crying
Agitation
Depression
Anxiety
Aggression
Fear
Terror
Hopelessness
Grief
Apathy
And even Death

Infrared energy waves are the lower frequency waves on the light spectrum. Low frequency waves have a longer wave length which correspond with lower emotional energies and moods. While higher frequency waves such as those in the green, blue and violet range produce higher emotional energies and moods.

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The same results can be seen in sound waves as well. A great study for comparison is Dr. Masaru Emoto in his groundbreaking research of how human consciousness can intentionally and unintentionally effect the molecular structure of water, as well as studying the result of sound wave vibrations. For example, research has been done in which large metal plates are subjected to a range of different sound waves that affect grains of sand sitting on top of the metal plate. The conclusion is that the grains of sand develop and shift into geometric patterns and shapes depending on the sound waves that are applied.

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Metaphysically, quartz crystals resonate very closely with the Piezoelectric effect that the Calcite Micro-crystals produce within the Pineal Gland as well as inner ear, which makes them highly effective for the usage of spiritual endeavors, meditation, altering one’s mood or altering one’s state of well being that range in subtlety or intensity for the individual using crystals as a form of energetic therapy.
Similar to how the lower infrared band of frequency waves can adversely affect the mood and health of the human body, so can the higher frequency waves that can positively affect the mood and health of the human body.
Avoiding geographical areas or electronic equipment that emit large quantities of infrared energy waves supports a more positive experience in relation to the Pineal Gland and assists in keeping in balance the moods, sleep cycles and sexual health of the person.

**From 2014: https://www.scientificamerican.com/article/5-scientists-weigh-in-on-acupuncture/

HEALTH

5 Scientists Weigh in on Acupuncture

Despite its popularity, opinions on acupuncture are divided

By Victoria Stern on July 1, 2014

Millions of Americans turn to acupuncture each year to treat chronic pains and even depression. Recently, researchers at Rutgers University reported that combining the acupuncturist’s needle with an electric current could yield a new treatment for severe inflammation. Yet many scientists look skeptically at the practice.

There may not be a clear verdict yet but Scientific American MIND has brought together several experts to share their views. These include acupuncturist Hugh MacPherson, senior research fellow at the University of York in England; Edzard Ernst, emeritus professor of complementary medicineat the University of Exeter; Shu-Ming Wang of the Department of Anesthesiology and Perioperative Care at the University of California, Irvine, School of Medicine; pharmacologist David Colquhoun at University College London, also author of the blog DC’s Improbable Science; and Harriet Hall, a retired family physician and U.S. Air Force flight surgeon who writes the SkepDoc column in Skeptic magazine.

What’s your opinion on the evidence for acupuncture’s effectiveness in medicine and specifically depression?
MacPherson: Strong evidence exists that acupuncture is effective for chronic pain conditions. For depression, we have evidence that acupuncture is a useful adjunct to conventional care. In one recent trial patients on antidepressants who received acupuncture did significantly better than those who just took medication. Patients who received counseling in addition to their medication received a similar benefit to the acupuncture group.

Ernst: Most studies examining the effectiveness of acupuncture are not rigorous. Those that are more rigorous fail to show that acupuncture is more than a placebo in managing depression.

Wang: My opinion is that acupuncture stimulations trigger the release of beneficial hormones and, theoretically, can serve as a mood stabilizer.

Colquhoun: Acupuncture does not work, which means all discussions of how it does work are irrelevant. I’m not aware of any evidence that acupuncture works for depression.

Hall: The published evidence on acupuncture indicates that it might be helpful for pain and possibly for postoperative nausea and vomiting, but not for any other indications. All the evidence is compatible with the hypothesis that acupuncture is no more than a placebo.

Why is it so hard to figure out whether acupuncture works or not?
MacPherson: Trials on acupuncture involve a lot of variability, especially in relation to depression, which is unlikely to be a single disease entity. Depression is commonly experienced with other symptoms. For example, the population of patients with depression we recruited in one study included around 50 percent in chronic pain. This variability creates what we could call “noise,” making it more difficult to see whether an intervention works. The benefit one can ascribe to the placebo effect is not an important clinical question because in the real world patients benefit from simply consulting an acupuncturist.

Ernst: Studies are fraught with methodological problems such as finding a good placebo as well as logistical obstacles such as finding funding to conduct high-quality trials.

Wang: There are various stimulating techniques, follow-up period and study designs used by the researchers in clinical trials; thus, when we lump all the data from one illness, the significance may not be there. Furthermore, the belief of the participants significantly affects the results of the intervention.

Colquhoun: There is a lot of money at stake for those who sell acupuncture—and a certain amount of fascination with New Age thinking. There are excellent controls such as retractable needles. Almost all experiments show no difference between real and sham acupuncture.

Hall: Researcher bias tends to intrude because acupuncturists are the ones providing the therapy. Patients who don’t believe in acupuncture are not likely to volunteer for an acupuncture study; those who accept the possibility that acupuncture will work may be biased. Also, the very nature of acupuncture insures that there will be a strong placebo component and it is impossible to do double-blind studies. For instance, patients will notice if you stick needles in them and acupuncturists know whether they are doing sham or real acupuncture.

Why would targeting the body with a physical intervention help depression?
MacPherson: Acupuncture is a mind–body intervention. It does not just target physical symptoms. One of the reasons acupuncture may have a useful role for depression is that depression is experienced physically and emotionally. An intervention that incorporates an integrated approach to mental and physical symptoms would appear appropriate and, according to our depression trial, also evidenced-based.

Ernst: One theory holds that acupuncture increases endorphin levels in the brain. If this were true, it might help explain how acupuncture reduces depression.

Wang: Similar to physical activities, acupuncture can improve depression. It also has hormonal effects.

Colquhoun: Nobody has the slightest idea what causes depression. Experiments find acupuncture doesn’t work any better than a control situation, at least not to any extent that a patient would notice.

Hall: In studies of depression any intervention may be helpful, even talking with a friend, so it is difficult to tease out the specific contribution of acupuncture. There appears to be no specific effect of the needles, only nonspecific treatment effects. For instance, patients get to relax for half an hour or so with personal, hands-on attention by someone who is convinced he or she is helping.

This article was originally published with the title “Acupuncture for Depression” in SA Mind 25, 4, (July 2014)

References:

How much do we know about acupuncture?

There have been extensive studies conducted on acupuncture, especially for back and neck pain, osteoarthritis/knee pain, and headache. However, researchers are only beginning to understand whether acupuncture can be helpful for various health conditions.

What do we know about the effectiveness of acupuncture?

Research suggests that acupuncture can help manage certain pain conditions, but evidence about its value for other health issues is uncertain.

What do we know about the safety of acupuncture?

Acupuncture is generally considered safe when performed by an experienced, well-trained practitioner using sterile needles. Improperly performed acupuncture can cause serious side effects.

What Is Acupuncture?

Acupuncture is a technique in which practitioners stimulate specific points on the body—most often by inserting thin needles through the skin. It is one of the practices used in traditional Chinese medicine.

See the NCCIH Web site for more information on traditional Chinese medicine.

What the Science Says About the Effectiveness of Acupuncture

Results from a number of studies suggest that acupuncture may help ease types of pain that are often chronic such as low-back pain, neck pain, and osteoarthritis/knee pain. It also may help reduce the frequency of tension headaches and prevent migraine headaches. Therefore, acupuncture appears to be a reasonable option for people with chronic pain to consider. However, clinical practice guidelines are inconsistent in recommendations about acupuncture.

The effects of acupuncture on the brain and body and how best to measure them are only beginning to be understood. Current evidence suggests that many factors—like expectation and belief—that are unrelated to acupuncture needling may play important roles in the beneficial effects of acupuncture on pain.

What the Science Says About Safety and Side Effects of Acupuncture

Relatively few complications from using acupuncture have been reported. Still, complications have resulted from use of nonsterile needles and improper delivery of treatments.
When not delivered properly, acupuncture can cause serious adverse effects, including infections, punctured organs, collapsed lungs, and injury to the central nervous system.

Read more about what the science says about safety and side effects of acupuncture:

NCCIH-Funded Research

NCCIH funds research to evaluate acupuncture’s effectiveness for various kinds of pain and other conditions, and to further understand how the body responds to acupuncture and how acupuncture might work. Some recent NCCIH-supported studies are looking at:

If acupuncture can reduce the frequency of hot flashes associated with menopause
Whether acupuncture can reduce pain and discomfort that may accompany chemotherapy
Objectively determining if actual acupuncture is more effective than simulated acupuncture or usual care for pain relief, and (if so) by how much.

More to Consider

Don’t use acupuncture to postpone seeing a health care provider about a health problem.

If you decide to visit an acupuncturist, check his or her credentials. Most states require a license, certification, or registration to practice acupuncture; however, education and training standards and requirements for obtaining these vary from state to state. Although a license does not ensure quality of care, it does indicate that the practitioner meets certain standards regarding the knowledge and use of acupuncture. Most states require a diploma from the National Certification Commission for Acupuncture and Oriental Medicine for licensing.

Some conventional medical practitioners—including physicians and dentists—practice acupuncture. In addition, national acupuncture organizations (which can be found through libraries or by searching the Internet) may provide referrals to acupuncturists. When considering practitioners, ask about their training and experience.

Ask the practitioner about the estimated number of treatments needed and how much each treatment will cost. Some insurance companies may cover the costs of acupuncture, while others may not. For more information, see NCCIH’s fact sheet Paying for Complementary Health Approaches.
Help your health care providers give you better coordinated and safe care by telling them about all the health approaches you use. Give them a full picture of what you do to manage your health.