Neurogenic pruritus: an unrecognised problem? A retrospective case series of treatment by acupuncture

Intractable localised segmental pruritus without a rash has been reported over the years under various titles depending on the area of the body affected. Notalgia paresthetica and brachioradial pruritus are the two terms used for what is believed to be a form of neuropathy. The clinical observations reported here suggest that other localised cases of pruritus exist that share common clinical features, and the term neurogenic pruritus is suggested to encompass these under one clinical condition. Acupuncture has been used to treat skin conditions, of which pruritus is one symptom. This retrospective study looked at the symptomatic relief of neurogenic pruritus in 16 patients using acupuncture. In 12 cases the affected dermatomes of the body were innervated by cervical spinal nerves, seven innervated by dorsal spinal nerves and four innervated by the lumbar spinal nerves. Seven patients had areas affected by two different regions of the spine. Restricted neck or back movements were noted in patients as were areas of paravertebral spasm or tenderness of the muscles. Total resolution of symptoms as judged by VAS occurred in 75% of patients. Relapse occurred in 37% of patients within 1-12 months following treatment. Acupuncture appeared to be effective in alleviating the distressing symptom of itching in patients presenting with neurogenic pruritus.     

Acupuncture for low back pain in pregnancy

Medical doctors are particularly cautious about using acupuncture in pregnancy. This derives from the mostly historical and anecdotal claims that acupuncture can promote abortion, coupled with the fact that spontaneous early pregnancy loss is common, and litigation is increasing. This case report describes the circumstances that lead to the author using deep paraspinal and periosteal acupuncture throughout a patient's pregnancy to help control her low back pain.     

Laser safety aspects for refractive eye surgery with femtosecond laser pulses

We report on laser safety aspects for near infrared femtosecond laser refractive surgery. In particular, the transmittance of microjoule laser pulses at 1040 nm through the cornea during flap procedures based on femtosecond laser induced multiphoton ionization and photodisruption has been determined. When using focusing optics with a numerical aperture of 0.3, more than 20% of the incident NIR photons are propagating towards the retina. In addition, self-focusing, white light and second harmonic generation, and destructive photodisruptive side effects have to be considered when using such high energy laser pulses of amplified laser systems. Microjoule femtosecond laser pulses in combination with low NA objectives have the potential to induce destructive intraocular side effects. Further studies are required to evaluate the damage potential of the transmitted photons absorbed by the retinal pigment epithelium and other intraocular compartments. Because of the fact that flaps can be also generated with low nanojoule energy femtosecond laser pulses of non-amplified MHz lasers in combination with high NA objectives, a compromise between procedure time, pulse energy and numerical apertures has to be found for safe ocular femtosecond laser surgery.     

Acupuncture for Uremic Pruritus: A Systematic Review and Meta-Analysis

Uremic pruritus (UP) is a chronic disease that can seriously affect the quality of life of dialysis patients. Acupuncture is a non-medication therapy that has been used to treat pruritus disorders. This systematic review aimed to evaluate the efficacy and safety of acupuncture for the treatment of UP. A total of nine Chinese and English databases were searched from their inception to December 31, 2021, and 214 studies were retrieved. Finally, seven randomized controlled trials (n=504) were included in the meta-analysis performed using RevMan V.5.3. Results included effective rate, recurrence rates, and adverse events. Compared with conventional treatment, acupuncture was more effective in treating UP (risk ratio [RR]=1.28, 95% confidence interval [CI]=1.09 to 1.50, P=0.003). The results were consistent after sensitivity analysis (RR=1.38, 95% CI=1.21 to 1.57, P<0.00001). In subgroup analysis, the efficacy rates of acupuncture and medications (oral and topical) were comparable (RR=1.20, 95% CI=0.98 to 1.47, P=0.07). Acupuncture combined with hemodialysis was more effective than hemodialysis alone in relieving pruritus (RR=1.42, 95% CI=1.18 to 1.72, P=0.0002). Adverse events were reported in only three studies, including one case of hyperphosphatemia in the medications group (RR=0.29, 95% CI=0.01 to 7.06, P=0.45). None of the studies reported recurrence rates. In conclusion, acupuncture is a safe treatment modality for patients with UP receiving hemodialysis that can effectively improve UP symptoms, and acupuncture in combination with hemodialysis has more efficacy than hemodialysis alone in improving the UP symptoms.     

Laser acupuncture treatment of neuropathic pain in a boy with brain tumour

Neuropathic pain occurrence is associated with some cytostatic and antibiotics use. Pharmacological therapy for the treatment of neuropathic pain is sometimes unsuccessful, and complementary methods like acupuncture are included. In this case report, a 14-year-old boy with cerebral tumour and neuropathic pain in his feet after chemotherapy and linezolid use is presented. A complete cessation of neuropathic pain symptoms like hyperalgesia and allodynia was accomplished after laser acupuncture application.     

中频脉冲电刺激联合针灸治疗脑卒中后神经源性膀胱尿潴留的效果

目的探讨中频脉冲电刺激联合针灸治疗脑卒中后神经源性膀胱尿潴留的临床效果。方法选取2017年6月至2018年6月我科收治的脑卒中后神经源性膀胱尿潴留患者84例,按照随机数字表法分为试验组(n=42)和对照组(n=42)。对照组给予常规导尿及膀胱功能训练,试验组在对照组基础上应用中频脉冲电刺激配合针灸治疗。比较两组患者的治疗效果。结果治疗后,两组患者的膀胱最大容量及残余尿量均优于治疗前,且试验组优于对照组(P<0.05);试验组的临床治疗总有效率高于对照组(P<0.05)。结论中频脉冲电刺激联合针灸治疗脑卒中后神经源性膀胱尿潴留能够明显改患者的膀胱功能,提高治疗效果,具有重要的临床意义。     

Laser acupuncture in children with headache: a double-blind, randomized, bicenter, placebo-controlled trial

To investigate whether laser acupuncture is efficacious in children with headache and if active laser treatment is superior to placebo laser treatment in a prospective, randomized, double-blind, placebo-controlled trial of low level laser acupuncture in 43 children (mean age (SD) 12.3 (+/-2.6) years) with headache (either migraine (22 patients) or tension type headache (21 patients)). Patients were randomized to receive a course of 4 treatments over 4 weeks with either active or placebo laser. The treatment was highly individualised based on criteria of Traditional Chinese medicine (TCM). The primary outcome measure was a difference in numbers of headache days between baseline and the 4 months after randomization. Secondary outcome measures included a change in headache severity using a 10 cm Visual Analogue Scale (VAS) for pain and a change in monthly hours with headache. Measurements were taken during 4 weeks before randomization (baseline), at weeks 1-4, 5-8, 9-12 and 13-16 from baseline. The mean number of headaches per month decreased significantly by 6.4 days in the treated group (p<0.001) and by 1.0 days in the placebo group (p=0.22). Secondary outcome measures headache severity and monthly hours with headache decreased as well significantly at all time points compared to baseline (p<0.001) and were as well significantly lower than those of the placebo group at all time points (p<0.001). We conclude that laser acupuncture can provide a significant benefit for children with headache with active laser treatment being clearly more effective than placebo laser treatment.     

近20年激光针灸脑效应研究进展

激光针灸作为社会科技进步的时代产物，是一种将低水平激光应用于经络系统的治疗方法，拓宽了传统针灸技术的应用及发展，其脑效应研究于近20年兴起，本文从当前应用较多的功能磁共振成像、脑电图和经颅多普勒超声3种技术层面对激光针灸脑效应的研究进展及未来展望加以论述。研究表明激光针灸在刺激不同穴位时产生的脑效应能够体现穴位的特异性且与其主治存在关联，同时有相似作用的穴位产生的脑效应存在一定的相关性。目前激光针灸作用机制仍未探查清楚，脑效应研究为探索其治疗以疼痛为代表的某些疾病的疗效机制提供了新的视角，虽然仍面临着许多挑战，但未来有着广阔的发展前景。      

Acupuncture for treating uremic pruritus in patients with end-stage renal disease: a systematic review

Uremic pruritus (UP) is a common and bothersome symptom in end-stage renal disease (ESRD) that does not always respond to conventional care. Acupuncture is frequently used for the treatment of a wide range of conditions, but its effects on UP in ESRD patients are unclear. The objective of this review was to evaluate the effectiveness of acupuncture for UP in patients with ESRD. We searched 16 electronic databases from their inception to November 2009. All prospective clinical studies of needle acupuncture for UP in hemodialysis patients with ESRD were included regardless of their design. Risk of bias of the included studies was assessed using the Cochrane criteria. Three randomized controlled trials and three uncontrolled observational studies were included. All of the included trials reported beneficial effects of acupuncture. However, most of the studies showed high risk of bias, which leaves their reports unconvincing. The current evidence is insufficient to show that acupuncture is an effective treatment for UP inpatients with ESRD because of suboptimal quality and lack of methodological rigor of included studies. Future trials should overcome the limitations of the currently available evidence. J Pain Symptom Manage 2010;40:117e125. 2010 U.S. Cancer Pain Relief Committee.     

激光照射足三里穴对慢性萎缩性胃炎大鼠胃酸分泌及NO含量的影响

目的探讨氦氖激光照射足三里穴对慢性萎缩性胃炎（CAG）大鼠胃液pH值、胃黏膜壁细胞超微结构及血清中一氧化氮（NO）含量的影响。 方法采用随机数字表法将60只健康雄性Wistar大鼠分成正常对照组、模型组、药物组、针刺组及激光穴位组。通过给予水杨酸钠、酒精灌胃并结合禁食禁水、跑步劳累等干预将模型组、药物组、针刺组及激光穴位组大鼠制成CAG动物模型。确认造模成功后,药物组、针刺组及激光穴位组大鼠分别给予药物（如延参健胃胶囊、康复新液灌注）、针刺、激光穴位照射干预。于治疗14d后断头取血,采集稀释胃液及部分胃组织;利用硝酸还原酶法检测血清中NO含量,采用酸度计测定胃液pH值,通过透射电镜观察胃黏膜超微结构变化。 结果模型组大鼠胃液pH值、血清中NO含量均较正常对照组明显升高（P<0.05）,其壁细胞胞膜结构缺失、部分溶解,线粒体肿胀。药物、针刺足三里穴及激光照射足三里穴均能降低胃液pH值及血清中NO含量,并且以激光穴位组胃液pH值及血清中NO含量的改善情况尤为显著,与模型组间差异具有统计学意义（P<0.05）,其壁细胞胞膜结构完整,胞浆细胞器基本恢复正常。 结论激光照射足三里穴能促进CAG大鼠壁细胞结构及功能恢复,提高胃酸分泌并降低血清NO水平,对缓解CAG病情具有较好疗效,该疗法值得临床进一步研究、推广。     

Low back pain in pregnancy

The aim of this case report is to discuss the subject of acupuncture in pregnancy and which acupuncture points, or areas, are safe to needle. Low back pain in a 21-year-old Caucasian primigravida at 24 weeks gestation was incapacitating and acupuncture was offered. Prior to pregnancy investigations had excluded a serious organic cause and acupuncture was employed successfully to control pain and improve function. Acupuncture can be offered to sufferers of low back pain in pregnancy after risk / benefit analysis is undertaken and informed patient consent is obtained.     

Acupuncture for schizophrenia: a systematic review and meta‐analysis

Background: Acupuncture is one of the most popular types of complementary/alternative medicine. It is sometimes used as a treatment for schizophrenia. Aims: The objective of this review is to assess systematically the clinical evidence for or against acupuncture as a treatment for schizophrenia. Methods: We searched 20 databases from their inception to May 2009 without language restrictions. All randomised clinical trials (RCTs) of acupuncture, with or without electrical stimulation or moxibustion for patients with schizophrenia were considered for inclusion. Results: Thirteen RCTs, all originating from China, met the inclusion criteria. One RCT reported significant effects of electroacupuncture (EA) plus drug therapy for improving auditory hallucunations and positive symptom compared with sham EA plus drug therapy. Four RCTs showed significant effects of acupuncture for response rate compared with antipsychotic drugs [n = 360, relative risk (RR): 1.18, 95% confidence interval (CI): 1.03–1.34, p = 0.01; heterogeneity: τ² = 0.00, χ² = 2.98, p = 0.39, I² = 0%]. Seven RCTs showed significant effects of acupuncture plus antipsychotic drug therapy for response rate compared with antipsychotic drug therapy (n = 457, RR: 1.15, 95% CI: 1.04–1.28, p = 0.008, heterogeneity: τ² = 0.00, χ² = 6.56, p = 0.36, I² = 9%). Two RCTs tested laser acupuncture against sham laser acupuncture. One RCT found beneficial effects of laser acupuncture on hallucination and the other RCT showed significant effects of laser acupuncture on response rate, Brief Psychiatric Rating Scale and clinical global index compared with sham laser. The methodological quality was generally poor and there was not a single high quality trial. Conclusion: These results provide limited evidence for the effectiveness of acupuncture in treating the symptoms of schizophrenia. However, the total number of RCTs, the total sample size and the methodological quality were too low to draw firm conclusions. As all studies originated from China, international studies are needed to test whether there is any effect.     

Bilateral hand oedema related to acupuncture

We report the case of bilateral hand swelling following acupuncture therapy for chronic low back pain. Despite thorough history, examination and laboratory testing no systemic cause for the swelling could be elicited. This case highlights the incomplete knowledge of acupuncture mechanisms and that limited acupuncture therapy can have significant adverse effects.     

针灸治疗脊髓损伤后神经源性肠道功能障碍的研究进展

神经源性肠道功能障碍是脊髓损伤后常见的并发症之一。本文从治疗处方、穴位选择、疗效评价和可能治疗机制四个方面,总结针灸治疗脊髓损伤后神经源性肠道功能障碍临床进展和存在的问题,并对今后研究提出建议。     

Acupuncture modulation of capsaicin-induced inflammation: effect of intraperitoneal and local administration of naloxone in rats. A blinded controlled study

OBJECTIVE: It is believed that acupunctural stimulation induces an analgesic response mainly through a central mechanism: that is, through an increase in the production of opioid peptides and their release at different levels in the nervous system. We sought to establish whether the modulating effect of acupuncture on experimental neurogenic edema can be attributed to a central mechanism only or whether a peripheral mechanism could also exist. Intraperitoneal administration was compared to local administration in the same paw in rats that were injected with capsaicin and in the same dermatome of the acupunctural stimulation. MATERIALS AND METHODS: Experimentation was conducted on 105 male Sprague-Dawley rats weighing 180-220 g, divided into 7 groups as follows: group 1, control; groups 2-4 (15 animals), stimulated with manual acupuncture; group 3 also treated with intraperitoneal naloxone 1 mg/kg; group 4 also treated locally with naloxone (20 microg); groups 5-7 (15 animals), stimulated with 5 Hz and 5 mA electroacupuncture (EAP); group 6 also treated with intraperitoneal naloxone, 1 mg/kg, group 7 also treated locally with naloxone (20 microg). RESULTS: The results indicate that the administration of 1 mg/kg of naloxone intraperitoneally can inhibit the modulating effect of acupunctural stimulation. Equally effective in inhibiting the modulating effect of acupunctural stimulation, although not having a systemic effect, is a 20-microg dose of naloxone administered peripherally on the site of edema induction. CONCLUSION: It is possible to conclude that both systemic and peripheral mechanisms seem to be implicated in the modulating effect of acupuncture on the neurogenic inflammation mechanism.     

激光穴位照射与针刺对血管性痴呆症状的疗效对照研究

目的探讨激光穴位照射与针刺法对血管性痴呆(VD)智力及症状的疗效。方法以波长为808nm的半导体激光器及单纯针刺法分别对31例VD患者进行穴位照射和针刺治疗,检测治疗前后长谷川痴呆修改量表(HDS-R)、日常生活能力(ADL)、神经功能缺损评分及主要症状的变化情况。结果激光穴位照射组与针刺组智力改善有统计学意义(P＜0.05,P＜0.01),两组临床症状改善明显(P＜0.005),但在改善ADL、神经功能缺损及自觉症状方面针刺组疗效较好(P＜0.05)。结论激光穴位照射可缓解VD患者的临床症状,促进智能及日常生活自理能力的康复,近期疗效明显,但仍不能完全取代传统针刺法。     

A conceptual framework of the effectiveness of acupuncture

The term, "Acupuncture," is used in its broadest senses to refer to needling, moxibustion, acupressure, laser acupuncture, electric acupuncture, and microsystem acupuncture, such as ear, face, hand and scalp acupuncture. Numerous surveys show that, of all the complementary medical systems, acupuncture enjoys the most credibility in the medical community. This article introduces a conceptual framework of the effectiveness of acupuncture from the perspective of responses to acupuncture shown in extensive, basic scientific evidence. The researchers hope, through this review of literature, to enable medical personnel to gain something of an understanding of acupuncture.     

Adjuvant laser acupuncture in the treatment of whiplash injuries: a prospective, randomized placebo-controlled trial

Following introduction of the compulsory use of seat belts in cars, whiplash injuries of the cervical spine have become common in everyday practice. Current treatment approaches lead to resolution of the symptoms within a short time in most cases but cannot prevent a small proportion of patients developing persistent health problems. The effects of adjuvant treatment with laser acupuncture on the acute symptoms and the results one year after the injury were studied in this prospective, randomized, placebo-controlled single-blind study. One group of patients (n = 23) were treated with laser acupuncture (5 mW HeNe laser on 22 acupuncture points for 15 s each) plus cervical collar and a combination of paracetamol and chlormezanone; a second group (n = 22) received the same treatments but with the use of a placebo laser. The treatment was given three times per week until the patient was asymptomatic. No statistically significant advantage of the laser acupuncture treatment was found in the acute phase (mobility in all three planes, duration of pain and duration of use of a cervical collar) or the chronic phase (drug use and the incidences of chronic recurrent problems such as myofascial pain, headaches, vertigo and tinnitus). CONCLUSION: Adjuvant laser acupuncture with a 5 mW HeNe laser and an irradiation time of 15 s appears to be ineffective in the management of whiplash injuries.     

Evidenz zur Laserakupunktur bei orthopädischen Erkrankungen

BACKGROUND AND OBJECTIVES: The aim of this review is to evaluate the evidence for laser acupuncture in selected orthopaedic diseases. MATERIAL AND METHODS: Randomized controlled studies, meta-analyses and systematic reviews were identified by a systematic search strategy in Medline and the Cochrane library. The studies were evaluated using the quality criteria of the Oxford Centre of Evidence Based Medicine. RESULTS: For the selected orthopedic diseases (medial and lateral epicondylitis, myofascial pain syndrome of the neck, back and shoulder and osteoarthritis), meta-analyses, systematic reviews and eight randomized controlled studies were found. All other published studies used laser therapy without consideration of classical acupuncture points. All studies had significant drawbacks in methodological quality and the number of patients included. In more recent trials, improvement towards higher methodological quality was obvious. Although current evidence is equivocal, positive effects can be assumed in myofascial pain syndromes of the neck, back and shoulder. Laser acupuncture is advantageous in terms of side effects compared to classical acupuncture techniques. CONCLUSION: Better, well designed randomized studies with higher power are mandatory in orthopedic diseases.     

The biological effects of low power laser irradiation on cultivated rat glial and glioma cells

Two cell lines were used as models to investigate the biological effects resulting from irradiation by low power lasers. One was a well-established rat glial cell line (RBA-1) obtained from the dissociated culture of normal neonatal rat (JAR-2, F-51) brain tissue. The other was a rat C6 glioma cell line obtained from a propagated culture of rat glial tumor induced by N-nitrosomethylurea. Both of them showed relatively constant cellular morphological characteristics and had steady growth and proliferation in the monolayer system. In this study, the monolayer cell culture was exposed to irradiation by various lasers at low power density in various situations. These lasers with their low energy range are used conventionally in bioregulation and acupuncture, so that their output power primarily will not cause a significant elevation of temperature of the irradiated tissue. The effects on cellular morphology, proliferation, and other functional activities after various conditions of irradiation were studied. A biostimulatory effect was noted after He-Ne laser irradiation on C6 glioma cells and was dose related. A biostimulatory effect was noted also after IR (gallium-arsenide infrared) laser irradiation but was not dose related. No significant biostimulatory effects on RBA-1 cells were noted after exposure to the four types of lasers used in this study.