急性疼痛及电针镇痛评估系统的临床研究

目的研究急性疼痛和电针镇痛时各项生理指标和血清生化指标之间的关系,从而探讨采用生理指标代替生化指标实现即时监测疼痛,调整针刺强度达到最佳针刺镇痛效果的可行性。方法100例患者随机分为疼痛刺激组和针刺镇痛组,疼痛刺激组和针刺镇痛组均分别以10Hz、20Hz、30Hz电刺激模拟不同强度的疼痛,刺激前及每次刺激后即刻记录生理指标并采集外周血检测血清生化指标,针刺镇痛组在模拟疼痛刺激前先采用电针刺足三里穴15min。结果两组在电疼痛刺激前后生理和生化指标都有显著差异,生理指标的变化和生化指标的变化之间存在显著的相关性,并且针刺镇痛组模拟疼痛刺激后的生理和生化指标变化幅度均小于疼痛刺激组。结论生理指标可以代替生化指标即时监测疼痛的程度,据此调节针刺强度,以优化针刺镇痛的效果。     

The soreness and numbness effect of acupuncture on skin blood flow

The purpose of this study was to investigate the effect of the De-Qi sensations of acupuncture (sourness-distension and distension-numbness) stimulation. Fifty-two healthy medical student volunteers were given acupuncture at the Hoku (LI-4) acupoint as they were resting. During a test that lasted 30 minutes, their skin blood flow was measured at the Quchi (LI-11) acupoint and their palm temperature was measured. Our results indicated that acupuncture increased blood flow when the De-Qi sensation occurred. If the needle was twirled a few minutes thereafter and the De-Qi feeling again occurred, the same blood flow increase was seen again. If the needle was not twirled, but the test person felt soreness, numbness and heat sensation within a few minutes after needle insertion, the same blood flow increase was also seen. After acupuncture, Quchi did not show continuous increase of blood flow as did Hoku. Hoku acupuncture also increased palm temperature suggesting that the blood flow increased from cutaneous vessel vasodilation. In conclusion, when the test person felt the sore and numb De-Qi sensation, there was an increase of blood flow at the acupuncture points. Thus, our results suggest that increased flow may be one of the mechanisms accounting for meridian system responses during acupuncture.     

Influence of naloxone on electro-acupuncture analgesia using an experimental dental pain test. Review of possible mechanisms of action

The purpose of this study was to examine in man the analgesic effect of non-segmental electroacupuncture (EA) limited to a single point (Hoku hand point) and the influence of naloxone using an original modified electrical dental pain test. Results in the literature are still contradictory as to the degree and specificity of acupuncture analgesia and its opioid nature. Acupuncture techniques as well as experimental pain models are factors accounting for the discrepancies in the results. For this reason, we designed an experimental pain test characterized by a high degree of specificity, validity and reliability. We chose optimal conditions for eliciting specific acupuncture effect, i.e. non-segmental, low frequency and painful intensity range. A cross-over repeated measure experimental design was used. Five normal trained subjects participated in 65 sessions under four conditions (control, EA, EA+naloxone, EA+placebo). Changes in experimental dental pain thresholds served as indices of analgesia. The results indicated a 27% pain threshold increase after 30 minutes of EA stimulation (p less than .0001), with no differential effect between pain detection (mild pain sensation) and pain discomfort (strong pain sensation). This increase was partially blocked by the double blind injection of 0.8 mg naloxone IM (p less than .005). The experiment was designed in such a way as to prevent the occurrence of a stress analgesic effect. The endogenous opioid system was shown to be partially involved in acupuncture analgesia. Other mechanisms of action are discussed in view of the literature findings.     

腕部运动对痛主诉及相关电位的影响

<正> 针刺治疗癌症过程中,运动患部或作广泛的伸展运动可提高镇痛疗效;针刺镇痛使用电针时可见明显的肢体抽动或局部肌颤,这些临床资料都表明针刺镇痛与运动系统有关。一些实验资料表明:针感来自深部组织,主要为肌肉;针感感受器以肌梭为主;针刺得气与肌电活动有关;针形电极插入肌肉时或在运动终板区微小的移动时;,可见到有关的电发放。以上资料提示,针刺时运动系统被兴奋,它可能是参与中枢镇痛的组成部分。我们已在     

针刺合谷、冲阳治疗牙根尖周炎性疼痛702例临床分析——兼论经络感传与针刺镇痛的关系

<正> 用针刺、按压、或其他方法,对穴位进行刺激时,一种酸、麻、胀、重感或其他特殊感觉,便从被刺穴位开始,沿着或大体沿着古典所述经脉循行路线传导的现象(经络感传现象),在针刺疗法和针麻中,颇为常见.因此,从控制经络感传的方向和强化经络感传的程度入手,去提高针刺镇痛的效果,都受到普遍的重视。     

Using a consensus acupoints regimen to explore the relationship between acupuncture sensation and lumbar spinal postoperative analgesia: A retrospective analysis of prospective clinical cooperation

ObjectiveThis study evaluated the effectiveness of acupuncture treatment on postoperative pain in patients with degenerative lumbar spine disease, and explored the relationship between the postoperative analgesic effect of acupuncture and the sensation of acupuncture experienced by the patients.MethodsThis retrospective study analyzed the medical records of 97 patients who had undergone an operation by the same surgeon due to degenerative lumbar disease. These patients were divided into acupuncture group (n = 32), patient-controlled analgesia (PCA) group (n = 27), and oral analgesia group (n = 38) according to the different postoperative analgesic methods. During their hospitalization, patients completed daily evaluations of their pain using a visual analogue scale (VAS), and injection times of supplemental meperidine were recorded. Also, the Chinese version of the Massachusetts General Hospital Acupuncture Sensation Scale (C-MASS) was used in the acupuncture group.ResultsEach of the three treatment groups showed significant reductions in postoperative pain, as shown by reduced VAS scores. The acupuncture group, however, had less rebound pain (P < 0.05) than the other two groups. Both the acupuncture and PCA groups experienced acute analgesic effects that were superior to those in the oral analgesia group. In addition, the higher the C-MASS index on the second day after surgery, the lower the VAS score on the fourth day after surgery. There was also a significant difference in the “dull pain” in the acupuncture sensation.ConclusionThe results demonstrated that acupuncture was beneficial for postoperative pain and discomfort after simple surgery for degenerative spinal disease. It is worth noting that there was a disproportionate relevance between the patient’s acupuncture sensation and the improvement of pain VAS score.     

外周乙酰胆碱对电针镇痛作用的影响

<正> 为了探讨外周乙酰胆碱(ACh)与针刺穴位引起感觉信息一级传入的关系,本文用不能通过血脑屏障的胆碱酯酶抑制剂(新斯的明)和乙酰胆碱合成阻断剂(密胆碱)及乙酰胆碱外周给药,以升高或降低外周乙酰胆碱     

大鼠下丘脑室旁核在针刺镇痛中的作用

<正> 多年来,人们对痛觉调制的研究主要集中于阿片类物质,大量的实验资料表明,各级中枢的阿片肽均参与痛觉调制。近来,人们对非阿片类神经肽在痛觉调制方面是否起作用开始感兴趣。精氨酸加压素(AVP)是下丘脑室旁核(PVN)分泌的一种非阿片类的9肽。已有实验表明,中枢或外周给予AVP可     

激光穴位镇痛的实验研究

<正> 引言近年来激光已广泛应用于医学领域作为诊断和治疗。激光穴位麻醉已获成功,这就向人们提出了很多问题:激光穴位是否具有镇痛作用?激光穴位镇痛是否具有后效应?激光穴位镇痛是局部的还是全身性的?激光     

The experiment studies of semiconductor GaAs-laser points irradiation the analgesic effect

The article reported that Rabbits threshold of Pain were made a target of observing analgesic effect of the Semiconductor GaAs laser irradiation Znsanli (V36) points. The relations between meridian with peripheral nervous and analgesic mechanism had been explored. The result showed that GaAs laser irradiation at Znsanli (V36) points not only increase basic threshold of pain for Rabbits, but also had all over analgesic effect. After irradiation fifteen minutes obviousness effect in particular. That both the low-frequency electropulse and the laser affected points can raised analgesic effect, but it showed obvious analgesic-back-effect. GaAs laser irradiation nervis fibularis profundus were similar analgesic effect to the points irradiation indicated that points irradiation stimulus conduction had relation to peripheral nervous. After intravenous injection naloxone analgesic effect that GaAs laser irradiation points arose reversion were similar acupuncture analgesia. It indicated that analgesic effect had relation release of the internal source opiate-like substance (OLS).     

半导体砷化镓激光穴位照射镇痛效应的实验研究

<正> 临床和动物实验证明,激光穴位照射对人体和动物有显著的镇痛效应,并且具有全身性镇痛和镇痛后效应特点。以往激光穴位照射代替传统针刺镇痛效应的研究多采用氦-氖激光,而对半导体砷化镓激光穴位照射镇痛效应的研究国内尚未报道。为此,我们以家兔痛阈为指标进行了半导体砷化镓激光或加低频电脉冲穴位照射镇痛效应的实验研究。同时对经穴与外周神经的关系和镇痛机理进行了探讨。现报道如下。     

孤啡肽是影响针刺镇痛的新因素

自从 1 994年发现阿片受体家族的新成员ＯＲＬ1受体、1 995年底寻找到该受体的内源性配基孤啡肽 (ｎｏｃｉｃｅｐｔｉｎ或ｏｒｐｈａｎｉｎＦＱ ,ＯＦＱ)以来 ,有关ＯＦＱ在痛觉调制中的作用一直引人注目 ,孤啡肽对针刺镇痛的影响也令人关注。现就我室近年来有关孤啡肽在痛觉调制及针刺镇痛中的作用作一小结。ＯＦＱ在脑内对抗阿片镇痛和针刺镇痛 :在福尔马林致痛模型上 ,观察到侧脑室注射ＯＦＱ能剂量依赖地加强痛反应 ,对抗吗啡及内吗啡肽引起的镇痛作用。电针可明显抑制福尔马林引起的痛反应 ,具有明显的镇痛作用 ,侧脑室注射ＯＦＱ则显…     

尾核在针刺镇痛中的作用

<正> 在传统概念中,尾核属于锥体外系,参与机体运动的调节。然而近三十余年来对尾核的研究逐渐深入,从形态、生理、生化和药理等方面提供了不少资料,表明它与行为植物性机能以及感觉机能有关。针刺镇痛原理研究的开展,进一步积累了尾核参与痛觉调制的资料,提出了它在针刺镇痛中的主要作用。本文将作一概述。     

镇痛效应对电灸调节荷瘤大鼠NK细胞活性的影响

为探讨针刺镇痛效应与针灸调节免疫作用间的相关性，以大鼠NK细胞活性变化为指标，通过荷瘤抑制大鼠免疫功能，观察电灸、电灸结合D-苯丙氨酸等对荷瘤大鼠和电针镇痛不同敏感状态荷瘤大鼠NK细胞活性的影响。结果显示：W256瘤株荷瘤大鼠NK细胞活性明显低于正常大鼠，电灸能明显改善其NK细胞活性。2Hz电针刺激大鼠“足三里”穴时，存在镇痛有效群（痛阈升高大鼠）和无效群（痛阈无变化大鼠）之别，电灸“关元”穴，能明显提高电针镇痛有效群荷瘤大鼠的NK细胞活性，但不能改善镇痛无效群荷痛大鼠的NK细胞活性，经加用吗啡分解酶抑制剂D-苯丙氨酸（250mg／kg，ip）后，镇痛有效群荷瘤大鼠的NK细胞活性有更大程度的提高，接近正常大鼠的水平。镇痛无效群荷瘤大鼠的NK细胞治性也有明显改善。单用同等剂量的D-苯丙氨酸并不影响NK细胞活性。本工作结果表明，电灸改善荷瘤大鼠NK细胞活性与大鼠本身对电针镇痛的敏感性有关，针刺镇痛效应可能影响其对免疫功能的调制作用。     

脑室注射环—磷酸鸟苷(cGMP)对大鼠电针镇痛的影响

<正> 近十余年来,对于环-磷酸鸟苷(cGMP)在中枢神经系统中的机能作用引起了人们的注意.有报导 cGMP 具有镇痛性质,并假设 cGMP 或许是一种或一种以上的神经递质的调节者。本工作是观察脑室注射cGMP 对针刺镇痛的影响,并探索它与乙酰胆碱及阿片样物质之间可能存在的关系.     

大鼠脑内生长抑素在电针镇痛中的作用

本文目的在于探讨脑内生长抑素（Som）在电针镇痛中的作用。脑室注射（icv）Som可使大鼠痛阈明显提高，电针镇痛效应显著加强，海马内Ca2+－ATP酶活力明显降低。电针镇痛时海马、脑干内Som和GABA含量均显著下降。以icv半胱胺耗竭脑内Som后，痛阈、电针镇痛效应均未受影响。实验表明脑内外源性Som可增强电针镇痛效应．而部分脑区的内源性Som含量降低参与了电针镇痛过程。     

PAIN AND SENSORY DETECTION THRESHOLD CAN BE MODULATED BY THE ASSOCIATION BETWEEN COPING STRATEGY AND ACUPUNCTURE SENSATION IN ACUPUNCTURE STIMULATION

Introduction: Although acupuncture reduces pain and is important in its effect, the role of coping strategy on acupuncture modulation of pain and sensory thresholds, and the association between acupuncture sensation and these modulatory effects, is currently unknown.Methods: Electroacupuncture(EA) was applied at acupoints ST36 and GB39 in 61 healthy adults.Two coping conditions were experimentally designed to form an active coping strategy group(AC group), who thought they could control EA stimulation intensity, and a passive coping strategy group(PC group), who did not think they had such control.However, the EA intensity was not changed.Quantitative sensory testing was performed before and after EA, and vibration(VDT), mechanical(MDT),warm(WDT), and cold(CDT) detection thresholds, and pressure(PPT), mechanical(MPT), heat(HPT) and cold(CPT) pain thresholds were measured.Autonomic measures, skin conductance response(SCR), were also acquired to quantify physiological response to EA under different coping conditions.Results: The AC group showed greater SCR to EA than the PC.Acupuncture sensation did not differ between the AC and PC groups.Increased pain/sensory threshold and acupuncture sensation were positively correlated in the AC group(VDT change vs.MI: r=0.58; CDT change vs.tingling: r=0.53; CPT change vs.tingling: r=0.55; CPT change vs.dull: r=0.55), and were negatively correlated in the PC group(CDT change vs.intensity: r=-0.52; WDT change vs.fullness: r=-0.57).Additionally, subjects in the AC group demonstrated reduced PPT following EA.Conclusion: Active coping strategy increased pain and sensory detection threshold when acupuncture sensation was high, while passive coping strategy produced an opposite association.Theassociation of descending cortical(psychological coping strategies) and ascending sensory afference(acupuncture sensation) might affect periaqueductal grey to modulate pain and sensory processing.Clinically, our findings suggest that acupuncture analgesia can be maximized by matching physical stimulation intensity with the psychological coping strategy inherent to different naturalistic subject-specific acupuncture contexts.     

Studies on the enhanced effect of acupuncture analgesia and acupuncture anesthesia by D-phenylalanine (first report)--effect on pain threshold and inhibition by naloxone

It has been claimed that the mechanism of acupuncture analgesia can be explained in part by endogenous opioids. If so, it might be possible to enhance the analgesic effect of acupuncture by the administration of endorphins. If D-phenylalanine (DPA), an inhibitor of the endorphin degrading enzyme, is administered, the analgesic effect of acupuncture should be prolonged due to the increased level of endorphins. From the changes of the pain threshold (PT), we investigated whether or not the pre-administration of DPA can enhance the analgesic effect of acupuncture in humans. In addition, we examined the inhibitory effect of naloxone. 1) In all five subjects whose PT was raised after acupuncture anesthesia (respondents), the rise in PT was significantly prolonged by DPA. 2) Out of 10 subjects whose PT remained almost unchanged after acupuncture anesthesia (non-respondents), the PT was increased by DPA in 5 cases. 3) The rise in PT was most prominent when DPA was administered 30 minutes before the start of acupuncture anesthesia. 4) In all 4 respondents in whom the rise in PT persisted after DPA and acupuncture anesthesia, their raised PT dropped after the intravenous injection of naloxone (10 mg). 5) These findings show that DPA enhances the analgesic effect of acupuncture by the "endorphin mechanism."     

纳洛酮、阿托品对环磷酸鸟苷增强大鼠针刺镇痛效应的影响

<正> 脑内不少神经递质以环磷酸腺苷(cA-MP)和环磷酸鸟苷(cGMP)作为第二信使,“调节着细胞功能。近年来,对cGMP在中枢镇痛中的作用引起了人们的重视。我们以前的工作证明,脑室内注射cGMP可使痛阈明显提高,并能增强大鼠电针镇痛效应。初步观察到,这可能与乙酰胆碱(Ach)和阿片样物质(OLS)的作用机理有关。有资料证明,Ach、OLS与脑内cGMP有着密切的关系,并设想cGMP可能是传递阿片受体兴奋的细胞内介质。本工作观察了脑室注射cGMP对