Gabriel Stux

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Research Shows Which Nerve Fibers Get the Point

May 3, 2010 in Acupuncture, News, Research | 1 comment

Let the good times roll.  Another study, as reported in various articles online, shows evidence that acupuncture works.  Ho hum, what’s new?

The difference is the method of evaluating the effect.  Instead of asking patients, hey does it hurt less?  They did Quantitative sensory testing.

What’s that?

The University of Chicago website defines quantitative sensory testing as:

Quantitative sensory testing (QST) is a method used to assess damage to the small nerve endings, which detect changes in temperature, and the large nerve endings, which detect vibration.

QST is used to diagnose and assess the severity of nerve damage, especially in the small nerve endings. It can also help determine if a neuropathy is responding to treatment. It is used to diagnose many different types of neuropathies, including peripheral neuropathies. It may also be used to identify where the nerves are damaged.

(It) ses a computer testing system to measure how the nerves involved react to vibration and changes in temperature. The test results are compared to a series of “normal” patients as well as to the patient’s unaffected side. (from http://peripheralneuropathycenter.uchicago.edu/

learnaboutpn/evaluation/quant/index.shtml or http://bit.ly/bb7gfC)

qst2 Research Shows Which Nerve Fibers Get the Point

Quantitative Sensory Testing

Photo from http://www.neurology.upmc.edu/neuromuscular/patient_info/testing.html

Pretty objective, if you ask me.

So what does the article say?

Dr. Philip Lang and colleagues of the University of Munich used quantitative sensory testing to identify changes in pain sensitivity with acupuncture in 24 healthy volunteers.
After applying acupuncture to the leg, the researchers found that pain thresholds increased by up to 50 per cent. Effects were noted in both the treated leg and the untreated (contralateral) leg.

…It includes tests of both thermal perception (heat and cold), and mechanical perception (pressure applied to the skin).

The patterns of response provide diagnostic information in patients with nerve injury regarding the type of nerve involved, and possible treatments.

Okay, in real life this is how it goes.  Sometimes people have nerve damage.  This obviously leads to decrease in sensations.  A perfect example would be a diabetic with peripheral neuropathy.  Peripheral neuropathy means that the nerve damage occurs at the very ends of the body – fingers and toes.  This test serves to try to measure the nerve response to various external stimuli. In this case, temperature change and pressure, among others.

It is also quantitative, meaning it is measured with numbers.  No more “uh I think it hurts a bit less” here.  Stimulus is given and we see how the nerves respond.

In this case, the body’s threshold of pain is increased – meaning treatment is effective and that a patient can tolerate pain better.

The results pointed to two nerve fibres-the ‘A delta’ pain fibers and the ‘C’ pain fibers-as being specifically affected by acupuncture.

Confirms what Berman, Pomeranz and Stux have been saying for decades.

Although the effects were modest, the researchers believe they provide the basis for future studies in individuals with chronic pain, where the effects might be more dramatic.

Here’s the crazy part.  An objective mind sees it this way, while a skeptic will say the effects are negligible so why bother.  A skeptic will also point out that it’s “just” a pilot study. Excuse me while I go find a toilet to relieve my nausea in.

Oh, and remember how I said that acupuncture can be dependent on the practitioner?

An experienced acupuncturist performed all treatments, applied to acupuncture points commonly used in pain management.

No newbies here who might eff things up!  I’m sure this acupuncturist had good skeeeelz.

And finally,

The results provide a scientific background for the ancient practice of acupuncture, according to Dr. Dominik Irnich, the study’s leading author.
“Our results show that contralateral stimulation leads to a remarkable pain relief. This suggests that acupuncturists should needle contralaterally if the affected side is too painful or not accessible-for example, if the skin is injured or there is a dressing in place,” added Irnich.
Dr. Steven L. Shafer, Editor-in-Chief of Anesthesia & Analgesia and Professor of Anesthesiology at Columbia University, views the results as an important preliminary finding.
“Reproducible findings are the cornerstone of scientific inquiry. The authors have clearly described their methodology, and their findings. If other laboratories can reproduce these results in properly controlled studies, then this provides further support for the scientific basis of acupuncture. Additionally, the ability of quantitative sensory testing to identify specific types of nerves involved in pain transmission may help direct research into the mechanism of acupuncture analgesia,” commented Shafer.
The study has been published in the May issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).

Note that the authors mention that contralateral needling works.  This is not a new discovery.  It fits perfectly with the Chinese theory of meridians and collaterals.  According to this, the meridians go up and down and are the big lines you see in point charts.  However, the collaterals also exist that connect one side to another.  While the existence of meridians may be doubted by some, the implication of this belief in meridians and collaterals indicates that what we are verifying scientifically now has been long known by the Chinese since ancient times.  May I also add, that the ancient Chinese put much weight in clinical experience.  They didn’t know how it was happening, but they saw what treatments work through trial and error.  I am glad that, thousands of years later, their hard work is paying off handsomely.

http://timesofindia.indiatimes.com/Life/Health-Fitness/Health/Acupuncture-the-best-bet-to-ease-pain/articleshow/5883083.cms

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Definite Proof: Acupuncture More Than Placebo

April 30, 2010 in Acupuncture, Research | No comments

Enough with answering back at mudslingers.  I get more than enough of that in the local media, with the Philippine elections just around the corner.  Let’s move on to being proactive instead of being defensive.

A common “debunking” technique of anti-acupuncture bigots is to come up with “evidence” that acupuncture is clinical similar to placebo and then “conclude” that acupuncture is therefore useless or irrelevant.  This plays the assumption that placebo = no effect, when in actuality placebo  = the doc does nothing but the patient feels an effect. (http://qi-spot.com/2010/04/28/the-smear-campaign-continues-acupuncture-does-not-relieve-childbirth-pain/)

Of course, even if both acupuncture and sham acupuncture have clinical effects that seem similar (and studies have shown that the real thing beats the fake stuff, even if not by much), the argument the skeptics pose is that if acupuncture is no different than placebo, then what’s the point of doing real acupuncture at all?

Well, a while back, I posted about a study I was looking forward to. (http://qi-spot.com/2010/04/04/a-study-to-look-forward-to-acupuncture-more-than-just-placebo/).  Thanks to Chris, I now have the whole article.   I would like to start by quoting thus:

As long as acupuncture and sham acupuncture treatments produce similar clinical improvements, the results of respective trials can only be taken as evidence against the efficacy of acupuncture. (I don’t think so… – Philip) Only when it can be shown that acupuncture and sham acupuncture effects are mediated differently, this can be taken as evidence that acupuncture effects are different from placebo effects, although both may still be equally effective.

I still can’t help but detect a bit of bias.  When something can be interpreted negatively, it “can only be taken as evidence against…” meaning there is no other way to interpret it, supposedly.

Coke can Definite Proof: Acupuncture More Than Placebo

Similar clinical effect, different mechanism of action

Still the point is valid.  If we can show that the real deal triggers physiologic reactions distinct from sham, then that should construe evidence that acupuncture is not only valid, but should be encouraged.

According to the article “Acupuncture, Psyche and the Placebo Response” (the article mentioned above) they HAVE found such physiologic differences.  Why does this matter?  It matters because a) skeptics can’t say it’s like placebo anymore and b) we now have an increased knowledge of acupuncture mechanism of action, which is more than what we can say for such western drugs as lithium.

533d8cf85e38b801ac15cad9c45dd896 Definite Proof: Acupuncture More Than Placebo

Take two of these and call me in the morning, even if we don't know how they work

So how does the real thing differ from the fake stuff?  Let’s count the ways as enumerated by Enck et al:

a) “Acupuncture but not sham acupuncture was found to induce both cerebellar as well as limbic cortex activation indicating both motor as well as affective component modulation of the pain matrix.  Acupuncture resp. electroacupuncture at non-acupuncture points and tactile stimulation alone served as controls in early fMRI studies (Wu et al., 2002; Yoo et al.m 2004)

b) Verum (true) acupuncture in contrast to non-penetrating placebo nedles activated cortical centers involved in affective pain modulation (Chae et al., 2009)

c) Greater activation of sensorimotor areas by sham procedure (superficial manipulation at acupuncture points) than by true acupuncture (Napadow et al 2009) – (note that stimulation of true acupuncture points by non-needling methods was considered sham by the authors, whereas in chinese medicine it is a valid method of stimulation)

d) Variances of time of central activation between verum and sham acupuncture, attributed to stronger peripheral actions of true acupuncture

e) PET scans on fibromyalgia patients show that needling at true points elicited significant activation of mu opoid receptor binding capacity in the cingulate, caudate, thalamus and amygdala both after one session and after four weeks, while with sham (insertion into non acupuncture points), small DEactivations were noted, an effect that is seen with placebo analgesia. (Zubieta et al., 2005)

There are more, but these should suffice to prove the point.

All in all I believe this evidence validates my personal belief that real acupuncture has longer lasting effects than sham acupuncture.  This is shown by the fact that real acupuncture has more central (meaning up in the brain, as opposed to just local pain mediation) effects.

Another thing worth noting is that different people have different definitions of sham.  For some, it’s using real points but not inserting.  For others, it’s inserting into non-acupoints.  Logic dictates that both have different effects.  Controls used in acupuncture studies should be standardized!

The crazy thing is that all this has been known by Stux, Berman and others since I was in grammar school in the early 80s!  Jeez!

_________________________
Enck, P., et al., Acupuncture, psyche and the placebo response.  Auton. Neurosci. (2010), doi: 10.1016/j.autneu.2010.03.005
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Scientists Find How Acupuncture Deactivates Pain (well, one of the ways)

February 7, 2010 in Acupuncture, Research | 5 comments

… but are a bit lacking in their conclusion.  Let me explain.

Their headline is “Acupuncture ‘lessens pain in brain not body’, scientists discover”.

Acupuncture works by making the brain, rather than the body, no longer experience pain, according to new research.

by Andrew Hough (http://www.telegraph.co.uk/health/healthnews/7167362/Acupuncture-lessens-pain-in-brain-not-body-scientists-discover.html)

Scientists who scanned the brains of volunteers as they were given the Chinese therapy found it deactivated pathways that govern pain.
Complementary medicine expert Dr Hugh MacPherson, of the University of York, said: “These results provide objective scientific evidence that acupuncture has specific effects within the brain which hopefully will lead to a better understanding of how acupuncture works.”
A commenter earlier hinted that I am not being objective while citing evidence in this blog.  Fine.  I’m not objective.  I’m biased because I use acupuncture myself and can see the effects on patients firsthand.  I cannot help but acknowledge it works.  I myself am a “victim” of being “duped” as my headaches were gone for four years.  So don’t take my word for it.  Take the scientists’ word for it.  Oh wait, another commenter said that these studies that promote acupuncture are funded by companies that make money of it.  Let’s ignore the fact that most if not all western medicine studies on drugs are also funded by the drugs’ manufacturers.  I’m just saying let’s be consistent.  If we’re going to accuse acupuncture research of being biased because of who funds it, let’s distrust western medicine also!
Anyway, if I’m not being objective, let’s take Dr. MacPherson’s word for it.  Or are we to think that the University of York makes money by selling acupuncture needles?
The findings, published in Brain Research, suggest acupuncture has a significant effect on specific nerve structures.
Dr MacPherson and colleagues explained when a patient receives acupuncture treatment a sensation called deqi can be obtained. Scientific analysis showed this switches off areas within the brain that are associated with the processing of pain.
After reading this, I came to the realization that one reason that people do not understand that it is quite difficult to conduct double blind studies with acupuncture is the fact that they fail to see that acupuncture is more than just sticking needles into points.  The manipulation of the aforementioned needles is important, as they lead to the deqi sensation.  The feeling of deqi (“acquiring qi”) or “needling sensation” can be present upon inserting the needles alone (if done right), or through a bit of manipulation.  These manipulations are very dependent on the manual skill of the practitioner.  Hence, acupuncture should be treated as a PROCEDURE and not a pill.
G 06A 300x251 Scientists Find How Acupuncture Deactivates Pain (well, one of the ways)

Electroacupuncture is a supplement to enhance the "de qi"

You can insert the needles on the same points and not have the same effect if one acupuncturist just pricks the skin and the other manipulates them properly according to the specific needs of the patient.  For example I know that some patients are sensitive at LI 4 and only insertion is needed.  At the same time others may need a bit of stroking at the handle of the needle to obtain the deqi.  This knowledge comes from experience both with the points themselves in general and from knowing patients personally.
Dr MacPherson said: “We carried out two tests of acupuncture on our participants, one where the needles are inserted at a shallow depth which is the practise in Japan and the other where they went in much deeper which is the Chinese tradition.
“We found 10 out of the 17 experienced ‘deqi’ while the others didn’t, and this appeared to help in deactivating areas in the brain that are associated with pain.
“The Chinese have been using acupuncture for 2,000 years for wide ranging illnesses but we have only touched the surface at the moment.
“We believe it can help relieve a number of conditions, including depression which we have recruited 640 people for another study where half will receive acupuncture and the others counselling.”
Note the sequence of events: those who experienced “de qi” deactivated pain centers in the brain.  Those who did not… well.  I recall the words of the Yellow Emperor’s medical classic, and I paraphrase: for acupuncture to work, you need to obtain de qi.  Once de qi is obtained, there is no further need for manipulation.
needle Scientists Find How Acupuncture Deactivates Pain (well, one of the ways)

It's not enough to stick it in. The needles may have to be manipulated to obtain the qi sensation or "de qi"

As for that depression study, I am looking forward to it.  Then again the skeptics will just say that a sample size of 640 is too small.  Then 1000 will be too small… then 10,000… sigh.
Last summer acupuncture was recommended for the first time by the drugs watchdog NICE (National Institute for Health and Clinical Excellence) as a treatment option for NHS patients with lower back pain.
Guidelines now state that GPs should “consider offering a course of acupuncture comprising a maximum of ten sessions over a period of up to twelve weeks” for patients with this common condition.
Nice of NICE to say so.
Co researcher Dr Aziz Asghar, a neuroscientist at Hull York Medical School, added: “The results are fascinating. Whether such brain deactivations constitute a mechanism which underlies or contributes to the therapeutic effect of acupuncture is an intriguing possibility which requires further research.”
The team is currently researching if acupuncture has the ability to successfully treat irritable bowel syndrome and depression. Previous studies have indicated the holistic treatment works on knee pain and migraines.
Dr MacPherson and colleagues say their research could help to clear the way for acupuncture to be more broadly accepted as a treatment option on the NHS for a number of medical conditions.
But it’ll never be good enough for the “skeptics”.
Oh and my beef about the article title?  It shows the linear method of thinking.  The scientists found that acupuncture “defuses” pain sensations in the brain – so they conclude that that’s ALL it does.  Previous studies have shown acupuncture mediates pain in the spinal level and local level through various mechanisms (google the research of Bruce Pomeranz and Gabriel Stux).  It is multifactorial.
For reference, here is the abstract of the article (http://tinyurl.com/yb5p452)
Research Report
Acupuncture needling sensation: The neural correlates of deqi using fMRI
Aziz UR Asghara, b, Gary Greena, Mark F. Lythgoec, George Lewithd and Hugh MacPhersone, Corresponding Author Contact Information, E-mail The Corresponding Author
a York Neuroimaging Centre, University of York, Y10 5DG, UK
b Hull York Medical School and Department of Biological Sciences, University of Hull, Hull, HU6 7RX, UK
c RCS Unit of Biophysics, UCL Institute of Child Health, University College London, WC1N 3JH, UK
d Complementary Medicine Research Unit, University of Southampton, SO17 1BJ, UK
e Department of Health Sciences, University of York, YO10 5DD, UK
Accepted 7 December 2009.
Available online 16 December 2009.
Abstract
The needling sensation of deqi is considered by most acupuncturists to be an important component of acupuncture, yet neuroimaging research that investigates this needle sensation has been limited. In this study we have investigated the effect of deqi and acute pain needling sensations upon brain fMRI blood oxygen level-dependent (BOLD) signals. Seventeen right-handed participants who received acupuncture at the right LI-4 (Hegu) acupoint were imaged in a 3T MRI scanner. fMRI datasets were classified, on the basis of psychophysical participants’ reports of needling scores, into those that were associated with predominantly deqi sensations versus those with predominantly acute pain sensations. Brain areas showing changes in BOLD signal increases (activations) and decreases (deactivations) were identified. Differences were demonstrated in the pattern of activations and deactivations between groupings of scans associated with deqi versus pain sensations. For the deqi grouping, significant deactivations occurred, whereas significant activations did not. In contrast, the predominantly acute pain grouping was associated with a mixture of activations and deactivations. For the comparison between the predominately deqi sensation grouping and the acute pain sensation grouping (deqi > pain contrast), only negative Z value voxels resulted (mainly from deactivations in the deqi grouping and activations in the pain grouping) in the limbic/sub-cortical structures and the cerebellum regions of interest. Our results show the importance of collecting and accounting for needle sensation data in neuroimaging studies of acupuncture.
Keywords: Functional magnetic resonance imaging; Acupuncture; Needling sensation
Corresponding author. Senior Research Fellow, Department of Health Sciences, Area 3, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK. Fax: +1904 321388.
Brain Research
Volume 1315, 22 February 2010, Pages 111-118
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Acupuncture “Wrecks” Nerves? Holy Guacamole!

October 7, 2009 in Acupuncture, News, Research | No comments

It’s news articles like these that make me both chuckle my early morning lethargy away and yet lose my appetite for breakfast.  Just read it and weep.

Original Article: http://www.theaustralian.news.com.au/story/0,25197,26170808-23289,00.html

AUSTRALIAN research could help unravel the mystery of how acupuncture works, suggesting it “destroys” nerves rather than stimulating them.

Morry Silberstein, of Curtin University of Technology in Western Australia, has been conducting research using electrical circuits to replicate nerve systems.

“For years people have believed that pricking the skin with a needle stimulates the nerves, but in actual fact it divides and destroys them,” Dr Silberstein said. “It’s like disrupting the nerves and numbing them so the sensation of pain goes away.

“People know that an acupuncture point has lower electrical resistance than the rest of the skin — I used the circuit to see why. I found that it was because the point must represent the nerve branching or being destroyed.”

He said the plan was to take the research further next year and conduct similar experiments on animals.

Dr Silberstein said a better scientific understanding of acupuncture would see it adopted more in Western medicine. “In the absence of scientific rationale, acupuncture has not been widely used in the mainstream medical community,” he said.

“It may provide us with new methods of treating sleep problems and high blood pressure.”

In scientific terms, his research suggests that the insertion of an acupuncture needle into the skin disrupts the branching point of nerves called C fibres, which transmit low grade sensory information over long distances by using merkle cells as intermediaries.

His research will be published in the Journal of Theoretical Biology in December.

Time for some commentary:

“He said the plan was to take the research further next year and conduct similar experiments on animals.” – you mean his theories haven’t been tried on any living creatures yet?

“”In the absence of scientific rationale, acupuncture has not been widely used in the mainstream medical community,” he said.” – Please please PLEASE do not say “absence”.  There are kaboodles of scientific rational.  Just check out the WHO article I mentioned earlier.

“”It may provide us with new methods of treating sleep problems and high blood pressure.” – new for who?  Acupuncture has been used even before the time of Christ for these problems.

“In scientific terms, his research suggests that the insertion of an acupuncture needle into the skin disrupts the branching point of nerves called C fibres, which transmit low grade sensory information over long distances by using merkle cells as intermediaries.”  I object to several things in this sentence.

Firstly, why say “in scientific terms”?  Does this mean that TCM theories are “unscientific”?  Since childhood I was taught that science is an “organized body of knowledge.”  Traditional Chinese Medicine has had a several thousand year history backing it up, with newer innovations building on older concepts and obsolete ideas cast away.  It is internally consistent and it’s applications have real world effects.

Second, Pomeranz, Stux and Brian Berman have clearly mentioned in their book “Basics of Acupuncture” that they believe that acupuncture has effects on a local, spinal, and even higher brain level, causing release of endorphins, enkephalins, dynorphins  and other regulatory substances.  Japanese studies imply release of NO, causing vasodilation, at a local level.

While Silberstein may have discovered (or perhaps re-discovered or simply verified) yet another mechanism of how acupuncture works, it is in my opinion simply tooting one’s own horn to speak as if claiming to have found the one, singular mechanism of action of acupuncture.  Typical western reductionism – only one mechanism of action is assumed.  Why not several, especially since the evidence for several has been around for decades?

Sources:

Campanella, Natasia. “Nerves Wrecked by Needle Pain Cure” The Australian 6 October 2009.  7 October 2009 <http://www.theaustralian.news.com.au/story/0,25197,26170808-23289,00.html>

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