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Acupuncture - effects on muscle blood flow and aspects of treatment in the clinicla context
Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to elucidate and investigate psychophysiological aspects and effects of acupuncture and needle stimulation. Within this framework emphasis was directed toward the effects of needle stimulation (acupuncture) on muscle blood flow in the tibialis anterior and trapezius muscles in healthy subjects and patients suffering from chronic muscle pain. This study also included evaluation of a new application of photoplethysmography in noninvasive monitoring of muscle blood flow. The evaluation was based on experiments known to provocate skin or muscle blood flow. The psychological aspects studied comprised the effects of manual acupuncture on pain in fibromyalgia patients and the effects of electro-acupuncture on psychological distress and vasomotor symptoms in postmenopausal women in the clinical context.

The results showed that photoplethysmography have potential to noninvasively monitor muscle blood flow and to discriminate between blood flow in skin and muscle, although some considerations still have to be accounted for. It was further shown that muscle blood flow change in response to needle stimulation differed between healthy subjects and patients. Deep needle stimulation in the muscle of healthy subjects consistently increased muscle blood flow more than subcutaneous needle stimulation. In the painful trapezius muscle of FMS patients, however, subcutaneous needling was equal or even more effective in increasing muscle blood flow than deep intramuscular stimulation. Generally, needle stimuli had weak effect on blood flow in the trapezius muscle of the severely affected trapezius myalgia patients, possibly depending on older age and lesser number of patients included in the study. The different patterns of blood flow response to needle stimulation between healthy subjects and patients with chronic muscle pain might be a manifestation of altered somatosensory processing in the patients.

The clinical studies showed that best pain relief of acupuncture in FMS patients was achieved in the neck-shoulder region, while the effect on the generalised symptoms was of short duration. Well-being and sleep was found to best predict treatment outcome. The results suggest that acupuncture treatment may be used for the alleviation of neck-shoulder pain, primarily, but it is not an alternative as the sole treatment. Electro-acupuncture, significantly decreased psychological distress and climacteric symptoms in postmenopausal women, but not better than a (near-) placebo control, implying pronounced non-specific effects.

Abstract [sv]

Akupunktur ingår som en del i traditionell kinesisk medicin (TCM) och har använts i över 2000 år för att lindra sjukdom och symptom. I Sverige blev akupunktur godkänd som smärtlindringsmetod inom Hälso- och Sjukvården 1984. Sedan nästan 10 år är akupunktur jämställd med övrig behandling i sjukvården vilket innebär, att akupunktur kan användas även för behandling av annat än smärta. Förutsättningen är emellertid, att det finns tillräckligt med vetenskapliga belägg, s.k. evidens, för detta. I de allra flesta fall saknas det idag. För att säkerställa att evidens föreligger krävs omfattande forskning om effekter av akupunktur.

Syftet med de olika studierna i avhandlingen var att belysa och studera psykologiska och fysiologiska aspekter och effekter av akupunktur och nålstimulering. Effekt på blodflöde i hud och muskel undersöktes på friska personer och på patienter med kronisk muskelsmärta. Normalt krävs ett mindre kirurgiskt ingrepp för att mäta blodflöde i muskel, men i dessa studier användes en mätmetod, som enkelt och utan ingrepp (icke-invasivt) i normala fall används för att mäta blodflöde i huden, s.k. fotopletysmografi (PPG, eng.). Med hjälp av ny teknik användes PPG i dessa studier för att mäta även muskelblodflöde. En studie för utvärdering av den nya PPG-tekniken ingick också i avhandlingen.

Utvärderingen av mätmetoden visade goda möjligheter att mäta muskelblodflöde icke-invasivt med hjälp av PPG. Hos friska personer blev effekten på blodflödet störst vid djup stimulering i muskeln och där den s.k. DeQi-känslan framkallades (som vid klassisk akupunktur). Hos patienter med fibromyalgi var nålstimulering i huden lika, eller t.o.m. mer, effektiv att öka muskelblodflödet i skuldran än den djupa nålstimuleringen. De olika mönstren av blodflödesökning mellan de friska personerna och patienterna kan bero på ett förändrat reaktionssätt i nervsystemet som svar på smärtsam stimulering.

I två kliniska studier studerades den smärtlindrande effekten av manuell akupunktur vid fibromyalgi och effekten av elektroakupunktur på stress och klimakteriebesvär hos kvinnor i övergångsåldern. Akupunktur vid fibromyalgi visade sig ha bäst smärtlindrande effekt i nack-skulderområdet, medan effekten på de generella symptomen var kortvarig. Patienter som mådde och sov relativt bra erhöll bäst effekt. Efter en behandlingsserie, bestående av elektroakupunktur, minskade stress och klimakteriebesvär påtagligt hos kvinnorna i övergångsåldern, men inte mer än hos en grupp kvinnor, som fick en kontrollbehandling bestående av mycket ytligt placerade nålar i huden. Detta tyder på att en betydlig del av behandlingsresultatet utgjordes av ospecifika effekter eller, s.k. eller placeboeffekter.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2004. , 83 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 867
Keyword [en]
Acupuncture, muscle blood flow, non-invasive, photoplethysmography, fibromyalgia, pain, postmenopausal symptoms, psychological distress
National Category
Physiotherapy
Identifiers
URN: urn:nbn:se:liu:diva-10456ISBN: 91-7373-841-7 (print)OAI: oai:DiVA.org:liu-10456DiVA: diva2:17198
Public defence
2004-11-19, Berzeliussalen, Campus US Linköping University, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2008-01-09 Created: 2008-01-09 Last updated: 2012-01-25Bibliographically approved
List of papers
1. Manual Acupuncture in Fibromyalgia: A Long-Term Pilot Study
Open this publication in new window or tab >>Manual Acupuncture in Fibromyalgia: A Long-Term Pilot Study
1999 (English)In: Journal of Musculoskeletal Pain, ISSN 1058-2452, Vol. 7, no 3, 39-58 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of this cross-over designed pilot study was to investigate the short-term and long-term effects on pain and other common symptoms present in fibromyalgia [FMS] of manual acupuncture with needles inserted into traditional Chinese acupuncture points.

Methods: Nine out of 10 consecutive FMS patients completed the study. Acupuncture was given in 10-14 sessions over two to three months, followed by an observation period of six months. The control regime consisted of continuous medical management. The patients were evaluated immediately after the completion of the treatment and at 4, 8, 12, and 24 weeks. Pain, sleep, medication, muscle tension, psychological tension, general well-being, the number of tender points, and range of movement in shoulders and neck were assessed.

Results: In general, significantly greater changes occurred for the variables under investigation during the acupuncture period than during the control period. Nine of the 11 outcome variables showed a significant improvement after acupuncture period. The number of tender points was significantly decreased and the sense of well-being significantly improved up to 12 week follow-up. A significant decrease in general pain persisted for eight weeks. Muscle tension and local pain in head, neck, and shoulder regions were significantly reduced throughout the whole 24 week follow-up period. According to the patients' evaluation of global treatment outcome, improvements remained significant until the four week follow-up. Base-line values of well-being and sleep patterns were the most important predictors of treatment outcome.

Conclusion: We conclude that for some FMS patients 10-14 acupuncture sessions seem to give additional benefits over a limited period.

Keyword
Fibromyalgia, acupuncture, manual needle stimulation, traditional chinese points
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12841 (URN)10.1300/J094v07n03_04 (DOI)
Available from: 2008-01-09 Created: 2008-01-09 Last updated: 2009-08-20
2. Effects of electro-acupuncture on psychological distress in postmenopausal women
Open this publication in new window or tab >>Effects of electro-acupuncture on psychological distress in postmenopausal women
Show others...
2002 (English)In: Complementary Therapies in Medicine, ISSN 0965-2299, Vol. 10, no 3, 161-169 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To evaluate effects of electro–acupuncture (EA) on general psychological distress and relate to experience of climacteric symptoms in 30 postmenopausal women.

Design: A randomised single-blind controlled design was used to evaluate effects of EA and extremely superficial needle insertion, with the latter serving as a near-placebo control.

Settings: The Linköping University Hospital in Sweden. Interventions: Fourteen treatments during 12 weeks with follow-ups at 3 and 6 months.

Outcome measures: General psychological well-being, mood and experience of climacteric symptoms. Results: Mood Scale improved only in EA group and not until 12 weeks compared to baseline, from 110 to 129 (P=0.01), and to 120 at 3-month follow-up (P=0.04). Mood was significantly better than control at 8 (P=0.05) and 12 weeks (P=0.01). Visual analogue scale estimation of climacteric symptoms was decreased at 4 weeks in both groups, and lasted throughout the study period, in EA group from 5 to 2 (P=0.04) and in control group from 5 to 3 (P=0.02) at 6-month follow-up. Well-being was ameliorated from 4 weeks in EA and from 8 weeks in control group until end of study (P=0.01, P=0.03). No significant differences on climacteric symptoms or well-being existed between the groups.

Conclusions: This study does not show that EA is better than superficial needle insertion for the amelioration of general psychological distress and experience of climacteric symptoms in women with vasomotor symptoms after menopause. However, the more pronounced effect on mood suggests that EA might have additional effects compared with superficial needle insertion.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12842 (URN)10.1016/S0965229902000547 (DOI)
Available from: 2008-01-09 Created: 2008-01-09 Last updated: 2009-08-20
3. Non-invasive monitoring of muscle blood perfusion by photoplethysmography: Evaluation of a new application
Open this publication in new window or tab >>Non-invasive monitoring of muscle blood perfusion by photoplethysmography: Evaluation of a new application
Show others...
2005 (English)In: Acta Physiologica Scandinavica, ISSN 0001-6772, Vol. 183, no 4, 335-343 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To evaluate a specially developed photoplethysmographic (PPG) technique, using green and near-infrared light sources, for simultaneous non-invasive monitoring of skin and muscle perfusion.

Methods: Evaluation was based on assessments of changes in blood perfusion to various provocations, such as post-exercise hyperaemia and hyperaemia following the application of liniment. The deep penetrating feature of PPG was investigated by measurement of optical radiation inside the muscle. Simultaneous measurements using ultrasound Doppler and the new PPG application were performed to elucidate differences between the two methods. Specific problems related to the influence of skin temperature on blood flow were highlightened, as well.

Results: Following static and dynamic contractions an immediate increase in muscle perfusion was shown, without increase in skin perfusion. Liniment application to the skin induced a rapid increase in skin perfusion, but not in muscle. Both similarities and differences in blood flow measured by Ultrasound Doppler and PPG were demonstrated. The radiant power measured inside the muscle, by use of an optical fibre, showed that the near-infrared light penetrates down to the vascular depth inside the muscle.

Conclusions: The results of this study indicate the potentiality of the method for non-invasive measurement of local muscle perfusion, although some considerations still have to be accounted for, such as influence of temperature on blood perfusion.

Keyword
blood flow, muscle blood perfusion, non-invasive, penetration depth, photoplethysmography, skin blood perfusion
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12843 (URN)10.1111/j.1365-201X.2005.01412.x (DOI)
Available from: 2008-01-09 Created: 2008-01-09 Last updated: 2009-06-03
4. Effects of acupuncture on skin and muscle blood flow in healthy subjects
Open this publication in new window or tab >>Effects of acupuncture on skin and muscle blood flow in healthy subjects
2003 (English)In: European Journal of Applied Physiology, ISSN 1439-6319, Vol. 90, no 1-2, 114-119 p.Article in journal (Refereed) Published
Abstract [en]

In 14 healthy female subjects, the effects of needle stimulation (acupuncture) on skin and muscle blood flow were investigated using a non-invasive custom-designed probe and photoplethysmography (PPG). In randomised order, 2–7 days apart, three modes of needle stimulation were performed on the anterior aspect of the tibia: superficial insertion (SF), insertion into the anterior tibial muscle (Mu), and insertion into the muscle including manipulation of the needle in order to elicit a distinct sensation of distension, heaviness or numbness (DeQi). Before intervention, the subjects rested for 30 min. After the intervention, the needle was left in situ for 20 min. Blood flow recordings were performed intermittently from 10 min prior to the intervention to the end of the trial. In a fourth session, serving as control, corresponding measurements were performed without any needle stimulation. Area under curve was calculated for 5-min periods prior to and after stimulation, respectively, and for the remaining 15-min period after stimulation. Compared to the control situation, muscle blood flow increased following both Mu and DeQi for 20 min, with the latter being more pronounced for the initial 5 min. Skin blood flow increased for 5 min following DeQi. However, no increase was found following SF. The DeQi stimulation was preceded by higher visual analogue scale ratings of anxiety prior to stimulation, which might have influenced skin blood flow to some extent. The results indicate that the intensity of the needling is of importance, the DeQi stimulation resulting in the most pronounced increase in both skin and muscle blood flow.

Keyword
Axon reflex, Needle stimulation, Non-invasive, Photoplethysmography (PPG), Vasodilatation
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12844 (URN)10.1007/s00421-003-0825-3 (DOI)
Available from: 2008-01-09 Created: 2008-01-09 Last updated: 2009-08-20
5. Peripheral effects of needle stimulation (acupuncture) on skin and muscle blood flow in fibromyalgia
Open this publication in new window or tab >>Peripheral effects of needle stimulation (acupuncture) on skin and muscle blood flow in fibromyalgia
2004 (English)In: European Journal of Pain, ISSN 1090-3801, Vol. 8, no 2, 163-171 p.Article in journal (Refereed) Published
Abstract [en]

Acupuncture has become a widely used treatment modality in various musculoskeletal pain conditions. Acupuncture is also shown to enhance blood flow and recovery in surgical flaps. The mechanisms behind the effect on blood flow were suggested to rely on vasoactive substances, such as calcitonin gene-related peptide, released from nociceptors by the needle stimulation. In a previous study on healthy subjects, one needle stimulation into the anterior tibial muscle was shown to increase both skin and muscle blood flow. The aim of this study was to examine the effect of needle stimulation on local blood flow in the anterior tibial muscle and overlying skin in patients suffering from a widespread chronic pain condition. Fifteen patients with fibromyalgia (FM) participated in the study. Two modes of needling, deep muscle stimulation and subcutaneous needle insertion were performed at the upper anterior aspect of the tibia, i.e., in an area without focal pathology or ongoing pain in these patients. Blood flow changes were assessed non-invasively by photoplethysmography (PPG). The results of the present study were partly similar to those earlier found at a corresponding site in healthy female subjects, i.e., deep muscle stimulation resulted in larger increase in skin blood flow (mean (SE)): 62.4% (13.0) and muscle blood flow: 93.1% (18.6), compared to baseline, than did subcutaneous insertion (mean (SE) skin blood flow increase: 26.4% (6.2); muscle blood flow increase: 46.1% (10.2)). However, in FM patients subcutaneous needle insertion was followed by a significant increase in both skin and muscle blood flow, in contrast to findings in healthy subjects where no significant blood flow increase was found following the subcutaneous needling. The different results of subcutaneous needling between the groups (skin blood flow: p=0.008; muscle blood flow: p=0.027) may be related to a greater sensitivity to pain and other somatosensory input in FM.

Keyword
Acupuncture, Blood flow, Fibromyalgia, Hyperexcitability, Non-invasive
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12845 (URN)10.1016/S1090-3801(03)00090-9 (DOI)
Available from: 2008-01-09 Created: 2008-01-09 Last updated: 2009-08-20
6. Different patterns of blood flow response in the trapezius muscle following needle stimulation (acupuncture) between healthy subjects and patients with fibromyalgia and work-related trapezius myalgia
Open this publication in new window or tab >>Different patterns of blood flow response in the trapezius muscle following needle stimulation (acupuncture) between healthy subjects and patients with fibromyalgia and work-related trapezius myalgia
2005 (English)In: European Journal of Pain, ISSN 1090-3801, Vol. 9, no 5, 497-510 p.Article in journal (Refereed) Published
Abstract [en]

Needle stimulation (acupuncture) has recently been shown to increase blood flow in the tibialis anterior muscle and overlying skin in healthy subjects (HS) and patients with fibromyalgia (FM). The aim of the present study was to examine the effect of needle stimulation on local blood flow in the trapezius muscle and overlying skin in HS and two groups of patients suffering from chronic pain in the trapezius muscle, i.e., FM and work-related trapezius myalgia (TM) patients. Two modes of needling, deep muscle stimulation (Deep) and subcutaneous needle insertion (SC), were performed at the upper part of the shoulder and blood flow was monitored for 60 min post-stimulation. Blood flow changes were measured non-invasively by using a new application of photoplethysmography. Increased blood flow in the trapezius muscle and overlying skin was found in all three groups following both Deep and SC. In HS, Deep was superior to SC in increasing skin and muscle blood flow, whereas in FM, SC was as effective as, or even more effective, than Deep. In the severely affected TM patients, no differences were found between the stimuli, and generally, a lesser blood flow response to the stimuli was found. At Deep, the muscle blood flow increase was significantly larger in HS, compared to the two patient groups. Positive correlations were found between muscle blood flow at Deep and pressure pain threshold in the trapezius muscle, neck movement and pain experienced at the stimulation, and negative correlations were found with spontaneous pain-related variables, symptom duration and age, pointing to less favorable results with worsening of symptoms, and to the importance of nociceptor activation in blood flow increase. It was hypothesized that the different patterns of muscle blood flow response to the needling may mirror a state of increased sympathetic activity and a generalized hypersensitivity in the patients. The intensity of stimulation should be taken into consideration when applying local needle stimulation (acupuncture) in order to increase the trapezius muscle blood flow in chronic pain conditions.

Keyword
Acupuncture; Fibromyalgia; Muscle blood flow; Non-invasive; Trapezius myalgia; Trapezius muscle
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12846 (URN)10.1016/j.ejpain.2004.11.002 (DOI)
Available from: 2008-01-09 Created: 2008-01-09 Last updated: 2009-06-03

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