Dr İlhan Öztekin, MD, Prof., PhD, Turkey
Biomedical Acupuncture for Pain Management
Biomedical acupuncture results from the integration of conventional Western medicine and traditional Oriental medicine. Biomedicine is defined in the same dictionary as ‘’the application of the natural sciences, esp. The biological and physiological sciences, to clinical medicine’’. This is exactly what biomedical acupuncture means: it is the application of biological and neurophysiological principals to clinical acupuncture. Most of acupuncture practitioners have found the old system unnecessarily diffucult and incompatible with their medical training but they have no modern system to turn to if they want to practice acupuncture. Dr H.C.Dung et al. have developed the Integrative Neuromuscular Acupoint System (INMAS), which uses both the principles of classic acupuncture and the latest scientific explanations of the underlying mechanisms, and can be easily learned by any practitioner who wants to integrate acupuncture into their routine practice of pain management. The INMAS consists of three types of acupoints : Homeostatic acupoints (Has), symptomatic acupoints (SAs), and paravertebral acupoints (PAs). The combination of the three types of acupoints forms a universally standardized protocal for all pain symptoms; at the same time this protocol ensures an individualizd approach, as is practiced in TCM, by identifying and treating the specific SAs of each patient. Priamary HAs are the same for every patient, whereas SAs are individualized symptomatic points. Different SAs require different PAs according to their neurosegmental connection. Thus this protocol contains both standardization and individualization.
The management of post-operative pain with acupuncture
Postoperative pain management with acupuncture is to use some selected points to tonify the Qi and Blood, active Qi and Blood circulation, and balance Yin and Yang Zang-Fu organs, as well as the body structure.
During postoperative pain manangement, acupuncture treatment is carried out in combination with moxibustion, point massage, cupping, electric stimulation, ear acupuncture, Chinese herbal medicine, etc., such treatments often being applied simultaneously. These additional techniques and methods are important treatments that aim in the same direction, i.e. the relief of postoperative pain.
In terms of postoperative pain control, the aims of acupuncture treatment include the following:
- To completely relieve pain, or provide as much relief as possible.
- To reduce pain levels
- To improve the ability to deal with pain
- To control the local tissue swelling
- To shorten the resolution of haematoma
- To assist the emotions
- To regulate the appetite
- To strengthen the energy
- To increase participation in usual functions
- To enhance the quality of life
- To minimise the side effects of the anaesthesia
- To diminish the dosage of painkillers after the operation or reduce reliance on painkillers
- To minimise the use of the other medications associated with the pain and their attendant side effects
- To stimulate the rapid recovery of functional activities after the operation, etc.
In short, acupuncture treatment for postoperative pain control accelerates patients’ recovery and brings all possible benefits without any harmful effects.
Dr Rong Peijing, MD, Prof., PhD, China
Acupoint accompanying with Pain
There is a painful sensation and perception process in the body. Objectively, there must be a material basis for feeling pain, including the body receiving stimuli from the inside and outside, the tissue producing and releasing sensitized substances, pain sensitized sensitization, painful information transmission and sensory central perception, and eventually into the consciousness phase.
Pain is a protection signal. The first manifestation of many diseases is often pain. Pain is the most primitive protection mechanism of our body. Animals with central nervous system, no matter how low the grade, will use pain to alarm and protect the body.
In visceral diseases, the body will appear to sensitive tender points. There is a clear relationship between these sensitive points and diseases. From the relative “silent” of the physiological state to the relative “activated” of the pathological state, the size of these points, the sensitivity and the function can occur corresponding changes.
Acupoint sensitization is an innovation which we have pioneered and have obtained systematic results. In the superficial medical system, the body state is the only important starting factors. It can be argued that the lack of human intervention, the self-healing of diseases is instinctive. In the theory of acupuncture, the effective acupoints stimulation is equally important. Acupuncture can stimulate, promote, enhance and accelerate this instinct self-healing process. All regulation caused by acupuncture stimulation are related to the cascade of biological procedures.
Dr G. Litscher Univ.Prof.,MSc PhD MDsc Medical University of Graz, Austria
High-tech laser acupuncture and pain: from experimental studies to clinical applications
Laser acupuncture is increasingly used as a complementary therapy for the treatment of pain. It is well tolerated by adults and children and even used in neonatology with a low risk of serious adverse effects. Traditional and modern laser acupuncture techniques may result in reported improvement in pain patterns. Controlled trials exists regarding acupuncture including laser stimulation for lumbar, shoulder, and neck pain, headache, arthritis, fibromyalgia, temporomandibular joint pain, postoperative pain and many other pain syndromes.
Based on published evidence, animal experimental studies performed together with renowned universities and institutions in China, experimental biomedical studies from the Medical University of Graz like quantitative thermal sensory and pain threshold testing before and after laser needle acupuncture and placebo stimulation, and also transcontinental clinical studies on high tech acupuncture will be presented within this lecture.
Using acupuncture instead of anesthetics to induce analgesia was performed in China many years ago in surgical anesthetization. Although many medical units in China’s cities and rural areas are applying these techniques in operations, it should be pointed out that acupuncture anesthesia is still in the process of development and is of next to no practical and even less scientific value in the western world. Recently acupuncture anesthesia has been converted into acupuncture-assisted anesthesia in China. Acupuncture-assisted anesthesia reduces the demands of anesthetics and the post-operative complications and has a potential organ protective effect. Therefore, acupuncture may be an excellent adjunct to reduce peri- and postoperative pain. This conclusion, however, has to be explored in detail in further scientific studies.
On the basis of studies performed in Graz, analgesic effects of laser acupuncture have been scientifically investigated. Laser acupuncture relieves pain through both anti-inflammatory and analgesic effects and it can be a useful and safe method for pain management.
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The studies were supported by the Austrian Ministry of Science, Research and Economy (BMWFW) and the German Academy of Acupuncture (DAA).
Dr A.C. Sant’Ana MD, Bauru Estadual Hospital, Brazil
To see what we look at: mechanisms for an integrative vision
The multiple dimensions of any defined object can sometimes be arbitrarily shortened or enlarged, depending on the subjective perspectives that are adopted by the way we focus our gaze on them. And as a complementary aspect, the resulting images can determinate the restricted limits or the endless boundaries of our interpretation on the objects worth and reach, as well as its possible involvements with the encircling environment. In this presentation we discuss the cibernetic mechanisms and concepts that we can make use to achieve a more thorough and diversified image of the objects as a whole.
Crossing and bending: integrating the complex paths of pain
Biological systems present and develop their functional behavior regulated by a systemic organization, where each system can assume different and simultaneous rules according to its placement both in micro and macro environments. This everchanging and holographic interrelations, with their dynamic responses to the challenges of the surroundings, may define the respective biofunctional adaptations of the structures. The present discussion aims to address the generalities of the integration by networks and the association by multifolded tissues in the build up for pain recognition and interdisciplinary treatment.
Dr Daniela Litscher. Msc, PhD, TCM Medical University of Graz, Austria
Stimulation of the ‘pain’ ear acupuncture point Shenmen with yellow and green laser – a cross over study in volunteers
One of the most commonly used auricular acupuncture point selected for different pain treatment is Shenmen. The Shenmen point at the ear has been recognized as having wide application. This master point alleviates pain, stress, tension, anxiety, depression, insomnia, restlessness and excessive sensitivity. It was one of the first points emphasized for the application of ear acupuncture for the detoxification from addictive drugs and for the treatment of alcoholism and substance abuse.
Within the study presented in this lecture we have stimulated the ear acupoint Shenmen with two different kinds of laser (yellow and green) in 22 healthy volunteers (13 female, 9 male; mean age + SD = 25.3 + 4.1 y; range 21 – 36 y). Both, yellow (589 nm) and green (532 nm) laser (30 mW; 500 µm) were used in a cross-over study each for duration of 15 min in the same volunteers in different sessions.
Most prominent finding was that systolic blood pressure deceases significantly (p = 0.048) after yellow laser stimulation. Heart rate also decreases significantly (p < 0.001) whereas heart rate variability (LF/HF; p < 0.001) increased. The effects were more pronounced in female than in male.
In addition temperature and microcirculation was measured and the increases are demonstrated at the different locations using imaging methods.
The results of the study show evidence of the effect of auricular laser acupuncture. However, a comparison with other studies was impossible because it is the first study using yellow and green laser stimulation at the ear.
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The study was supported by the Austrian Ministry of Science, Research and Economy (BMWFW) and the German Academy of Acupuncture (DAA).
Dr Konstantina Theodoratou MD, Med Psych. MSc Guangzhou University, President of Icmart, President of Samag, Athens, Greece
Neuroscience of mental pain and acupuncture
Pain is an unpleasant sensory and emotional experience, an incredibly complex perceptual system. Physical and psychological pain are close related. Research from animals and humans supports the idea that both types of pain rely on same neurobiological and neural substrates, involved in pain processing.
What is the “psychological pain” that leads people to lose their joy of living? Why does depression feel so bad? What actually are our emotions and what controls them? In psychology, emotion is often defined as a complex state of feeling that results in physical and psychological changes that influence thought and behavior. The study of emotion is a subfield of neuroscience, the affective neuroscience, which tries to understand the neural mechanisms behind how the brain creates emotional response.
A major distinction between physical and psychological pains is the lack of a sensory component to psychological pain. Does pain is something that happens in our mind? Medical science is always studying the connection between mind and body. Of particular interest is pain perception as a phenomenon with complex physical and mental components.
Recent research has provided evidence of a central pain modulation system. Neuroimaging data in humans suggest that acupuncture may modulate activity in many brain areas. The wide range of physical effects exerted by acupuncture and its efficacy for a compendium of clinical pathologies suggest that the brain may be responsible for transducing the needle stimulus into signals aimed at maintaining homeostatic balance within and across functional subsystems. These effects are very important for regulating emotions and most specific emotional pain by acupuncture.
More than 30% of the planet’s population receive acupuncture treatment to relieve painful pathologic conditions. According to modern science, acupuncture’s effects on central action causes changes on different brain regions resulting on a balancing function and reducing physical and /or emotional pain.
Workshop: Management of pain in integrative medicine
Pain is a universal phenomenon with complex biochemical, neural, and mental components. Pain is not just a tissue damage and is not created at the tissues. Pain is a function of the brain. The very moment brain activity may alter, ignore or enlarge, the incoming message. Understanding how neural circuits, synapses and neurotransmitters are altered in people feelings is critical in the development of new treatments and prevention strategies.
Acupuncture causes changes in brain chemistry sensation and involuntary body functions: studies have shown that acupuncture may alter brain chemistry by changing the release of neurotransmitters and neurohormones. Acupuncture also has been documented to affect the parts of the central nervous system related to sensation and involuntary body functions, such as immune reactions and processes whereby a person’s blood pressure, blood flow and body temperature are regulated. As we understand the network involved in processing pain, we hope we can use that to lead to more targeted treatment that will change the functioning of specific areas of the brain.
To date, pain relief is the most thoroughly studied application of acupuncture.
Dr Michael Tarabe, MD, MSc, PhD, Dipl. BSBRM, FEBOPRAS, Plastic Surgeon, Athens, Greece
Scientific basis of pain management in auriculotherapy: State of the art
The fundamental theory of Auricular Acupuncture is the existence of a microsystems of the organs and various metabolic functions of the human body on the Ear surface. This microsystem can work either diagnostically or and therapeutically.
Various recent publications support the effects of Ear Acupuncture in the management of chronic and acute pain as it interferes by stimulating the vagus nerve on the ear concha , which in turn produces an anti-inflammatory action by releasing pro inflammatory cytokines and promoting the formation of a special cholinergic receptor on the macrophage surface and inhibiting at the same time of the production and release of the TNF.
Detailed protocols are presented for acute and chronic pain management .
References
- Chung WY, Zhang HQ, Zhang SP. Peripheral muscarinic receptors mediate the anti-inflammatory effects of auricular acupuncture. Chin Med. 2011
- Zhao YX, He W, Gao XY, Rong PJ, Zhu B. Effect of electroacupuncture of auricular concha on inflammatory reaction in endotoxaemia rats Zhen Ci Yan Jiu. 2011
- Krahl SE, Vagus nerve stimulation for epilepsy : A review of the peripheral mechanisms. Surg Neurol Int. 2012
- Bush V, Zeman F, Heckel A, Menne F, Ellrich J, Eichhammer P. The effect of transcutaneous vagus nerve stimulation on pain perception- An experimental study. Brain Stimul. 2012
- Tracey KJ. Physiology and immunology of the cholinergic antiinflammatory pathway. J Clin Invest 2007
- Diamond B, Tracey KJ Mapping. The immunological homunculus. Proc Natl Acad Sci. 2011
Analgesic Efficacy and Safety of Curcuminoids in Clinical Practice: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
The global tradition combined with modern clinical studies leads us to the specialized use of medicinal plants to protect the quality of life of humans. The bioavailable extracts of turmeric and bowels effectively act on inflammation and pain.
Low Level Laser Therapy (LLLT) Transmission of energy at low power but with high effectiveness. Basic Principles and Applications in Muscular-Skeletal and Neuropathic Pain.
From 1970 and onwards since the first invention of the laser applications on surgical treatments there have been designed several randomized double-blind clinical trials, so as to understand the effects of the light not only on local therapies but also on secondary metabolic pathways. The focus has always been on the activation mechanisms of systemic responses from the human body. The membranes of the human cells have many channels and proteins that act as enter-exit control factors of substances that move across them. This movement can cause cascades of chemical reactions and thus activate the necessary metabolic responses. The easier way to affect the metabolic responses is to target at these “control”- photoreceptors. Studies of spectroscopy have revealed the range of absorbance of these photoreceptors molecules and thus the effect on metabolic pathways has been feasible. Most of the biological molecules absorb energy at 400nm-904nm and most of the activations take place at the red and infrared spectrum (600-900nm). We can achieve significant results on a short time period by selecting the right target and the appropriate parameters such as energy density, pulse of the wave and site of the application. Bibliographic references indicate several conflicting results, since the modification of the parameters according to the different models plays an important role. The Arndt Schulz law has to be taken into account in order to modify the suggested energy dosages from the WALT tables according to the needs of each patient. In most of the cases of muscular skeletal issues infrared pulsed lasers with 2-3 treatments weekly are followed. In cases of neuropathic pain mixtures of red and infrared light for 20 treatments are used.
Dr George Lazarou , MD, MSc, PhD, Orthopaedic Surgeon, Athens, Greece
Acupuncture in low back pain
In low back pain the physician’s role is to perform a clinical examination of the patient and result in the diagnostic triage: serious spinal pathology, nerve root/radicular pain and non-specific low back pain. Medical acupuncturists are better equipped for this role, since non-medical acupuncturists may be in a disadvantage, regarding the evaluation of the patient as a whole. On the other hand modern western physicians come to realize that history taking and clinical examination have been severely downgraded in favor of diagnostic and therapeutic procedures that should not be deemed indispensable, at least not a priori. Therefore, the role of the medical acupuncturist could vary according to the initial triage. In serious spinal pathology he should insist on a full diagnostic work out and possibly postpone acupuncture until after a final diagnosis has been confirmed, in radicular pain imaging is usually necessary, since the efficacy of acupuncture is usually reduced and it should probably be combined with other procedures, while in the case of non-specific low back pain acupuncture may be the first and possibly also the only procedure needed.
Dr Aggeliki Tsirigoti, Dental Surgeon, Athens, Greece
Toothache and acupuncture
Dental pain is a symptom frequently encountered in the daily practice. There is the post operative pain concerning pain after the intervention of the dentist and it has to do with pain after a tooth extraction,gingivectomy or another operation to the tooth or to the periodontal tissues.
Usually when we refer to toothache we also mean the pain before the dentist’s intervention and may be from pulpitis,dental or periodontal abcess e.tc resulting from increased sensitivity of the teeth to thermal stimuli to severe toothache, headache, a swollen cheek, fever, insomnia.
Tooth pain in Traditional Chinese Medicine is usually caused by invasion of Toxic-Heat,accumulation of Heat in the Stomach,hyperactivity of Deficient Kidney-Fire,deficiency of Kidney Yang and bacterial infection.
Acupuncture is one of the most powerful techniques and approaches in dealing with dental pain.Early application of acupuncture after an oral operation could be helpful in the prevention of post operative pain and accelerate the healing process.
Dr Evdokia Tsalkama, DVM Equine Practitioner, Thessaloniki, Greece
Pain management of animal patients with the use of acupuncture (from food producing to companion animals)
Acupuncture is an integrative medical modality fully incorporated into every day clinical veterinary medicine. Successful pain management is a mainstream for veterinary acupuncture. Either food producing or companion animals they all suffer pain inevitably. Managing pain suffering animals is not always cost effective, productivity levels drop suddenly and medicines although often effective tend to produce unwanted side effects and prolong withdrawal periods for meat, milk, etc. On the other hand, welfare and quality of life of both animals and human partners is getting worse bit by bit. A new trend from people that tends to increase is the pursuit of less invasive, less chemical, more natural treatments, not only for themselves but for the animals they care for as well. Acupuncture although an ancient medical treatment modality is reinvented offering minimally invasive, natural therapy able to treat and manage pain in animals and a future arsenal for veterinary practitioners.
Dr Achilles E. Georgiadis, MD, PhD, Rheumatologist, Athens, Greece
Chronic Back Pain (CBP): A Revolutionary Approach to the Disease’s Etiology and Treatment
Dr Georgios J. Bellos, MD, PhD, MR CGP, MEPMA, Athens, Greece
Chronic pain (in diabetic patients) as a consequence of metabolic inflammation (metainflammation)- The new holistic approach including modern medical acupuncture
Diabetic polyneuropathy (DPN) represents a major health problem, associated with excruciating neuropathic pain, increased morbidity and impaired quality of life, affects approximately 30% of hospital-based populations, 20% of community-based samples, and 10% of the diabetic population identified by screening. Chronic painful DPN is present in 13-26% of diabetic patients. Between 25% and 62% of patients with idiopathic peripheral neuropathy have prediabetes. Among pre-diabetic subjects, 11-25% exhibit peripheral neuropathy and 13-26% neuropathic pain.
Mortality is higher in people with cardiovascular autonomic neuropathy (CAN). The overall mortality rate over periods up to 10 years was 27% in patients with DM and CAN detected, compared with a 5% mortality rate in those without evidence of CAN. Biomarkers associated with peripheral diabetic neuropathy: elevated TSH, high serum CysC, inverse association with serum total bilirubin, vit.D deficiency, increased serum uric acid levels, increased serum TNF-a levels, and finally as a surrogate marker the calcium and zinc heterocomplex protein: calprotectin. The most important etiologic factors are poor glycemic control, age, diabetes duration, visceral obesity, height, hypertension, age, smoking, hypo-insulinemia, and dyslipidemia. BUT recently and according to -omics science technology all these factors are forgathered in the pathophysiology of chronic subclinical inflammation with neuro-immune-micribiome-metabolic origins. Impairment of small nerve fibers could be the earliest detectable sign. There is currently no specific treatment approved for diabetic neuropathy, a huge unmet clinical need since up to half of all patients with diabetes will eventually develop neuropathy. The only therapeutic strategy shown to prevent development or curtail progression of neuropathy is tight glucose control. But even the approved treatments for diabetic neuropathy pain are not ideal.
As a result, there is growing interest in nonpharmaceutical approaches such as a-lipoic acid, to the treatment of both diabetic neuropathy itself and the associated pain, with a plethora of vitamins, vitamin complex combinations, and other agents as Electro-Acupuncture emerging that purport. One of the most exciting areas is electrical stimulation that can alter immune function. This new research gives hope of understanding how acupuncture works to integrate complex circuits throughout the body from points that has no obvious neuronal or vascular origin as it happens in the Axon Reflex for Pain and Inflammation. The vagus nerve innervates the GI tract and regulates it with reflex changes in secretion of molecules and movement, but it also is connected to centers related to eating and metabolism. Diabetes has been known to promote-ed inflammation elevated by a variety of cytokines and hormones. Immune cells enter the adipose tissues and cause a low-grade inflammation that is caused also by neuronal reflex circuits connected to the hypothalamus centers. Studies are being done using vagus stimulation in metabolic diseases with hopeful results (see, main BIBLIOGRAPHY by Dr. Kevin Tracey, 2002-17).
Dr F. Christidi, MSc, PhD, Clinical Neuropsychologist, Greece
Neuroimaging evidence of pain modulation in headache disorders
The perception of pain is an active process, resulting for the coordinated activity in a number of brain regions that integrate sensory inputs with ongoing memories and internal representations. The experience of pain results from the convolution of brain processing circuits which represent the so-called “pain matrix”. The “pain matrix” is further divided into further anatomico-functional sub-systems that encode signals with regards to location, intensity and qualitative features of sensations and mediate the unpleasant affective features of pain. The immediate perception of the pain can be furthered modulated by higher-order processes driven by internal states and emotional contexts. Specific structural brain connections (e.g. white matter pathways) and brain regions are included in the above-mentioned pain sub-systems. Pain is inherent to non-acute (a) primary or (b) other secondary headaches, such as (a) migraine or tension-type and (b) medication-overuse headache, respectively. The unprecedented evolution and use of advanced neuroimaging techniques enables the in-vivo study of the structural and functional neuroanatomical profile of the brain and provides strong evidence for the involvement of the parts of the pain matrix in headache-related disorders. Changes in the volume of gray matter regions and the microstructural integrity of white matter connections, as well as the functional network connectivity between brain regions that are involved in somatosensory, affective, and higher-level cognitive aspects of pain are more-and-more identified using different neuroimaging techniques in non-acute headaches. An interesting and on-going field of study always remain the short-term and long-term effects of pharmacological and/or non-pharmacological pain-related interventions upon the structural and functional neuroanatomical underpinnings of the pain matrix in headaches.
Dr E. Georgiadis MD, PhD, Μolecular Βiologist, Athens, Greece
The placebo and nocebo effect in the treatment of chronic pain
Placebo and nocebo phenomena are two sides of the same coin. They are defined as the positive or negative effect of a certain therapy when administered to a patient. According to the literature, both placebo and nocebo responses are the result of brain activity, induced by psychological stimuli and processes, such as expectation and learning. Indeed, studies show that placebo mimics the action of real therapies and induces the endogenous secretion of opioids in animals and humans alike. Thus, expectations of pain relief, feelings and various psychosocial factors all contribute to the analgesic effect of placebo. On the other side, nocebo effect is associated with a large number of adverse events and can negatively influence the outcome of a prescribed therapy. Nocebo effects also have a psychosomatic basis and could also be triggered by involuntary negative communication from the doctor to the patient, for example negative comments about the progression of the disease. In some cases of chronic pain, recession of pain has been observed when placebo or sham therapy is administered after pharmacologic therapy with analgesics. In some other cases, administration of placebo showed statistically significant results in pain even after patients were informed about its use. In some diseases, placebo proved to be more effective than expected compared with real therapies, either pharmacologic or complementary. Therefore, the clinical significance of placebo and nocebo responses leads the medical community to reevaluate common medical approaches and incorporate placebo and nocebo in the daily medical practice in combination with existing therapies.