Acupuncture with moxibustion is more effective than drugs for the alleviation of knee pain. Research published in the Anhui Medical and Pharmaceutical Journal demonstrates that acupuncture combined with moxibustion outperforms nonsteroidal anti-inflammatory medications (NSAIDs) for the treatment of knee osteoarthritis. NSAIDs provided a faster onset of initial effective therapeutic actions. However, acupuncture provided superior long-term relief from pain and improvements in range of motion.
Two study groups were compared. Group one received acupuncture plus moxibustion at a rate of once per day, five times per week, for a total of four weeks. Group two received the NSAID diclofenac in 75 mg time-release enteric coated capsules, once per day, for twenty days. The NSAID group had a 33.33% total effective rate. The acupuncture plus moxibustion group had a 63.33% total effective rate.
The primary acupuncture point prescription included the following acupoints:
Xiyan, (M-NLE-16)
Heding, (M-LE-27)
A secondary set of acupuncture points was added dependent upon differential diagnostics in the Traditional Chinese Medicine (TCM) system. For stomach yangming channel related knee osteoarthritis, the following acupoints were added:
Liangqiu, ST34
Zusanli, ST36
Futu, ST32
For gallbladder shaoyang related disorders, the following were added:
Yanglinquan, GB34
Xiyangguan, GB33
Waiqiu, GB36
Juegu, GB39
For bladder taiyang related disorders, the following acupoints were added:
Weizhong, BL40
Weiyang, BL39
Chengshan, BL57
Kunlun, BL60
For spleen taiyin related disorders, the following acupuncture points were added:
Xuehai, SP10
Yinlingquan, SP9
Taibai, SP3
For liver jueyin related conditions, the following acupoints were included:
Xiguan, LV7
Taichong, LV3
Yinbao, LV9
For wind-cold channel blockages, the following acupoints were added:
Quchi, LI11
Dazhui, DU14
Fengchi, GB20
For blood stasis, the following were added:
Taichong, LV3
Geshu, BL17
Xuehai, SP10
For liver and kidney related conditions, the following acupoints were added:
Ganshu, BL18
Shenshu, BL23
Qihai, CV6
Rapid needle insertion was performed. Twisting, lifting, and thrusting manual acupuncture techniques were applied to elicit deqi. After the arrival of deqi, the needle retention time was thirty minutes.
Drugs achieved the most rapid relief from pain. Acupuncture plus moxibustion achieved the highest total effective rate for pain relief and range of motion improvements. NSAIDs were 33.33% effective and acupuncture plus moxibustion was 63.33% effective.
Zhou et al. (2014) had similar findings. . Patients receiving electroacupuncture had a 60% total effective rate and patients receiving manual acupuncture with moxibustion had a 48.89% total effective rate for the treatment of knee osteoarthritis. The primary acupuncture point selection was different and included the following acupoints:
SP10
Xiyan
ST36
SP9
BL23
Sanyinjiao (SP6) was added for patients with continuous pain and Weizhong (BL40) was added for patients with severe pain intensity levels. Although using different clinical protocols, both research teams demonstrated that acupuncture is an effective modality for the treatment of knee osteoarthritis.
Li et al. (2011) find acupuncture effective for the treatment of osteoarthritis. They concluded that electroacupuncture “inhibits osteoarthritis-induced pain by enhancing 5-HT2A/2C [serotonin] receptor activity.” The research team consisted of researchers from the University of Maryland (Baltimore) and Shanxi Medical University. The team made important findings noting that electroacupuncture activates serotonergic neurons and attenuates osteoarthritis pain by activating serotonin receptors that “play an important role in pain modulation at the spinal level.”
References:
Sun K, Huang XY & Wei FL. (2015). Clinical study on the treatment of knee osteoarthritis by acupuncture of Wei’s acupoints. Anhui Medical and Pharmaceutical Journal. 19(8).
Chen B, Fang ZC & Xiong FL. (2011). Acupuncture in treating knee osteoarthritis and improving the patients’ quality of life. Journal of Guiyang College. 33(3): 7-9.
Zhou WC. (2014). Clinical Comparative Study of Electro-acupuncture and Warm Acupuncture on Kidney Marrow Deficiency Syndrome of Knee Osteoarthritis. Journal of Emergency in Traditional Chinese Medicine. 23(8).
Serotonin Receptor 2A/C Is Involved in Electroacupuncture Inhibition of Pain in an Osteoarthritis Rat Model. Aihui Li, Yu Zhang, Lixing Lao, Jiajia Xin, Ke Ren, Brian M. Berman, and Rui-Xin Zhang. Hindawi Publishing Corporation. Evidence-Based Complementary and Alternative Medicine Volume 2011, Article ID 619650, 6 pages.
Acupuncture and herbs restore motility for patients with motor impairments due to sports injuries. Researchers from the Physical Education Institute at Zhengzhou University investigated the effects of Traditional Chinese Medicine (TCM) style acupuncture and herbs on amateur and professional athletes suffering from motor impairments due to the demands of physical training. The researchers concluded that restoration of motility is significant as a result of applying acupuncture and herbs. However, an additive effect was discovered by combining acupuncture and herbs into a therapeutic regimen. The combination therapy produced superior patient outcomes.
Participants in the study suffered from physical motility limitations. Head and neck impairments accounted for 42% of the patients. Upper limb impairments comprised 24.6% and lower limb impairments accounted for 85.4% of participants. Acute physical limitations accounted for 85.4% of participants and 14.6% were patients with chronic motility impairments.
The total effective rate was calculated from a combination of patients in three categories of improvement: cured, effective, and improved. Patients rated as cured had freer movements of the limbs without any limitations and were able to participate in normal physical training. Patients in the effective category had complete resolution of soreness at the affected regions and movement was free and without limitation at lower levels of physically demanding activity. Improved patients had reduced pain levels and patients were able to perform simple exercises.
The total effective rate for the acupuncture only group was 70%. The herbal medicine group achieved a 62% total effective rate. A group receiving both acupuncture and herbal medicine achieved a total effective rate of 84.4%. The researchers concluded that acupuncture combined with herbs is highly effective for the treatment of physical activity induced motility impairments. The combined therapeutic approach is more effective than either treatment modality as a standalone procedure.
Many of the herbs used in the study were selected for their ability to nourish the liver, kidneys, spleen, and stomach. Another major treatment principle was promoting blood circulation. The herbal medicine given to the participants included Gou Qi Zi, Shan Yao, Di Long, DangGui, and related herbs. A decoction was taken once per day by participants for a total of 30 times.
Acupuncture was applied to areas locally at the limbs with 0.30 mm X 40 mm needles. Distal acupoints were also added. Needle retention time was 20 minutes per session. Treatment was given once per day with a grand total of 30 treatments per participant. Acupoints used in the study included:
Yang Xi (LI5)
He Gu (LI4)
Zhou San Li (LI10)
Liang Qiu (ST34)
The research was published in the Bulletin of Science and Technology. This type of research has been conducted in hospitals and universities throughout the world, including the US. At the Healthcare Medicine Institute, we provide acupuncture continuing education courses featuring the treatment of pain and motor impairment related disorders. To learn about the treatment of plantar fasciitis for state acupuncture CEUs and NCCAOM PDAs, click the following: Plantar Fasciitis And Acupuncture. To view an example of a continuing education course on the treatment of wrist pain and carpal tunnel syndrome, click on the following: Wrist Pain And Carpal Tunnel Syndrome.
References:
Ji, H. (2014). Traditional Chinese Medicine Acupuncture and Clinical Research for the Treatment of Motility Limited Physical Activity. Bulletin of Science and Technology, 30 (7).
Sun, H. (2006). Challenges Faced by Acupuncture Technique and the Strategies to Overcome. Journal of Chinese Acupuncture, 26 (4).
Recent research indicates acupuncture is an effective and safe treatment for heel pain. Heel pain is a common foot condition often characterized by intense pain, especially when placing weight onto the foot. Pain on the back of the heel often indicates achilles tendinitis and pain on the underside of the heel often indicates plantar fasciitis.
One of the most common causes of heel pain, plantar fasciitis involves pain and inflammation of the band of tissue running across the bottom of the foot. The new research indicates that acupuncture is effective for plantar fasciitis, achilles tendinitis and many other forms of heel pain. Treatments for heel pain are featured in the HealthCMi online acupuncture CEU and PDA course entitled Plantar Fasciitis.
Biomedical approaches to heel pain treatment include behavioral therapy, nonsteroidal antiinflammatory drugs (NSAIDs), corticosteroid injections, small needle knife therapy, block therapy, shockwave therapy and surgery. Traditional Chinese Medicine (TCM) historical records document success in the treatment of heel pain using acupuncture. This new scientific investigation confirms the historical data.
The researchers from Guangzhou Dongsheng Hospital and Guangzhou Social Welfare House examined 19 separate clinical investigations and discovered that 16 of the 19 studies made extensive use of ahshi acupuncture points to achieve optimal patient outcomes. In one investigation carried out by Xu Xuemeng et al., 66 patients were randomly divided into an acupuncture group and a control group. The acupuncture group received filiform acupuncture needle method treatment and the control group received triamcinolone acetonide acetate injections and local blocking therapy. The results were assessed six months following the treatment. The acupuncture group achieved an effective rate of 97% and the drug therapy group had a 76% effective rate.
Studies also indicate needling combined with moxibustion have a positive effect on patient outcomes. In one investigation carried out by He Yucai et al., 75 cases of heel pain were treated with acupoints Yongquan (KI1), Rangu (KI2), Taixi (KI3), Sanyinjiao (SP6), Chengshan (BL57) and ashi acupoints on the affected side. During the treatment, needles were quickly inserted perpendicularly using the lifting and thrusting method and mild reinforcing-reducing manipulation methods were applied. Needles were immediately withdrawn after a deqi sensation was achieved.
After needling, moxibustion was applied to ashi points on the heel. The moxibustion was applied for 10 minutes. Acupuncture and moxibustion were administered once per day for a period of six days, comprising one course. The second course started two days after the completion of the first. After two courses of treatment, the acupuncture group significantly outperformed the control group that was treated with ibuprofen sustained release capsules and the herbal formula Zhuanggu Guanjie Wan (Strengthening Bone and Joint Pills). Based on the 19 reviewed studies that were performed in the past five years, the researchers conclude that acupuncture is safer, easier to apply, and more effective than conventional treatments for heel pain.
TCM Theory
The researchers give a historical account of TCM theory for the treatment of heel pain. In TCM theory, heel pain is often categorized as an illness of Numbness of Kidney or Numbness Syndrome. Heel pain often occurs in middle-aged or elderly people and is therefore in accordance with the TCM theory of “kidney governing bone.” A primary principle of acupuncture treatment is tonifying kidney Qi, warming the Du Channel and invigorating collaterals to unblock numbness and stop pain. To emphasize the importance of tonifying kidney Qi and Yin, acupuncture is mostly applied to the acupoints on kidney and bladder channels plus ashi points. To learn more about heel pain including plantar fasciitis, visit the HealthCMi webpage featuring the acupuncture continuing education CEU course entitled Plantar Fascitis.
Reference:
Tang, Cuanqi, et al. “Progress of Clinical Research on Acupuncture and Moxibustion for Heel Pain.” World Chinese Medicine 9.1 (2014): 120-123.
Acupuncture Unlocks Frozen Shoulder Pain Research
10 December 2013
Researchers conclude that acupuncture effectively reduces frozen shoulder pain and restores functionality. Frozen shoulder, also known as adhesive capsulitis, is a disorder of the connective tissue in the rotator cuff region wherein there is pain, inflammation and motor impairment. All patients in the study suffered from shoulder periarthritis resulting in adhesive capsulitis. Two types of acupuncture were compared. Local acupuncture points scored a 71.8% effective rate and abdominal style acupuncture scored a 92.4% effective rate. The researchers concluded that acupuncture relieves frozen shoulder pain and improves shoulder functional ability.
A group of 157 cases of shoulder periarthritis characterized by adhesive capsulitis was randomly divided into 2 groups. Group 1 consisted of 79 patients who received abdominal style acupuncture. The acupuncture points used on these patients were CV12 (Zhongwan), KI17 (Shangqu) and ST24 (Huaroumen). Group 2 consisted of 78 patients who received acupuncture at local body style points: LI15 (Jianyu), TB14 (Jianliao), SI9 (Jianzhen). Treatment was administered at a rate of 3 times per week until a total of 10 treatments were achieved. The effective rate for the abdominal acupuncture group scored significantly higher than the local acupuncture group in this research conducted at Zhejiang Hospital of TCM, China.
German researchers came up with similar results in related research. Researchers at Ruhr-University Bochum (Orthopedic Surgery and Research) concluded that acupuncture is an effective alternative to conventional orthopedic treatments for chronic shoulder pain. A total of 424 patients were involved in the study. Each received 15 acupuncture treatments over a period of 6 weeks. Orthopedists were given rudimentary training in acupuncture and administered all acupuncture treatments. This is distinctly different than the Chinese study wherein acupuncture was applied by highly trained, licensed acupuncturists.
Three groups were compared in the German study. Group 1 of received true acupuncture. Group 2 received sham acupuncture. Group 3 received conventional orthopedic care. In a 3 month follow-up, the true acupuncture group had a 65% recovery rate, the sham acupuncture group had a 24% recovery rate and the conventional orthopedic group had a 37% recovery rate.
In another recent study of 17,922 patient outcomes, researchers determined that acupuncture is effective for the treatment of neck and back pain, osteoarthritis, headaches and shoulder pain. The researchers concluded, “Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option.” This large sample size meta-analysis included only randomized controlled trials with placebo (sham) controls. Additionally, the current episode of pain studied needed to be at least 4 weeks in duration and the follow-up needed to be no less than 4 weeks after the initial acupuncture treatment. Strict controls were also placed on data extraction, quality assessment, data synthesis and analysis. As such, the results are drawn from a quality sample and conclusions are drawn from quality investigations.
The investigators set out to create a review based on a high quality methodology. Randomized controlled trials of low quality were not admitted into the meta-analysis. The researchers included investigators from the Departments of Epidemiology and Biostatisitcs at Memorial Sloan-Kettering Cancer Center in New York City. Other researchers hailed from the Center for Outcomes and Policy Research Dana Farber Cancer Institute in Boston, Massachusetts and other prestigious institutions including the University of York, the Group Health Research Institute in Seattle, Washington, the University of Southhampton and other top notch institutions.
Many high quality investigations have been completed in the last several years on the efficacy of acupuncture for the treatment of chronic pain and other conditions. This includes both primary and secondary research using only randomized controlled trials. This latest research on the efficacy of acupuncture for the treatment of shoulder pain assists efforts in the proper integration of acupuncture into conventional pain management protocols.
References:
Mo, X. F., L. H. Xuan, Y. B. Jin, X. H. Cheng, and B. Y. Yu. "[Efficacy observation on abdominal acupuncture for adhesion-stage shoulder periarthritis]." Zhongguo zhen jiu= Chinese acupuncture & moxibustion 33, no. 9 (2013): 847-849. Department of Acupuncture and Moxibustion, Zhejiang Hospital of TCM, Hangzhou, China.
Pain. 2010 Oct;151(1):146-54. Epub 2010 Jul 23. German Randomized Acupuncture Trial for chronic shoulder pain (GRASP) - a pragmatic, controlled, patient-blinded, multi-centre trial in an outpatient care environment. Molsberger AF, Schneider T, Gotthardt H, Drabik A.
Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis. Arch Intern Med. Published online September 10, 2012. doi:10.1001/archinternmed.2012.3654.
