Qi Spot

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)

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

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>