The effect of acupuncture duration on analgesia and peripheral sensory thresholds
The effect of acupuncture duration on analgesia and peripheral sensory thresholds
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DOI：
10.1186/1472-6882-8-18
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发表时间：
2008-05-01
影响因子：
--
通讯作者：
Yaksh, Tony
中科院分区：
文献类型：
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作者：
Leung, Albert Y.;Kim, Susan J.;Yaksh, Tony
背景：针灸提供了一种外周刺激缓解疼痛的方法。然而，针灸缓解疼痛的详细神经机制仍然知之甚少，有关最佳治疗设置的信息仍然不足。以前的研究与短脉冲的单方面电针（EA）在肌腱肌经（TMM）治疗模型疼痛表现出短暂的皮肤相关的双边镇痛效果与相应的外周模态特异性感觉阈值的改变。然而，在这种特定的治疗模型中，EA持续时间对镇痛效果的影响尚不清楚。为了获得机械和临床上重要的信息，关于EA镇痛，目前的前瞻性交叉研究评估镇痛和热感觉阈值在TMM treatment model.Methods的EA持续时间的影响：基线外周感觉阈值测量在预先标记的测试站点沿着内侧方面（肝和脾经络）的双侧下肢。向测试部位递送5秒热痛刺激，并记录相应的疼痛视觉模拟量表（VAS）评分。随机测试三种不同的EA（5Hz）刺激持续时间（5、15和30分钟），间隔至少一周。在每次EA会话的最后10秒，向测试部位递送5秒的受试者特定HP刺激。记录电针过程中及电针后相应的疼痛及德气感（刺痛）VAS评分。在EA刺激后立即、30和60分钟重复测量。结果：电针刺激时间、部位（大腿与小腿）、同侧与对侧对感觉阈值和HPVAS评分的主效应均显著（P < 0.01），但时间效应无显著性差异。使用HP VAS观察到相似的时间和位置效应，较长刺激持续时间（15和30分钟）显示起效较慢，但比短刺激持续时间（5分钟）更可持续的双侧镇痛获益。15分钟的刺激导致在早期发作的镇痛效果比30分钟的刺激paradig.Conclusion：较长的持续时间的EA刺激提供了一个更持久的镇痛效益，热伤害性刺激比较短的刺激持续时间。冷阈值的增加与持续的温暖阈值温度升高观察在较长的持续时间的EA表明，作为EA的持续时间延长，有一个逐渐转变，从最初的主要是脊髓介导的镇痛作用的superspinally介导的调制机制的热痛。15分钟的刺激似乎是治疗下肢急性疼痛的最佳设置。
Background: Acupuncture provides a means of peripheral stimulation for pain relief. However, the detailed neuronal mechanisms by which acupuncture relieves pain are still poorly understood and information regarding optimal treatment settings is still inadequate. Previous studies with a short burst of unilateral electroacupuncture (EA) in the Tendinomuscular Meridians (TMM) treatment model for pain demonstrated a transient dermatomally correlated bilateral analgesic effect with corresponding peripheral modality-specific sensory threshold alterations. However, the impact of EA duration on the analgesic effect in this particular treatment model is unknown. To obtain mechanistically and clinically important information regarding EA analgesia, this current prospective cross-over study assesses the effects of EA duration on analgesia and thermal sensory thresholds in the TMM treatment model.Methods: Baseline peripheral sensory thresholds were measured at pre-marked testing sites along the medial aspects (liver and spleen meridians) of bilateral lower extremities. A 5-second hot pain stimulation was delivered to the testing sites and the corresponding pain Visual Analog Scale (VAS) scores were recorded. Three different EA (5Hz) stimulation durations (5, 15 and 30 minutes) were randomly tested at least one week apart. At the last 10 seconds of each EA session, 5 seconds of subject specific HP stimulation was delivered to the testing sites. The corresponding pain and EA VAS scores of de qi sensation (tingling) during and after the EA were recorded. The measurements were repeated immediately, 30 and 60 minutes after the EA stimulation. A four-factor repeat measures ANOVA was used to assess the effect of stimulation duration, time, location (thigh vs. calf) and side (ipsilateral vs. contralateral) of EA on sensory thresholds and HP VAS scores.Results: A significant (P < 0.01) main effect of time and location with warm, cold and hot pain thresholds at the four testing sites without any significant difference in duration effect was observed. Similar time and location effects were observed with HP VAS with the longer durations (15 and 30 minutes) of stimulation showed a slower onset, but a more sustainable bilateral analgesic benefit than the short stimulation duration (5 minutes). The 15-minute stimulation resulted in an earlier onset of analgesic effect than the 30-minute stimulation paradigm.Conclusion: Longer durations of EA stimulation provide a more sustainable analgesic benefit to hot noxious stimulation than a shorter duration of stimulation. The increase of cold threshold with sustained warm threshold temperature elevation as observed in the longer durations of EA suggests that as the duration of EA lengthened, there is a gradual shifting from an initial predominantly spinally mediated analgesic effect to a supraspinally mediated modulatory mechanism of thermal pain. The 15-minute stimulation appeared to be the optimal setting for treating acute pain in the lower extremities.