Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture

May 10, 2017
Brain. 2017 Mar 2. doi: 10.1093/brain/awx015.
By Maeda Y, Kim H, Kettner N, Kim J, Cina S, Malatesta C, Gerber J, et al.,

Abstract
Carpal tunnel syndrome is the most common entrapment neuropathy affecting the median nerve at the wrist. Acupuncture is a minimally invasive and conservative therapeutic option, and while rooted in a complex practice ritual, acupuncture overlaps significantly with many conventional peripherally-focused neuromodulatory therapies. However, the neurophysiological mechanisms by which acupuncture impacts accepted subjective/psychological and objective/physiological outcomes are not well understood. Eligible patients (n = 80, 65 female, age: 49.3 ± 8.6 years) were enrolled and randomized into three intervention arms: (i) verum electro-acupuncture 'local' to the more affected hand; (ii) verum electro-acupuncture at 'distal' body sites, near the ankle contralesional to the more affected hand; and (iii) local sham electro-acupuncture using nonpenetrating placebo needles. Acupuncture therapy was provided for 16 sessions over 8 weeks. Boston Carpal Tunnel Syndrome Questionnaire assessed pain and paraesthesia symptoms at baseline, following therapy and at 3-month follow-up. Nerve conduction studies assessing median nerve sensory latency and brain imaging data were acquired at baseline and following therapy. Functional magnetic resonance imaging assessed somatotopy in the primary somatosensory cortex using vibrotactile stimulation over three digits (2, 3 and 5). While all three acupuncture interventions reduced symptom severity, verum (local and distal) acupuncture was superior to sham in producing improvements in neurophysiological outcomes, both local to the wrist (i.e. median sensory nerve conduction latency) and in the brain (i.e. digit 2/3 cortical separation distance). Moreover, greater improvement in second/third interdigit cortical separation distance following verum acupuncture predicted sustained improvements in symptom severity at 3-month follow-up. We further explored potential differential mechanisms of local versus distal acupuncture using diffusion tensor imaging of white matter microstructure adjacent to the primary somatosensory cortex. Compared to healthy adults (n = 34, 28 female, 49.7 ± 9.9 years old), patients with carpal tunnel syndrome demonstrated increased fractional anisotropy in several regions and, for these regions we found that improvement in median nerve latency was associated with reduction of fractional anisotropy near (i) contralesional hand area following verum, but not sham, acupuncture; (ii) ipsilesional hand area following local, but not distal or sham, acupuncture; and (iii) ipsilesional leg area following distal, but not local or sham, acupuncture. As these primary somatosensory cortex subregions are distinctly targeted by local versus distal acupuncture electrostimulation, acupuncture at local versus distal sites may improve median nerve function at the wrist by somatotopically distinct neuroplasticity in the primary somatosensory cortex following therapy. Our study further suggests that improvements in primary somatosensory cortex somatotopy can predict long-term clinical outcomes for carpal tunnel syndrome.

 

Acupuncture For Coccyx Pain

March 30, 2017
25-year-old Beth suffered from a bad pain in her coccyx for 6 months. The pain came every month for a few days and mainly at night time. It was so intense and pain killers didn't help at all. When Beth described the symptom to me, I suspected it was something to do with her menstrual cycle. But I was told that she'd had a coil put in 2 years ago and had no periods since then. On physical examination, I found some sensitive points around her sacrum area and chose two of them for acupuncture. M...
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Acupuncture For Thoracic Outlet Syndrome

February 13, 2017
43-year-old Linda had been suffering from a pain in her left shoulder and chest for a month. The pain was excruciating and radiating down into her left arm. It had come on gradually over a few days without any clear incident associated with symptoms. Linda could only think of a fall about 10 days before the pain started, in which she fell on her left wrist. The doctor gave her pain killers which hadn't help at all. Then she tried a few sessions of sports massage but couldn't get any relief. T...

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Acupuncture for Headaches (Occipital Neuralgia)

January 20, 2017
68-year-old Patricia has had headaches for a week. The pain begins in the left side of her upper neck and back of the head and sometimes radiates forward toward the left eye. It is an intense stabbing pain, and the bouts of pain are quite frequent. Since she had benefited a lot from my acupuncture treatments in the past, Patricia decided to see me again for this problem. According to the character of the pain, I believed this condition was occipital neuralgia, which is caused by damage to the...

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Battlefield acupuncture: Opening the door for acupuncture in Department of Defense/Veteran's Administration health care

January 6, 2017
Nurs Outlook. 2016 Sep-Oct;64(5):491-8.
By Walker PH 

Abstract
Battlefield acupuncture is a unique auricular acupuncture procedure which is being used in a number of military medical facilities throughout the Department of Defense (DoD). It has been used with anecdotal published positive impact with warriors experiencing polytrauma, post-traumatic stress disorder, and traumatic brain injury. It has also been effectively used to treat warriors with mu...

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Electroacupuncture For Patients With Diarrhea-predominant Irritable Bowel Syndrome or Functional Diarrhea: A Randomized Controlled Trial

October 27, 2016
http://www.ncbi.nlm.nih.gov/pubmed/27310980
Medicine (Baltimore). 2016 Jun; 95(24):e3884.
By Zheng H

Abstract

Diarrhea-predominant irritable bowel syndrome (IBS-D) and functional diarrhea (FD) are highly prevalent, and the effectiveness of acupuncture for managing IBS-D and FD is still unknown. The aim of this study was to compare the effectiveness of electro-acupuncture with loperamide. It was a prospective, randomized, parallel group controlled trial. A total of 448 participants were randomly a...

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