A Possible Correlation Between Auricular Angiomas and Breast Cancer Through Auricular Acupuncture Diagnosis: An Observational Case-Control Study.

Introduction Auricular acupuncture (AA) can be used for both diagnosis and therapy. Diagnosis done with AA has become more prominent, with inspection by evaluating skin alterations considered the most important step. Literature on AA diagnosis in cancer patients is scarce. Globally, breast cancer (BC) is the most commonly diagnosed cancer in women. Materials and methods Subjects accessing the outpatient Breast Unit Clinic of Padua for BC were evaluated for auricle angiomas, with collected data including a number of angiomas, Romoli's Sectogram sector of identified angiomas, laterality of the auricle with the angioma, age, and laterality of BC. Results Of the 438 subjects evaluated, 129 had BC, and 64 had an identifiable auricle angioma. The odds of an auricular angioma were higher in subjects with BC diagnosis, mainly localized in tumor area II and predominantly ipsilateral to the side affected by BC. Conclusions AA auricle inspection is a simple, quick, and easy diagnostic tool. Screening for the presence and location of auricular angiomas may help health practitioners refer women for BC screening for early diagnosis.

Ultrasound-guided caudal epidural injection to treat symptoms of lumbar spinal stenosis: a retrospective study.

Lumbar spinal stenosis (LSS) occurs when bony, ligamentous, and synovial elements of the lower axial spine degenerate and overgrow, compressing neural and vascular elements in the spinal canal. Compression can cause static back pain, radicular lower extremity pain, or neurogenic claudication. Radiological and clinical findings are needed to diagnose lumbar stenosis. In this framework, caudal epidural steroid injection (ESI) is a standard treatment. The volume injected and needle positioning are the main issues that could compromise the effectiveness of the epidural injection. However, ultrasound-guided caudal epidural injections have become more common in recent years. Since Klocke and colleagues described the ultra-sound-guided caudal block in 2003, it has grown in popularity. Multiple ethnic studies have reported ultrasound-guided caudal injection success rates of 96.9-100%. Color Doppler ultrasonography can also determine if a drug solution reaches the lumbosacral region. We enrolled 42 patients with lumbar spinal stenosis, persistent lumbosciatalgia, and neurogenic claudicatio unresponsive to painkillers who were not surgical candidates. Each patient receives four weekly injections for four weeks. If the patient responds to treatment but still has pain, monthly injections are needed to reach and maintain the benefit. Treatment will be changed if the patient does not respond after 4 caudal injections. Sterile caudal epidural injections are performed with ultrasound guidance and a spinal needle 21G. Triamcinolone 40 mg, levobupivacaine 10 mg, and physiological solution 10 ml are delivered. Each patient received an average of 4 injective treatments (4±2, Means 4, SD 2). Data analysis shows that the treatment reduced pain significantly before and after therapy, which persisted after 3 months. Caudal epidural injection is one of the most common conservative treatments for chronic low back pain with radiculopathy, and lidocaine alone or with steroids is effective. In this framework, the two main literature issues about caudal epidural injection effectiveness on lumbar pain are correct. Therefore, 10 ml is suitable and effective for treating symptoms without side effects. Pain reduction of over 50% from start to finish and three-month follow-up have shown significant results in pain control and disability improvement. Finally, caudal epidural injection for lumbar spinal stenosis symptoms is effective, safe, and provides long-term pain relief.

Needle contact test in auricular acupuncture for shoulder pain and where effective auricular acupoints identified are positioned on the map: A controlled study.

Active Points Test on auricle was renamed Needle Contact Test (or NCT), considered an extremely effective method to select most efficient auricle acupoint for Auricular Acupuncture (or AA) therapy. Our aims were to evaluate NCT efficiency as viable diagnostic option to identify the most appropriate AA acupoints to be selected for SupraSpinatus Tendinopathy (SST) associated shoulder pain treatment and to evaluate which auricle area has greater concentration of NCT positive acupoints in subjects with SST shoulder pain, comparing results with available AA ear maps. 45 subjects with SST diagnosis were enrolled. On 30 subjects in treatment group, NCT was performed on acupoints of the auricle shoulder representation areas (i.e., Scaphoid Fossa), while in 15 subjects of control group, NCT was performed on auricle areas not shoulder associated. Statistically significant lower Numeric Pain Rating Scale scores were seen for study group over time and compared to control. A small sample showed statistically significant increase of SST shoulder maximum abduction range of Movements. NCT identified best SST shoulder pain AA acupoints in Scaphoid Fossa (or SF1 and SF2). In conclusion NCT is a viable tool to efficiently identify the best AA acupoints in SST shoulder pain treatment.

Effect of Low- and High-Frequency Auricular Stimulation with Electro-Acupuncture on Cutaneous Microcirculation: A Cross-Over Study in Healthy Subjects.

Background: The regulation of microcirculation depends on the dynamic interaction of different factors: the autonomic nervous system plays a pivotal role in the blood flow and acupuncture can modulate it, obtaining different results depending on the site, the frequency, and the intensity of the stimulation. Methods: 18 healthy subjects have been enrolled and have undergone two sessions of electroacupuncture stimulations: one session using high frequency and one with low frequency. Microcirculation has been monitored continuously during stimulation using the laser Doppler method. Results: The microcirculatory parameters have shown a significant difference between high and low-frequency stimulation, suggesting that low-frequency stimulation is more effective for obtaining a vasodilator effect. Discussion: Our results show that low-frequency stimulation can increase the cutaneous microcirculatory flux, without significantly modifying blood pressure and heart rate. The auricular stimulation causes an increase in the activity of the vagus nerve, increasing the cholinergic activity without acting on post-junctional muscarinic receptors. Conclusion: Auricular acupuncture has a significant impact on the regulation of microcirculation.

The Medial Surface of the Auricle: Historical and Recent Maps. What Are the Possible Expectations of the "Thumb-Index Technique".

INTRODUCTION: The medial surface of the auricle (MSotA), as compared to the lateral, has been less studied and has limited consensus among schools of auricular acupuncture (AA) due to its small size, greater difficulty in carrying out an adequate physical examination on it, and less precise and limited agreement on its anatomical references as compared to the lateral surface. The thumb-index technique TIT is performed using a guiding finger (taking advantage of the anatomical conformation of the lateral surface) to guide the explorer finger (placed on the MSotA) to project the therapeutic areas and land marks on the MSotA. TIT could be considered useful and effective in AA to make the most of diagnostic and therapeutic MSotA potential. METHODS: An investigation was carried out on the impact of TIT in AA practice through a survey collected from former AA students. RESULTS: TIT showed a high consensus, and is used and appreciated by AA practitioners. Discussion/ Conclusions: To date, in AA, there is no thoroughly shared nomenclature for MSotA. TIT is simple and quick to project on to MSotA the well-coded lateral surface auricular maps from French or Chinese AA schools.

The effects of acupuncture after thyroid surgery: A randomized, controlled trial.

BACKGROUND: Acupuncture is a safe and well-tolerated treatment for pain relief. Previous studies supported the effectiveness of several acupuncture techniques for postoperative pain. The aim of this randomized, controlled trial was to evaluate the efficacy of acupuncture in reducing pain after thyroid surgery. METHODS: We randomized 121 patients to a control group (undergoing only standard postoperative analgesic treatment with acetaminophen) and an acupuncture group, undergoing also either electroacupuncture (EA) or traditional acupuncture (TA). Pain was measured according to intraoperative remifentanil use, acetaminophen daily intake, Numeric Rating Scale (NRS), and McGill Pain Questionnaire on postoperative days (POD) 1-3. RESULTS: Acupuncture group required less acetaminophen than controls at POD 2 (P = .01) and 3 (P = .016). EA patients required less remifentanil (P = .032) and acetaminophen than controls at POD 2 (P = .004) and 3 (P = .008). EA patients showed a trend toward better NRS and McGill scores from POD 1 to 3 compared with controls. EA patients had a lower remifentanil requirement and better NRS and McGill scores than TA patients. No differences occurred between TA patients and controls. CONCLUSION: Acupuncture may be effective in reducing pain after thyroid surgery. EA is more useful; TA achieves no significant effects.

3,5,11 needles: looking for the perfect number of needles--a randomized and controlled study.

Acupuncture has been successfully used in myofascial pain syndromes. However, the number of needles used, i.e. the "dose" of acupuncture stimulation, to obtain the best antinociceptive efficacy, is still a matter of debate. The question was addressed comparing the clinical efficacy of 3 different therapeutic schemes, mainly characterized by different numbers of needles used on 90 patients affected by a painful cervical myofascial syndrome. Patients were divided into 3 groups; the first group of 30 patients was treated with 11 needles, the second group of 30 patients was treated with 5 needles and the third group of 30 patients was treated with 3 needles. Each group underwent eight cycles of somatic acupuncture. In each session and in each group, all needles were stimulated until the pain tolerance threshold was reached; "pain tolerance is the amount of pain a person can handle without breaking down, either physically or emotionally". Pain intensity was evaluated before therapy, immediately after, and at 1 and 3 months follow-up by means of both the Mc Gill Pain Questionnaire and the Visual Analogue Scale (VAS). Pain and the repercussion of pain on the patient's quality of life (DOPE- Descriptors Of Pain Effects) were also measured using a test we developed, administered at each session. In all groups, needles were inserted superficially, except for the two most painful trigger points that were deeply inserted. All groups, independently from the number of needles used, obtained a good and significant therapeutic effect without clinically relevant differences among groups. For this pathology and patients of this kind, the number of needles, 3 or 5 or 11, seems not to be an important variable in determining the therapeutic effect.

Complementary and alternative medicine in fibromyalgia: a practical clinical debate of agreements and contrasts.

Fibromyalgia (FM) is currently classified as a chronic pain syndrome. Its main features are chronic widespread pain in the presence of tender points (TPs) upon physical examination, sleep disturbances and fatigue, although patients also report a variety of other complaints. Many therapies have been proposed over recent years with mixed results, including various pharmacological therapies for the treatment of symptoms; but there is still no effective drug treatment for the syndrome itself. Non-pharmacological therapies are an important part of the treatment, and there is evidence supporting a number of interventions, including aerobic exercise, strength and stretching training, cognitive-behavioural therapy, and patient education. Complementary and alternative medicine (CAM) techniques have not yet been fully acknowledged by scientific medicine because little is known about their mechanisms of action and usefulness. The aim of this wide-ranging review of the literature is to analyse the types of CAM techniques used to treat FM and their effectiveness, highlighting the disagreements among the authors of more specialised reviews.

Somatic acupuncture versus ear acupuncture in migraine therapy: a randomized, controlled, blind study.

This study compares the clinical effectiveness of somatic and ear acupuncture for treatment of migraine without aura. 35 patients were divided into 2 groups, one receiving somatic and the other ear acupuncture. Both groups were treated once a week for 8 weeks and needles were stimulated manually. The severity of pain was evaluated with the Migraine Index and the visual analogue of Scott-Huskisson; other 2 tests were used to monitor the pain threshold and Zung's Self-rating Depression Scale was applied to assess variations in patients' mood. These tests were performed before the beginning and at the end of treatment and, for the follow up, after 1, 3 and 6 months from the end of therapy. On the basis of the migraine index, pain at the end of therapy was significantly lower than before the treatment, being residual pain 54.83% and 63.43%, respectively for somatic and ear acupuncture. Apparently, the 2 treatments were equally effective, as no significant difference could be assessed. On the contrary, a significant difference between the 2 groups was clear during the follow up: in fact, after 6 months residual pain was 16.80% and 48.83% for somatic and ear acupuncture, respectively (p=0.038). These results were confirmed by the Visual Analogue Scale (VAS) test and by the evaluation of pain threshold. It is noteworthy that also Zung's depression test showed a significant decrease of score was present in both groups, at all the times investigated with no difference between the two treatments. These results, though preliminary, are quite promising in supporting the effectiveness of ear acupuncture for treatment of migraine without aura.

Neck pain treatment with acupuncture: does the number of needles matter?

OBJECTIVES: Acupuncture has been successfully used in myofascial pain syndromes. However, the number of needles used, that is, the dose of acupuncture stimulation, to obtain the best antinociceptive efficacy is still a matter of debate. The question was addressed comparing the clinical efficacy of two different therapeutic schemes, characterized by a different number of needles used on 36 patients between 29-60 years of age with by a painful cervical myofascial syndrome. METHODS: Patients were divided into two groups; the first group of 18 patients were treated with 5 needles and the second group of 18 patients were treated with 11 needles, the time of needle stimulation was the same in both groups: 100 seconds. Each group underwent six cycles of somatic acupuncture. Pain intensity was evaluated before, immediately after and 1 and 3 months after the treatment by means of both the Mc Gill Pain Questionnaire and the Visual Analogue Scale (VAS). In both groups, the needles were fixed superficially excluding the two most painful trigger points where they were deeply inserted. RESULTS: Both groups, independently from the number of needles used, obtained a good therapeutic effect without clinically relevant differences. CONCLUSIONS: For this pathology, the number of needles, 5 or 11, seems not to be an important variable in determining the therapeutic effect when the time of stimulation is the same in the two groups.

Phantom limb pain relief by contralateral myofascial injection with local anaesthetic in a placebo-controlled study: preliminary results.

OBJECTIVE: To ascertain the existence of contralateral painful muscle areas mirroring phantom pain and to evaluate the short-term effects of anaesthetic vs saline, injected contra notlaterally to control phantom and phantom limb pain. DESIGN: Double-blinded cross-over study. SETTING: Inpatients; rehabilitation institute. PARTICIPANTS: Eight lower limb amputees with phantom limb pain in the past 6 months. INTERVENTIONS: Either 1 ml of 0.25% bupivacaine or 0.9% saline injected alternately in each point with a 28-gauge needle, with 72 h between injections. Main outcome measurePhantom sensation modification and the intensity of phantom limb pain (visual analogue scale) before and after injections. RESULTS: Although present, painful muscle areas in the healthy limb do not mirror the topographical distribution of phantom limb pain. Sixty minutes after the injection, a statistically significant greater relief of phantom limb pain was observed after using local anaesthetic than when using saline injection (p = 0.003). Bupivacaine consistently reduced/abolished the phantom sensation in 6 out of 8 patients. These effects on phantom sensation were not observed after saline injections. CONCLUSION: Contralateral injections of 1 ml 0.25% bupivacaine in myofascial hyperalgesic areas attenuated phantom limb pain and affected phantom limb sensation. The clinical importance of this treatment method requires further investigation.

The role of the intensity of low frequency electroacupuncture stimulation on the modulation of capsaicin-induced edema in the rat paw. A blind controlled study.

Experimental animal and clinical human data suggest that electroacupuncture (EAP) reduces the release of substance P from sensitive neurons, both at medullar level and in the periphery. Aim of our study is to verify the effect of different intensities of stimulation on edema induced by subcutaneous administration of capsaicin. The study was performed on 72 male Sprague-Dawley rats divided into 4 experimental groups according to the intensity of electrostimulation (5, 10, 50, 70 mA) and a control group. A constant current electrical stimulator delivering positive and negative biphasic wave (duration of one pulse wave complex: 500 microsec; pulse repetition rate: 5/sec) has been used for the stimulation. The lowest intensity of stimulation (5 mA) was effective in the prevention of neurogenic edema. Conversely, higher stimulation intensities, namely 10 and 50 mA, were not effective in reducing edema. Stimulation at 70 mA caused a worsening of edema, probably due to an increased release of substance P in the paw.

The therapeutic efficacy of somatic acupuncture is not increased by auriculotherapy: a randomised, blind control study in cervical myofascial pain.

Auriculotherapy (ear acupuncture) is a therapeutic technique in which points on the auricle are stimulated with needles. Usually it is combined with somatic acupuncture because of possible synergy, although the efficacy of this pairing has neither been confirmed nor disproved. The aim of this study was to verify: (1) if somatic acupuncture can reduce myofascial cervical pain; (2) if concomitant auriculotherapy improves the efficacy of somatic acupuncture. A group of 62 patients affected by cervical myofascial pain was randomly divided into two groups of 31. Group A (6 males and 25 females) underwent eight sessions of somatic acupuncture. Group B (7 males and 24 females) underwent eight sessions of somatic acupuncture in the same way as group A, paired with auriculotherapy. Pain was scored using the McGill Pain Questionnaire before and at the end of treatment, and 1 and 3 months later. The results showed that both somatic acupuncture and somatic plus ear acupuncture have a positive effect in reducing pain. The pain intensity score was 40.70 +/- 17.78 in group A before therapy and 13.32 +/- 9.62 after therapy; in group B it was 38.90 +/- 15.31 and 13.43 +/- 10.96. Somatic plus auriculotherapy was therefore not statistically significantly superior to somatic therapy alone in the treatment of cervical myofascial pain.

Acupuncture modulation of capsaicin-induced inflammation: effect of intraperitoneal and local administration of naloxone in rats. A blinded controlled study.

OBJECTIVE: It is believed that acupunctural stimulation induces an analgesic response mainly through a central mechanism: that is, through an increase in the production of opioid peptides and their release at different levels in the nervous system. We sought to establish whether the modulating effect of acupuncture on experimental neurogenic edema can be attributed to a central mechanism only or whether a peripheral mechanism could also exist. Intraperitoneal administration was compared to local administration in the same paw in rats that were injected with capsaicin and in the same dermatome of the acupunctural stimulation. MATERIALS AND METHODS: Experimentation was conducted on 105 male Sprague-Dawley rats weighing 180-220 g, divided into 7 groups as follows: group 1, control; groups 2-4 (15 animals), stimulated with manual acupuncture; group 3 also treated with intraperitoneal naloxone 1 mg/kg; group 4 also treated locally with naloxone (20 microg); groups 5-7 (15 animals), stimulated with 5 Hz and 5 mA electroacupuncture (EAP); group 6 also treated with intraperitoneal naloxone, 1 mg/kg, group 7 also treated locally with naloxone (20 microg). RESULTS: The results indicate that the administration of 1 mg/kg of naloxone intraperitoneally can inhibit the modulating effect of acupunctural stimulation. Equally effective in inhibiting the modulating effect of acupunctural stimulation, although not having a systemic effect, is a 20-microg dose of naloxone administered peripherally on the site of edema induction. CONCLUSION: It is possible to conclude that both systemic and peripheral mechanisms seem to be implicated in the modulating effect of acupuncture on the neurogenic inflammation mechanism.

Comparison of superficial and deep acupuncture in the treatment of lumbar myofascial pain: a double-blind randomized controlled study.

OBJECTIVE: The aim of the study was to compare the therapeutic effect of the superficial and in-depth insertion of acupuncture needles in the treatment of patients with chronic lumbar myofascial pain. DESIGN: A prospective randomized double-blind study of superficial and deep acupuncture was conducted. SETTING: The study was conducted in the Pain Service Unit of the University of Padova. PATIENTS: The study comprised 42 patients with lumbar myofascial pain who were divided into two equal groups (A and B). INTERVENTION: In group A, the needle was introduced in the skin at a depth of 2 mm, whereas in group B the needle was placed deeply into muscular tissue. The treatment was planned for a cycle of eight sessions. OUTCOME MEASURES: The intensity of pain was evaluated with the McGill Pain Questionnaire before and after treatment and at the 3-month follow-up examination. RESULTS: Although at the end of the treatment there was no evidence of significant statistical differences between the two different groups, pain reduction was greater in the group treated with deep acupuncture. A statistical difference existed between the two groups at the 3-month follow up, with a better result in the deeply stimulated group. CONCLUSIONS: Clinical results show that deep stimulation has a better analgesic effect when compared with superficial stimulation.

Modifications of [3H]imipramine binding sites in platelets of chronic pain patients treated with mianserin.

Tritiated imipramine binding to whole platelets was measured in 16 chronic pain patients who were free from major depression, and in a control group. The maximum binding was significantly lower in chronic pain patients than in the control group, whereas the binding affinity was not significantly different. Twelve patients were treated with mianserin for 21 days; this produced a significant improvement in the mean scores for pain (evaluated with the McGill Questionnaire) and depressive symptoms (assessed with the Zung Self-Rating Scale). The improvement in both types of symptom was accompanied by a significant mean increase in the density of the [3H]imipramine binding sites without modifications in the values of the constant of affinity. All the patients who responded well to treatment (N = 8) had a family history of depressive spectrum disorders (DSD), while none of those who failed to respond had a first degree relative with DSD.