Acupuncture and transcutaneous nerve stimulation in stroke rehabilitation: a randomized, controlled trial.

BACKGROUND AND PURPOSE: In small trials with control groups that receive no intervention, acupuncture has been reported to improve functional outcome after stroke. We studied effects of acupuncture and transcutaneous electrical nerve stimulation on functional outcome and quality of life after stroke versus a control group that received subliminal electrostimulation. METHODS: In a multicenter randomized controlled trial involving 7 university and district hospitals in Sweden, 150 patients with moderate or severe functional impairment were included. At days 5 to 10 after acute stroke, patients were randomized to 1 of 3 intervention groups: (a) acupuncture, including electroacupuncture; (b) sensory stimulation with high-intensity, low-frequency transcutaneous electrical nerve stimulation that induces muscle contractions; and (c) low-intensity (subliminal) high-frequency electrostimulation (control group). A total of 20 treatment sessions were performed over a 10-week period. Outcome variables included motor function, activities of daily living function, walking ability, social activities, and life satisfaction at 3-month and 1-year follow-up. RESULTS: At baseline, patients in each group were closely similar in all important prognostic variables. At 3-month and 1-year follow-ups, no clinically important or statistically significant differences were observed between groups for any of the outcome variables. The 3 treatment modalities were all conducted without major adverse effects. CONCLUSIONS: When compared with a control group that received subliminal electrostimulation, treatment during the subacute phase of stroke with acupuncture or transcutaneous electrical nerve stimulation with muscle contractions had no beneficial effects on functional outcome or life satisfaction.

Laser treatment applied to acupuncture points in lateral humeral epicondylalgia. A double-blind study.

Forty-nine patients suffering from lateral humeral epicondylalgia were enrolled in a double-blind study to observe the effects of Ga-As laser applied to acupuncture points. The Mid 1500 IRRADIA laser machine was used, wavelength: 904 nm, mean power output: 12 mW, peak value: 8.3 W; frequency: 70 Hz (pulse train). Localization of points: LI 10, 11, 12, Lu 5 and SJ 5. Each point was treated for 30 sec resulting in a dose of treatment of 0.36 J/point. The patients were treated 2-3 times weekly with 10 treatments in all. Follow-ups were done after 3 months and 1 year. No significant differences were observed between the laser and the placebo group in relation to the subjective or objective outcome after 10 treatments or at the follow-ups.

Is low-energy laser treatment effective in lateral epicondylalgia?

The aim of this double-blind study was to explore the pain-alleviating effect of low energy laser in lateral epicondylalgia. Forty-nine patients were consecutively assigned at random to two groups, laser or placebo. The Mid 1500 Irradia laser was used with the following parameters: wavelength 904 nm; average power output 12 mW; peak value 8.3 W; frequency 70 Hz (pulse train 8000 Hz). The laser (Ga-As) was locally applied to 6 sites on and around the epicondyle. Each point was treated for 30 sec, resulting in a dose of 0.36 J/point and an area of treatment of 0.2 mm2. Patients were treated 2-3 times weekly, for a total of 10 treatments. Follow-ups were done after three and 12 mo. The statistical analysis showed that the laser treated group had a significant improvement in some objective outcomes after the treatment period and at the 3 mo follow-up, but there were no significant differences in the subjective outcomes between the groups. Irradia laser treatment may be a valuable therapy in lateral epicondylalgia, if carried out as described in this study. However, further studies are necessary before low energy laser can be employed as a pain-relieving method.

Acupuncture treatment in epicondylalgia: a comparative study of two acupuncture techniques.

The purpose of this study was to compare the pain-alleviating effect of classical acupuncture with superficial needle insertion in 82 patients suffering from lateral epicondylalgia. Sessions were 20 min long, two to three times weekly with 10 treatments in all. Five acupuncture points were treated: LI 10, 11, 12, Lu 5, and SJ 5. After 10 treatments significant differences were observed between the groups favoring the classical acupuncture technique in relation to subjective and objective outcome. No such differences could be observed at the follow-ups after 3 months and 1 year. This study showed that classical "deep" acupuncture is superior to superficial needle insertion in the short-term symptomatic treatment of lateral epicondylalgia, but not at 3- and 12-month follow-up.

A nonconventional approach to the treatment of "environmental illness".

Twenty patients with symptoms of "environmental illness" were subject to a controlled study of deep versus superficial acupuncture. The patients were evaluated by a detailed questionnaire concerning their occupational, environmental, and medical history. Blood samples were taken as well. Patients were randomized to deep or superficial acupuncture. Both groups improved significantly in key variables during and after treatment. There were no group differences. There were no changes in biological variables apart from a gradual and continuous increase in serum cortisol and a decrease in neuropeptide Y, which was somewhat more accentuated in those receiving deep acupuncture. This rise in cortisol may have contributed to decreased dermal symptoms among the participants. It is hypothesized that the positive treatment results observed are partly due to weakening of the conditioned response, linking bodily symptoms to environmental agents. To date, a number of different methods have been tried in the management of patients with environmental illness. However, only rarely have the treatments been evaluated in controlled studies.

An experimental study of the neurogenic and the immunological contribution to "tennis elbow" in rats.

In the present study the content of substance P (SP)-, neurokinin A (NKA)-, calcitonin gene-related peptide (CGRP)- and neuropeptide Y (NPY)-like immunoreactivity (-LI) was measured in rats cerebrospinal fluid (CSF), plasma and perfusates (PF) from both elbow enthesis during acute inflammation. Either substance P, SP, (10-5 M, 0.01 ml) or human recombinant interleukin-1 alpha (hrIl-1 alpha, 0.01 ml) were injected into the right enthesis of the extensor carpi radialis brevis (ECRB). The left ECRB and both ECRBs of control rats, were injected with 0.01 ml saline. Samples of CSF, plasma and PF from both ECRBs were obtained at 2, 6, and 24 h following injection and neuropeptide-LI was analysed by specific radioimmunoassays. Neuropeptide-LI was compared with control values and between the treated groups. In both treated groups NKA- and CGRP-LI was increased in CSF and NKA-LI decreased in plasma, while CGRP- and NPY-LI were raised to a similarly significant degree in the enthesis of the ECRB. SP-LI was increased in ECRB PF in comparison with controls and NKA-LI levels were higher in the hrIl-1 alpha group both in comparison with controls and between treated groups. In summary an unilateral injection of either SP or hrIl-1 alpha into the enthesis of the ECRB of the rat showed a similar influence at 2, 6, and 24 h following injection. The most pronounced changes in neuropeptide-LI occurred in the ECRB PF of both treated groups.

An experimental model of tennis elbow in rats: a study of the contribution of the nervous system.

The contribution of the sensory and autonomic nervous system to experimentally induced tennis elbow or lateral epicondylalgia was investigated by analyses of the release of neuropeptides from sensory (substance P, SP, neurokinin A, NKA, calcitonin gene-related peptide, CGRP) and sympathetic (neuropeptide Y, NPY) nerves. SP, CGRP, NKA, NPY-like immunoreactivity (-LI) was studied in rats cerebrospinal fluid (CSF), plasma and perfusates (PF) from the enthesis of the extensor carpi radialis brevis (ECRB) of the right elbow at 2, 6 and 24 h following 0.01 ml injection of either complete Freund adjuvans (FA) or 2% Carrageenan (CAR). The control group was injected with 0.01 ml saline. In general the changes of neuropeptide-LI in the CSF and plasma were similar for both treated groups compared with the controls, but they were more pronounced in the FA group than the CAR. SP-, NKA-, CGRP- and NPY-LI were significantly increased to a similar degree in the perfusates of the ECRBs of the treated groups with a greater increase in SP-LI in the FA than the CAR group compared with controls. When comparing the neuropeptide-LI in the CSF, plasma and PF between the 2 treated groups, there were thus few differences found. Generally a unilateral injection with either FA or CAR into the rat ECRB induced a similar alteration in the concentration of SP-, NKA-, CGRP- and NPY-LI in the CSF, plasma and PF at 2, 6 and 24 h following injection. However, the most pronounced changes in neuropeptide-LI occurred locally in the elbow ECRBs PF in both treated groups.

Pulsed ultrasound treatment in lateral epicondylalgia.

This study was carried out to explore the pain-alleviating effect of pulsed ultrasound in lateral epicondylalgia. Forty-five patients were consecutively assigned at random to two groups for pulsed ultrasound or placebo. The parameters for ultrasound were 1 MHz; 1:4; 1 W/cm2. Each session was for 10 min, two to three times weekly, ten treatments in all. Follow-ups were done after three and twelve months. The statistical analysis showed no significant differences in relation to subjective or objective outcomes between the groups after the treatment period or at the follow-ups. Our results do not support the use of pulsed ultrasound treatment with the chosen parameters in lateral epicondylalgia.

Iontophoresis with cortisone in the treatment of lateral epicondylalgia (tennis elbow)--a double-blind study.

Lateral epicondylalgia (tennis elbow) is a common dysfunction of the arm. Because there is no agreement concerning the pathophysiology, several modes of treatments have been tried and one of the most common is local steroid injection. Iontophoresis using corticosteroids is a fairly new method recommended in the treatment of lateral epicondylalgia and has become popular owing to impression of superiority compared to local injections-noninvasive, painless and nontraumatic. The aim of this double-blind prospective, randomized study was to evaluate the short- and the long-term pain-relieving effect of corticosteroid iontophoresis in lateral epicondylalgia. Sixty-four patients suffering from lateral epicondylalgia were consecutively randomized into two groups for corticosteroid or placebo iontophoresis. The patients were treated four times during 2 weeks. Follow-ups were done the day after the final treatment and after 3 and 6 months. Twenty-three patients dropped out before the 3-month follow-up because they wanted to complement the treatment or replace it with other treatments. No significant difference between the corticosteroid group and the placebo group in relation to subjective and objective outcome could be observed after the treatment period or at the follow-ups. In fact, both groups improved throughout the study. The results of the present study do not support the use of corticosteroid iontophoresis in lateral epicondylalgia.

Lateral epicondylalgia: report of noneffective midlaser treatment.

This study was carried out to explore the pain-alleviating effect of Ga-As + He-Ne laser (gallium-arsenide + helium-neon) in lateral epicondylalgia. A Space Mid Laser Mix 5-up laser was used. The probe consisted of five Ga-As emitters and one He-Ne emitter in the center. The parameters for Ga-As were wavelength, 904nm; average output power, 4mW, peak power, 10W; pulse frequency, 3800Hz; pulse duration, 180nsec; divergence, 70mrad. The He-Ne parameters were wavelength, 632.8nm; continuous; power output, 5mW, divergence 60mrad. A pen laser (Ga-As) was also included in the equipment. Two machines were available; one of them had no output in the Ga-As diodes, and the He-Ne emitter was replaced with a red light emitter. Fifty-eight patients were consecutively assigned to two groups for laser or placebo. The probe was applied perpendicularly over the painful area for eight minutes, and then the pen probe was applied to two acupuncture points, LI 11 and LI 12, for two minutes per point. The treatments were given three to four times weekly, ten treatments in all. Follow-ups were done after 3, 6, and 12 months. The treatment procedure was performed exactly according to the manufacturer's manual for this diagnosis. No other therapeutic measures were used, and medication use was proscribed during the treatments and the follow-up period. The statistical analysis showed no significant differences in subjective or objective outcome between the laser and placebo treatments after the treatment period. However, the objective outcome indicated a difference in favor of the placebo treatment (p less than .06).(ABSTRACT TRUNCATED AT 250 WORDS)

A comparative study of continuous ultrasound, placebo ultrasound and rest in epicondylalgia.

In this study the pain alleviating effects of continuous ultrasound treatment in epicondylalgia has been compared to placebo ultrasound and to rest. Of 99 patients 33 were randomly allocated to receive continuous ultrasound treatment, 33 to placebo ultrasound treatment and 33 were recommended only rest. The 66 patients treated were each given 10 treatments over 5 to 6 weeks. The condition was significantly improved in the group treated with continuous ultrasound in 36%, in 30% given placebo, and in 24% of those recommended rest. A significant improvement was noted when the effect of continuous ultrasound was compared with rest, but continuous ultrasound treatment was not significantly better than placebo ultrasound.

Effect of laser versus placebo in tennis elbow.

The purposes of this study were to compare the pain alleviating effects of laser treatment and placebo in tennis elbow. Also, the effects of laser radiation on the radial sensory nerve conduction, and the temperature changes in the tissue surrounding the treated radial nerve were studied. The results show that laser treatment is not significantly better than placebo in treating tennis elbow. Furthermore, no significant change was noted in the evoked sensory potential as well as subcutaneous temperatures in either experimental or control groups as a result of the applications of the laser radiation treatment.

Effect of sensory stimulation (acupuncture) on sympathetic and parasympathetic activities in healthy subjects.

It has been postulated that sensory stimulation (acupuncture) affects the cardiovascular system via the autonomic nervous system. Previously, skin temperature, thermography, plethysmography and blood pressure changes have been used in evaluation of sympathetic nerve activity following acupuncture. By using power spectral analysis, the low frequency and high frequency components of heart rate variability can be calculated reflecting the sympathetic and parasympathetic activity. The purpose of this study was to investigate to what extent acupuncture applied into the thenar muscle and into the cavum concha of the ear induced changes in the sympathetic and/or parasympathetic nervous system in healthy subjects. MATERIALS AND METHODS: Twelve healthy volunteers, six men and six women, mean age 34.4 (range 23-48) participated in three balanced, randomly distributed sessions. At an individual initial visit the 12 volunteers were introduced to the needle sensation by having a needle inserted into the point LI 11. The needle sensation was evoked and the subject was trained to identify the characteristic needle sensation. The introduction was followed by three test sessions. SESSION A: A short acupuncture needle, (Seirin no 3, ∅0.20x15 mm) was inserted perpendicular into the earpoint, Lu 1, in the left inferior hemi-conchae. SESSION B: An acupuncture needle (Hwato, ∅0.30x30 mm) was inserted perpendicular into the Hegu point (LI 4) in the middle of the right dorsal thenar muscle. SESSION C: An acupuncture needle (Hwato, ∅0.30x30 mm) was inserted perpendicular superficially into the skin overlying the Hegu point on the left hand. Results. Stimulation of the ear induced a significant increase in the parasympathetic activity during the stimulation period of 25 min (P<0.05) and during the post-stimulation period of 60 min (P<0.05). No significant changes were observed in either the sympathetic activity, blood pressure or heart rate. Stimulation of the thenar muscle resulted in a significant increase in the sympathetic and the parasympathetic activity during the stimulation period (P<0.01) and during the post-stimulation period (P<0.01 and P<0.001, respectively). A significant decrease in the heart rate frequency (P<0.05) at the end of the post-stimulation period was also demonstrated. The superficial needle insertion into the skin overlaying the right thenar muscle caused a pronounced balanced increase in both the sympathetic and parasympathetic activity during the post stimulation period of 60 min (P<0.01) while no changes were observed during the stimulation period. CONCLUSION: It is indicated that sensory stimulation (acupunctura) in healthy persons is associated with changed activity in the sympathetic and parasympathetic nervous system depending on site of stimulation and period of observation.

Effect of vibratory stimulation on experimental and clinical pain.

The effect of vibratory stimulation on experimental pain of the skin overlying the right and left extensor carpi radialis longus muscle induced by electrical stimulation was studied in 16 healthy subjects and in 18 patients suffering from chronic epicondylalgia of the right elbow. In the healthy subjects there were no side differences whereas in the patients, the skin pain threshold over the painful right muscle was lower than that on the left unaffected side under resting conditions. After vibratory stimulation, the skin pain threshold increased bilaterally by 1.1-1.6 times the pre-stimulation threshold in the healthy subjects and by 1.2-2.3 times this threshold in the patients. In 8 of the healthy subjects there was an increase in peripheral blood flow during stimulation and in 8 there was a small decrease. In 13 patients the change in pain threshold was seen in phase with the local increase and peripheral decrease in peripheral blood flow. In all individuals, the pain thresholds were regained within 45 min of cessation of stimulation. This was in contrast to the general subjective pain in the patients; 12 patients reported that the relief of pain lasted for a period of 1-7 hours.

Vibratory stimulation compared to placebo in alleviation of pain.

The placebo effect of vibratory stimulation was studied in 72 patients with chronic pain syndromes in a double-blind crossover trial using a vibrator and a "placebo unit". Pain alleviation was reported by 48% of the patients during vibratory stimulation compared with 34% for placebo treatment; statistical significance (p less than 0.005).