Effects on temporomandibular disorder in the treatment of tension-type headache with acupuncture and therapeutic exercises. A secondary analysis from a randomized controlled trial.

OBJECTIVES: To examine the effects of acupuncture and therapeutic exercise alone and in combination on temporomandibular joint symptoms in tension-type headache and to evaluate the potential interaction of existing temporomandibular dysfunction on the success of headache treatment. DESIGN: Pre-planned secondary analysis of a randomized controlled, non-blinded trial. SETTING: Outpatient clinic of a German university hospital. SUBJECTS: Ninety-six Participants with frequent episodic or chronic tension-type headache were randomized to one of four treatment groups. INTERVENTIONS: Six weeks of acupuncture or therapeutic exercise either as monotherapies or in combination, or usual care. Follow-up at 3 and 6 months. MAIN MEASURES: Subjective temporomandibular dysfunction symptoms were measured using the Functional Questionnaire Masticatory Organ, and the influence of this sum score and objective initial dental examination on the efficacy of headache treatment interventions was analyzed. RESULTS: Temporomandibular dysfunction score improved in all intervention groups at 3-month follow-up (usual care: 0.05 [SD 1.435]; acupuncture: -5 [SD 1.436]; therapeutic exercise: -4 [SD 1.798]; combination: -3 [SD 1.504]; P = 0.03). After 6 months, only acupuncture (-6 [SD 1.736]) showed a significant improvement compared to the usual care group (P < 0.01). Subjective temporomandibular dysfunction symptoms had no overall influence on headache treatment. CONCLUSIONS: Only acupuncture had long-lasting positive effects on the symptoms of temporomandibular dysfunction. Significant dental findings seem to inhibit the efficacy of acupuncture for tension-type headache.

Effects of acupuncture and medical training therapy on depression, anxiety, and quality of life in patients with frequent tension-type headache: A randomized controlled study.

OBJECTIVES: To compare the effects of acupuncture and medical training therapy in combination or individually with usual care on quality of life, depression, and anxiety in patients with tension-type headache. METHODS: In this single-center, prospective, randomized, controlled, unblinded trial, 96 adults (38.7(+/-13.3) years of age; 75 females/20 males/one dropout) with frequent episodic or chronic tension-type headache were randomized to one of four treatment groups (n = 24). The treatment groups received six weeks of either acupuncture or medical training therapy as monotherapies or in combination (12 interventions each), or usual care. We assessed depressiveness (PHQ-9), anxiety (GAD-7), and health-related quality of life (SF-12) as secondary outcome parameters at baseline, six weeks, three months, and six months after initiation of treatment. Linear mixed models were calculated. RESULTS: Both, acupuncture (baseline to six-weeks change scores: mean: -2(standard deviation: 2.5 points), three months: -2.4(2.4), six-months -2.7(3.6)) and the combination of acupuncture and medical training therapy (-2.7(4.9), -2.2(4.0), -2.2(4.2)) (each within-group p < .05) significantly reduced depressiveness-scores (PHQ-9) to a greater extent than medical training therapy (-0.3(2.0), -0.5(1.6), -0.9(2.6)) or usual care alone (-0.8(2.9), 0.1(2.8), 0.2(3.6)). We found similar results with anxiety scores and the physical sum scores of the SF-12. No severe adverse events occurred. CONCLUSIONS: Acupuncture and the combination of acupuncture and medical training therapy elicit positive effects on depression, anxiety, quality of life, and symptom intensity in patients with episodic and chronic tension-type headache. Acupuncture appears to play a central role in mediating the therapeutic effects, underscoring the clinical relevance of this treatment. An additive benefit of the combination of both therapies does not appear to be relevant.Trial registration: Registered on 11 February 2019. German Clinical Trials Register, DRKS00016723.

Combination of acupuncture and medical training therapy on tension type headache: Results of a randomised controlled pilot study.

OBJECTIVES: The aim of this study was to compare the effects of acupuncture and medical training therapy alone and in combination with those of usual care on the pain sensation of patients with frequent episodic and chronic tension-type headache. DESIGN: This was a prospective single-centre randomised controlled trial with four balanced treatment arms. The allocation was carried out by pre-generated randomisation lists in the ratio 1:1:1:1 with different permutation block sizes. SETTING: The study was undertaken in the outpatient clinic of Rehabilitation Medicine of the Hannover Medical School.Participants and interventions: Ninety-six adult patients with tension-type headache were included and randomised into usual care (n = 24), acupuncture (n = 24), medical training (n = 24), and combination of acupuncture and medical training (n = 24). One patient was excluded from analysis because of withdrawing her/his consent, leaving 95 patients for intention to treat analysis. Each therapy arm consisted of 6 weeks of treatment with 12 interventions. Follow-up was at 3 and 6 months. MAIN OUTCOME MEASURES: Pain intensity (average, maximum and minimum), frequency of headache, responder rate (50% frequency reduction), duration of headache and use of headache medication.Clinical results: The combination of acupuncture and medical training therapy significantly reduced mean pain intensity compared to usual care (mean = -38%, standard deviation = 25%, p = 0.012). Comparable reductions were observed for maximal pain intensity (-25%, standard deviation = 20%, 0.014) and for minimal pain intensity (-35%, standard deviation = 31%, 0.03). In contrast, neither acupuncture nor medical training therapy differed significantly from usual care. No between-group differences were found in headache frequency, mean duration of headache episodes, and pain medication intake. At 3 months, the majority of all patients showed a reduction of at least 50% in headache frequency. At 6 months, significantly higher responder rates were found in all intervention groups compared to usual care. CONCLUSIONS: In contrast to monotherapy, only the combination of acupuncture and medical training therapy was significantly superior in reduction of pain intensity compared to usual care.Trial registration: Registered on 11 February 2019. German Clinical Trials Register, DRKS00016723.

Efficacy of Fascial Distortion Model Treatment for Acute, Nonspecific Low-Back Pain in Primary Care: A Prospective Controlled Trial.

Context • Low-back pain (LBP) is a prevalent and potentially crippling condition for which treatment is often unsatisfactory from the perspectives of physicians, patients, and payers. The application of the fascial distortion model (FDM), an integrated concept for the diagnosis and manipulative treatment of musculoskeletal disorders, is conceptually promising for LBP but has not been investigated systematically. Objective • The study intended to provide proof of concept to establish the noninferiority of the FDM treatment as opposed to the therapy recommended by the German National Disease Management Guideline (NDMG) for acute LBP. Design • The study was a prospective, nonrandomized, controlled, parallel-group trial. Setting • The study took place in a private practice for surgery and orthopedics. Participants • Seventy-seven outpatients with acute LBP with an average age of 42.6 ± 13.5 y, 50.6% of whom were male, took part in the study. Intervention • Participants in the intervention group (FDM group) received osteopathic manipulative treatments according to the FDM, whereas the control group (NDMG group) received an active control treatment following the NDMG. Outcome Measures • Comparing the FDM group (n = 39) and the NDMG group (n = 38), the study measured pain (visual analog scale, patient diary), functional (FFbH-R) and self-reported vocational status, and use of medication (patient diary) at baseline and after 1, 4 and 12 wk of treatment. Results • The study found marked improvements of the symptoms in both groups, with a faster onset of efficacy and significantly less medication under the FDM treatment. Conclusions • FDM appears to be effective with regard to pain relief and functional improvement for LBP.

Effects of acupuncture on quality of life and pain in patients with osteoporosis-a pilot randomized controlled trial.

In this sham-controlled study, 53 patients received 10 sessions of acupuncture treatment over 5 weeks to investigate the effects of acupuncture on the pain and quality of life of patients with osteoporosis. The results showed significant favorable effects of verum acupuncture on quality of life. Both interventions showed sustained and clinically relevant effects on pain. PURPOSE: Standard analgesic treatment is associated with adverse events in patients with osteoporosis, especially elderly and/or comorbid patients. As acupuncture has gained widespread acceptance as a complementary treatment modality with few side effects, the aim of this study was to evaluate the effects of acupuncture on the pain and quality of life of patients with osteoporosis. METHODS: In total, 53 patients with vertebral compression fractures, osteoporosis-associated spinal deformities, and resultant pain were randomly allocated to the verum acupuncture with deep needling of specific points following the principles of traditional Chinese medicine (n = 29) or control acupuncture group with superficial needling of non-acupuncture points (n = 24). All patients received 10 sessions of standardized verum or control acupuncture treatment over 5 weeks. Pain (VAS score 1-100) and quality of life (QUALEFFO-41) were measured at the start of treatment (T0), before each acupuncture session (T1), and at 1 (T2) and 3 months (T3) post-treatment. RESULTS: Both acupuncture treatments significantly reduced activity-related pain and pain at rest over time. The verum acupuncture group experienced a significantly greater reduction in mean pain intensity at rest than the control group. In the control group, quality of life improved only temporarily post-treatment (T2) and slightly declined at the end of the follow-up period (T3). In contrast, patients in the verum acupuncture group experienced continuous and significant improvements in quality of life up to 3 months after treatment (T3). CONCLUSIONS: Both types of acupuncture were equally effective in producing sustained, clinically relevant pain relief in patients with osteoporosis. Verum acupuncture had stronger and longer-lasting effects on quality of life and pain at rest. The possible reasons for these findings include the specificity of acupuncture point selection and the performance of needle stimulation.

Multimodal therapy concept and aerobic training in breast cancer patients with chronic cancer-related fatigue.

UNLABELLED: HYPOTHESE: Cancer-related fatigue (CRF) and sleep disorders are some of the most wearing and common symptoms in disease-free breast cancer patients (BC). Aerobic training (AT) is the treatment with the best available evidence, even though it seems to be insufficient with regards to improvements in cognitive fatigue. We introduced a new multimodal therapy concept (MM) consisting of psycho-, sleep-education and new approaches based on anthroposophic medicine such as eurythmy and painting therapy. STUDY DESIGN: This pilot study will test the implementation of MM and yield first results of the MM and AE in our centres. METHODS: 31 out of 34 patients suffering from BC and CRF were fully assessed in a ten-week intervention study. 21 patients chose MM and 10 decided on AT. CRF was measured with the help of the Cancer Fatigue Scale (CFS-D), and the global quality of sleep was measured with the Pittsburgh Sleep Quality Index (PSQI). We also captured autonomic regulation (aR) and patients' satisfaction with questionnaires. Statistical analysis was done with SAS 9.1.3 for windows. RESULTS: The new MM therapy can be implemented with high satisfaction among patients. Significant improvements were found in the MM group with regards to CFS-D, global quality of sleep, sleep efficiency (PSQI), aR and rest/activity regulation compared to baseline (all p<0.05). In the AT group aR orthostatic-circulatory and rest/activity regulation improved significantly (p<0.05), too. However, no improvement in cognitive fatigue was seen in either group. CONCLUSION: The multimodal therapy concept was feasible and improved cancer fatigue, sleep quality, autonomic and rest-/activity regulation in breast cancer patients. It may therefore constitute a valuable treatment option in addition to aerobic training for BC patients with CRF. A further study with larger sample size needs to be carried out to assess the efficacy of combined multimodal-aerobic therapy.

Effect of Traumeel S on pain and discomfort in radiation-induced oral mucositis: a preliminary observational study.

CONTEXT: Painful oral mucositis is an almost inevitable side effect of radiotherapy of head and neck tumors that simultaneous chemotherapy intensifies and that is notoriously difficult to treat. In a previous study, chemotherapy-induced stomatitis in children undergoing bone marrow transplantation responded well to the homeopathic complex remedy Traumeel S. OBJECTIVE: To evaluate the efficacy of Traumeel S in the management of radiation-induced oral mucositis in patients with head and neck tumors. DESIGN: The research team designed a nonrandomized, prospective, observational study with matched pairs. SETTING: The research team performed the study in a tertiary cancer-care center at the Institute of Radiotherapy and Special Oncology, Medical School Hanover, Germany. PARTICIPANTS: The participants were 20 patients who were receiving radiotherapy or radiochemotherapy for head and neck tumors. INTERVENTION: Five times per day during the observational period, participants self-administered daily mouth rinses with either sage tea (Salvia officinalis, control group) or Traumeel S solution (intervention group). OUTCOME MEASURES: Two independent physicians determined the grade of oral mucositis at least once per week, and the research team derived the degree of oral pain from diaries that participants kept. RESULTS: Both groups were comparable in terms of tumor and treatment characteristics. The research team could not confirm any appreciable specific effect of Traumeel S on the primary endpoints; the limited reduction in pain for the intervention group compared to the control group was not significant, and the more frequent analgesia in the Traumeel S group most likely explained that reduction. Among the secondary endpoints, loss of taste and swallowing difficulty responded to Traumeel S to some extent. CONCLUSIONS: Traumeel S may have some potential in the treatment of radiation-induced oral mucositis, but its possible effects need confirmation by further studies. This article discusses some methodological requirements.

Effectiveness of leech therapy in chronic lateral epicondylitis: a randomized controlled trial.

OBJECTIVES: Leech therapy has been found to be effective in osteoarthritis of the knee and hand in previous trials. Chronic epicondylitis is a prevalent pain syndrome with limited treatment options. In this study, we tested whether leech therapy would be beneficial in the symptomatic treatment of chronic lateral epicondylitis. METHODS: Forty patients with manifestation of epicondylitis of at least 1-month duration were randomized to a single treatment with 2 to 4 locally applied leeches or a 30-day course with topical diclofenac. The primary outcome was change of pain sum score on day 7 calculated from 3 visual analog scales for pain during motion, grip, and rest. Secondary outcomes included disability (Disability of the Arm, Shoulder, Hand questionnaire), physical quality of life (Short Form-36), and grip strength. Outcomes and safety were assessed on days -3, 0, 7, and 45. RESULTS: Leeches induced a significantly stronger decrease of the pain score (143.7±36.9 to 95.3±45.1) compared with topical diclofenac (131.6±29.6 to 134.7±70.7; mean difference -49.0; 95% confidence interval,-82.9--15.1; P=0.0075) after 7 days. On day 45, this group difference was reduced (-27.5; confidence interval, -60.8-5.8; P=0.110) due to delayed pain relief with diclofenac. Functional disability showed a stronger decrease in the leech group, which was most prominent after 45 days (P=0.0007). Quality of life increased nonsignificantly in the leech group. Results were not affected by outcome expectation. DISCUSSION: A single course of leech therapy was effective in relieving pain in the short-term and improved disability in intermediate-term. Leeches might be considered as an additional option in the therapeutic approach to lateral epicondylitis.

Is acupuncture in addition to conventional medicine effective as pain treatment for endometriosis? A randomised controlled cross-over trial.

OBJECTIVE: The aim of the study was to examine whether acupuncture is an effective additional pain treatment for endometriosis. STUDY DESIGN: One hundred and one women aged 20-40 years participated and were randomised into two groups, each receiving two units of 10 acupuncture treatments, twice a week over a period of five weeks. Group 1 (n = 47) received verum-acupuncture during the first series, and group 2 (n = 54) received non-specific acupuncture. After the first unit of 10 treatments, an observation period of at least two menstruation cycles was set, followed by a second unit, according to a cross-over design. Prior to the study (during a two-week run-in period) the patients' actual pain intensity was surveyed. Throughout the study period, participants were asked to keep a 'pain protocol', in which they defined and recorded their pain according to the 10-point visual analogue scale (VAS). RESULTS: Eighty-three out of a total of 101 patients finished the study. Group 1 showed a significant reduction of pain intensity after the first 10 treatments. In comparison, group 2 showed significant pain relief only after the cross-over. CONCLUSION: Acupuncture treatment on specific acupuncture points appears to be an effective pain treatment for endometriosis, but this has to be confirmed in further study.

Acupuncture induces a pro-inflammatory immune response intensified by a conditioning-expectation effect.

BACKGROUND: In a previous study it has been shown that acupuncture activates the respiratory burst (RB) of neutrophils as measured by the differences to baseline of the mean channel number of fluorescence intensity (mfi) in volunteers. Since this result could have been affected by a placebo effect, a study has been designed that controls for the different facets of placebo mechanisms such as expectancy, suggestibility, and conditioning. PARTICIPANTS AND METHODS: 60 healthy volunteers were randomized either to acupuncture of the acupoint Large Intestine 11 (LI 11) (groups 1 and 2) or relaxation (group 3) twice a week for 4 weeks. Only acupuncture group 1 and the relaxation group were provided with the additional suggestion that the treatment may strengthen the immune system. RESULTS: The repeated measurement analysis for differences of follow-ups to baseline showed significantly different treatment effects for neutrophils but not for monocytes (unprimed neutrophils: p = 0.004; neutrophils primed with TNF-alpha/FMLP or with FMLP only: p = 0.026 and p = 0.019, respectively) between groups. For both cell types post-hoc Dunnett's t-tests using the relaxation group as control showed significantly stronger treatment effects for acupuncture group 1. Combining all priming procedures, the average increase in mfi for both cell types was about 30% greater in acupuncture group 1 than in the relaxation group. Plasma concentrations of pro-inflammatory cytokines only increased significantly in the acupuncture groups. CONCLUSION: Repetitive acupuncture increases the cytotoxicity of leukocytes in healthy volunteers, which might be intensified by a conditioning-expectation effect.

Adjuvant auricular electroacupuncture and autogenic training in rheumatoid arthritis: a randomized controlled trial. Auricular acupuncture and autogenic training in rheumatoid arthritis.

BACKGROUND: In contrast to psychological interventions the usefulness of acupuncture as an adjuvant therapy in rheumatoid arthritis (RA) has not yet been demonstrated. OBJECTIVE: The efficacy of auricular electroacupuncture (EA) was directly compared with autogenic training (AT). METHODS: Patients with RA (n = 44) were randomized into EA or AT groups. EA and lessons in AT were performed once weekly for 6 weeks. Primary outcome measures were the mean weekly pain intensity and the disease activity score 28 (DAS 28); secondary outcome measures were the use of pain medication, the pain disability index (PDI), the clinical global impression (CGI) and pro-inflammatory cytokine levels, which were assessed during the study period and 3 months after the end of treatment. RESULTS: At the end of the treatment and at 3-month follow-up a clinically meaningful and statistically significant improvement (p < 0.05) could be observed in all outcome parameters and both groups. In contrast to the AT group, the onset of these effects in the EA group could already be observed after the 2nd treatment week. In the 4th treatment week the EA group reported significantly less pain than the AT group (p = 0.040). After the end of treatment (7th week) the EA group assessed their outcome as significantly more improved than the AT group (p = 0.035). The erythrocyte sedimentation rate in the EA group was significantly reduced (p = 0.010), and the serum concentration of tumor necrosis factor-alpha was significantly increased compared to the AT group (p = 0.020). CONCLUSIONS: The adjuvant use of both EA and AT in the treatment of RA resulted in significant short- and long-term treatment effects. The treatment effects of auricular EA were more pronounced.

Effectiveness of leech therapy in women with symptomatic arthrosis of the first carpometacarpal joint: a randomized controlled trial.

Leech therapy has been shown to be effective for symptomatic treatment of osteoarthritis of the knee. We aimed to investigate the effectiveness of leech therapy in another type of osteoarthritis, osteoarthritis of the first carpometacarpal joint (thumb saddle joint). Thirty-two women with symptomatic painful osteoarthritis of the first carpometacarpal joint and who scored>40 mm on a 100mm VAS pain scale were randomized to a single treatment with 2-3 locally applied leeches (leech group) or a 30-day course with topical diclofenac twice a day. Primary outcome measure was change of overall pain (mean of VAS for pain at rest, in motion, during grip) from baseline to day 7. Secondary outcomes were functional disability (DASH-questionnaire), quality of life (QoL, SF-36) and grip strength. Patients were examined baseline and at days 7, 30 and 60 after treatment. Overall pain score at day 7 was reduced from 59.6+/-13.8 to 27.1+/-20.6 in the leech group (n=16) and from 50.6+/-13.3 to 46.9+/-18.5 with diclofenac (n=16) (group difference -26.5, 95%CI -40.3; -12.7; p=0.0003). Group differences for pain relief favoring the leech treatment increased at days 30 and 60. Significant treatment effects were also observed for the DASH score, QoL and grip. Results were not affected by outcome expectation or consumption of analgetics. A single course of leech therapy is effective in relieving pain, improving disability and QoL for at least 2 months. The potential of leech therapy for treatment of arthritic pain and underlying mechanisms should be further investigated.

Auricular acupuncture for dental anxiety: a randomized controlled trial.

Auricular acupuncture can be an effective treatment for acute anxiety, but there is a lack of direct comparisons of acupuncture to proven standard drug treatments. In this study we compared the efficacy of auricular acupuncture with intranasal midazolam, placebo acupuncture, and no treatment for reducing dental anxiety. Patients having dental extractions (n = 67) were randomized to (i) auricular acupuncture, (ii) placebo acupuncture, and (iii) intranasal midazolam and compared with a no treatment group. Anxiety was assessed before the interventions, at 30 min, and after the dental extraction. Physiological variables were assessed continuously. With the no treatment group as control, the auricular acupuncture group, and the midazolam group were significantly less anxious at 30 min as compared with patients in the placebo acupuncture group (Spielberger Stait-Trait Anxiety Inventory X1, P = 0.012 and <0.001, respectively). In addition, patient compliance assessed by the dentist was significantly improved if auricular acupuncture or application of intranasal midazolam had been performed (P = 0.032 and 0.049, respectively). In conclusion, both, auricular acupuncture and intranasal midazolam were similarly effective for the treatment of dental anxiety.

Acupuncture in the treatment of painful dysfunction of the temporomandibular joint -- a review of the literature.

OBJECTIVE: The aim of the present study was to analyze the results of randomized clinical trials on the efficacy of acupuncture in the treatment of painful dysfunction of the temporomandibular joint. MATERIALS AND METHODS: A literature search of 3 electronic databases was performed, and only randomized studies comparing acupuncture-treated patients with either untreated or conservatively treated control groups were included. For this purpose, results were compared in narrative and tabular form. RESULTS: To date, only 8 publications representing 6 randomized clinical trials have looked into the efficacy of acupuncture in the treatment of craniomandibular dysfunction. With the exception of one, all studies were published in Sweden, between 1985 and 1992. A more recent US study was the only one to apply sham acupuncture to test the efficacy of acupuncture. All studies share methodological shortcomings, including a lack of detailed descriptions of the randomization procedures, point selection, possible dropouts and undesirable events as well as attempts to identify a possible placebo effect of the acupuncture. Only 1 study investigated long-term results. Although based on the improvement of subjective and objective criteria, all studies consider acupuncture as an effective treatment for painful dysfunction of the temporomandibular joint, the good results achieved must be interpreted with caution because of the methodological shortcomings identified. CONCLUSION: Acupuncture appears to be a suitable complementary treatment method in the management of craniomandibular dysfunction. However, its significance has to be further evaluated in future studies.

["Applied kinesiology" in medicine and dentistry--a critical review]. / "Angewandte Kinesiologie" in Medizin und Zahnmedizin--eine kritische Ubersicht.

The "Applied Kinesiology" evolved in the USA is increasingly being used in Central Europe. In this review the development of the method and its practical application in medicine and in dentistry are elucidated. Furthermore the propagation of the method by the International College of Applied Kinesiology (= ICAK) and the "Touch for Health" (=TFH) is described. School medicine's criticism of "Applied Kinesiology" as well as the methodological replies from "Applied Kinesiologists" are outlined. It is important to realise that there is to date a lack of evidence for the effectiveness, validity and reliability of "Applied Kinesiology". The following requirements are thus vital: "Applied Kinesiologists" must develop clear criteria for single subgroups of "Applied Kinesiology", prove the effectiveness of their methods, and explain their findings in agreement with current medical knowledge.

Needle acupuncture in chronic poststroke leg spasticity.

OBJECTIVE: To determine whether needle acupuncture may be useful in the reduction of leg spasticity in a chronic state. DESIGN: Single-blind, randomized, placebo-controlled trial. SETTING: Neurologic outpatient department of a medical school in Germany. PARTICIPANTS: Twenty-five patients (14 women) suffering from chronic poststroke leg spasticity with pes equinovarus deformity (Modified Ashworth Scale [MAS] score, >/=1), aged 38 to 77 years (mean +/- standard deviation, 58.5+/-10.4 y), were enrolled in the study. The mean time from stroke to inclusion in the study was approximately 5 years (mean, 65.4+/-48.3 mo; range, 7-180 mo). INTERVENTIONS: Participants were randomly assigned to placebo treatment (n=12) by using a specially designed placebo needling procedure, or verum treatment (n=13). MAIN OUTCOME MEASURES: MAS score of the affected ankle, pain (visual analog scale), and walking speed. RESULTS: There was no demonstrated beneficial clinical effects from verum acupuncture. After 4 weeks of treatment, mean MAS score was 3.3+/-0.9 in the placebo group versus 3.3+/-1.1 in the verum group. The neurophysiologic measure of H-reflex indicated a significant increase of spinal motoneuron excitability after verum acupuncture (H-response/M-response ratio: placebo,.39+/-.19; verum,.68+/-.41; P<.05). CONCLUSIONS: This effect might be explained by afferent input of A delta and C fibers to the spinal motoneuron. The results from our study indicate that needle acupuncture may not be helpful to patients with chronic poststroke spasticity. However, there was neurophysiologic evidence for specific acupuncture effects on a spinal (segmental) level involving nociceptive reflex mechanisms.

Acupuncture has no immediate treatment effect on the neutrophil respiratory burst: a randomized single-blinded two-period crossover study.

Little is known about the influence of acupuncture treatment on the immune system. The respiratory burst (RB) of polymorphonuclear leukocytes (PMN) is a recognized measure of their cytotoxicity, an important component of the immune system. The present trial was therefore performed to examine whether a single-acupuncture treatment has an immediate effect on the RB of neutrophil PMNs. Sixteen volunteers were enrolled in the study. After randomization, eight volunteers were treated bilaterally with standard needles at acupoint LI11 and eight volunteers with placebo needles at the same acupoint, each for 30 min. The RB was determined before and 30 min after treatment. After two weeks, each group received the alternative treatment. There was a drop-out of two volunteers. No period or carryover effects were found in the remaining fourteen volunteers. No effect of acupuncture on the neutrophil RB was observed.

Repetitive transcranial magnetic stimulation for the treatment of chronic pain - a pilot study.

Invasive electrical stimulation of the motor cortex has been reported to be of therapeutic value in pain control. We were interested whether noninvasive repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex might also act beneficially. Twelve patients with therapy-resistant chronic pain syndromes (mean age 51.3 +/- 12.6, 6 males) were included in a pilot study. They were treated with rTMS of the corresponding motor cortex area for 20 min (20 Hz, 20 x 2 s trains, intensity 80% of motor threshold) and sham stimulation (sequence-controlled cross-over design). Some of the patients (6/6) had an analgesic effect, but for the whole group, the difference between active and sham stimulation did not reach a level of significance (active rTMS: mean VAS reduction -4.0 +/- 15.6%; sham rTMS: -2.3 +/- 8.8%). Further studies using different rTMS stimulation parameters (duration and frequency of rTMS) or stimulation sites (e.g. anterior cingulate gyrus) are strongly encouraged.

Medical and physical therapy of temporomandibular joint disk displacement without reduction.

The objective of this study was to determine the influence of medical and physical therapy on long-term treatment outcome in 72 patients with anterior disk displacement without reduction. Patients were treated solely with occlusal splints (group I), with splints and supplementary medical therapy (group II), with splints and physical therapy (group III) or with splints, medical, and physical therapy (group IV). After therapy, the maintenance of improvement was objectively and subjectively assessed with an extensive clinical examination and a postal questionnaire. The percentage of pain free patients after therapy was 76% in group I, 88% in group II, 43% in group III, and 65% in group IV. There was a statistically significant higher increase of maximum jaw opening after therapy in group II than in the control groups (p<0.05). The improvement in mouth opening came to 9.7 mm in group I, 14.5 mm in group II, 7.3 mm in group III, and 11.2 mm in group IV. Medical therapy seems to have a positive influence on the treatment outcome of patients with anterior disk displacement without reduction.