Insomnia Increases Symptom Severity and Health Care Utilization in Patients With Fibromyalgia: A Population-based Study.

OBJECTIVE: This study aimed to determine whether comorbid insomnia is associated with increased use of fibromyalgia-related medications and health resources in fibromyalgia (FM) patients. MATERIALS AND METHODS: We analyzed data retrieved from the Longitudinal Health Insurance Database 2010, which contains claims data of 1 million beneficiaries randomly selected from Taiwan's National Health Insurance program. Patients treated for FM (n=17,920) on 2 separate visits between 2000 and 2001 were selected and subsequently divided into 2 groups: patients with and without comorbid insomnia (n=5466 and 12,454, respectively). Insomnia was identified through diagnosis on 2 separate visits after the index FM date. FM-related pharmacotherapies and ambulatory care visits were tracked from the index date to the end of 2013. RESULTS: Insomnia was associated with increased likelihood of future use of antidepressants (adjusted odds ratio [OR]=3.84, P<0.001), gabapentin (adjusted OR=1.67, P<0.001), pregabalin (adjusted OR=1.79, P=0.046), muscle relaxants (adjusted OR=3.05, P<0.001), and opioids and tramadol (adjusted OR=1.59, P<0.001) among FM patients compared with FM patients without insomnia. In addition, a diagnosis of insomnia was associated with an increased frequency of visits to ambulatory care services for both FM (ß=1.79; 95% confidence interval, 1.57-2.02; P<0.001) and other conditions (ß=108.51; 95% confidence interval, 103.14-113.89; P<0.001). DISCUSSION: This study demonstrates the substantial burden of comorbid insomnia in patients with FM.

Acupuncture stimulation of ST36 (Zusanli) attenuates acute renal but not hepatic injury in lipopolysaccharide-stimulated rats.

BACKGROUND: We sought to determine the effects of ST36 acupuncture on sepsis-induced kidney and liver injuries. METHODS: A total of 120 rats were randomized into 10 groups: 1) lipopolysaccharide (LPS), 2) normal saline (N/S), 3) LPS + ST36, 4) ST36, 5) LPS + P-ST36, 6) P-ST36, 7) LPS + Sham, 8) Sham, 9) LPS + P-Sham, and 10) P-Sham groups. Rats in the LPS + ST36, ST36, LPS +Sham, and Sham groups received ST36 (designated as "ST36") or a nonacupoint (designated as "Sham") acupuncture for 30 min followed by LPS or N/S injection. Rats in the LPS + P-ST36, P-ST36, LPS + P-Sham, and P-Sham groups received LPS or N/S injection for 3 h followed by a 30 min of ST36 or a "nonacupoint" acupuncture. Rats were killed at 6 h after LPS injection. RESULTS: LPS caused prominent kidney and liver injuries. The renal and hepatic nitric oxide (NO) concentrations and inducible NO synthase (iNOS) expression were also increased by LPS. ST36 acupuncture pretreatment significantly attenuated the LPS-induced kidney injury and the increases in renal NO concentration and iNOS expression. However, ST36 acupuncture pretreatment did not affect the LPS-induced liver injury and increases in hepatic NO concentration or iNOS expression. Furthermore, ST36 acupuncture performed after LPS did not affect the LPS-induced organ injuries or increases in NO concentration and iNOS expression. CONCLUSIONS: ST36 acupuncture pretreatment significantly attenuated sepsis-induced kidney, but not liver, injury in rats, whereas ST36 acupuncture performed after sepsis induction had no protective effects against sepsis-induced organ injuries.

Pre-treatment of acupuncture stimulation of ST36 (Zusanli) significantly attenuates CAT-2, CAT-2B and GTPCH transcription in septic rat lungs.

BACKGROUND: The isozymes of type-2 cationic amino acid transporter (including CAT-2 and CAT-2B) and guanosine triphosphate cyclohydrolase I (GTPCH) constitute part of the down-stream regulatory pathways that regulate nitric oxide (NO) production mediated by inducible NO synthase (iNOS). We sought to evaluate the effects of acupuncture stimulation of ST36 (Zusanli) on the expression of CAT-2, CAT-2B, and GTPCH in lipopolysaccharide (LPS)-stimulated rat lungs. METHODS: Sixty rats were randomized into 6 groups (n = 10 in each group): 1) LPS, 2) Normal saline (N/S), 3) LPS + ST36, 4) ST36, 5) LPS + Sham, and 6) Sham groups. Manual acupuncture stimulation of ST36 (designated as "ST36") or a "nonacupoint" (designated as "Sham") was performed in lightly immobilized rats for 30 minutes. Then, LPS injection was performed to induce the expressions of iNOS, CAT-2, CAT-2B, and GTPCH in rat lungs. Rats were sacrificed 6 hours after LPS injection and the expressions of these enzymes were assayed. RESULTS: Reverse transcription and polymerase chain reaction (RT-PCR) data revealed that the expressions of iNOS, CAT-2, CAT-2B, and GTPCH in N/S-stimulated rat lungs were low. Exposure to LPS significantly induced the expressions of iNOS, CAT-2, CAT-2B, and GTPCH. In addition, the pre-treatment of ST36 acupuncture significantly attenuated the LPS-induced expressions of iNOS, CAT-2, CAT-2B, and GTPCH in stimulated rat lungs. CONCLUSIONS: Pre-treatment of acupuncture stimulation of ST36 had significantly inhibitory effects on LPS-induced iNOS, CAT-2, CAT-2B, and GTPCH expressions in septic rat lungs.