Clinical effectiveness of trigger point acupuncture on chronic neck and shoulder pain (katakori) with work productivity loss in office workers: a randomized clinical trial.

OBJECTIVES: To evaluate whether trigger point acupuncture (TrPA) is beneficial for office workers who have reduced job performance (presenteeism) due to chronic neck and shoulder pain (katakori). METHODS: A 4-week single-center randomized controlled trial was conducted on 20 eligible female office workers with chronic neck and shoulder pain of at least 3-month duration. The control group implemented only workplace-recommended presenteeism measures, whereas the intervention group received TrPA up to 4 times per month in addition to the presenteeism measures recommended by each workplace. The major outcome measure was the relative presenteeism score on the World Health Organization Health and Work Performance (WHO-HPQ). The secondary outcome measures were pain intensity (numerical rating scale), absolute presenteeism (WHO-HPQ), anxiety and depression (Hospital Anxiety and Depression Scale; HADS), catastrophic thoughts related to pain (Pain Catastrophizing Scale; PCS), and sleep (Athens Insomnia Scale; AIS). RESULTS: All 9 cases in the intervention group and 11 cases in the control group were analyzed. TrPA up to 4 times per month reduced the intensity of neck and shoulder pain by 20% (P < .01, d = 1.65) and improved labor productivity (relative presenteeism value) by 0.25 (P < .01, d = 1.33) compared with the control group over 1 month. No significant differences were observed between the 2 groups in terms of absolute presenteeism score, HADS, PCS, or AIS. CONCLUSIONS: These results suggest that regular intervention with TrPA may be effective in the relative presenteeism score before and after the intervention and the degree of neck and shoulder pain over 28 days compared with the control group.

Health status of university football athletes through multidimensional screening.

OBJECTIVE: Adequate conditioning results from various physical, environmental, and psychological factors in sports activities. In this study, we aimed to clarify the concurrence and relevance of injuries, psychological problems, and sleep disturbance in university football (soccer) players. Biomechanical characteristics and risk factors for those injuries were also investigated. METHODS: Overall, 1,084 university football players participated in this cross-sectional study using a web-based health history questionnaire. Assessments were made via the presence of injuries for physical problems, the Athlete Psychological Strain Questionnaire (APSQ) for psychological problems, and the Athlete Sleep Screening Questionnaire (ASSQ) for sleep difficulties. RESULTS: There were 200 (19%) athletes with injuries; 413 (38%) of these were APSQ-positive, 246 (23%) were ASSQ-positive, and 468 (43%) athletes had no physical, psychological, or sleep problems. APSQ-positive respondents were significantly more likely to have a current injury than those who were APSQ-negative. No significant difference was observed between the number of ASSQ-positive and -negative respondents and current injuries. Those with sleep problems were significantly more likely to have psychological problems. CONCLUSION: More than 60% of university football players had one or more physical, psychological, or sleep problems. Players may have co-occurring problems, and it is important to address them for these athletes to reach peak performance.

Managing office worker presenteeism by providing financial aid for acupuncture therapy: a pragmatic multicenter randomized comparative study.

To evaluate whether financial aid for acupuncture therapy is beneficial for non-manufacturing job workers (office workers) who are aware of reduced job performance due to health issues (presenteeism), a four-wk pragmatic multicenter randomized controlled trial was conducted with office workers who were aware of their presenteeism. The control group only implemented the workplace-recommended presenteeism measures, whereas the intervention group received financial aid for acupuncture therapy of up to 8,000 JPY (Japanese yen) in addition to implementing the presenteeism measures recommended by each workplace. The major outcome measure was the World Health Organization Health and Work Performance Questionnaire relative presenteeism score. A total of 203 patients were assigned to the intervention (n=103) and control (n=108) groups. The intervention group underwent a median of 1.0 (interquartile range [IQR], 1.0 to 2.0) sessions of acupuncture for neck disorders (64%), back disorders (16%), and depressed mood/anxiety/irritation (5%), among others. Results showed that the intervention group had slightly better job performance than the control group (effect size [r]=0.15, p=0.03). Financial aid for acupuncture therapy may help compensate for losses incurred by enterprises in the form of 14,117 JPY per worker a month.

Trigger Point Acupuncture and Exercise for Chronic Low Back Pain in Older Adult: a Preliminary Randomized Clinical Trial.

Background: Exercise therapy is the first choice non-pharmacotherapeutic approach for musculoskeletal pain; however, it often interferes with the implementation and continuation of exercise due to fear-avoidance behaviors. Trigger point acupuncture (TrPAcp) has been reported to reduce musculoskeletal pain. Objectives: To examine the efficacy of exercise combined with TrPAcp compared to exercise alone for older patients with chronic low back pain (CLBP), the most common subjective symptom reported by old people of both sexes in Japan. Methods: In this single-center randomized controlled trial conducted at Teikyo Heisei University, 15 men and women aged ≥ 65 years with low back pain for at least 3 months who met the eligibility criteria were included. The Ex+TrPAcp group received exercise and trigger point acupuncture, while the Ex group received only exercise for 3 months. The main outcome, pain intensity, was measured using the numerical rating scale (NRS). Improvement was defined as a decrease in NRS of ≥ 2 or less than moderate (NRS < 4). Results: The analysis included 7 of 8 cases in the Ex+TrPAcp group and 7 of 7 cases in the Ex group. NRS improved in 6 of 7 and 1 of 7 patients in the intervention and control groups, respectively, with a significant difference between groups (p = 0.03, ϕ = 0.71). Regarding adverse events due to acupuncture, one patient (14.3%) complained of heaviness after acupuncture. Nothing specific was reported with exercise. Conclusion: Compared with Ex alone, Ex+TrPAcp may be more effective therapy for older people with CLBP who do not have an exercise habit.

Acupuncture Relaxation, Vigilance Stage, and Autonomic Nervous System Function: A Comparative Study of Their Interrelationships.

Objective: During acupuncture stimulation, autonomic nervous system (ANS) function changes toward being parasympathetic-dominant, with a transient decrease in heart rate (HR). The aim of this research was to determine the relationships between cortical relaxation and vigilance as observed on background electroencephalograms (EEGs), HR, and ANS function during deep acupuncture. Materials and Methods: This comparative study was conducted at Teikyo Heisei University, in Toshima-ku, Tokyo, Japan, with 27 healthy male volunteers. After resting for 20 minutes, the men received manual acupuncture at LI 10 on the left forearm for 2 minutes at a depth of 15-20 mm at a 1-Hz frequency while undergoing concurrent EEG and electrocardiography (ECG) monitoring. Each subject described his level of comfort during acupuncture. HR; power ratios (normalized units [n.u.]) of EEG alpha, beta, delta, and theta waves; and HR variability (HRV) indices were calculated. Results: In the subgroup who experienced discomfort, delta and theta n.u. were decreased while alpha n.u. were increased, indicating increased vigilance and decreased relaxation. In the subgroup who experienced comfort, there were no significant changes. HRV indices suggested parasympathetic-dominant changes in both subgroups. Weak correlations were observed between a decrease of theta n.u. and sympathetic-dominant changes in HRV indices. Conclusions: Alterations in background EEG activities were not the primary factors changing ANS function to parasympathetic-dominant and decreasing HR, but these alterations related to a weak secondary factor changing ANS function. EEG activity by which cortical relaxation and vigilance were represented was the weak secondary factor changing ANS function during acupuncture; the primary factor might be supraspinal reflection.

Effects of a Standardized Oligomerized-Polyphenol from Litchi chinensis Fruit Extract and Mixed Plant Extract Supplementation on Peripheral Circulation and Cold Sensitivity.

Certain individuals tend to suffer from a cold sensation-particularly in the lower extremities-despite most people not suffering from the same sensation. In Japan, this phenomenon is called "hie-sho" and reduces quality of life for several people, particularly women. A previous study has shown that a standardized oligomerized-polyphenol from Litchi chinensis fruit extract (OPLFE) reportedly causes a significant increase in body surface temperature. The present study aimed to investigate whether supplementation with OPLFE affected peripheral circulation and cold sensitivity. This randomized, double-blind, placebo-controlled trial was performed including 25 participants (age, 45.0±10.4 y; 3 males and 22 females) who were assigned to consume OPLFE, mixed plant extract with OPLFE, or placebo capsules for 14 d. Participants were instructed to relax for 60 min in a temperature-controlled room prior to obtaining measurements. Changes in skin temperature and peripheral blood flow of the middle finger were assessed immediately before and 1, 5, 10, 20, and 30 min after immersion in cold water (10ºC). Participants' height, weight, skin temperature, and blood flow in peripheral tissue were measured; furthermore, their "hie-sho" was measured using the Visual Analog Scale (VAS). Skin temperature and blood flow in peripheral tissue increased in the OPLFE and mixed plant extract with OPLFE groups on day 14 compared with those on day 1. In addition, cold sensitivity in these two groups significantly improved between day 1 and day 14. These findings suggest that OPLFE improves "hie-sho" by increasing peripheral blood flow and skin temperature.

Electroacupuncture of the Ophthalmic Branch of the Trigeminal Nerve: Effects on Prefrontal Cortex Blood Flow.

Objective: The current authors observed enhanced cerebral blood flow (CBF) in the prefrontal cortex (PFC) in response to 100-Hz electroacupuncture (EA) stimulation of the ophthalmic branch of the trigeminal nerve. However, it is not yet clear if responsiveness to 100-Hz EA depends on stimulus intensity. This study examined the effects of stimulus strength on PFC CBF during 100-Hz EA of the ophthalmic branch of the trigeminal nerve. Materials and Methods: Twelve subjects underwent 3 acupuncture sessions: I, control, no stimulation; II, 0.1 mA EA; and III, 0.2 mA EA). Needles were inserted 1 cm lateral of the head median line; the anterior insertion point was on the front hairline and the posterior insertion point was ∼7 cm behind the hairline. Stimulation frequency was set to 100-Hz. PFC CBF was measured in terms of oxygenated, deoxygenated, and total hemoglobin (OxyHb, DeoxyHb, TotalHb, respectively), using 16-channel (Ch) near-infrared spectroscopy. Results: Stimulation of 0.2 mA was associated with significant elevation of OxyHb levels in the 0.1 mA condition in Chs 6, 10, and 12. Ch 2-6, 10, 12 signals were notably higher than in the control condition. Stimulation of 0.2 mA and 0.1 mA were associated with significant declines in DeoxyHb levels, compared to the control condition in Ch 4. Finally, 0.2 mA stimulation in Chs 12 and 13 was associated with significant elevation of TotalHb levels in the control condition. Conclusions: Using 0.2-mA stimulation, 100-Hz EA of the ophthalmic nerve enhances PFC CBF more strongly than 0.1-mA stimulation.

Effects of Acupuncture Sensations on Transient Heart Rate Reduction and Autonomic Nervous System Function During Acupuncture Stimulation.

Objective: During acupuncture stimulation, heart rate (HR) transiently decreases and autonomic nervous system (ANS) function becomes parasympathetic-dominant. To clarify the effect of acupuncture sensations (pain, De Qi), the effects of deep acupuncture sensations on HR and ANS functions were determined. Materials and Methods: In this comparative study at Teikyo Heisei University, Tokyo, Japan, 40 healthy, male student volunteers rested for 20 minutes before undergoing manual acupuncture to the Shousanli (LI 10) acupoint on the left forearm for 2 minutes at a frequency of 1 Hz, with concurrent electrocardiography. Depth of stimulation was 15-20 mm. These subjects described their subjective acupuncture sensations. Calculations were performed, using HR variability analysis to find HR and low-frequency (LF) normalized units (nu), the ratio of LF components to total components (as an index of sympathetic nervous system function), high-frequency (HF)nu, the ratio of HF components to total components (as an index of parasympathetic nervous system function), and LF/HF (as an index of sympathetic and parasympathetic balance). Results: For the final analysis, data were available for 32 subjects. Compared to before acupuncture, HR decreased during acupuncture. HR decreased when no acupuncture sensations or when weak De Qi sensations were perceived, and remained unchanged when acupuncture sensations without De Qi or strong De Qi were perceived. LFnu decreased, HFnu increased, and LF/HF decreased, regardless of pain or De Qi. Conclusions: Acupuncture stimulation reduced HR even without De Qi sensations and caused ANS function to be parasympathetic-dominant, irrespective of the perception of acupuncture sensations.

Evaluation of Autonomic Nervous System Function Using Heart Rate Variability Analysis During Transient Heart Rate Reduction Caused by Acupuncture.

Objective: Human studies have demonstrated that heart rate (HR) decreases during acupuncture stimulation, and pharmacologic studies have shown that this autonomic nervous system (ANS) response is parasympathetic-dominant. It has become clear that significant changes occur in the ANS after acupuncture, based on HR variability (HRV). However, it is inconclusive, according to HRV analysis, if acupuncture induces a significant change in autonomic function during stimulation. The aim of this study was to investigate ANS function using HRV analysis during HR reduction induced by manual acupuncture stimulation to the muscles. Materials and Methods: In this study, electrocardiograms of 25 adult men were analyzed. After resting for 20 minutes, participants underwent 15-20-mm deep acupuncture stimulation at the Shousanli (LI 10) point at 1 Hz for 2 minutes. Instantaneous HR was recorded. The index of parasympathetic nervous activity high-frequency (HF) normalized units (HFnu) and the ratio of sympathovagal balance (low frequency [LF]/HF) were calculated by HRV analysis. Results: HR during acupuncture was significantly lower, compared to HR both before and after acupuncture. HFnu during acupuncture were significantly higher, compared to HFnu both before and after acupuncture. The LF/HF ratio during acupuncture was significantly lower, compared to the ratio before acupuncture, and remained low after acupuncture, compared to before acupuncture. Conclusions: Acupuncture stimulation to the muscle can effectively reduce HR, increase HFnu, and decrease LF/HF that depends on autonomic regulation of both sympathovagal balances.

Effects of AHCC® on Immune and Stress Responses in Healthy Individuals.

AHCC® is a functional food from the basidiomycete Lentinula edodes. We evaluated the effects of AHCC® on subjects under different kinds of stress and at rest. Physical stress was imposed using an active standing test, known as Schellong's test. Sympathetic nervous activity in the standing position was significantly greater in AHCC®-treated subjects than in a placebo group. In contrast, AHCC® significantly increased parasympathetic nervous activity at rest. Under mental stress, AHCC® increased sympathetic nervous activity, with no difference in the parasympathetic nervous system. In subjects with chronic mental stress, self-reported "initiation and maintenance of sleep" was significantly greater in the AHCC®-intake period than in the placebo intake period, and natural killer cell activity also increased after AHCC® intake, suggesting a possible mechanism of action of AHCC®. Our findings indicate that AHCC® is potentially effective in stress management and may be useful in the treatment of depression.

Effects of electroacupuncture to the trigeminal nerve area on the autonomic nervous system and cerebral blood flow in the prefrontal cortex.

BACKGROUND: The autonomic nervous system and trigeminal nerve are involved in adjusting flow through diverging cerebral arteries in the prefrontal cortex. The purpose of this study was to examine the effect of 100 Hz electroacupuncture (EA) to the trigeminal nerve area on cerebral blood flow and autonomic nervous system function. METHOD: This was a randomised crossover study of 16 healthy volunteers who were assigned to an EA or control group. Stimulation (in the EA group) was performed five times, each after 1 min of rest. Needles were inserted at the inner edge of the eyebrows and 1 cm from the front hairline midpoint. We used high-frequency (HF) and low-frequency (LF) components of heart rate (HR) variability to assess autonomic nervous system function. HF and LF/HF ratio were taken as indicators of parasympathetic and sympathetic nervous system activity, respectively. We measured cerebral blood flow using a two-channel near-infrared spectroscope. RESULTS: In the EA group, HR significantly decreased (p=0.004) and HF significantly increased (p=0.006) relative to baseline. By contrast, there were no significant changes in HR or HF within the control group (p>0.05). Accordingly, HR tended to be lower (p=0.087) and HF greater (p=0.071) in the EA group versus the control group. There were no significant differences in LF/HF ratio within/between groups. Compared with the control group, cerebral blood flow was significantly greater in the left (p=0.048) and right (p=0.016) prefrontal cortex in the EA group. CONCLUSIONS: Delivery of 100 Hz EA to the trigeminal nerve area reduces HR and increases parasympathetic nervous activity and cerebral blood flow.

Effect of Enzyme-Treated Asparagus Extract (ETAS) on Psychological Stress in Healthy Individuals.

The aim of this study was to examine the effectiveness of Enzyme-Treated Asparagus Extract (ETAS) on improving stress response. A randomized, double-blind, placebo-controlled cross-over trial was undertaken in healthy volunteers. ETAS (150 mg/d) or a placebo was consumed for 28 d, with a washout period. Psychological parameters were examined using a self-report scale questionnaire and psychological stress was applied using the Uchida-Kraepelin (U-K) test. During the stress load, autonomic nervous function was analyzed. After the stress load, a profile of mood states (POMS) psychological rating was performed, and serum cortisol, plasma catecholamine, salivary secretory immunoglobulin A (sIgA), and salivary cortisol were analyzed. ETAS intake improved the self-reported rating for the items "Feel tired," "Hard to get up," and "Feel heavy" in the psychological questionnaire; ameliorated the self-reported rating for the items "Depression-Dejection" and "Fatigue" in the POMS questionnaire; and increased salivary sIgA levels after the U-K test. In contrast, serum and salivary cortisol levels, and plasma catecholamine did not change. During the U-K test, ETAS significantly upregulated the sympathetic nerve activity. Furthermore, ETAS intake significantly increased the number of answers and the number of correct answers in the U-K test, suggesting that it might improve office work performance with swiftness and accuracy under stressful conditions. In conclusion, ETAS supplementation reduced feelings of dysphoria and fatigue, ameliorated quality of sleep, and enhanced stress-load performance as well as promoted stress response by increasing salivary sIgA levels. These data suggest ETAS intake may exert beneficial effects, resulting from well-controlled stress management, in healthy individuals.