Effects of low- and high-frequency electroacupuncture on protein expression and distribution of TRPV1 and P2X3 in rats with peripheral nerve injury.

BACKGROUND: Whether electroacupuncture (EA) stimulation at different frequencies has a similar effect on spared nerve injury (SNI) as other neuropathic pain models, and how EA at different frequencies causes distinct analgesic effects on neuropathic pain is still not clear. METHODS: Adult male Sprague-Dawley rats were randomly divided into sham SNI, SNI, 2 Hz, 100 Hz and sham EA groups. Paw withdrawal threshold (PWT) and paw withdrawal latency (PWL) were measured. EA was performed once a day on days 1 to 14 after SNI. The expressions of transient receptor potential cation subfamily V member 1 (TRPV1) and peripheral purinergic P2X receptor 3 (P2X3) were determined by western blotting and immunofluorescence. TRPV1 siRNA and P2X3 siRNA were administered by intrathecal injection. TRPV1 or P2X3 agonists were combined with EA. RESULTS: There were significant decreases in PWT, but no changes in PWL in the 14 days after SNI. EA using 2- or 100-Hz stimulation similarly increased PWT at every time point. The cytosol protein expression of P2X3 in the L4-L6 dorsal root ganglia (DRG) increased, but the expression of TRPV1 decreased in the SNI model. Both these effects were ameliorated by EA, with 2-Hz stimulation having a stronger effect than 100-Hz stimulation. Blocking either TRPV1 or P2X3 specific siRNAs attenuated the decreased PWT induced by SNI. Administration of either a TRPV1 or P2X3 agonist inhibited EA analgesia. CONCLUSION: 2- and 100-Hz EA similarly induced analgesic effects in SNI. This effect was related to up-regulation and down-regulation, respectively, of cytosol protein expression of P2X3 and TRPV1 in L4-L6 DRG, with 2 Hz having a better effect than 100 Hz.

Time-effective analgesic effect of acupressure ankle strip pressing wrist and ankle acupuncture point on primary dysmenorrhea: Study protocol clinical trial (SPIRIT compliant).

BACKGROUND: Dysmenorrhea seriously affects the ability of women to perform normal social activities and decreases their quality of life. Primary dysmenorrhea can be effectively treated with acupuncture. Based on the wrist-ankle acupuncture (WAA) theory, we designed a portable WAA point compression treatment strap that treats diseases by automatically applying pressure to acupuncture points. The proposed study aims to evaluate the immediate analgesic effect of the acupressure wrist-ankle strap in patients with primary dysmenorrhea. METHODS: The study will be a randomized controlled trial conducted from May 1, 2019 to May 30, 2020 that includes 78 students from Shanghai University of Traditional Chinese Medicine who have primary dysmenorrhea and meet the eligibility criteria. Participants will be randomly divided into 2 groups in a 1:1 allocation ratio. The intervention group will use the acupressure wrist-ankle strap equipped with tip compression component parts on the internal side; the control group will use the nonacupressure wrist-ankle strap with the tip compression parts removed. All participants will be treated for 30 minutes on the 1st day of menstruation. The primary outcome is the pain intensity score measured by the visual analog scale. The secondary outcomes are the onset time of analgesia, the pain threshold at Yinlingquan (SP 9), skin temperature at Guanyuan (CV 4), and expectations and satisfaction of patients as investigated via the expectation and treatment credibility scale. DISCUSSION: This trial will be the 1st study to evaluate the analgesic effect of the acupressure wrist-ankle strap in patients with primary dysmenorrhea. The quality of this study is ensured by the randomization, nonacupressure control, and blinded design. The results may provide evidence for a potential alternative treatment for primary dysmenorrhea and evidence-based proof of the analgesic effect of WAA.

Effect of Transcutaneous Electrical Nerve Stimulation on the Pain Intensity During Insertion of Needle in Patients Undergoing Spinal Anesthesia: A Randomized Controlled Study.

BACKGROUND AND OBJECTIVES: Needle insertion pain during spinal anesthesia is an unpleasant experience for patients. This study aimed to investigate the effects of Transcutaneous Electrical Nerve Stimulation (TENS) on the pain intensity during the insertion of spinal needles in patients undergoing spinal anesthesia. MATERIALS AND METHODS: In a double-blind clinical trial, 60 candidates for elective Trans Ureteral Lithotripsy surgery under spinal anesthesia were randomly divided into intervention and control groups. The electrodes of the TENS device were placed in the space between L3-L4 and L5-S1 vertebrae. The intensity of pain during insertion of the spinal needle by Visual Analog Scale and the frequency of attempts were recorded. RESULTS: The mean age of the study samples was 34.26 ± 5.07 and 32.8 ± 5.28 in the control and intervention group, respectively. The pain intensity during insertion of spinal needles was less significant in the intervention group compared to the control group (p = 0.001). The number of attempts to insert the spinal needle between the two groups was not statistically significant (p = 0.51). The duration of spinal anesthesia implementation procedure by physician in the intervention group was significantly shorter than that of the control group (p = 0.001). CONCLUSION: The use of TENS effectively reduced the pain of spinal needle insertion. Considering these beneficial effects, it is suggested that this procedure be used to relive pain in patients with spinal anesthesia.

Effect of fascia dry needling on non-specific thoracic pain - A proposed dry needling grading system.

This case report describes a 42-year-old female who presented with complaints of diffuse pain in her thoracic paraspinal region from T2 to T7. Physical examination revealed tenderness, increased turgor and restriction of her superficial fascia. A potential first time description of successful management utilizing fascia dry needling is described in this report with improvements noted in pain, range of motion, and functional activities. The patient was discharged from physiotherapy after four treatment sessions, and a follow-up after 3 months revealed that she was pain free and fully functional. A grading system (Sudarshan and Murugavel Dry Needling Grading Scale©) is proposed describing the various grades of dry needling to guide clinical reasoning and decision-making.

Coarse needle surface potentiates analgesic effect elicited by acupuncture with twirling manipulation in rats with nociceptive pain.

BACKGROUND: Biomechanical phenomenon called "needle grasp" through the winding of connective tissue has been proposed as an action mechanism of acupuncture manipulation. The aim of the present study is to verify whether the needle grasp force affects the pain-relieving activity of acupuncture in the tail-flick latency (TFL) and the rat paw formalin tests. METHODS: In order to make different roughness on the acupuncture needle surface, the needles with 0.2 mm-diameter were scratched using silicon carbide sandpapers with the grit numbers of 600 (mild coarse) and 200 (extra coarse). The surface roughness and rotation-induced torque of the scratched needles were then measured by atomic force microscope and Acusensor®, respectively. Rat abdominal wall tissues including insertion site of acupuncture needle were excised after 5 unidirectional rotations of the needles having various degrees of roughness, and the morphological changes of connective tissues were analyzed using hematoxylin and eosin (H-E) staining. Finally, the effects of coarse needle surface on anti-nociception induced by twirling manipulation were tested in rat TFL and formalin test. RESULTS: It was observed that the rougher the needle surface, the stronger the needle grasp force and thickness of subcutaneous connective tissue while rotating. TFL increased in proportion to surface roughness of the ground needles 10 min after acupuncture into the Zusanli acupoint (ST36) on rat's legs. In the rat formalin test, the rougher needle also significantly exerted the larger analgesic effect during both early and late phases compared to non-ground normal needle. CONCLUSION: Surface roughness of the acupuncture needle enhanced an anti-nociceptive activity of acupuncture therapy in rats, which partially supports the mechanical signaling theory through connective tissues in acupuncture manipulation.

[Research on Acupuncture Anesthesia-analgesia].

In the present paper, the author retrospects the historical developmental stages of acupuncture anesthesia-analgesia from 1) preliminary exploration:the creative application of acupuncture therapy to surgery with lower dosage or without anesthetics began in Shanghai and Xi'an in 1958; 2) clinical popularization:the acupuncture anesthesia-analgesia became popularized from 1965, peaked in 1970s' and declined from 1980s'; 3) mechanism study:from 1970 to 2000, a large quantity of research papers were published to confirm the validity of acupuncture analgesia (AA), and in 1997, NIH Consensus Conference for acupuncture was held, promoting the related research in the world; 4) focused research:from 2007 to now, the acupuncture anesthesia-analgesia was listed as one of the key research program in China; 5) theoretical summary:in view of the uncertainty of the scientific basis of the meridian system of traditional Chinese medicine, the nerve fibers distributed under the acupoint are now considered to be the indispensable components for AA, and the knowledge of modern neuroscience is competent to explain the underlying mechanism of AA; 6) returning to reality:AA has been accepted by the international scientific community, and the "acupuncture-assisted anesthesia", or "compound acupuncture and anesthetics anesthesia" has been used as the first choice for some types of surgical operation. The research on acupuncture anesthesia-analgesia greatly facilitates clinical application of acupuncture therapy in the world, and also promotes the development of acupuncture therapy itself and neuroscience. However, the transformation between theory and practice and their mutual interaction are endless endeavor. Thus, a careful review of the half-century-long practice of acupuncture anesthesia-analgesia is painstakingly necessary in order to clarifying the mechanisms, to raise the efficacy of clinical practice and to correct the possible errors referred to this concept.

[Anti-inflammatory and analgesia effects of electroacupuncture device of point injection on rats of inflammatory pain].

OBJECTIVE: To explore the anti-inflammatory and analgesia mechanism of electroacupuncture (EA) device of point injection (PI) on rats of inflammatory pain. METHODS: 48 Sprague Dawley (SD) rats were randomly assigned into a control group, a model group, an EA+PI group, an EA device of PI (EAPI) group, an EA group and a PI group, eight rats in each one. The rats in the control group were subcutaneously injected with 50 µL of liquid paraffin oil solvent into the dorsum of left hindpaw, while rats in the remaining groups were treated with 50 µL of complete freund's adjuvant (CFA) at identical location to induce the model of inflammatory pain. After model establishment, the rats in the EA+PI group, EAPI group, EA group and PI group were treated with EA+PI,EA device of PI, EA and PI, respectively, once every other day (the 2nd day, 4th day and 6th day). Each treatment was given for 30 min. The mechanical withdrawal threshold, thermal withdrawal threshold and foot swelling before and 1 d to 6 d after model establishment were observed; the western blotting method was applied to measure IL-1ß expression in inflammatory tissue of skin. RESULTS: After model establishment, compared with the control group, the mechanical withdrawal threshold and thermal withdrawal threshold were reduced (all P<0.05) and the foot swelling was increased in the rest groups (all P<0.05). After treatment, the mechanical withdrawal threshold and thermal withdrawal threshold in the EAPI group were significantly increased compared with those in the EA+PI group, EA group and PI group (all P<0.05), but the foot swelling was reduced (all P<0.05). The IL-1ß expression in the model group was higher than that in the control group (P<0.05); after treatment, the IL-1ß expression in the EAPI group was lower than that in the model group, EA group and PI group (all P<0.05), but no significantly different from that in the EA+PI group (P>0.05). CONCLUSIONS: The efficacy of EA device of PI on inflammatory pain is superior to EA combined with PI, EA alone and PI alone, which is suitable for further popularization and application.

[Parametric optimization of electroacupuncture against bone-cancer pain in rats and its intervention on mRNA expression of opioid receptor and precursor].

OBJECTIVE: To observe the intervention of electroacupuncture (EA) with different current frequencies and treatment frequencies on pain thresholt in rats with bone-cancer pain, so as to optimize treatment parameters of EA against bone cancer pain; and by measuring gene expression of opioid receptor and precursor in different tissues to preliminarily explore the possible mechanism of EA against bone cancer pain. METHODS: Ninety healthy female SD rats were randomly divided into a control group, a model group, EA groups (6 subgroups according to different frequencies) and a sham EA group, ten rats in each one. Rats in the control group were injected with 10 µL of amicrobic phosphate buffer solution (PBS) into tibial cavity; rats in the remaining groups were injected with Walker 256 cancer cells to establish model of bone-cancer pain. No treatment was given to rats in the control group and model group; rats in the EA groups were treated with EA at bilateral "Housanli" (ST 36) and "Genduan" with 3 different current frequencies (2 Hz, 100 Hz and 2 Hz/100 Hz), once a day and once every other day, 30 min per treatment (1mA for 15 min, 2 mA for 15 min); rats in the sham EA group were treated with identical acupoints as the EA group, but the acupoints were needled subcutaneously and EA was connected with power off. All the treatment was given for 14 days. Dynamic plantar aesthesiometer was applied to measure the paw withdrawal thresholds (PWTs) of the affected side before the model establishment, 6d, 8d, 10d, 12d, 14d, 16d, 18d, and 20d after model establishment. The mRNA expressions of µ-opioid receptor (MOR), κ-opioid receptor (KOR), δ-opioid receptor (DOR), proopiomelanocortin (POMC) and prodynorphin (PDYN) in dorsal root ganglion (DRG) and lumbar spinal cord dorsal horn (SCDH) of L4-L6 of the affected side were detected by PCR method. RESULTS: There were no differences in PWTs among all groups before model establishment (P>0. 05). Each time point after model establishment, PWTs in model group were obviously lower than those in the control group (all P<0. 01). Compared with the model group, PWTs in each EA subgroup were all increased (all P<0.05), but the differences at different time points were not significant among EA subgroups (P>0.05). The mRNA expressions of MOR, KOR, POMC, and PDYN in L4-L6 DRG in the 2 Hz/100 Hz II group were significantly higher than those in model group (P<0. 05, P<0. 01), while the mRNA expressions of MOR, KOR, DOR, POMC and PDYN in SCDH were not different compared with the model group (P>0. 05). CONCLUSION: EA treatment has obvious analgesic effect on bone-cancer pain, however, its effect is not related with current frequency and treating frequency. EA against bone-cancer pain may be related with increasing the mRNA expression of some peripheral opioid receptors and precursor.

Can acupuncture treatment be double-blinded? An evaluation of double-blind acupuncture treatment of postoperative pain.

Blinding protects against bias but the success of blinding is seldom assessed and reported in clinical trials including studies of acupuncture where blinding represents a major challenge. Recently, needles with the potential for double-blinding were developed, so we tested if acupuncture can be double-blinded in a randomized study of sixty-seven patients with acute pain ≥ 3 (0-10 scale following third molar removal) who received active acupuncture with a penetrating needle or placebo acupuncture with a non-penetrating needle. To test if acupuncture was administered double-blind, patients and acupuncturists were asked about perceived treatment allocation at the end of the study. To test if there were clues which led to identification of the treatment, deep dull pain associated with needle application and rotation (termed "de qi" in East Asian medicine), and patients' pain levels were assessed. Perceived treatment allocation depended on actual group allocation (p < 0.015) for both patients and acupuncturists, indicating that the needles were not successful in double-blinding. Up to 68% of patients and 83% of acupuncturists correctly identified the treatment, but for patients the distribution was not far from 50/50. Also, there was a significant interaction between actual or perceived treatment and the experience of de qi (p = 0.027), suggesting that the experience of de qi and possible non-verbal clues contributed to correct identification of the treatment. Yet, of the patients who perceived the treatment as active or placebo, 50% and 23%, respectively, reported de qi. Patients' acute pain levels did not influence the perceived treatment. In conclusion, acupuncture treatment was not fully double-blinded which is similar to observations in pharmacological studies. Still, the non-penetrating needle is the only needle that allows some degree of practitioner blinding. The study raises questions about alternatives to double-blind randomized clinical trials in the assessment of acupuncture treatment.

[The enlightenment of Fu's subcutaneous needling on pain medicine].

Fu's subcutaneous needling (FSN) is a modern approach developed from traditional Chinese acupuncture. It could give some stimulation in the subcutaneous region that has a quick and long-lasting effect on soft tissue injuries and some of the internal medicine diseases. It is a safe approach without adverse reaction. Through analysis of the features and possible mechanism of FSN, it is believed that research on mechanism of FSN is beneficial to the development of modern medicine, especially to pain management.

[Efficacy on analgesia with electric stimulation of long-term retaining needle after laparoscopic cholecystectomy].

OBJECTIVE: To observe the clinical effect of electric stimulation of long-term retaining needle on analgesia after laparoscopic cholecystectomy (LC) and the impacts on the post-surgical flatus time. METHODS: Under static absorptive composite general anesthesia, 90 cases of LC were randomized into three groups, 30 cases in each one. In the control group, the analgesia was not applied after LC. In the analgesia-pumper group, the patient controlled intravenous analgesia (PCIA) was used. In the needle-retaining group, the electric acupuncture stimulator was used. The needles were inserted transversely at Riyue (GB 24), Qichong (ST 30) and Yanglingquan (GB 34) and fixed with sterile sticker. Separately, in 8 h and 24 h after surgery, the electric acupuncture stimulation with disperse-dense wave, 2 Hz/100 Hz frequency was applied continuously for 30 min. Visual analogue scale (VAS), adverse reactions such as vomiting and nausea and the postoperative flatus time in 2, 4, 8, 12, 24 and 36 h after surgery were observed and recorded in the three groups. RESULTS: In 2, 4, 8, 12 and 24 h after surgery, VAS scores in the needle-retaining group and the analgesia-pumper group were all lower than those in the control group (P < 0.05, P < 0.01). The analgesia effect at the above time points in the needle-retaining group was better than that in the analgesia-pumper group (all P < 0.05). There was not adverse reaction in the needle-retaining group. But there were 3 cases of somnolence, 6 cases of nausea and 3 cases of vomiting in the analgesia-pumper group, and 2 cases of nausea and 1 case of vomiting in the control group. The flatus time was quite earlier in the needle-retaining group as compared with the other two groups [(14.77 +/- 4.99) h vs (18.50 +/- 4.22) h, P < 0.01; (14.77 +/- 4.99) h vs (18.17 +/- 4.69) h, P < 0.05]. CONCLUSION: The electric stimulation of long-term retaining needle is safe and effective in analgesia after LC. It avoids the adverse reactions of analgesics and promotes postoperative flatus.

Electroacupuncture analgesia in a rabbit ovariohysterectomy.

This study investigated the effectiveness of electroacupuncture analgesia (EAA) at local and paravertebral acupoints for a rabbit undergoing an ovariohysterectomy. Twelve clinically healthy New Zealand white rabbits were chosen and divided into two groups: the control group (5 rabbits) and the experimental group (7 rabbits). A neuroleptanalgesic (ketamine + xylazine) was administered to the control group (NLA group); the experimental group received EAA treatment (EAA group). The EAA treatment includes one acupuncture formula for local stimulation at the incision site and systemic stimulation. Results of clinical research have shown postoperative analgesia using EAA treatment to be superior to that using NLA. The average postoperative recovery time was 5.2 times longer in the NLA group than in the EAA group. Because consciousness was maintained, EAA presented an advantage in thermoregulation. Animals administered NLA had prolonged thermal homeostasis because of neurovegetative disconnection. For the EAA group, the operative times were characterized as excellent (28%, p = 0.28) or good (72%, p = 0.72). Local stimulation at the incision site provided excellent analgesia of the abdominal wall (100%). In conclusion, EA can provide general analgesia with a considerable analgesic effect for a rabbit undergoing an ovariohysterectomy, resulting in a short postoperative recovery time.

Acupuntura, electroacupuntura, moxibustión y técnicas relacionadas en el tratamiento del dolor / No disponible

La acupuntura, un componente fundamental en la medicina china, tiene una historia de más de dos mil años, siendo desde entonces útil para mantener una buena salud y para el tratamiento de diversas enfermedades, especialmente el dolor. Según la teoría de la acupuntura clásica, existe una red de canales (los meridianos) en el cuerpo humano con puntos de acupuntura, situados sobre la piel y los tejidos más profundos. La punción en los puntos de acupuntura modula la fisiología del cuerpo a través de esa red de canales o meridianos. Las estructuras anatómicas y las funciones fisiológicas de los puntos de acupuntura, según la medicina china y la acupuntura tradicional, a través de la teoría de los meridianos o canales no han demostrado equivalentes en la ciencia biomédica moderna, pero la neurociencia moderna y los ensayos clínicos muestran un alto potencial terapéutico en el tratamiento del dolor crónico (AU)

Acupuncture, a major component in Chinese medicine, has a history of well over two thousand years and is effective to maintain good health and to treat various diseases, especially pain. According to classic acupuncture theory, there is a network of meridian channels inside the human body with acupoints on the skin and deeper tissues. Needling at the acupoints modulates the physiology of the body through the meridian channel network. The anatomical structures and physiological functions of the Chinese medicine acupoints, meridian channels and acupuncture have not been shown to have equivalents in modern biomedical science, but modern neuroscience and clinical trials show a high therapeutic potential in the treatment of chronic pain (AU)

[Observation on clinical efficacy of acute pain treated with the intervention of different time of needle retention].

OBJECTIVE: To compare the efficacy on acute pain treated under the different time of needle retention so as to provide the scientific evidence for the optimization of needle retention time for acupuncture analgesia. METHODS: Eighty cases of acute pain (acute lumbar sprain, stiffness of neck) were randomized into 4 groups. Acupuncture was applied to all the patients. After the arrival of needling sensation, the needles were retained for 20 min, 30 min, 45 min and 60 min in different groups separately. For acute lumbar sprain, Ashi (Extra), Houxi (SI 3) and Weizhong (BL 40) were the main points. For stiffness of neck, Ashi (Extra), Fengchi (GB 20) and Lieque (LU 7) were the main points. McGill pain scale, the internationally recognized pain description and measurement was adopted to observe the indexes and record the score changes of each item of pain symptoms before and 3 months after treatment. The immediate analgesic efficacy under different time of needle retention and the longterm efficacy in follow-up visit 3 months after treatment were compared and assessed among the groups. RESULTS: The scores of visual analogue scale (VAS) and present pain intensity (PPI) after treatment were all improved significantly as compared with those before treatment in the 4 groups (all P<0. 01), and the result in the 45 min group was superior to the other 3 groups (VAS: 2.90+/-0.87 vs 5. 52 +/-1.01, 4.45+/-0.81, 5.95+/-1.07; PPI: 1.40+/-0.21 vs 2.26+/-0.54, 2. 21+/-0. 43, 2. 28+/-0. 74, all P<0. 01). The total effective rate of the immediate analgesia was 95. 0% (19/20) in the 45 min group, which was better than that in each of the other 3 groups. CONCLUSION: The 45 min of needle retention achieves the best efficacy of acupuncture analgesia in treatment of acute pain.

[Time-effect study on instant analgesic effect of the dragon-tiger fighting needling method on primary dysmenorrhea].

OBJECTIVE: To observe the clinical analgesic efficacy and the relation between clinical analgesic effect and duration of effect of two acupuncture methods of Longhu Jiaozhan (fight of dragon and tiger, an acupuncture reinforcing and reducing manipulation characterized with nine counterclockwise and six clockwise rotations) and even manipulations. METHODS: Sixty-two patients with primary dysmenorrhea were randomly divided into an observation group (32 cases) and a control group (30 cases). The observation group was applied with Longhu Jiaozhan manipulation, while the control group was applied with even manipulation. Acupuncture treatment was given on both of the groups since onset of the pain. The score of the visual analogue scale (VAS) of the 2 groups was observed at different times. And 8 VAS values were recorded at the point right before acupuncture, needle remaining of 5 min, 10 min, 20 min and 30 min as well as and 30 min, 60 min, 120 min after needle withdrawal. Comparison was made on differences between the 2 groups. RESULTS: Comparison with the same group before acupuncture showed that the VAS difference of the time from needling remaining of 5 min to 120 min after acupuncture were all with statistic significance (all P<0. 01). The score of VAS of needle remaining for 20 min and 30 min of the observation group was without significant difference (P>0. 05). The score of VAS value of needle remaining for 20 min and 30 min of the control group was with significant difference (P<0. 01). Comparison of the VAS scores before the treatment and the scores of the 2nd menstrual cycle were found with significant difference (P<0. 01). The VAS score of 2nd menstrual cycle was (28. 73 +/- 16. 15) in the observation group, which was better than (46. 93+/-12. 18) in the control group (P<0. 001). Comparison of the VAS score of the two groups at 5 min r emaining of the needle was without statistic significance between two groups (P>0. 05). However, the VAS impairment magnitude difference at that moment was with statistic significance (P<0.01). From the time of needle remaining for 10 min, 20 min, 30 min until 120 min after needling, the differences of the VAS scores and impairment range were all with statistic significance (all P<0. 01). The effects of the two acupuncture techniques could both be maintained up to 2 hours after needling. CONCLUSION: Both methods of acupuncture have immediate and long-term analgesic effect in a certain degree on primary dysmenorrhea. However, compared with the control group, the advantage of analgesic effect in the observation group is significantly superior. 20 min needling remaining can reach the best analgesic effect.

[Review on the role of Fu's subcutaneous needling (FSN) in pain relieving].

Through retrieval of all medical journals of CNKI and VIP from Jan. 1996 to Oct. 2012, ninety-nine articles were selected and analyzed. The result shows that reliable effect can be found in pain relieving, especially in pain of muscles and soft tissues. In mechanism research, action mechanism of Fu's subcutaneous needling (FSN) on pain relieving is expounded through theory of traditional medicine and modern medicine. Although the effect of FSN on pain relieving has been confirmed by numerous clinical trials, it is still lack of explanation on mechanism revealing. The further studies should focus on mechanism expounding, improving research methods and selecting more objective and reasonable evaluation system. Therefore, the effectiveness and scientificalness of FSN can be further enhanced.

Fundamentos actuales de la terapia acupuntural / No disponible

La acupuntura es una de las modalidades terapéuticas últimamente más estudiadas y documentadas en el campo de la medicina y la veterinaria. El mecanismo de acción de la acupuntura ha resultado controvertido durante bastante tiempo por el intento de identificación de un proceso único. La estimulación con acupuntura de las fibras nerviosas periféricas envía impulsos a la médula espinal y activa varios centros en el cerebro, para liberar neurotransmisores que ejercen un efecto homeostático en todo el cuerpo. Modula la actividad neural en el diencéfalo, que ejerce influencia en las funciones autonómica, endocrina e inmune a través del eje hipotálamo-hipófisis-adrenal, regulando la liberación circadiana de ACTH, vasopresina y cortisol, conduciendo igualmente a la homeostasis. Los estudios por imagen han mostrado que la estimulación por acupuntura activa estructuras de inhibición descendente del dolor, demostrando que la acupuntura asume una vía central en el control del dolor. Igualmente, la acupuntura actúa sobre el sistema límbico y la integración talámica. Los potenciales evocados corticales somatosensoriales han mostrado que los canales de acupuntura son pasajes bioeléctricos que permiten la transmisión de impulsos. Diversos mecanismos locales de acción explican algunos de los efectos de la acupuntura. Es preciso estudiar si el genotipo y la influencia de factores ambientales ejercen una influencia importante en predecir qué pacientes serán beneficiados por la terapia acupuntural (AU)

Interest in the scientific basis of acupuncture has been increasing, as reflected by a dramatic rise in the number of scientific publications on medical and veterinary acupuncture. The mechanism of action remains unclear because it is not only one. Activation of the descending pain inhibitory system with spinal and supraspinal endorphin release as well as the involvement of other neurotransmitters like serotonin and norepinephrine have been analyzed. Acupuncture triggers a sequence of events involving the release of central endogenous opioid-like substances, as well as ACTH, vasopressin and cortisol, which modulate signals processed along the pathway and have effects on the immunoinflammatory response, the hypothalamic-pituitary axis and homeostasis. Central nervous system imaging techniques allow evaluate the events that occur after acupuncture-induced stimulation, including spinal gating and descending inhibitory pathways. The limbic system and thalamus play an important role in acupuncture-induced analgesia. Cortical somatosensoryevoked potentials have provided compelling evidence for the hypothesis that peripheral driver stimulation is the key element in producing propagated sensations along the meridians. Acupuncture has both local and distant analgesic effects that may be mediated by different mechanisms. The acupuncture points traditionally used for the treatment have a neuroanatomical significance from the viewpoint of western medicine; from that one can hypothesizes a plausible mechanism of action as to how acupuncture achieves its therapeutic effects in terms of contemporary western medicine (AU)