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Immediate effects of variable durations of pressure release technique on latent myofascial trigger points of the levator scapulae: a double-blinded randomised clinical trial
Daniel Pecos-Martin, Manuel José Ponce-Castro, José Jesús Jiménez-Rejano, Susana Nunez-Nagy, César Calvo-Lobo, Tomás Gallego-Izquierdo
First Published May 7, 2019; pp. 141–150
Abstract
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Objective:
Latent myofascial trigger points (MTrPs) of the levator scapulae have a high prevalence and may influenceconditions of the neck and shoulder. The pressure release technique is one of the most recommended manual therapy techniques. The aim of this study was to determine the effect of varying durations of the pressure release technique application on latent MTrPs of the levator scapulae.
Methods:
In a three-arm (1:1:1 ratio), double-blinded, parallel, randomised clinical trial, 60 healthy university students (23 men, 37 women) with a mean±SD age of 20.0±2.67 years were recruited. Subjects were assigned to receive pressure release in one latent MTrP of the levator scapulae lasting 30s (T30s; n=17), 60s (T60s; n=22) or 90s (T90s; n=21). Active cervical range of movement (CROM), strength, pressure pain threshold (PPT) and neck pain intensity at full stretch were measured immediately before and after treatment.
Results:
Mixed-model analyses of variance showed statistically significant differences for PPT (P=0.045; partial Eta2=0.103), comparing T60s versus T30s (P=0.009; Cohen’s d=1.044) and T90s versus T30s groups (P=0.001; Cohen’s d=1.253), and for left side bending strength (P=0.043; partial Eta2=0.105), comparing T90s versus T30s (P=0.023; Cohen’s d=0.907). The rest of the comparisons did not present any significant differences (P⩾0.05).
Conclusions:
The 60 s and 90 s applications of the pressure release technique may be recommended to increase PPT and strength, respectively, in latent MTrPs of the levator scapulae in the short term.
Trial registration number:
NCT03006822.
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Effects of dry needling in the sternocleidomastoid muscle on cervical motor control in patients with neck pain: a randomised clinical trial
Aida Martín-Rodríguez, Esther Sáez-Olmo, Daniel Pecos-Martín, César Calvo-Lobo
First Published April 24, 2019; pp. 151–163
Abstract
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Objective:
To determine the changes produced by trigger point dry needling (TrP-DN) of sternocleidomastoid in patients with neck pain, and to observe how it might modify cervical motor control (CMC).
Design:
Single-centre, randomised, double-blinded clinical trial.
Setting:
Participants were recruited through advertising. The duration of the study was 6 months.
Subjects:
Thirty-four subjects with non-specific neck pain, aged over 18 years with an active myofascial trigger point in sternocleidomastoid, participated in the study. They were randomly assigned to treatment or control groups.
Methods:
TrP-DN inside or (1.5 cm) outside of the active myofascial trigger point of sternocleidomastoid.
Main outcome measures:
CMC, visual analogue scale and cervical range of motion were assessed before treatment, immediately post treatment, and 24 h, 1 week and 1 month after the intervention; the neck disability index was evaluated before treatment and 1 month later.
Results:
With a confidence interval of 99%, TrP-DN of sternocleidomastoid was associated with a decrease in pain after 1 week and CMC improved 1 month after the intervention (p < 0.001), when compared with baseline measurements, within the experimental group; there were no statistically significant differences between experimental and control groups.
Conclusion:
The effects of TrP-DN inside and outside of active myofascial trigger points did not differ in this study. Both interventions were associated with a similar temporal effect, specifically a reduction in neck pain at 1 week and an increase CMC at 1 month. However, these findings should be interpreted with caution due to the lack of a contemporaneous untreated control group.
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Acupuncture for symptoms management in Korean breast cancer survivors: a prospective pilot study
Tae-Hun Kim, Jung Won Kang
First Published March 21, 2019; pp. 164–174
Abstract
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Background:
There is an unmet need for effective treatment of the various treatment-related symptoms experienced by breast cancer survivors. These symptoms could be alleviated by acupuncture. Although several lines of evidence in Western countries suggest that acupuncture has a beneficial effect on symptoms in breast cancer survivors, few relevant studies have been conducted in Korean patients. This pilot study assessed the feasibility of acupuncture for a variety of treatment-related symptoms in Korean breast cancer survivors.
Method:
From October 2015 to March 2016, we recruited patients who had undergone treatment for breast cancer and subsequently reported symptoms, including aromatase inhibitor-related knee pain, vasomotor symptoms, insomnia, sexual dysfunction and post-mastectomy pain in the chest wall or shoulder. The women received 4 weeks of symptom-specific acupuncture followed by a further 4 weeks of follow-up to evaluate the feasibility of acupuncture for this indication, and its impact on common and symptom-specific outcome variables.
Results:
Eight study participants were recruited over a period of 6 months, six of whom completed the planned acupuncture treatment and follow-up assessments. A total of 78 acupuncture sessions were performed. We found that acupuncture was feasible, with only six minor self-limiting acupuncture-related adverse events. Most of the women felt that they had benefitted from participation in the study. The preliminary analysis indicated improvement in common symptom-specific outcomes.
Conclusion:
Our findings suggest that acupuncture is feasible, but low recruitment rates should be considered when considering future acupuncture research in Korean breast cancer survivors. Rigorous evaluation of this symptomatic treatment strategy is now needed in the Korean population.
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Acupuncture treatment and the risk of urinary tract infection in stroke patients: a nationwide matched cohort study
Jen-Lin Yang, Ta-Liang Chen, Chun-Chieh Yeh, Chaur-Jong Hu, Chien-Chang Liao, Hsin-Long Lane, Chun-Chuan Shih
First Published April 29, 2019; pp. 175–183
Abstract
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Background:
The association between acupuncture treatment and post-stroke urinary tract infection (UTI) remains incompletely understood.
Objective:
To compare the long-term risks of UTI among stroke patients treated with or without acupuncture treatment.
Methods:
This retrospective cohort study was based on data from the National Health Insurance Research Database in Taiwan that included hospitalized stroke patients. We identified 19,286 patients aged 30 years and older who were hospitalized for newly diagnosed stroke between 1 January 2000 and 31 December 2004. Considering immortal time bias, we compared the incidence of UTI during the follow-up period until the end of 2009 in patients with stroke who did and did not receive acupuncture. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of UTI associated with acupuncture were calculated using multivariate Cox proportional hazard regression analysis.
Results:
Stroke patients who received acupuncture treatment experienced a lower incidence of UTI than those who were not treated with acupuncture (95.4 vs 110.0 per 1000 person-years) with an HR of 0.76 (95% CI: 0.73–0.80). The association between acupuncture treatment and UTI was significant for both sexes and for patients older than 40 years of age, particularly for patients who had no history of medical conditions.
Conclusions:
In this nationwide retrospective cohort study, we raised the possibility that acupuncture treatment may be associated with a reduced risk of UTI among stroke patients. However, the protective effect associated with acupuncture treatment requires further validation using randomized clinical trials.
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Developing and employing a ‘responsive manualization’ in the ‘Acupuncture Approaches to Decrease Disparities in Outcomes of Pain Treatment’ comparative effectiveness study
Arya Nielsen, Belinda Anderson, Claudia Citkovitz, Patricia Botet, Susana Correia, Valentina Duque, Selina Greene, Donna Mah, Dana Moore, Amy Pagliarini, M Diane McKee, Benjamin Kligler
First Published March 22, 2019; pp. 184–191
Abstract
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Objective:
The aim of this article is to describe the process used to develop an acupuncture therapy manual for a large effectiveness trial comparing individual care against group care for chronic pain in an underserved population. The design needed to not only ensure research consistency and replicability but also be ‘responsive’ to real world heterogeneous and evolving presentations in challenging physical settings.
Background:
Chronic pain is prevalent in the United States. While acupuncture is effective for chronic pain, minority, ethnically diverse and lower socioeconomic populations have limited access. Group acupuncture is proposed as a lower cost option to facilitate access in safety net settings, but research on the effectiveness of group versus individual acupuncture is lacking.
Methods:
We engaged a modified Delphi process with expert practitioners from diverse backgrounds who were experienced in individual and group practice. All contributions were recorded and collated for second- and third-round consensus discussions that included contributions by the trial’s research acupuncturists.
Results:
A ‘responsive manual’ flow chart was created with suggested sequencing that included interviews concurrent with palpation, Tui na, Gua sha, acupuncture needling, ear treatment, basic recommendations and options for departure with rationale. The manual was implemented by six research acupuncturists in five primary care settings in the Bronx, New York, with weekly team meetings to discuss manual use. There were no serious adverse events (AE) and few minor AE reported in this trial.
Conclusion:
A ‘responsive manual’ can be structured and implemented that is not only consistent and replicable but also flexible to accommodate the real-world clinical needs of practitioners and patients in challenging physical settings.
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Alleviation of trigeminal neuropathic pain by electroacupuncture: the role of hyperpolarization-activated cyclic nucleotide-gated channel protein expression in the Gasserian ganglion
Liuyue Yang, Weihua Ding, Zerong You, Jinsheng Yang, Shiqian Shen, Jason T Doheny, Lucy Chen, Ruhui Li, Jianren Mao
First Published April 12, 2019; pp. 192–198
Abstract
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Introduction:
The aim of this study was to examine the effect of electroacupuncture (EA) on trigeminal neuropathic pain in rats and explore the potential mechanism underlying the putative therapeutic effect of EA.
Methods:
Trigeminal neuropathic pain behavior was induced in rats by unilateral chronic constriction injury of the distal infraorbital nerve (dIoN-CCI). EA was administered at ST2 (Sibai) and Jiachengjiang. A total of 60 Sprague Dawley rats were divided into the following four groups (n = 15 per group) to examine the behavioral outcomes after surgery and/or EA treatment: sham (no ligation); dIoN-CCI (received isoflurane only, without EA treatment); dIoN-CCI+EA-7d (received EA treatment for 7 days); and dIoN-CCI+EA-14d (received EA treatment for 14 days). Both evoked and spontaneous nociceptive behaviors were measured. Of these, 12 rats (n = 4 from sham, dIoN-CCI, and dIoN-CCI+EA-14d groups, respectively) were used to analyze protein expression of hyperpolarization-activated cyclic nucleotide-gated (HCN) channel in the Gasserian ganglion (GG) by immunohistochemistry.
Results:
dIoN-CCI rats exhibited mechanical allodynia and increased face-grooming activity that lasted at least 35 days. EA treatment reduced mechanical allodynia and face-grooming in dIoN-CCI rats. Overall, 14 days of EA treatment produced a prolonged anti-nociceptive effect as compared to 7-day EA treatment. The counts of HCN1 and HCN2 immunopositive puncta were increased in the ipsilateral GG in dIoN-CCI rats and were reduced by 14 days of EA treatment.
Discussion:
EA treatment relieved trigeminal neuropathic pain in dIoN-CCI rats, and this effect was dependent on the duration of EA treatment. The downregulation of HCN expression may contribute to the anti-nociceptive effect of EA in this rat model of trigeminal neuropathic pain.
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