Physiological impact of nanoporous acupuncture needles: Laser Doppler perfusion imaging in healthy volunteers

English version

Autoři: Koh-Woon Kim ^aff001; Sanhwa Hong ^aff002; Hong Soo Kim ^aff004; Taehun Kim ^aff002; Jaeha Ahn ^aff002; Hyun-Seo Song ^aff002; Yu-Kang Kim ^aff002; Ju-Young Oh ^aff002; Tae-Yeon Hwang ^aff002; Hyangsook Lee ^aff002; Su-Il In ^aff004; Hi-Joon Park ^aff002
Působiště autorů: Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea ^aff001; Acupuncture and Meridian Science Research Center, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea ^aff002; Department of Meridian Medical Science, College of Korean Medicine, Graduate School, Dongdaemun-gu, Seoul, Republic of Korea ^aff003; Department of Energy Science and Engineering, DGIST, Hyeonpung-myeon, Dalseong-gun, Daegu, Republic of Korea ^aff004; Department of Anatomy and Information Science, College of Korean Medicine, Dongdaemun-gu, Seoul, Republic of Korea ^aff005
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0226304

Souhrn

Background

Recently, porous acupuncture (PA), which is anodized to increase its surface area for higher stimulation intensity, was developed and showed significantly improved therapeutic effects with more comfort as compared with original acupuncture (OA) in vivo. However, the impact of PA on the change of local blood flow as well as its efficacy and acceptability has not yet been confirmed in a clinical trial. In a randomized, controlled crossover clinical trial, we investigated the effects of PA on the change in local blood flow using laser Doppler perfusion imaging and considered the sensation of pain intensity and discomfort severity using a visual analogue scale (VAS) to explore its physiological impact and the possibility of PA in clinical use.

Methods

Twenty-one healthy participants were randomly treated with PA or OA on one side of Zusanli (ST36) and each participant served as his or her own control. Baseline local blood flow and galvanic skin response (GSR) were obtained for 5 min and acupuncture interventions were subsequently performed. Next, local blood flow and GSR were subsequently obtained for 10 min after insertion, 10 min after manipulation, and 5 min after the withdrawal of acupuncture. At the end of the experiment, participants were asked to indicate the sensation of pain intensity at each session of insertion, retention, manipulation, and withdrawal as well as the overall pain intensity and discomfort severity.

Results

PA significantly increased the local blood flow as compared with OA and there was no significant difference in GSR between patients treated with PA versus OA in each phase of insertion and manipulation. No significant difference in pain intensity or discomfort severity was found during manipulation, retention, or withdrawal of acupuncture.

Conclusions

These results indicate that PA increases local blood flow, which can be closely related to the observed enhanced performance, without any associated discomfort or pain, suggesting its applicability in clinical practice.

Klíčová slova:

Blood – Sensory perception – Lasers – Blood flow – Pain sensation – Acupuncture – Fluid physiology – Doppler imaging

Zdroje

1. Ceniceros S, Brown GR. Acupuncture: a review of its history, theories, and indications. South Med J. 1998;91(12):1121–5. doi: 10.1097/00007611-199812000-00005 9853723

2. Chao G-Q, Zhang S. Effectiveness of acupuncture to treat irritable bowel syndrome: a meta-analysis. World J Gastroenterol. 2014;20(7):1871. doi: 10.3748/wjg.v20.i7.1871 24587665

3. Pang B, Jiang T, Du Y-H, Li J, Li B, Hu Y-C, et al. Acupuncture for functional dyspepsia: what strength does it have? A systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med. 2016;2016.

4. Chen N, Wang J, Mucelli A, Zhang X, Wang C. Electro-acupuncture is beneficial for knee osteoarthritis: The evidence from meta-analysis of randomized controlled trials. Am J Chin Med. 2017;45(05):965–85.

5. Liu L, Skinner M, McDonough S, Mabire L, Baxter GD. Acupuncture for low back pain: an overview of systematic reviews. Evid Based Complement Alternat Med 2015;2015.

6. Clark NA, Will M, Moravek MB, Fisseha S. A systematic review of the evidence for complementary and alternative medicine in infertility. Intern J Gynecol Obstet. 2013;122(3):202–6.

7. Lim CED, Ng RW, Xu K, Cheng NCL, Xue CC, Liu JP, et al. Acupuncture for polycystic ovarian syndrome. Cochrane Catabese Syst Rev. 2016.

8. Kou R-z, Chen H, Yu M-l, Xu T-c, Fu S-p, Lu S-f. Acupuncture for behavioral changes of experimental depressive disorder: a systematic review and meta-analysis. Sci Rep. 2017;7(1):9669. doi: 10.1038/s41598-017-09712-1 28851961

9. Lee S-H, Lim S. Clinical effectiveness of acupuncture on Parkinson disease: A PRISMA-compliant systematic review and meta-analysis. Medicine. 2017;96(3).

10. Zhou J, Peng W, Xu M, Li W, Liu Z. The effectiveness and safety of acupuncture for patients with Alzheimer disease: a systematic review and meta-analysis of randomized controlled trials. Medicine. 2015;94(22).

11. Faircloth A. Acupuncture: History from the Yellow Emperor to Modern Anesthesia Practice. AANA J. 2015;83(4).

12. Napadow, Napadow V, Ahn A, Longhurst J, Lao L, Stener Victorin E, et al. The Status and Future of Acupuncture Mechanism Research. J Altern Complement Med. 2008;14(7):861–9. doi: 10.1089/acm.2008.SAR-3 18803495

13. Langevin HM, Bouffard NA, Badger GJ, Churchill DL, Howe AK. Subcutaneous tissue fibroblast cytoskeletal remodeling induced by acupuncture: evidence for a mechanotransduction-based mechanism. J Cell Physiol. 2006;207(3):767–74. Epub 2006/03/03. doi: 10.1002/jcp.20623 16511830.

14. Langevin HM, Churchill DL, Cipolla MJ. Mechanical signaling through connective tissue: a mechanism for the therapeutic effect of acupuncture. FASEB J. 2001;15(12):2275–82. Epub 2001/10/20. doi: 10.1096/fj.01-0015hyp 11641255.

15. Langevin HM, Yandow JA. Relationship of acupuncture points and meridians to connective tissue planes. Anat Rec. 2002;269(6):257–65. Epub 2002/12/06. doi: 10.1002/ar.10185 12467083.

16. Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008;85(4):355–75. Epub 2008/06/28. doi: 10.1016/j.pneurobio.2008.05.004 18582529.

17. Han JS. Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends Neurosci 2003;26(1):17–22. Epub 2002/12/24. doi: 10.1016/s0166-2236(02)00006-1 12495858.

18. Kim DH, Ryu Y, Hahm DH, Sohn BY, Shim I, Kwon OS, et al. Acupuncture points can be identified as cutaneous neurogenic inflammatory spots. Sci Rep. 2017;7(1):15214. Epub 2017/11/11. doi: 10.1038/s41598-017-14359-z 29123119.

19. Li P, Longhurst JC. Neural mechanism of electroacupuncture's hypotensive effects. Auton Neurosci. 2010;157(1–2):24–30. Epub 2010/05/07. doi: 10.1016/j.autneu.2010.03.015 20444652.

20. Takahashi T. Mechanism of acupuncture on neuromodulation in the gut—a review. Neuromodulation: journal of the International Neuromodulation Society. 2011;14(1):8–12; discussion Epub 2011/10/14. doi: 10.1111/j.1525-1403.2010.00295.x 21992155.

21. Hui KK, Nixon EE, Vangel MG, Liu J, Marina O, Napadow V, et al. Characterization of the "deqi" response in acupuncture. BMC Complement Altern Med 2007;7:33. Epub 2007/11/02. doi: 10.1186/1472-6882-7-33 17973984.

22. Yang XY, Shi GX, Li QQ, Zhang ZH, Xu Q, Liu CZ. Characterization of deqi sensation and acupuncture effect. Evid Based Complement Alternat Med. 2013;2013:319734. Epub 2013/07/19. doi: 10.1155/2013/319734 23864884.

23. Shi G-X, Yang X-M, Liu C-Z, Wang L-P. Factors contributing to therapeutic effects evaluated in acupuncture clinical trials. Trials. 2012;13:42-. doi: 10.1186/1745-6215-13-42 22520963.

24. Min S, Lee H, Kim SY, Park JY, Chae Y, Lee H, et al. Local changes in microcirculation and the analgesic effects of acupuncture: a laser Doppler perfusion imaging study. J Altern Complement Med. 2015;21(1):46–52. Epub 2014/10/30. doi: 10.1089/acm.2013.0442 25354241.

25. Mayor D. An exploratory review of the electroacupuncture literature: clinical applications and endorphin mechanisms. Acupunct Med. 2013;31(4):409–15. Epub 2013/08/07. doi: 10.1136/acupmed-2013-010324 23917395.

26. Hou PW, Hsu HC, Lin YW, Tang NY, Cheng CY, Hsieh CL. The History, Mechanism, and Clinical Application of Auricular Therapy in Traditional Chinese Medicine. Evid Based Complement Alternat Med. 2015;2015:495684. Epub 2016/01/30. doi: 10.1155/2015/495684 26823672.

27. Baxter GD, Bleakley C, McDonough S. Clinical effectiveness of laser acupuncture: a systematic review. J Acupunct Meridian Stud. 2008;1(2):65–82. Epub 2008/12/01. doi: 10.1016/S2005-2901(09)60026-1 20633458.

28. Lao L. Acupuncture techniques and devices. J Altern Complement Med. 1996;2(1):23–5. Epub 1996/04/01. doi: 10.1089/acm.1996.2.23 9395637.

29. Hsu W-S, Shen X-Y, Yang J-M, Luo L, Zhang L, Qi D-D, et al. Effects of acupuncture applied to sanyinjiao with different stimuli on uterine contraction and microcirculation in rats with dysmenorrhea of cold coagulation syndrome. Evid Based Complement Alternat Med. 2014;2014:328657-. Epub 2014/04/09. doi: 10.1155/2014/328657 24812566.

30. Zhang X, Park H-J, Lee H. Do acupuncture needle size and needling depth matter? A laser Doppler imaging study. Integr Med Res. 2015;4(1, Supplement):66–7. https://doi.org/10.1016/j.imr.2015.04.075.

31. Ceccheerelli F, Bordin M, Gagliardi G, Caravello M. Comparison between superficial and deep acupuncture in the treatment of the shoulder's myofascial pain: a randomized and controlled study. Acupunct Electrother Res. 2001;26(4):229–38. Epub 2002/02/14. doi: 10.3727/036012901816355938 11841108.

32. Henry S, McAllister DV, Allen MG, Prausnitz MR. Microfabricated microneedles: a novel approach to transdermal drug delivery. J Pharm Sci. 1998;87(8):922–5. Epub 1998/08/04. doi: 10.1021/js980042+ 9687334.

33. Shirkhanzadeh M. Microneedles coated with porous calcium phosphate ceramics: effective vehicles for transdermal delivery of solid trehalose. J Mater Sci Mater Med. 2005;16(1):37–45. Epub 2005/03/09. doi: 10.1007/s10856-005-6444-2 15754142.

34. Tang L, Du D, Yang F, Liang Z, Ning Y, Wang H, et al. Preparation of Graphene-Modified Acupuncture Needle and Its Application in Detecting Neurotransmitters. Sci Rep. 2015;5:11627. Epub 2015/06/27. doi: 10.1038/srep11627 26112773.

35. Kwon S, Lee Y, Park HJ, Hahm DH. Coarse needle surface potentiates analgesic effect elicited by acupuncture with twirling manipulation in rats with nociceptive pain. BMC Complement Altern Med. 2017;17(1):1. Epub 2017/01/05. doi: 10.1186/s12906-016-1505-2 28049463.

36. In SL, Gwak YS, Kim HR, Razzaq A, Lee KS, Kim HY, et al. Hierarchical Micro/Nano-Porous Acupuncture Needles Offering Enhanced Therapeutic Properties. Sci Rep. 2016;6:34061. Epub 2016/10/08. doi: 10.1038/srep34061 27713547.

37. Lee BR, Kim HR, Choi ES, Cho JH, Kim NJ, Kim JH, et al. Enhanced Therapeutic Treatment of Colorectal Cancer Using Surface-Modified Nanoporous Acupuncture Needles. Sci Rep. 2017;7(1):12900. Epub 2017/10/12. doi: 10.1038/s41598-017-11213-0 29018212.

38. Hsiu H, Huang SM, Chao PT, Jan MY, Hsu TL, Wang WK, et al. Microcirculatory characteristics of acupuncture points obtained by laser Doppler flowmetry. Physiol Meas. 2007;28(10):N77–86. Epub 2007/10/02. doi: 10.1088/0967-3334/28/10/N01 17906382.

39. Kim SY, Min S, Lee H, Cheon S, Zhang X, Park JY, et al. Changes of Local Blood Flow in Response to Acupuncture Stimulation: A Systematic Review. Evid Based Complement Alternat Med. 2016;2016:9874207. Epub 2016/07/13. doi: 10.1155/2016/9874207 27403201.

40. Litscher G. Bioengineering assessment of acupuncture, part 2: monitoring of microcirculation. Crit Rev Biomed Eng. 2006;34(4):273–94. Epub 2007/01/09. doi: 10.1615/critrevbiomedeng.v34.i4.10 17206916.

41. World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4. Epub 2013/10/22. doi: 10.1001/jama.2013.281053 24141714.

42. Kim YJ, Lee IS, Kim HS, Lee H, Park HJ, Lee H, et al. Validation of the Korean version of the Acupuncture Expectancy Scale. Acupunct Med. 2014;32(1):51–5. Epub 2013/10/10. doi: 10.1136/acupmed-2013-010412 24103416.

43. Kim HS, Kim YJ, Lee HJ, Kim SY, Lee H, Chang DS, et al. Development and validation of acupuncture fear scale. Evid Based Complement Alternat Med. 2013;2013:109704. Epub 2013/05/11. doi: 10.1155/2013/109704 23662109.

44. Takakura N, Ogawa H, Iijima S, Nishimura K, Kanamaru A, Sibuya M, et al. Effect of acupuncture at the Hoku point on vibration-induced finger flexion reflex in man: comparison between press needle technique, electroacupuncture, and in-situ technique. Am J Chin Med. 1995;23(3–4):313–8. Epub 1995/01/01. doi: 10.1142/S0192415X95000377 8571928.

45. Kim JH, Min BI, Schmidt D, Lee HJ, Park DS. The difference between electroacupuncture only and electroacupuncture with manipulation on analgesia in rats. Neurosci Lett. 2000;279(3):149–52. Epub 2000/02/25. doi: 10.1016/s0304-3940(99)00994-5 10688051.

46. Xu S, Wang L, Cooper E, Zhang M, Manheimer E, Berman B, et al. Adverse events of acupuncture: a systematic review of case reports. Evid Based Complement Alternat Med. 2013;2013:581203. Epub 2013/04/11. doi: 10.1155/2013/581203 23573135.

47. Langevin HM, Churchill DL, Fox JR, Badger GJ, Garra BS, Krag MH. Biomechanical response to acupuncture needling in humans. Journal of applied physiology. 2001;91(6):2471–8. Epub 2001/11/22. doi: 10.1152/jappl.2001.91.6.2471 11717207.

48. Langevin HM, Churchill DL, Wu J, Badger GJ, Yandow JA, Fox JR, et al. Evidence of connective tissue involvement in acupuncture. FASEB J. 2002;16(8):872–4. Epub 2002/04/23. doi: 10.1096/fj.01-0925fje 11967233.

49. Habler HJ, Wasner G, Janig W. Interaction of sympathetic vasoconstriction and antidromic vasodilatation in the control of skin blood flow. Exp Brain Res. 1997;113(3):402–10. Epub 1997/03/01. doi: 10.1007/pl00005594 9108208.

50. Janig W, Lisney SJ. Small diameter myelinated afferents produce vasodilatation but not plasma extravasation in rat skin. J Physiol. 1989;415:477–86. Epub 1989/08/01. doi: 10.1113/jphysiol.1989.sp017732 2640468.

51. Kashiba H, Ueda Y. Acupuncture to the skin induces release of substance P and calcitonin gene-related peptide from peripheral terminals of primary sensory neurons in the rat. Am J Chin Med. 1991;19(3–4):189–97. Epub 1991/01/01. doi: 10.1142/S0192415X91000260 1722639.

52. Sato A, Sato Y, Shimura M, Uchida S. Calcitonin gene-related peptide produces skeletal muscle vasodilation following antidromic stimulation of unmyelinated afferents in the dorsal root in rats. Neurosci Lett. 2000;283(2):137–40. Epub 2000/03/31. doi: 10.1016/s0304-3940(00)00932-0 10739894.

53. Sandberg M, Lundeberg T, Lindberg LG, Gerdle B. Effects of acupuncture on skin and muscle blood flow in healthy subjects. Eur J Appl Physiol. 2003;90(1–2):114–9. Epub 2003/06/27. doi: 10.1007/s00421-003-0825-3 12827364.

54. Andersson S, Lundeberg T. Acupuncture—from empiricism to science: functional background to acupuncture effects in pain and disease. Med Hypotheses. 1995;45(3):271–81. Epub 1995/09/01. doi: 10.1016/0306-9877(95)90117-5 8569551.

55. Ernst M, Lee MH. Sympathetic effects of manual and electrical acupuncture of the Tsusanli knee point: comparison with the Hoku hand point sympathetic effects. Exp Neurol. 1986;94(1):1–10. Epub 1986/10/01. doi: 10.1016/0014-4886(86)90266-9 3758275.

56. Sato A, Sato Y, Schmidt RF. The impact of somatosensory input on autonomic functions. Rev Physiol Biochem Pharmacol. 1997;130:1–328. Epub 1997/01/01. 9019119.

57. Sugiyama Y, Xue YX, Mano T. Transient increase in human muscle sympathetic nerve activity during manual acupuncture. Jpn J Physiol. 1995;45(2):337–45. Epub 1995/01/01. doi: 10.2170/jjphysiol.45.337 7563968.

58. Boutouyrie P, Corvisier R, Azizi M, Lemoine D, Laloux B, Hallouin M, et al. Effects of acupuncture on radial artery hemodynamics: controlled trials in sensitized and naive subjects. Am J Physiol Heart Circ Physiol. 2001;280(2):H628–33. Epub 2001/02/13. doi: 10.1152/ajpheart.2001.280.2.H628 11158960.

59. Widerstrom-Noga E, Dyrehag LE, Borglum-Jensen L, Aslund PG, Wenneberg B, Andersson SA. Pain threshold responses to two different modes of sensory stimulation in patients with orofacial muscular pain: psychologic considerations. J Orofac Pain. 1998;12(1):27–34. Epub 1998/07/10. 9656896.