Original Article
Journal of Anesthesia
Management of acupuncture therapy
in painful peripheral neuropathy in China
Yang Bai*, Yuan Xu*, Ye Zhang, Bo Chen, Hailong Yu, Qiang Li, Kuo
Zhang, Yi Guo
Affiliation: School of Tianjin Traditional Chinese Medicine The Research Center of
Experiment Acupuncture Science 300193 China
Abstract:
Context: Acupuncture is currently used widely throughout China and many other countries. It
aims at treating a range of clinical conditions, especially used for pain relief. Modern scientific
research studies have revealed the analgesia mechanisms of acupuncture. Our purpose was
through literature retrieval to describe the current status of acupuncture therapy in peripheral
neuropathic pain in China, to promote the spread and development of acupuncture therapy in
relieving peripheral neuropathic pain.
Methods: An electronic search was conducted using China National Knowledge Infrastructure
(CNKI), with the medical heading subject ‘acupuncture’ and ‘neuralgia’ . Then we
summarized the top three diseases in acupuncture therapies. Lastly we selected high-quality
observational studies and RCT articles of randomized controlled trials in acupuncture，which
were in line with reporting standards (STRICTA) .
Results: 1250 studies and 13 diseases retrieved from CNKI . The occurrence frequencies with
acupuncture therapies in peripheral neuropathic pain were sciatica, postherpetic neuralgia,
trigeminal neuralgia. And then introduced these diseases from the aspects of interventions,
acupuncture points choice, course of treatment, the effective targets.
Conclusion: Acupuncture therapy has the advantage of relieving pain, decreasing side effects,
and promoting the quality of life than western medicine, and combined acupuncture therapies
could increase efficacy of neuropathic pain.
Key words: Painful Peripheral Neuropathy, acupuncture therapy, treatment status
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Background
Peripheral neuropathy is damage to, or disease
function, such as Yanhusuo, Wuzhuyu, Wulingzhi,
affecting the peripheral nervous system, which may
Moyao, and so on. Some of the herbs have not been
impair the function of peripheral nervous system.
documented for their analgesic function by ancient
Common causes include systemic diseases (such as
herbal medicine books, but they were found to have
diabetes), infection, metabolic abnormalities and
analgesic effects in experimental studies, such as
immune system
disease[1].The
estimated prevalence
Lingzhi,
Dangshen,
Haishen,
Tufuling,
of peripheral neuropathies in the general population is
Tianzhuhuang[7].
approximately 2%, and in adults over 55 years of age
action slowly, and can't achieve the analgesic effect
it can reach 8%
[2],
and its main clinical manifestations
are motion disorders and
paresthesia[1].
However, Chinese herbs take on
immediately. In china, non-drug therapy showed an
Pain is the
advantage in the treatment of pain, the main therapy
main symptom of paresthesia. The experts consensus
is acupuncture, which is the stimulation of specific
revised in 2013 classified them as neuropathic pain;
acupuncture points along the skin of the body,
symptoms included stabbing pain, burning pain,
involving various methods includes moxibustion,
radiating pain which patients could hardly bear and
acupoints injection, pricking blood, cupping, acupoints
seriously affected the patient's quality of life
[3].
Most
application,
transcutaneous
electrical
nerve
common diseases which could cause peripheral
stimulation, acupoints catgut implantation. It also
neuropathic pain are sciatica, postherpetic neuralgia,
includes other physical treatment methods such as
trigeminal neuralgia. The principle of treatment is
massage, infrared spectroscopy treatment, drug
analgesic therapy, on the basis of active treatment of
fumigation and so on. These therapies take effects by
primary diseases. The therapies can be roughly
opening the meridians and collaterals, regulating of Qi
divided into drug therapy and non-drug therapy. In
and blood, with less side effects, easy to operate,
China, the drug treatments can be divided into
affordable, which relieve pain and improve quality of
Western drugs and Chinese herbs. Western drugs
life. This article focuses on the status of acupuncture
mainly include:
Ca+
Channel Modulators (Pregabalin
therapy on peripheral neuropathic pain in China.
and Gabapentin), Tricyclic Antidepressants (TCA),
Serotonin(5-HT)
and
Selective
Serotonin
Methods
Norepinephrine Reuptake Inhibitor(SSNRI), Local
An electronic search was conducted using China
lidocaine, Carbamazepine, Oxcarbazepine, Opioid
National Knowledge Infrastructure(CNKI), with the
Analgesics(morphine, oxycodone, methadone), etc[3].
medical
But the western drugs for analgesia can produce
‘neuralgia’ . Then we summarized the top three
more side effects at the same time, such as nausea
diseases in acupuncture therapies. Lastly we selected
and
drug
high-quality observational studies and RCT articles of
addiction , and some may lead to kidney dysfunction
randomized controlled trials in acupuncture，which
in severe cases[4-6]。Chinese herbs could bring good
were in line with reporting standards (STRICTA) [8] .
vomiting,
gastrointestinal
discomfort,
heading
subject
‘acupuncture’
and
clinical effects. More than 300 kinds of Chinese herbs
have been demonstrated to have analgesic effect.
Some of the herbs are clearly documented in the
ancient herbal medicine books for their analgesic
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Result
diseases, and the most common diseases which
required the acupuncture therapy were chosen, such
There were 1250 studies and 13 diseases retrieved
from
CNKI.
The
occurrence
frequencies
with
acupuncture therapies in peripheral neuropathic pain
are summarized as follows (Figure 1). This article is
as
sciatica,
postherpetic
neuralgia,
trigeminal
neuralgia. And then these diseases were introduced
from the aspects of interventions, therapies, course of
treatment,
the
effective
targets[8]
based on the occurrence frequencies of these
3%
1% 1%
0% 0% 0% 0%
2% 1% 1%
Sciatica
Postherpetic neuralgia
36%
24%
Trigeminal neuralgia
Occipital neuralgia
Great occipital neuralgia
31%
Intercostal neuralgia
Figure 1 The occurrence frequencies
Acupuncture therapy for sciatica
showed that acupuncture improved blood circulation,
increased the body's pain threshold and pain
Sciatica is pain of the nerve pathway and its
distribution areas. The symptoms are paroxysmal and
persistent pain in the hip, the back of the thighs, the
lateral of cruel region and border of foot. The nature
of pain is mostly dull pain, there might be burning or
stabbing pain sometimes. The reason for it is the
pathological changes of the sciatic nerve and
tolerance threshold, relieved muscle spasms and
pain, promoted the functional recovery of body[9].
Statistical results show that the top three therapies for
sciatica, respectively is: acupuncture, acupuncture
plus medicine and warming acupuncture（Figure 2）,
we summarized the therapies of acupuncture for
sciatica as follows (Table1)
surrounding structures[1] , Related systematic reviews
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Figure 2 therapies for sciatica
Table 2 The acupuncture therapies for sciatica
Source
Invention
Therapies
MA
Zhibian(BL54),Huantiao(GB30),Yinmen(
BL37),Weizhong(BL40),Chenshan(BL57),
Konglun(BL60),Xuanzhong(GB39),Ahshipoint .
Chen
2010[10]
Main outcomes
—Total efficacy rate
Qd/2W
Effect
Be better
than
—SF-36
—McGill pain scale
Western
medicine
—VAS(pain intensity)
Lie
2014[11]
Course of
treatment
MA plus
Tongbi
Zhitong
Decotion
MA：Zhibian(BL54),Chengfu(BL36),
Huantiao(GB30),Fengshi(GB31),
Weizhong(BL40),Dachangshu
(BL25),Chenshan(BL57),Yaoyangguan(D
U3) plus Tongbi Zhitong Decotion
Qd/10d
—Oswestry disability
index
Be better
than
acupuncture
only
— JOA score
—Total efficacy rate
Chen
2007[12]
Warming
acupuncture
moxibustion
with warming needle moxibustion at
Shenshu (BL23), Dachang shu (BL25),
Huantiao(GB30) ,et.al
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Be better
than
— pain threshold
Qd/10d
—Total efficacy rate
Control
group
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Notes：MA :manipulation acupuncture；SF-36 : the MOS item short from health survey； VAS: Visual analogue scale; JOA score:
Japanese orthopaedic association low back pain score.
Acupuncture therapy for Postherpetic neuralgia
Acupuncture
therapies
have
a
unique
effect.
Statistical results show that the top three therapies,
Postherpetic
neuralgia
(PHN)
is
a
syndrome
characterised by pain persisting for more than 3
months following the resolution of herpes zoster. In
addition, the clinical manifestations include allodynia,
dysaesthesia and pruritus along the distribution of the
respectively, are: acupuncture and moxibustion,
acupuncture
plus
medicine
and
combination
therapies: the top three kinds of therapies（Figure
3）,
and
the
related
therapies
in
china
are
summarized as follows (Table1).
involved dermatome. The incidence of PHN is 4/1000
per year, which further increases to12/1000 among
people aged over 80 years [13].
Figure 3 therapies for postherpetic neuralgia
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Table3 The acupuncture therapies for postherpetic neuralgia
Source
Invention
Course of
treatment
Therapies
Main outcomes
Effect
—Total efficacy rate
Zhu
MA
Jiaji points and surrounding needling
2011[14]
With
medical
conditions
—The clinical efficacy
rate
—McGill
—VAS(pain intensity)
Be better
than
Western
medicine
—HAMA
Lei
2011[15]
Hui
[16]
2007
Jiaji points and acupoints in local
lesions ;Acupoint injection B12 in
Zusanli(ST 36),Neiguan(PC 6), Quchi(LI
11),Taichong(LR 3)
MA plus
western
medicine
ear point
taping and
pressing
therapy plus
acupoint
injection
plus western
medicine
Qd/7d
1/3d(total of
four times)
anesthetic), cupping and bleeding，and
TCM herbs l
Qd/15d(five
days a
week)
Be better
than
— VRS
— The clinical efficacy
rate
— 10-point Likert pain
scale
acupunture, neural therapy (1 %
procaine injection as a local
— disease's progression
time
—SF-36
— CES-D
western
medicine
reduced subacute
and chronic
post-herpes
zoster
neuralgia
pain
—Adverse effects
Notes: McGill:The McGill Pain Questionnaire Overview；VAS: Visual analogue scale;HAMD:Hamilton Depression Scale；HAMA:
Hamilton Anxiey Scale；VRS：Verbal rating scale；SF-36 : the MOS item short from health survey；CES-D：Centre for
Epidemiological Studies Depression Scale.
Acupuncture therapy for Trigeminal neuralgia
high frequency, which lies in the sixth position in the
acupuncture disease spectrum[18]. And the system
Trigeminal neuralgia is a chronic recurrent pain
condition that affects the trigeminal nerve, which
carries sensation from face to brain. The episodes of
intense pain may occur paroxysmally and might be
reoccuring[17]. The rate of incidence is higher among
the
middle
aged
people.
Clinical
reports
of
acupuncture therapy in trigeminal neuralgia have a
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reviews indicated that acupuncture is of similar
efficacy as carbamazepine but with fewer adverse
effects in treatment of trigeminal neuralgia [19]. The top
three therapies , respectively are: acupuncture and
moxibustion, acupuncture plus medicine and acupoint
injection plus acupuncture(Figure 4). the acupuncture
therapies are summarized as follows (Table3).
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Figure 4 therapies for Trigeminal neuralgia
Table3 The acupuncture therapies for Trigeminal neuralgia
Source
Invention
Therapies
Course of
treatment
MA
Main acupoint: Zhiyang(GV9),Matching
acupoint:Shangxing(GV23) pierce
Baihui(GV20),Xiaguan(ST7),Yintang(GV29),H
anyan(GB20),Fenchi(GB20),Ahshi-point using
triple puncture.
Qd/30d
Wang
2013[20]
Zhai
2010[21]
MA plus western
medicine
first branch took Tinggong（SI19）,
Yingxiang( LI20 ), Yangbai (GB14); second
and third branches took Sibai( ST2), Xiaguan(
ST7 ),Chengjiang (RN24),et,al.
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Qd/10d(total
of 20d)
1/3d(total of
20d)
Main outcomes
Effect
—VAS(pain intensity)
Be better than
—Total efficacy rate
carbamazepine
— The clinical efficacy rate
Be better than
Control group
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western medicine : carbamazepine
MA plus
acupoint
injection
Sun
2014[22]
first branch took TaiYang(EX-HN5)
penetration Yangbai (GB14), Cuanzhu(BL2)
penetration Yuyao (EX-HN4);second branch
took Yingxiang( LI20 ) penetration Sibai(
ST2), Quanliao(SI18) penetration Xiaguan(
ST7 );third branch took Daying(ST5)
penetration Jiache(ST6),Dicang(ST5)
penetration Daying(ST5)
Qd/14d
— The clinical efficacy rate
effictive
1/2d(total of
14d)
acupoint injection lidocaine and VB12 first
branch took Yuyao (EX-HN4); second branch
took Sibai( ST2); third branch took
Chengjiang (RN24)
MA plus
acupoint
injection
Sun
2014[22]
first branch took TaiYang(EX-HN5)
penetration Yangbai (GB14), Cuanzhu(BL2)
penetration Yuyao (EX-HN4);second branch
took Yingxiang( LI20 ) penetration Sibai(
ST2), Quanliao(SI18) penetration Xiaguan(
ST7 );third branch took Daying(ST5)
penetration Jiache(ST6),Dicang(ST5)
penetration Daying(ST5)
Qd/14d
— The clinical efficacy rate
effictive
1/2d(total of
14d)
acupoint injection lidocaine and VB12 first
branch took Yuyao (EX-HN4); second branch
took Sibai( ST2); third branch took
Chengjiang (RN24)
Notes:VAS: Visual analogue scale.
COPY RIGHT: © 2014; Yi Guoet al. licensee Scholoxy Publications Ltd. This is an Open Access article distributed under the
terms of Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0). This permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
Conclusion
work. Secondly, the choice of acupuncture points has
a certain regularity for the pain of peripheral
Through
the
summary
about
the
acupuncture
treatment of these diseases , we found that
acupuncture treatment in neuropathic pain has certain
characteristics and regularities. Firstly, acupuncture is
not limited to filiform needles, often with other
therapies like acupoint injection, auricular-plaster,
acupoint catgut embedding, bloodletting, cupping,
transcutaneous electrical nerve stimulation, TDP
(specific electromagnetic wave treatment machine),
etc. Combination therapies can achieve the efficiency
neuropathy. The points of primary disease should be
selected firstly , and compared with the points in the
pain area and specific points in treatment, such as
when
we
treated
the
Huantiao(GB30)
sciatica,
should
Zhibian(BL54),
be
selected;
Weizhong(BL40), Chenshan(BL57) could be selected
too, and Ashi points were used widely. In addition,
acupoints could be selected according to nerve
branches,
such
as
trigeminal
neuralgia
and
postherpetic neuralgia, we could select the points in
the distribution of skin lesion. Lastly, acupuncture
therapy
8 | Scholoxy Publications | www.scholoxy.org
has
the
advantage
of
relieving
pain,
Volume 1 | Issue 4
decreasing side effects, and promoting the quality of
and to promote the spreading and development of
life
acupuncture abroad.
than
western
medicine,
and
combined
acupuncture therapies could result in increased
efficacy.
Discussion
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