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Treatment approaches - physical

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ORAL ACUPUNCTURE

J. Gleditsch*. N. Behrens*, D. Imich* (Spon: H. Zoller), Consultant for Pain Therapy, Clinic for Anesthesiology, Ludwigs-Maximilians-Univ, Munich, Germany

Orofacial pain conditions as well as trigeminal neuralgia respond well to enoral treatment performed at precisely detected points of irritation, situated in the mucous membrane of the mouth. The points in question usually arc sensitive to pressure and therefore can be detected easily by careful digital palpation. Exact hitting and injection of a local anesthetic is performed best by means of "very point technique", i.e. a gentle dabbing along the suspected area with the needle itself. When the "very point" is touched, the patient probably will give sign of consent and the needle seems to "drop" into the mucous tissue. Only some few drops of local anesthetic need to be injected, trying to "extinguish" the tenderness of the point in order to get improvements of the pain condition. The specific enoral points are situated labially and bucally to the adjacent teeth as well as in the surroundings of the wisdom teeth. Via these reflectory sites, even illfunctions and restricted movement of the cervical spine, and other Joints can be improved in many cases. In severe cases of trigeminal neuralgia, contralateral injection is to be preferred: As a rule, in the exact contralateral site, a "symmetrical" enoral point or points of irritation can be spotted and inserted. For pain conditions of the lower legs - even phantom pain - points adjacent to the front teeth and the lower lips have proven to be effective, even with patients non-responding to other therapies.

A COMPARATIVE STUDY OF EFFETIVENESS OF ACUPUNCTURE AND SHAN ACUPUNCTURE IN TREATMENT OF CHRONIC MUSCULO-SKELETAL PAIN.

J.P. Hong, M.J.Tcixeira, T.Y.Lin. S. Abramavicus, R.M. Basseto, S.Y.Chen, T.H, Wu, Pain Center, Hospital das Clinicas of Sao Paulo, Univ Medical School, R. Conselheiro Brotcro 1539, cj 12, Cep 01232-010, Sao Paulo, Brazil

Aim of Investigation: The study was designed to compare the effectiveness of the traditional acupuncture methods and Shan acupuncture, in the treatment of patients with chronic musculo-skeletal pain (CMP).

Methods: Seventy-seven patients presenting chronic musculo-skeletal pain have been randomized selected and treated with acupuncture accordingly 3 therapeutic procedures, following the double blind method; 1) traditional acupuncture technique (n=28); 2) Shan acupuncture I: insertion of needles superficially (less than 5mm deep) in points outside the classical acupuncture points (n=27); 3) Shan acupuncture 11: insertion of needles superficially (less than 5mm deep) in the classical acupuncture points (n=22). The pain intensity was evaluated using VAS, and the improvement was evaluated using the following formula: % of improvement = (VAS initial - VAS final) x 100/VAS initial. The acupuncture treatment was performed once a week, during 5 sessions.

Results: No ANOVA differences in the pre-treatment pain levels was found. Mean VAS before treatment of the acupuncture group was 7.3, of Shan I was 7.6 and of Shan 11, 7.7. All 3 treatments reduced pain. After the treatment, the mean VAS decreased to 2.6 in acupuncture group (p<0.000*), to 5.1 in the Shan 1 group (p<0.05*) and to 4.4 (p<0.05*) in Shan II group. The percentage of improvement in the acupuncture group was 62% (p<0.000*), Shan I; 33.7%, and Shan II; = 34.8%. No significant differences were observed among the Shan groups.

Conclusion: Traditional Chinese acupuncture has superior analgesic effect than Shan acupuncture.

TREATMENT OF NEUROPATHIC PAIN THROUGH THE ASSOCIATION OF ACUPUNCTURE AND WESTERN MEDICINE

M.T.R.J. Jacob. Pnvate Pain Clinic, L.G.Jacob*, H.J.R.Ulson*, Hand Surgery, Hospital Samaritano, Unicamp, Campinas, Sao Paulo, 13023-030, Brazil

Aim of Investigation: The present study aims to demonstrate the validity of joining acupuncture and western medicine for treatment ofneurophatic pain from different etiologies.

Methods: 36 patients with neuropathic pain, 22 male and 14 female, have been treated since 1993. 9 with postherpetic neuralgia, 8 after brachial plexus lesion, 7 after stroke and 12 with peripheral polincuropathy. The treatment consists ofauriculotherapy with semipermanent needles after electrical detection, associated with xylocaine 0,5% blockade in acupuncture points in the painful area (only when painful under digital pressure, i.e., trigger points), administration oftncyclic antidepressants (amitriptylinc 10 -30 mg at bed time) and anticonvulsants (carbamazepine 300mg a day). Sections take place every 10 days at the beginning and once a month in the maintenance period.

Results: Patients are examined 10 days after beginning the treatment. Most present a relief of 30% of pain (40% to 70%). The numerical rating scale is used as the subjective measurement parameter. The desirable established result of 70% of relief was obtained around 105 days of treatment (20 to 390 days). It should be observed that not always do patients after stroke reach this desirable reliefer reach it later.

Conclusions: Neuropathic pain is frequently refractory to treatment and none of them universally successful. The present study shows that patients keep motivated to maintain treatment due to the significant relief. Required time to reach the desirable relief is relatively short considering the seriousness of the cases and oral medication dosage necessary is low, leading us to maintain this method.

RESONANCE ELECTROPUNCTURE ANALGESIA AND THERAPY (REAT) - A REAL ALTERNATIVE TO THE INVASIVE REFLEXOTHERAPEUTIC METHODS.

S. Kartavenko, Russian Research Center of Surgery, Russian Academy of Medical Sciences Dept of Pain Syndromes Therapy, Moscow, Russia

In view of great frequency of AIDS and infectious hepatitis, non-invasive methods of treatment appear to be of great importance. Method of resonance electropuncture analgesia and therapy (REAT) worked out by the author is based on integration of some basic principles of traditional eastern acupuncture and novel, specially elaborated ones of non-invasive clectroinfluence on patient with smusoidal complexly modulated current. It's been established that one basic mechanisms of REAT action is resonance activation (or, on the contrary, inhibition) of some biooscillatory processes and systems of the organism.

REAT provides up to 5 types of analgesia (using our classification: mcridianal, regional, micropuncturc projection organo-zonal, local; total hipoalgesia) and renders pronounced therapeutic effect via creation, in addition to analgesic, of sedative, relaxing, vasodilative effects (or, if necessary, of contrary ones: tonic, myostimulating, moderate vasoconstrictive); peripheral microcir-culation improvement; oedema reduction, anti-inflammatory and imn-iunomodulation effects; normalisation and activation of metabolism; acceleration of injured tissues regeneration.

After 20 years of clinical observations and studies (the former abbreviations for the method were EPA, EPA SMC), reliably established is higher efficacy ofREAT (as compared with acupuncture, electroacupuncture, common electropuncture, and TENS) in many pain syndromes including such most difficult for treatment as post-herpetic neuralgia (mean REAT efficacy - 86,7%), trigeminal nerve neuralgia (94,1%), pain in chronic pancreatitis exacerbation (82,3%), phantom limb pain (85,7%). In addition to high efficacy and security, REAT has such merits as convenience, indolence and comfort in application.

Original apparatus EPANAL has been worked out for clinical application of REAT.

RELIEF OF LOW BACK PAIN WITH LOW-REACTIVE LASER ACUPUNCTURE TECHNIQUES

Howard D Kurland. Northwestern Univ Medical School, 500 Green Bay Road, Kenilworth, IL, 60043-1002, USA

Aim of Investigation: To assess efficacy of low reactive-level laser therapy (LLLT) with Nogier frequencies in the relief of low back pain.

Methods: Twelve patients who had refractory low back pain problems related to spinal arthritis and complicated by hemiated discs were treated with LLLT. GaAs lasers with Nogier frequencies (largely 2.82 to 146 Hz) were utilized to treat neuropathy and myopathy. Improvement was quantified by elimination of pain medications and decrease of pain-related restrictions in activities of daily living.

Results: Clinical effectiveness was observed with immediate improvement in pain and muscle spasm. Elimination of pain medication and improvement in functional activities was progressive in 10 of the 12 patients. Two patients with spinal stenosis failed to maintain improvement for more than brief period of time (measured in days). One had surgical relief of the spinal stenosis, and then responded with relief of post-operative residual symptoms.

Conclusions: The IASP Task Force on Pain In the Workplace concluded that "cutaneous laser treatment, transcutaneous electric neu-rostimulation, and needle acupuncture" have no proven benefits in the treatment of acute low back symptoms. In a contrary opinion, the US National Institutes of Health Office of Alternative Medicine concluded that a series of controlled studies has shown evidence for the efficacy of acupuncture in the treatment of back pain. This study supported the conclusions of the US NIH. It demonstrated the benefits and limitations of LLLT with Nogier frequencies for relief of back pain.

EFFECT OF ACUPUNCTURE/ACUPRESSURE ON GAGGING DURING DENTAL PROCEDURE.

Gabriel P. Lu*. Ronald Kaplan, Dominic P. Lu *' Dept ofAnes-thesiology, Montefiore Medical Center, Bronx, NY 10467, USA, 'Dept of Dentistry, Univ of Pennsylvania, Lehigh Valley Hospital, Allentown.PA 18105, USA

Aim of Investigation: To treat gagging during dental procedures can be frustrating for both clinicians and patients. The Neikuan (P6) acupuncture point located on the wrist has been known for its anti-nausea and anti-emesis property. Recently, stimulating the P6 point has been suggested for its possible anti-gagging effect.' The purpose of this investigation is to evaluate the anti-gagging effect of the Neikuan point.

Methods: Forty gagging patients, age 8-67, were randomized to 1 of 4 treatment groups for operative dental therapy. First group was treated with Tigan capsule (250mg for adults and 100-200mg for children under 12 years old). The second group was treated with acupuncture. The third group was treated with acupressure: thumbs applied firm pressure on the Neikuan sites of both wrists. The fourth group was firmly grasped around the wrists, but the Neikuan point was avoided. The relief of gagging was rated as: greatly relieved to no relief.

Results: Group 1 (N=9) 8 Pts. (89%) felt greatly relieved, 1 (11%) felt somewhat relieved. Group 2 (N=11) 8 (73%) felt greatly relieved, 2, (18%) felt somewhat relieved, 1 (9%) had no relief. Group 3 (N=12) 7 (58%) felt greatly relieved, 2 (17%) felt somewhat relieved and 3 (25%) felt no relief. Group 4 (N=8) felt no relief.

Conclusions: We conclude that, although Tigan has the best effect, acupuncture/acupressure is simple, relatively reliable and safe which offers an alternative method to treat gagging during dental procedure.

Reference: 1. Morrish RB, Suppression and prevention of the gag reflex with a TENS device during dental procedures. Gen Dent 1997:448-450

UP-TO-DATE ASPECTS OF TREATMENT OF PAIN ASSOCIATED WITH CEREBROVASCULAR PATHOLOGY IN LOWER EXTREMITY AMPUTEES.

Margarita Malashenko*, Dept ofNeurorehabilitation, Rehabilitation Centre, 654055, Novokuznetsk, Russian Federation, CIS

Aim of Investigation: To develop up-to-date methods of rehabilitation of lower extremity amputees suffering from cerebro-vascular disease (CVD) as well as to improve non-medicamental approaches to restorative treatment ofsensory-algetic symptom-complex in the a.m. cohort.

Methods: We observed 163 patients with the lower extremity amputated for obliterating atherosclerosis. Of them, 18,7% sustained transitory ischemic attacks, 36,5% demonstrated postinsult paralysis and paresis, 44,8% had vascular encephalopathy. Structure of scnsory-algetic symptom-complex characterized by various types of pain modality manifestated itself in headache (63,5%) and pain in paretic extremities (36,5%). Patho- and sanogenetic mechanisms of the basic disease were taken into account in complex treatment. As pathogenetic therapy antihypoxants and cerebral metabolism promoters were administered. Phenomenon of cerebral algetic manifestations in amputees was notable for high resistance to various treatment approaches. We have developed and applied an up-to-date technique ofcraniopuncture to treat pain associated with CVD. Sensory, vasomotor, motor and psychoaffective zones of scalp underwent effects by acupuncture needles that were introduced up to a routine depth until specific sensations appeared.

Results: In 72% complete regression ofnociceptive component was achieved, 24,5% demonstrated considerable subsidence of headache and pain in paretic extremities.

Conclusions: Described method ofcraniopuncture proved to be effective and it may be recommended as a method of choice for treatment ofsensory-algetic symptom-complex associated with CVD.

ANALGESIC EFFECT OF HIGH VS LOW FREQUENCY ELECTRO-ACUPUNCTURE IN POSTSURGICAL PAIN.

M.S. Mok*. J.G. Lm*. M.W. Lo*, S.N. Stcen*, L.J. Rever, Dept. of Anesthesia, Taipei Medical College, & China Medical College, Taiwan, LAC-USC Medical Center, Los Angeles, CA 90033, USA

Aim of Investigation: To evaluate the analgesic effect of electro-acupuncture (EA) with different stimulation frequency in the relief of pain after abdominal hysterectomy.

Method: 100 patients were randomly divided into 4 equal groups receiving the following: Sham EA for Group (Gp) 1, EA of 2 Hz for Gp. 2, EA of 100 Hz for Gp. 3 and no EA for Gp. C for 20 mm before induction of inhalation anesthesia. After surgery all patients were given Patient Controlled Analgesia with bolus of morphine 2 mg q.10 min lock out. Pain intensity, vital signs, adverse effects and dose of morphine used were recorded for 24 hours.

Results: All 3 EA groups showed significantly less total amount of morphine used than Gp. C. Among the EA groups there was significant difference in the reduced amount of morphine used with both groups 2 and 3 better than 1 and group 3 better than 2. Group 3 also showed the least adverse effects.

Conclusion: Our study showed that acupuncture prior to surgery seems to provide pre-emptive analgesia in reducing the dose of morphine by PCA post surgery EA with high frequency produced significantly greater analgesic effect than that of low frequency EA (p<0.05).

A PILOT STUDY TO COMPARE ACUPUNCTURE VERSUS TENOXICAM FOR SYMPTOMATIC KNEE OSTEOARTHRITIS IN ASIANS.

Swee Cheng Ng*, Kay-Fei Chan. Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore 569766

Aim of Investigation: This is a double-blind, placebo-controlled study to compare self-reported pain and physical function of patients with symptomatic osteoarthritis who underwent either of the treatments.

Methods: Eighteen patients (all female, ages between 47 to 79 years and comparable in age, disease duration and X-ray grading of severity) were each randomised to 2 arms of treatment lasting 8 weeks - biweekly. Acupuncture sessions with dummy tablets whilst the comparison group had Tenoxicam 20 mg daily with mock TENS . Luquesne Osteoarthritis Indices assessment and walking time measurements at 0, 4, 8 and 12 week intervals were carried out.

Results: At week 8, all the study subjects reported benefit to either treatment arms but 4 weeks after cessation of treatment, only 6 out of 9 acupuncture patients have sustained benefits compared to sustained benefit seen in the Tenoxicam group. Patients also improved in physical function as measured by the Lequesne Indices and walking time and trends indicated improvement as treatments extended beyond 4 weeks.

Conclusions: Acupuncture is as effective as Tenoxicam in managing pain and physical limitation arising from knee osteoarthritis and should be offered to those who are intolerant to the latter treatment. However this treatment may have less sustained benefit. Issues of cultural acceptance, choice of placebo and assessment instruments in Asian patients will be raised.

TREATMENT OF FACIAL PAIN SYNDROMES WITH SINGLE NEEDLE EAR ACUPUNCTURE - PRELIMINARY RESULTS OF AN OPEN PILOT TRIAL.

Helmut F. Novak* (SPON: G. Pauser), Dept of Neurology, Lan-desnervenklinik Salzburg/Austria

Aim of Investigation: To show efficacy of ear acupuncture in facial pain syndromes with or without concomitant medication despite of lacking recommendation in prepositional literature.

Methods: Thirty-three patients have been treated for trigeminal neuralgia (n=17) and atypical facial pain (n=16) with single needle ear acupuncture. Each treatment one stainless steel needle was positioned from the area of maxilla or mandibula to the area of temporomandibular joint after determination of laterally by pressure test. After vigorous rotatory stimulation needles were fixed with tape. Sessions were held mainly two times a week, needles kept in place at least for two hours. Pain relief was rated with a visual analog scale and divided to categories: poor or no pain relief, moderate or remarkable pain relief, sufficient pain reliefer painless.

Results: In 15/33 patients sufficient pain reliefer painless conditions were found. Only 5/33 (18%) remained without acceptable result. There was no obvious correlation between immediate responding and pain relief. Only 3/33 (9%) experienced pain relapses. There were no inflammations of ear-lobe or auricle. Minimal bleeding after removal of needles occurred in many patients without further consequence.

Conclusions: Single needle ear acupuncture turned out to be effective in treatment of facial pain syndromes. Dangerous side effects can be excluded. Prognosis of further clinical course remains difficult.

IS IT POSSIBLE TO MEASURE AN EFFECT AFTER ACUPUNCTURE ON THE RESTING EEC?

P. Posted. P.A. Griffiths*, N. Gravill* and P. Bacon*. Dept of Medical Physics, Lincoln County Hospital, Lincoln, England

Aim of Investigation: To investigate if acupuncture has a measurable effect on the resting EEG using topographic mapping and quantitative data analysis techniques.

Methods: 14 healthy volunteers took part in the study. A paperless digital storage EEG recorder was used. Electrodes were placed over the scalp following the 10/20 system using mastoid as the reference. All data was collected with the patient alert but with eyes closed, electrode Oz was chosen to minimise artefacts. Frequency analysis was performed using fast Fourier (FFT) in 2 second epoch's giving a frequency resolution of 0.5 Hz. Because of a large variability in the data over this 2 seconds period it was decided to average the data over longer epochs. Examination of the EEG traces showed it was possible to obtain 18 seconds periods of data for all events. Baseline eyes closed EEG data was obtained before and after all acupuncture procedures which consisted of manual manipulation of the Li-4 acupuncture point. Frequency analysis of the EEG data from each acupuncture event was obtained and compared to the baseline data to show any significant changes in the amplitude spectra over the bandwidth 0.3 to 30 Hz. To ensure the validity of the data, only changes more that two standard deviation were considered valid.

Results: In ten out of fourteen subjects there were no change in any of the three frequency spectra before, during and after acupuncture. Three subjects showed increases in the delta band.

Conclusion: From the present data it seems unlikely that acupuncture has a measurable effect on the resting EEG.

WESTERN ACUPUNCTURE VERSUS CLASSICAL CHINESE ACUPUNCTURE IN PATIENTS WITH SPINAL PAIN.

Beatrice Sofaer. Simon Thorp, Vanessa Skelton*, Andrew Nico-laou*, Dympna Copley*. Pain Management Unit, Hove Polyclinic, Brighton NHS Trust, BN3 7HY, UK

Aim of Investigation: To compare the effect of two different types of acupuncture on patients with spinal pain. Method: A quasi experimental cross over design was used to investigate ten patients' responses to the two types of acupuncture (Chinese versus trigger point electroacupuncture). Each patient had five sessions of each type of acupuncture at weekly intervals. Pain was measured before and after each treatment by a blinded observer using the short McGill and VAS.

Results: Data were analysed using interferential non-parametric statistics. No statistical differences were found between the two types of acupuncture, however the results indicated that patients had better pain relief when Western acupuncture preceded the Chinese. All patients reported beneficial results. Observer report indicated an element of possible complacency on the part of patients whilst completing the McGill questionnaire towards the end of the treatments.

Conclusions: This small investigation demonstrated no difference in effect between the two types of acupuncture, however, the timing of the treatments may be important and warrants further investigation with a larger sample size.

A PROSPECTIVE RANDOMISED STUDY OF ELECTRO-ACUPUNCTURE VERSUS ALFENTANIL AS ANAESTHESIA DURING OOCYTE ASPIRATION IN VITRO FERTILIZATION.

Elisabet Stener-Victorin. Urban Waldenstrom*, Lars Nilsson*, Matts Wikland, Per OlofJanson, Dept ofObst. & Gyn, Goteborg Univ, Fertility Centre Scandinavia, Goteborg, IVF-unit, Falu la-sarett, Falun; Sweden.

Aim of Investigation: The aim of the study was to compare electro-acupuncture (EA) and paracervical block using lidocain hydro-cloride (PCB) with a fast acting opiod (alfentanil) and PCB as anaesthetic during oocyte aspiration.

Material and Methods: In the first part of the study, 150 women undergoing in-vitro fertilization (IVF) with vaginal ultrasound guided oocyte aspiration were randomized into two groups; 1) EA + PCB 2) Alfentanil + PCB. Thirty-four women who did not become pregnant after the first treatment cycle and who returned for another IVF cycle participated in the second part of the study. They were offered the anaesthetic method to which they had not been randomized in the first part of the study. Visual analogue scales (VAS) were used in order to evaluate subjective experiences during oocyte aspiration. Variable used were; abdominal pain, pain directly related to oocyte aspiration, adequacy of anaesthesia, time of discomfort, stress and nausea.

Results: There were no differences between the groups in the VAS ratings with respect to pain directly related to oocyte aspiration, adequacy of anaesthesia during oocyte aspiration, abdominal pain and degree of nausea. Before oocyte aspiration, the level of stress was significantly higher in the EA group than in the alfentanil group (p<0.05), and the EA group experienced discomfort for a significantly longer period of time during oocyte aspiration (p<0.01). No differences in any of the VAS ratings made by the women in the second part of the study were found. Significantly more of the women in the second part of the study stated that they i would prefer EA as anaesthesia if they had to repeat oocyte aspiration (p<0.01).

Conclusion: In conclusion, in combination with a PCB, EA has been shown to be as good an anaesthetic method as alfentanil during oocyte aspiration, and we suggest that EA may be a good alternative to conventional anaesthesia during oocyte aspiration.

LOW FREQUENCY TREATMENT WITH NEEDLES OR DISK ELECTRODES COMBINED WITH DRUG THERAPY FOR THE INTRACTABLE OROFACIAL PAIN.

Nagaaki Suzuki, Masato Kawashima, Shigenari Mashu and Masa-hiro Umino, Div of Oro facial Pain & Symptom Management, Dept of Dent Anesthesiol, Fac of Dent, Tokyo Med & Dent Univ, Tokyo, Japan

Aim of Investigation: To evaluate low frequency treatment with needles or disk electrodes, and drug therapy for intractable orofa-cial pain.

Methods: Thirty patients aged 23-86 years (27 women, 3 men) with intractable orofacial pain were treated with low frequency electrical stimulation using needles or disk electrodes, and drugs. Disk electrodes were used for the patients who were fearful of needle insertion. The degree of clinical effect was evaluated.

Results: Pain was completely relieved in 7 of 21 patients in needle therapy, 1 of 3 patients in needle and disk electrode therapy, and 1 of 6 patients in disk electrode therapy. However, pain was remained unchanged in 4 of 21 patients in needle therapy, 1 of 3 patients in needle and disk electrode therapy, and 1 of 6 patients in disk electrode therapy. Pain has improved in the remaining 15 patients. The meridian points frequently used were ST7, ST6, ST5, LI 10, ST3, SI 18, and GB21. These therapies were repeated 5-40 times once a week or two weeks. Many patients were in highly anxious state, and some patients were in lightly or moderately depressive state. In combined drug therapy, oriental herb medicines, NSAIDs, antianxiety agents, and/or antidepressants were prescribed.

Conclusions: Low frequency treatment with needles or disk electrodes combined with drug therapy was effective to relieve their pain completely in 9 of 30 patients. This combined treatment is worth trying to relieve the intractable orofacial pain.

SUPPRESSION OF FORMALIN-INDUCED C-FOS PROTEIN AND BEHAVIORAL RESPONSE IN RATS RECEIVING INTENSE ELECTRO-ACUPUNCTURE - LIKE STIMULATION

Yeong-Ray Wen*. Wei-Zen Sun, Wen-Yeong Hou, Fun-Yen Huang*, Dept ofAnesthesiology, Hsin Kong Wu-Ho-Su Memorial Hosp, No.95 Wen Chang Rd, Taipei, 10016, Taiwan, ROC

Aim of Investigation: The present study is designed to examine the induction ofc-Fos protein in the spinal dorsal hom and its behavioral correlates following intense electroacupuncture-like stimulation.

Methods: SD rats were anesthetized with 1% halothane and subjected to EA stimulation (4 Hz, 20 times of basal intensity, left Zusanii) for 30 min during anesthesia. After 10 min post-anesthesia, rats were subcutaneously injected with formalin (1%, 50 nl) in the right hind paw and weighted-scores were recorded for 60 min. Control groups were rats receiving anesthesia alone (AC), anesthesia + EA (EC), and anesthesia + formalin (FC). Morphine (1 mg/kg) was subcutaneously applied in some rats without EA treatment. All rats were sacrificed for immunohistochemical study.

Results: The late phase behavioral hyperalgesia was comparably suppressed in EA-treated and Morphine-treated group by 24% and 32.6% (p<0.05), respectively. Fos-like-immunoreactivity (FLI) labeled neurons were densely distributed in the superficial layer and neck of L4/5 dorsal hom ipsilateral to the formalin-injected side, but only neurons in the neck portion were significantly reduced by EA (43.0%) and morphine (48.0%) treatment. Despite the intensity being used, EA stimulation alone did not activate greater number of FLI neurons in the L4/5 segment than that of anesthetic control. Furthermore, c-fos expression between both sides of L4/5 dorsal hom in EC group was identical.

Conclusions: Intense EA-like stimulation produces mild to moderate lasting analgesic effect. In the spinal cord level, this suppression occurs predominantly at the deep, but not the superficial, dorsal hom neurons. Acknowledgments: Supported by Grant. DOH 84-CM-031.

EFFECT OF SENSORY STIMULATION (ACUPUNCTURE) ON SYMPATHETIC AND PARASYMPATHETIC ACTIVITY IN HEALTHY SUBJECTS.

E.Haker *, H.Egekvist, P.Bjemng, Dept of Physical Therapy,Karolinska Instt, Stockholm, Sweden & Dept. of Dermatology, Aarhus Univ Hospital, Denmark.

Aim of Investigation: To investigate to what extent acupuncture applied into the thenar muscle and into the cavum concha of the earinduced changes in the autonomic nervous activity, recorded by power spectral analysis of heart rate variability.

Methods: Twelve volunteers, mean age 34.4 years, participated in 3 randomly distributed sessions. A. A needle, 0 0.20 x 15mm, was inserted into the Lung point in the left inferior hemi-conchae. B. A needle, 0 0,30 x 30mm, was inserted into the Hegu point in the right dorsal thenar muscle. C. A needle, 0 0.30 x 30mm, was inserted superficially into the Hegu point on the left thenar muscle. Power spectral analysis of the low frequency (sympathetic) and high frequency (parasympathetic) components of heart rate variability was used for the calculations.

Results: Stimulation of the ear induced a significant increase in the parasympathetic activity during the stimulation period of 25 minutes (p<0.05) and during the post stimulatory period of 60 minutes (p <0.05). Stimulation of the thenar muscle resulted in a significant increase in the sympathetic and the parasympathetic activity during the stimulation period (p<0.01) and during the post-observation period (p<0.01 and p<0.001, respectively). A significant decrease in the heart rate frequency (p<0.05) at the end of the post-stimulation period was demonstrated. The superficial needle insertion caused an increase in both the sympathetic and parasympathetic activity during the post-stimulation period of 60 minutes (p<0.01).

Conclusions: Sensory stimulation (acupuncture), is associated with changes in the autonomic nervous system depending on site of stimulation and period of observation.

ACUPUNCTURE APPROACHES IN CHRONIC POSTOPERATIVE PELVIC PAIN AFTER GYNECOLOGICAL SURGERY

Madina Safina* (SPON: L. Bogatcheva), Dept ofGynec & Obstet, Minsk Medical Inst, Mogylevskaja str., 4/1-198, 220007 Minsk, Belarus

Aim of Investigation: To determine the diagnostic effectiveness and acupuncture treatment of women with chronic lower abdominal pain caused by gynecological surgery. Subjects: Chronic pelvic pain syndrome accounts for 2% in-patient female concerning the gynecology practice. Every fifth of them had suffered from pelvic pain and postinjury cutaneous hypersensitivity for 6-12 month after gynecological surgery. For pain relief acupuncture was performed in 12 patients. The pain originated from adhesions, varicose dilatation of pelvic veins and probably was due to peripheral neural mechanism after complicated surgical procedure.

Methods: Acupuncture points (AP) choice was based on local and segmental viscero-cutaneous connections. Individually were used AP V24-28, 31-35, 40, 53, 54, 60, 62, VG1, 2, 4, VC2-4, 7, GI4, 10,11, E28, 30, 36, RP6, R1, 3, 6, 11, 13 and auricular points 22, 23,55,56,58.

Results: 10 of 12 women experienced a complete relief of pain syndrome after 12-15th procedures. 2 patients showed particular decrease of pain and improved quality of life.

Conclusions: The results indicate acupuncture to be an effective treatment of chronic postoperative pain and permit to avoid subsequently technically difficult repeated operation for some of these patients.

THE EFFECTS OF LOW-LEVEL MICROWAVE IRRADIATION ON ACUTE PAIN IN MICE.

Yuri Limansky. Zinaida Tamarova*, Nikolai Kolbun*, Dept of Brainstem Physiology, Bogomoletz Inst of Physiology, Bogo-moletz str 4, Kiev, 252601, Ukraine

Aim of Investigation: To investigate the effects of low-level microwave irradiation (LM1) at acupuncture point (AP) on acute pain in mice.

Methods: The experiments were carried out on white male mice. Electric-shock vocalization threshold was measured before and after LMI at Tzu-sn-li (E-36) AP. We used noise (30-300 HHz, 10" 1510"'8 W/sm2) and coherent (604 HHz, lO"4 W/sm2) irradiation. Time of irradiation was 3 min or 10 min.

Results: 40 mice were tested on LM1 (10 in a group). It was found that LMI suppressed pain sensitivity to electrical stimuli. Immediately after microwave irradiation the average pain threshold was significantly raised. Maxima] effect was observed in 60-90 min after the beginning of irradiation at AP. LMI 10 min pretreatment increased vocalization threshold on 28% (coherent LMI) or 23.5% (noise LMI). Differences with control were significant (P 0.001, P 0.01). LMI 3 min pretreatment was less effective.

Conclusions: Our experiments revealed that LMI at Tzu-san-li AP could produce analgesic effect in test of acute pain (electric-shock vocalization). Together with our previous results about high anal-getic action of LMI on tonic pain (formalin test) these data indicate that non-thermal microwaves can be used for effective pain management

9th WORLD CONGRESS ON PAIN, 1999, Vienna, Austria, p.348 - 352

   

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