Lasers in Medical Science

ISSN: 0268-8921 (printed version)
ISSN: 1435-604X (electronic version)

Abstract Volume 15 Issue 1 (2000) pp 57-62

Specific Effects of Laserpuncture on the Cerebral Circulation

G. Litscher (1), L. Wang (1), M. Wiesner-Zechmeister (2)

(1) Biomedical Engineering, Department of Anesthesiology and Critical Care, University of Graz, Graz, Austria
(2) European Forum for Lasertherapy and Fractal Medicine

Paper received 10 May 1999; accepted after revision 23 August 1999.

Abstract . Acupuncture is a form of traditional Chinese medicine that has developed over thousands of years. We studied the effects of laser puncture, needle acupuncture, and light stimulation on cerebral blood flow in 15 healthy volunteers (mean age 25.0±1.9 years, 5 female, 10 male) with non-invasive transcranial Doppler sonography. In addition 40-Hz stimulus-induced brain oscillations, heart rate, blood pressure, peripheral and cerebral oxygen saturation, and the bispectral index of the EEG were recorded. Stimulation with light significantly increased blood flow velocity in the posterior cerebral artery (p<0.01, ANOVA). Similar but less pronounced effects were seen after needle acupuncture (p< 0.05, ANOVA) and laserpuncture (n.s.) of vision-related acupuncture points. Furthermore both, laserpuncture and needle acupuncture, led to a significant increase in the amplitudes of 40-Hz cerebral oscillations. Stimulation of vision-related acupuncture points with laser light or needle acupuncture elicits specific effects in specific areas of the brain. The results indicate that the brain plays a key intermediate role in acupuncture. However, brain activity of itself does not explain anything about the healing power of acupuncture.

Keywords: Acupuncture; Brain; 40 Hz brain oscillations; Cerebral blood flow velocity; Laserpuncture; Light stimulation; Middle cerebral artery (MCA); Posterior cerebral artery (PCA); Transcranial Doppler sonography (TCD)

Behandlung der zervikalen Tendomyose

Randomisierte, kontrollierte Doppelblindstudie zur dosierten Lasertherapie an Akupunkturpunkten und klassischen Akupunktur

Ulf Seidel, Christine Uhlemann, Klinik für Orthopädie Klinikum Neustadt
Institut für Physiotherapie Friedrich-Schiller-Universität Jena

Zusammenfassung

In einer randomisierten, plazebokontrollierten, bezüglich Lasertherapie doppelblinden klinischen Therapiestudie wurde die therapeutische Wirksamkeit einer dosierten Lasertherapie (niedrig energetischer Laser = low level laser therapy, LLLT) an Akupunktur-Punkten und einer konventionellen Akupunktur (AP) bei der Behandlung von Patienten mit Zervikaltendomyose untersucht und verglichen.

Methodik:

48 Patienten (43 Frauen, 5 Männer) mit chronischem Zervikalsyndrom erhielten randomisiert 8 Behandlungen (4 Wochen, 2 × wö.) mittels LLLT, Ausgangsleistungen: 0 mW (Plazebo), 7 mW und 30 mW bzw. Akupunktur (4 ×n = 12). Die Nadelbehandlung wurde als klassische Körperakupunktur durchgeführt, Nadelliegedauer 15 Minuten pro Behandlung, maximal 15 Nadeln. Bei der LLLT wurden, vergleichbar zur AP, Akupunkturpunkte mit einer Bestrahlungszeit von 1 min pro Punkt (maximal 15 Pkt.) behandelt.

Die Follow up-Untersuchung erfolgte 4 Wochen nach Therapieende.

Hauptzielparameter: 1. „Schmerz”: Schmerzintensität, Schmerzempfinden; 2. zervikale Bewegungsfunktion. Nebenzielparameter: 1. Befindlichkeit, 2. subjektive Einschätzung (Schmerz, Beweglichkeit); 3. klinische autonome Funktionsparameter: Blutdruck, Puls, Hauttemperatur. Für die statistische Auswertung wurden nichtparametrische Tests angewendet.

Ergebnisse:

Mittels AP konnte im Therapieverlauf eine signifikante Schmerzreduktion um 82,2 % erreicht werden, die 1 Monat nach Therapieende noch nachweisbar war. Die LLLT bewirkte ebenfalls eine signifikante Schmerzreduktion, wobei die analgetische Wirkung mit dem 7 mW-Laser am größten war (Schmerzreduktion um 55,4 %). Die Druckschmerzschwelle der Zervikalregion konnte in allen Behandlungsgruppen signifikant gesteigert werden.

Hinsichtlich der zervikalen Bewegungsfunktion (Axialrotation, Lateralflexion, Ante-/Retroflexion) waren AP, 7 mW-Laser und 30 mW-Laser der Plazebobehandlung signifikant überlegen.

In der subjektiven Einschätzung des Therapieeffektes (bzgl. Schmerz, Beweglichkeit) wurde keine Verschlechterung angegeben, deskriptiv erschien die AP den Lasertherapiegruppen überlegen.

Im deskriptiven Vergleich der Blutdruckwerte und der Herzfrequenz vor und nach jeder Behandlung wurde für alle Therapieverfahren eine Tendenz zu höheren systolischen und diastolischen Werten sowie niedrigeren für die Herzfrequenz jeweils nach der Behandlung aufgezeigt. Die Hauttemperatur stieg am AP-Punkt Dickdarm 4 während der Behandlung in allen Therapiegruppen an im Gegensatz zum Kontrollpunkt.

Schlussfolgerung:

AP kann eine Therapieoption für die Beeinflussung unspezifischer Nackenschmerzen sein. Mit dem niedrig energetischen Laser lassen sich hinsichtlich der Hauptzielparameter (Schmerz und Bewegung) dosisabhängige Effekte feststellen. Die Ausgangsleistung 7 mW (Laserdosis 21 J/cm²) zeigt einen günstigeren Einfluss auf Schmerz und Befindlichkeit. Auch der Plazebo-Laser beeinflusste Schmerz und Befindlichkeit positiv.

Quelle:

Dt Ztschr f Akup 2002;  258-269
DOI: 10.1055/s-2002-36555

LASERACUPUNCTURE

Pekka J. Pöntinen, M.D, Ph.D, F.I.C.A.E., Tampere University, Tampere, Kuopio University, Kuopio, Finland E-mail: pontinen@sci.fi

Traditionally acupuncture means stimulation of specific points on the surface of the body in order to produce mainly regulatory effects on the functions of the internal organs. The same points have been used to increase or decrease the functional state of different organs. In Traditional Chinese Medicine (TCM) the acupuncture points (AP) are connected by channels or meridians in and under the skin and have deep connections to the internal organs. The selection of the proper points has been as important as the correct type of stimulation, either reinforcement or sedation. In the traditional Chinese medicine the human model has been mainly energetic, physiological, not anatomical. The changes in the energy flow induced by the blocks in the channels or acceleration of the flow leading either to the deficit or excess of the vital energy, Chih, were believed to be the origin of diseases. The APs were the loci to balance the energy flow through needle stimulation. Modern acupuncture has a different nature. For the consensus conference arranged by the National Institutes of Health (NIH) and held in Bethesda, Maryland in November 1997 the term acupuncture was defined as stimulation, primarily by the use of solid needles, of traditionally and clinically defined points on and beneath the skin, in an organized fashion for therapeutic and/or preventive purposes. Application of stimulus to the reactive points (by needle, heat, massage, transcutaneous electric nerve stimulation/TENS, laser, etc.) according to TCM can influence the pathophysiological function of the affected organ-meridian systems.

In modern Chinese AP therapy, a combination of local tender points (AHSHI) and classical peripheral APs is common. Laseracupuncture (LAP) Today LAP provides a noninvasive and low risk alternative to needle stimulation. A combination of local reactive (tender) points or Ahshi points and active muscle TPs form a practical and effective basis for LAP in pain treatment. LAP can replace needles in the treatment of functional disorders and is then directed to classical APs. As a painless modality of acupuncture LAP is well accepted by children and other sensitive patients. LAP provides excellent possibilities for clinical studies on acupuncture. Recently Schlager and coworkers confirmed the efficacy of AP Neiguan (PC6) in the prevention of postoperative vomiting in children undergoing strabismus surgery. In another randomized, double-blind placebo-controlled study low-intensity laser therapy effectively prevented the recurrence of Herpes simplex infection.

Our study groups at the Universities of Kuopio and Tampere have studied the analgetic effect of peripheral stimulation (needle acupuncture, transcutaneous electrical stimulation/TENS, massage, electric stimulation, low energy laser) applied on APs or TPs using pressure algometry . We have conducted a series of experiments using different wavelengths (633-904 nm) and both coherent and noncoherent irradiation. LEPT was given directly to TPs (1-2 J/TP) or local tender spots.

In blind, cross-over studies both HeNe- and IR-diode (904 nm) lasers elevated pressure pain threshold (PTH). In a follow-up study on 54 MPS patients LEPT (820 nm, 1-2 J/TP) PTH increased from 2.94+1.44 tp 6.56+0.96 kg/cm² (p<0.001) and MGF from 0.60+0.28 to 1.03+0.29 bar (p<0.05), whereas VAS decreased from 44.6+11.3 to 9.3+6.4 (p<0.001). In this and other series we have found that the effect is greater on the side where PTH and MGF values are initially lower. As in our earlier studies with low and high freguency TENS one sided HeNe-laser irradiation elevated PTH of the corresponding, contralateral nontreated TPs in addition to the response on the treated side. More recently the main emphasis has been turned to the central mechanisms and pathways. In a pilot study LED-light (880 nm, 1J/cm2) given to TPs in trapezius muscle (TE15) bilaterally and upon proc. spinosus of C7 (DU14) significantly altered regional cerebral blood flow e.g. in thalamus, caudate nucleus and prefrontal cortex.

In our experience less than 1 J/point or 100-200 J/cm² given in a contact mode is mainly ineffective in clinical practice when treating musculoskeletal disorders and myofascial pain through TPs. In many well controlled, blind and double-blind cross-over studies showing insignificant results the actual radiant exposure to the target site has been a mere fraction of the dose normally used in clinical practice. When treating APs of low resistance and high sensitivity the irradiation dose should be reduced to about 0.1-0.2 J/point (10 per cent of the normal dose [1-2 J/point] used at muscle TPs).

Treatment of the acute Periarthritis humeroscapular with laserpuncture.

Odalys Gonzáles Álvarez, Main Educational Clinic of Urgencies "Antonio Maceo", Cerro Municipality, Havana City.

The periarthritis humeroscapular is a syndrome that contains very precise affections: the bursitis, the calcified tendinitis of supraespinoso, the bicipital tendinitis, among others. Pain and limitation of the joint movements of the shoulder characterize it. The treatment with laser of low power can produce resolution of the lesion, whenever it is made in early phases of the disease. In this study we propose the use of the laserpuncture, due to our accumulated experience in the treatment of these affection in acute phase, with acupuncture.

A prospective study was carried out during 2 years (1997 - 1999), where 62 patients were selected because they accomplished the Approaches of Inclusion for the study. The sample was divided by aleatory assignment in 2 Groups of Treatment. Th study Group I was treated with laserpuncture, using Cuban laser equipment of HeNe of 632,8 nm and a dose of joule/cm2 was applied, and the Control Group II was treated with acupuncture needles. The conventional medical treatment was suspended. Daily sessions were given from Monday to Friday, for two weeks, until a total of 10. Both techniques demonstrated to be effective in the treatment of these affections, improving the clinical and radiological symptoms significantly when the treatment sessions was concluded. The patients accepted the laserpuncture better because of its painless character, less time of application, and the absence of bleeding and stress.

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