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Zusammenfassung Einleitung Physiologische Wirkungen der Akupunktur in der Behandlung von Schmerzen sind Gegenstand von über drei Jahrzehnten Forschung. Zielsetzung Aktuelle Übersicht über die Wirkmechanismen der Akupunktur-induzierten Analgesie Methodik Es wurde eine ausführliche Recherche auf der Basis relevanter Übersichtsarbeiten der letzten Jahre, deren Sekundärliteratur („Schneeballrecherche”) und MEDLINE-Recherchen zu den einzelnen Unterpunkten mithilfe gängiger Suchwörter durchgeführt. Die Studienergebnisse wurden entsprechend der folgenden Teilbereiche zusammengefasst: 1 Bedeutung der Endorphine und Aktivierung der absteigenden Schmerzhemmung 2 Wirkung auf das autonome Nervensystem 3 Veränderte zerebrale Schmerzverarbeitung 4 Segmentale Inhibition 5 Lokale Mechanismen Ergebnisse Die Endorphinfreisetzung als anti-nozizeptiver Mechanismus der Akupunktur ist gut belegt. Es bestehen Hinweise auf einen Einfluss der Stimulationsfrequenz im Rahmen der Elektrostimulationsakupunktur (ESA). Belege für die Beteiligung verschiedener Neuromodulatoren – v. a. Serotonin und Noradrenalin – bei der Aktivierung der absteigenden Schmerzhemmung liegen vielfach vor. Wirkungen der Akupunktur auf das autonome Nervensystem scheinen möglich, aber sind noch weitgehend ungeklärt. Die Beeinflussung der zerebralen Schmerzverarbeitung durch Akupunktur ist dagegen gut untersucht, ebenso wie die Aktivierung der segmentalen Hemmung. Gut beschrieben ist die periphere Ausschüttung verschiedenster Neurotransmitter als potenzieller Wirkmechanismus der Akupunkturanalgesie. Schlussfolgerungen Die Akupunktur-induzierte Analgesie beruht auf einem komplexen Zusammenspiel peripherer, spinaler und zerebraler Effekte. Dies ist durch eine große Anzahl an Grundlagenstudien belegt. Offen bleibt, zu welchen Anteilen die einzelnen Mechanismen zur schmerzlindernden Wirkung der Akupunktur beitragen, und auf welche Weise sie zusammenwirken. Erforderlich sind Studien zur Punktspezifität, zum Einfluss verschiedener Stimulationsarten und -intensitäten, sowie insbesondere human-experimentelle Grundlagenstudien, um die Übertragbarkeit der Ergebnisse aus tierexperimentellen Studien zu überprüfen. Background Physiological mechanisms of pain relief achieved by acupuncture are subject to three decades of intensive research. Objective To give an overview about the current knowledge on mechanism underlying acupuncture induced analgesia Methods An extensive literature search based on significant reviews of the last years was performed. Secondary literature was reviewed and Medline searches using respective keywords were carried out. Results were summarized in the following sections: 1 Importance of endogenous opioids and descending pain inhibitory circuits 2 Effects on the autonomous nervous system 3 Impacts on central pain processing 4 Segmental inhibition 5 Local mechanisms Results There is substantial evidence for the release of endorphins as a central anti-nociceptive mechanism of acupuncture. With regard to electroacupuncture (EA) it has been suggested that stimulation frequency impacts on treatment outcome. The decisive role of further neuromodulators of the descending pain inhibitory circuits, primarily serotonin and norepinephrine, is well established. Effects of acupuncture on the autonomous nervous system seem likely, but remain largely unclear. In contrast, the impact of acupuncture on central pain processing is well characterized, as well as the activation of segmental inhibition occurring in the spinal cord. The peripheral release of various neuromodulators is also fairly well described as a potential mechanism contributing to acupuncture analgesia. Conclusion Acupuncture induced analgesia is based on a complex interplay of peripheral, spinal and central mechanisms. A large number of basic science and clinical studies support this notion. However it remains largely unclear how these different mechanisms are interwoven and how their contributions to the analgesic acupuncture effect compare to each other. Future studies need to address the specificity of acupuncture points or point regimens and the impact of different types and intensities of needle stimulation. In addition, it needs to be clarified whether the mechanisms identified through animal studies apply to acupuncture in humans as well. [ABSTRACT FROM AUTHOR]

Abstract: Background: Two 32-item questionnaires designed to assess expectation and experience of the relatively nonspecific feelings (whether bodily, emotional or mental) that may arise in response to acupuncture-type interventions have been developed and tested on acupuncture and other complementary health practitioners and students (N = 204). Objectives: To conduct a survey to assess content validity (CV) for the questionnaires, following two methods popularised by Lawshe and Lynn, and to compare the results. A secondary objective was to reduce questionnaire length from 32 to 20 items. Methods: Two surveys (Phase 1, 48 items; Phase 2, 18 items) were conducted among 20 experienced acupuncture practitioners and researchers, who scored items as either ‘essential’, ‘useful but not essential’, or ‘not necessary’. Lawshe's and Lynn's methods were applied to the returned data, the former using Wilson's recent modification, the latter with ‘useful but not essential’ rescored as either ‘essential’ or ‘not necessary’. Some subgroup analysis was carried out. In addition, Randolph's multi-rater kappa was used to assess inter-rater reliability as a further measure of content validity. Results: There were 17 usable responses in Phase 1, 13 in Phase 2. In both surveys, women considered more items as ‘essential’ than men, but fewer as ‘not necessary’, and vice versa (p < 0.001). Lawshe's content validity ratio (CVR) was significant for only 3 items, and the resulting content validity index (CVI) therefore meaningless. When ‘useful’ was rescored as ‘essential’ and Lynn's Scale CVI (S-CVI) calculated as the average of the CVI only for those items considered appropriate for retention (S-CVIAV-UA), acceptable values were found for subsets of the full list of items, although only for the women respondents. Inter-rater reliability was low for most items, but on the basis of the content validity analysis, together with respondent reservations about particular items and analysis of actual questionnaire usage, a 20-item list was created and circulated to the survey respondents for further feedback. Discussion: This shorter scale is now being tested on electroacupuncture training courses, and may be useful in determining whether different feelings are elicited by different types of acupuncture, other CAM modalities, or even other, unrelated activities. Conclusions: A modified content validity assessment method was found to give more usable results than conventional methods. With this new approach, 32-item questionnaires on expectation and experience of nonspecific feelings were shortened to more manageable 20-item instruments. In general, CV was greater among women than among men. [Copyright &y& Elsevier]

Copyright of Deutsche Zeitschrift für Akupunktur is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Schmerz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Schmerz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Hautarzt is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Copyright of Deutsche Zeitschrift für Akupunktur is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Electroacupuncture (EA) has been reported to produce antiedema and anti-hyperalgesia effects on inflammatory disease. However, the mechanisms are not clear. The present study investigated the biochemical mechanisms of EA anti-inflammation in a rat model. Methods: Three experiments were conducted on male Sprague-Dawley rats (n = 7–8/per group). Inflammation was induced by injecting complete Freund''s adjuvant (CFA) subcutaneously into the plantar surface of one hind paw. Experiment 1 measured plasma corticosterone (CORT) levels to see if EA regulates CORT secretion. Experiment 2 studied the effects of the adrenal gland on the therapeutic actions of EA using adrenalectomy (ADX) rats. Experiment 3 determined whether a prototypical glucocorticoid receptor antagonist, RU486, affects. EA anti-edema. EA treatment, 10 Hz at 3 mA and 0.1 ms pulse width, was given twice, for 20 min each, once immediately after CFA administration and again 2 h post-CFA. Plasma CORT levels, paw thickness, indicative of the intensity of inflammation, and paw withdrawal latency (PWL) were measured 2 h and 5 h after the CFA injection. Results: EA significantly increased plasma corticosterone levels 2 h (5 folds) and 5 h (10 folds) after CFA administration compared to sham EA control, but EA alone in naive rats and CFA alone did not induce significant increases in corticosterone. Adrenalectomy blocked EA-produced anti-edema, but not EA anti-hyperalgesia. RU486 (15 μl, 15 μg/μl), a prototypical glucocorticoid receptor antagonist, also prevented EA anti-edema. Conclusion: The data demonstrate that EA activates the adrenals to increase plasma corticosterone levels and suppress edema and suggest that EA effects differ in healthy subjects and in those with pathologies. [Copyright &y& Elsevier]

TENS therapy represents a good completion of chronic pain treatment, prolonging the effects of acupuncture and helping to overcome therapy resistance. Application for patients who are under Warfarin treatment and anxious of needles is obvious. Under the careful control of physicians TENS therapy is harmless. This report should be stimulating and enlarge knowledge of physicians specialized on pain treatment.

In recent years unconventional diagnostic and therapeutic concepts proposed by a number of doctors have increasingly been brought into the public's attention. Those involved have wanted to draw the distinction between the conventional understanding of medicine taught at universities and their concepts of "Holistic Medicine" ("Ganzheitsmedizin"), "Therapy by Experience" ("Erfahrungsheilkunde") and "Biological Medicine" ("Biologische Medizin"). The case of "Elektroakupunktur nach Dr. Voll (EAV)" will be taken as an example to show how an unconventional technique has been used for decades without its efficacy ever having been proven according to the criteria of scientifically orientated medicine. Nevertheless, the advocates of these unconventional concepts keep on supporting their views! The completely different approach to medicine and science--the cause of this divergence--will be explained. Furthermore, it will be considered if the high claims for this way of alternative medicine can be justified. However, even if no such alternative forms of medicine can be supported, some reorientation of the conventional medicine seems to be necessary.

An experimental model of acute painful trauma under electroacupuncture (EAP) protection was established. During the first 15 minutes of acute pain and EAP F2 alpha-prostaglandin, serotonin, and histamine concentrations decreased in arterial blood corresponding to increased concentrations of endogenous opiates in cerebrospinal fluid. In 30 minutes of acute pain and EAP the concentration of opiates (methionine-enkephaline, leucine-enkephaline) begins to decrease, but F2 alpha-prostaglandine, serotonin and histamine content increases significantly. The concentration of cyclic nucleotides changes significantly at investigation stages. However, they are not significant in EAP mechanism, but they are modulators of endogenous opiate effects and implement interaction between them and prostaglandines. We consider that the analgetic effect caused by EAP under acute surgical trauma is connected not only with endogenous opiate system activation, but with synthesis suppression of "pain substances".