Clinical Research On The Lumbar Intervertebral Disc Herniation Patients Treated With Abdominal Acupuncture

Background:The lumbar intervertebral disc herniation that is definded as a kind of syndroma associated with nerve root and cauda equina compressed by the lumbar disc degeneration, the annulus fibrosis disruption and the nucleus pulposus herniation is a frequent source of low back pain, approximately as many as20%of people. The most common site of disc herniation is at the L4-5and L5-S1interspace. The tipical symptom of this disorder is the patient’s back pain often localized to the lower back and gluteal area and the backleg pain which radiates down the leg, particularly below the level of the knee. The group most commonly affected is adults aged25-55years.There are two kinds of therapeutic methods for patients with the lumbar intervertebral disc herniation. One is surgical treatment, the other is conservative treatment. As many as80%of patients have resolution of their symptoms with conservative treatment, such as epidural injection, lumbar traction, acupuncture and moxibustion, manipulation and so on. Acupuncture and moxibustion as an important part of traditional Chinese medicine(TCM) has won worldwide popularity for its advantages of simplicity, convenience, low cost and efficacy. With the development of social, material and spiritual needs of people is getting higher and higher. Everybody wants not only a good healing, but the good quality of life(QOL). We find that abdominal acupuncture is widely used in clinical because it is safe, painleess, efficient, suitable and so forth.But the treatment of the lumbar intervertebral disc herniation is not so satisfied, and the recurrence rate is high, so scholars is trying their best to find a better therapeutic regimen.Based on this, we have studied on the lumbar intervertebral disc herniation patients treated with abdominal acupuncture to observe the improvement of clinical effect and the QOL and to provide clinical evidence for treating this disorder.Objective:1. To sum up all the literatures about the lumbar intervertebral disc herniation to analyse its category, epidemiological characterstics, pathophysiological mechanisms, pathogenesis, clinical diagnosis and treatment both of Western medicine and TCM.2. To investigate the clinical effect via comparing and analysing abdominal acupuncture and routine acupuncture treating the lumbar intervertebral disc herniation.3. To observe the improvement of symptoms and signs of the lumbar intervertebral disc herniation via comparing and analysing abdominal acupuncture and routine acupuncture.4. To observe the improvement of back pain or backleg pain of the lumbar intervertebral disc herniation via comparing and analysing abdominal acupuncture and routine acupuncture.5. To observe the improvement of the QOL of the lumbar intervertebral disc herniation patients via comparing and analysing abdominal acupuncture and routine acupuncture.6. To find a better therapeutic regimen for treating the lumbar intervertebral disc herniation in clinic.Methods:1. Literature research: Sift out literatures about the lumbar intervertebral disc herniation through searching several databases, such as the CJFD, the VIP, the pubmed and so on. And conclude the development of this disorders in both Western medicine and TCM.2. Clinical research:70cases of lumbar intervertebral disc herniation patients gathering strictly according to the inclusion criteria and the exclusion criteria were randomly divided into2groups. One was the treatment group including35patients taking abdominal acupuncture, the other was the control group, also including35patients taking routine acupunture. All the patients were assessed with the JOA score, the SF-MPQ and the WHOQOL-BREF before and after the treatment of1,2and3weeks. All data analyses were performed using SPSS13.0.Results:1. the result of the two groups’baseline index:There were no significant differences from the gender composition, aging and course of disease between the two groups (P>0.05), so other indexes of the two groups could be compared.2. the result of JOA scores:(1) the result of symptoms scores of JOA:After the treatment of1,2and3weeks, the two groups’symptoms scores, including back pain score, backleg pain and numbness score and walking function score were significantly improved versus before treatment (P<0.05). Before treating, there were no significant differences from symptoms scores between the two groups (P>0.05). After1and2weeks, the scores about back pain and walking function of the treatment group were significantly improved versus the control group (P<0.05), except the backleg pain and numbness score. After3weeks’treatment, the scores about back pain and backleg pain and numbness were significantly improved versus the control group (P<0.05), except the walking function score which was almost arrived at the high score (3point) in the two groups (P>0.05).(2) the result of signs scores of JOA:After the treatment of1,2and3weeks, the treatment group’s signs scores, including sensory disturbance score, dyskinesia score and straight leg raising test score were significantly improved versus before treatment (P<0.05); the control group was failed to find any statistical superiority of any signs scores until treating2and3weeks. Not only before but after every week’s treatment, the scores of all the signs of the treatment group were significantly improved versus the control group (P<0.05). Only the sensory disturbance score of the treatment group at2and3weeks was significantly improved versus the other group through further computing (P<0.05).(3) the result of normal activities scores of JOA:After the treatment of1,2and3weeks, the two groups’normal activities scores, including rolling over from supine position score, standing score, washing face and brushing teeth score, leaning forward score, sitting for1hour score, lifting heavy object score and walking score was significantly improved versus before treatment (P<0.001). Before treating, the normal activities scores only about washing face and brushing teeth and sitting for1hour of the treatment group were significantly improved versus the control group (P <0.05). After1,2and3weeks’treating, only washing face and brushing teeth score, leaning forward score and lifting heavy object score were significantly improved versus the control group (P<0.05), besides the walking score was significantly improved after1week but not2weeks or3ones.(4) the result of bladder function score of JOA:There was no bladder dysfunction berore or after treating in the two groups. That was to say neither abdominal acupuncture nor routine one would cause bladder dysfunction.(5) the result of the total JOA scores:After the treatment of1,2and3weeks, the two groups’total JOA scores including symptoms scores, signs scores, normal activities scores and bladder function score were significantly improved versus before treatment (P<0.05). What’s more, with time going, the total JOA scores becomed higher and higher. Before treating, signs scores and the total JOA scores of the treatment group were significantly improved versus the control group (P<0.001), except symptoms scores and normal activities scores. After1,2and3weeks’ treating, the total JOA scores of the treatment group were significantly improved versus the other one (P<0.05).3. the result of the clinical effect:The total effective rate of the treatment group at1st and2nd week were significantly higher versus the control group(P<0.05). But at3rd week, there is no significant differences between them. By further computing, we known that the clinical effect at1st and2nd week were significantly improved versus the control group(P<0.05). After2weeks’treating, the total effective rate of the treatment group was arriving at100%with the total cure rate of77.1%which was28.5%higher than that of the control group after3weeks’treating.4. the result of the short-form of McGill pain questionnaire (SF-MPQ) scores:After the treatment of1,2and3weeks, the two groups’SF-MPQ scores were significantly improved versus before treatment (P<0.05). What’s more, with time going, SF-MPQ scores becomed lower and lower. Before treating, there were no significant differences from SF-MPQ scores between the two groups (P>0.05). After1week, the sense score of the pain rating index (PRI), the PRI score and the visual analogue scale(VAS) score, excluding emotion score of PRI and the present pain Intenstty (PPI) score, of the treatment group were significantly lower than that of the control group (P<0.05). After2weeks, almost all SF-MPQ scores were significantly lower than that of the control group (P<0.05), except emotion score of PRI. Until3weeks later, all SF-MPQ scores of the treatment group were significantly lower than that of the control group (P<0.05).5. the result of the QOL scores:After the treatment of1,2and3weeks, the two groups’QOL scores, including the whole QOL score, the whole health status score, physiology score, psychology score and environ score were significantly improved versus before treatment (P<0.05), except communication score. By further computing, there were significant differences from almost all the QOL scores between two time points (P<0.05) which were becoming higher and higher with time going, but not the environ score at3rd week versus2nd week.Before treating, there were no significant differences from QOL scores between the two groups (P>0.05). After1and2weeks’ treating, all the QOL scores of the treatment were significantly higher than that of the control group (P<0.05). After3weeks, excluding environ score, other scores of the treatment were significantly higher than that of the control group too(P<0.05).6. the result of the adverse reactions:There were some adverse reactions, such as pain when needling, bleeding when removing the needles, haematoma, banding needle or feeling faints when needling both in the two groups, but there were less adverse reactions of the treatment group than that of the control group.Conclusions:In the study, we take into lumbar intervertebral disc herniation patients treating with abdominal acupuncture, comparing with other patients who received routine acupunture. All the patients were assessed with the JOA score, the SF-MPQ and the WHOQOL-BREF. To observe the improvement of clinical effect and the QOL and to provide clinical evidence for treating this disorder.According to the data analyses, firstly, we have found that both abdominal acupuncture and routine acupunture can effectively improve the clinical effect of the patients with the lumbar intervertebral disc herniation. Secondly, there is a more telling advantage about total effect of abdominal acupuncture than that of routine acupuncture, while after2weeks, the total effective rate of abdominal acupuncture was arriving at100%; after3weeks, the total cure rate of77.1%of abdominal acupuncture was28.5%higher than that of routine acupuncture. Thirdly, the QOL of the abdominal group is better than the other one. Finaly, there are less adverse reactions of abdominal acupuncture. Overall, abdominal acupuncture is one of treatment which is worth clinical using.But there are still some weakness in our clinical research, for example, the position of points, the way of needling, the selecting of measuring scale and questionnaire. In the future, we could mending our weakness above, enlarge the sample size and take a further study on mechanism of abdominal acupuncture treating the lumbar intervertebral disc herniation.