| BackgroundLumbar disc herniation is series of clinical symptoms due to the lumbar disc degeneration, annular disruption, nucleus pulpous herniated, and the prominence stimulated the nerve root and the cauda equine. It is the main reason which causes the lumbago and pain of legs. In severe cases, it can cause disability and loss of ability to work, seriously affect the patient’s life and work. The epidemiological survey said that about0.95%of the Chinese population, the incidence of lumbar disc herniation, lumbar,4to5, L5～S1gap the highest incidence, accounting for about90%to96%, while the incidence of multiple intervertebral only5%to22%. Male patients than female, with the social development, mental increase in the number affected by the long-term sitting posture, occupational factors, physical exercise reduced the incidence of the disease has an upward trend and the trend of younger age.Western medicine treatment for lumbar disc herniation including surgical methods and non-surgical methods. The surgical treatment could be linked to some sequelae, such as chronic low back pain or numbness symptoms. The most common treatment of non-surgical methods is the use of NSAID (non-steroidal anti-inflammatory pain medication), but it needs to be administered in a long term, where the patients may be complicated in its possible toxicity side-effects. Numerous of Chinese medicine methods can be used for the disease, such as herbs, external application of herbs, massage, and acupuncture and moxibustion. The affirmation of acupuncture and moxibustion for lumbar disc herniation in recent years make it an effective treatment for the disease. And studies show that further optimizing the acupuncture and moxibustion therapy for the disease is significant meaningful. A number of clinical and experimental studies show that electro-acupuncture(EA) of Jiaji points can relieve the severe pain caused by lumbar disc herniation, which also show that electro-acupuncture is a painless, convenient, safe and non-obvious-toxicity therapy, and it is significant to society for the ease of the patient’s pain and the improvement of life quality. The integrative medicine which was recalled by Chinese medicine recently gave me a new idea for this disease, and this study was established based on it and my clinical experience.Object i veTo study the differentiation of the clinical efficacy and the influence of pro-inflammatory cytokine for lumbar disc herniation in terms of the integrative treatment of electro-acupuncture therapy and rehabilitation therapy.MethodsA simple random method was selected, and the patients were all from Taiwan Xin hua clinic of Chinese medicine in November2010to November2012. And there were92cases all collected which met the inclusion criteria. And according to the ratio of1:1:1, all cases were randomly assigned to integrative treatment group (electro-acupuncture combined with rehabilitation group)(31cases), EA Jiaji group (31cases), and rehabilitation group (30cases).Integrative treatment group has chosen Jiaji points of the abnormal vertebra and "Ashi" points as the main points for acupuncture treatment, and the priscribtion was referenced to the Acupuncture and Moxi bust ion Therapy, with the treatment of electro-acupuncture and rehabilitation; EA Jiaji group were using the aforementioned points, and only electro-acupuncture was used; rehabilitation group were taking rehabilitation treatment including intermediate frequency (IF) physiotherapy, traction and functional exercises.All included cases were observated according to designed requirements, therapeutic treatment were three times a week and the total treatment period was1month. The specific efficacy outcomes for observation include:JOA low back pain scale, the World Health Organization Quality of Life Scale Short Form (WHOQOL-BREF), simplified McGill Pain Questionnaire, biochemical indicators (that is proinflammatory cytokines include interleukin prime-1β, tumor necrosis factor a and plasma thromboxane prime B2). The JOA low back pain scale was used as the primary efficacy outcome, and efficient efficacy evaluation was reference to Chinese Disease Diagnosis and Effieacy Standards.Application SPSS17.0statistical software was used for statistical analysis. Measurement data are expressed as mean±standard deviation, F-test was used to compare measurement data groups (heterogeneity of variance using Kruskal-Wallis H rank sum test) between groups comparison, and LSD test for between group comparison, the paired t test was used for within group comparison, Wilcoxon rank sum test was for the non-normal distribution comparison. Grouped data between groups were compared using chi-square test, the ranked data were compared using Kruskal-Wallis H rank sum test. All statistical tests were two-sided test, the detection level is α=0.05.Results1. Baseline ComparisonComparative analysis between groups on three groups of gender, age, course of disease, syndrome of TCM and other demographic information showed there were no significant difference among three groups on demographic data and basic information (P>0.05), excluding the bias due to the demographic data and basic information, suggesting that three groups were comparable.2. Efficacy Comparison①JOA low back pain scoresFor improving the clinical symptoms of lumbar disc herniation, integrative therapy and rehabilitation therapy have a good effect, and integrative method was better after the treatment. In releaving the low back pain, the electro-acupuncture therapy has better effect (P<0.05), but after midterm treatment was not that better (P>0.05). Analysis of group comparison showed that all three treatments for improving the clinical symptoms of lumbar disc herniation have a certain effect, and integrative therapy is particularly significant, followed by rehabilitation therapy, and EA Jiaji is relatively poor.②Quality of life comparisonsWhether total quality of life and total health, or scale comparison of the four dimensions, three treatments can improve the patient’s quality of life, when the most significant treatment is integrative therapy. Within group comparison suggested that the integrative treatment were better than the electro-acupuncture treatment and rehabilitation treatment (P<0.05), and electro-acupuncture Jiaji treatment is only better than the rehabilitation group after midterm time-point (P<0.05). After treatment and1month follow-up time-point, the rehabilitation group is better than the EA Jiaji group (P<0.05), which indicated that the electro-acupuncture therapy is better than the rehabilitation therapy on the immediate effects, but the long-term efficacy is dominant rehabilitation therapy.③McGill scores comparison:Evaluation of McGill Questionnaire before and after the treatment of patients with lumbar disc herniation, three methods have different levels of efficacy (P<0.05), while the scores of integrative group and rehabilitation group after treatment decreased significantly than scores after the6th treatment (P<0.01), which indicated that pain releave after treatment effect is particularly evident; but scores of the EA therapy after treatment has a minor decline, shows that the electro-acupuncture therapy for pain releave of the disease need a longer course of treatment. By between group comparison, at the aspect of the extent releaving patients’pain, the scale of integrative treatment group and the rehabilitation group score decreased more than the EA group (P<0.05), which showed that clinical efficacy of integrative therapy and the rehabilitation therapy is better than EA therapy.④Proinflammatory cytokines of Biochemical indicators comparisonIn reducing the interleukin-1β (TL-1β) serum of patients with lumbar disc herniation, after6-times treatment (midterm), all three therapies cannot reduce interleukin prime-1β expression (P>0.05). After treatment, all three therapies for reducing the serum of patients’interleukin-1β (IL-1β) was significant (P<0.05) in varying degrees. Between groups comparison showed that after the treatment, of declining expression levels of serum interleukin-1β (IL-1β), the integrative therapy has the most significant efficacy (P<0.01), followed by rehabilitation therapy (P<0.05), and then electro-acupuncture treatment.In lower lumbar disc herniation in patients with tumor necrosis factor a (TNF-α), a course of three treatments to reduce the effect of TNF-α is not obvious (P>0.05), but after treatment TNF-α have a certain level of reduction, integrative and rehabilitation therapy TNF-reduce the magnitude significant (P<0.01). Group comparison:integrative therapy for reducing lumbar disc herniation in patients with tumor necrosis factor α (TNF-α) is better than of electro-acupuncture treatment and rehabilitation treatment (P<0.05) after two courses.After a course of integrative therapy for reducing the content of the patients plasma thromboxane B2(TXB2) have a certain effect (P<0.05), but the EA Jiaji, rehabilitation treatment had no significant effect. Two courses, the most significant effect of the content of the three therapy for reducing the patients plasma thromboxane B2(TXB2) have different levels of effect, and integrative therapy (P<0.05). Group comparison:integrative treatment for the improvement of the lumbar disc herniation plasma thromboxane B2(TXB2) better than the EA Jiaji and rehabilitation treatment (P<0.05) after two courses.⑤linical EfficacyBy rank sum test, three groups of clinical efficacy difference was statistically significant (P<0.05), and the total effective rate of integrative treatment group was87.1%, when EA group was53.3%and rehabilitation group was70.0%. Which indicated that compared with EA therapy and rehabilitation therapy, integrative therapy treatment of lumbar disc herniation patients has better better clinical efficacy in releaving the patient’s back pain, improving waist activities, daily work and life.Conelusion1. The integrative treatment is more effective than electro-acupuncture therapy or rehabilitation therapy in the evaluation of JOA scale and McGill scale;2. All3therapies can reduced lumbar disc herniation patients’ proinflammatory cytokines level, but integrative treatment treat the shortest times;3. For improving the patients’quality of life within three treatments, the advantages of electro-acupuncture therapy reflected in its immediate effects, when the continuing effect of the rehabilitation therapy is better. The integrative of the two therapies include both the advantage of them, and is a best solution to improve the patients’quality of life. |
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