To Evaluate The Efficacy Of Sensitive Acupoint Acupuncture Treatment In Cervical Spondylosis (Cervical Type)

ObjectiveTo analysis the correlation and practical efficacy of meridian-differentiation method in treating cervical spondylosis.Methods and Results135 participants with cervical spondylosis (cervical type) compliance with the recruitment criteria were recruited from the Department of Orthopedics outpatient clinic, Guangdong Province Traditional Chinese Medical Hospital. Sufficient information were explaned to ensure participant realize about the study before signing the informed consent form. Participants were randomly allocated into 3 treatment groups according to random number table method following recruitement consequence. The 3 treatment groups are:Sensitive-acupoint group, Shu-acupoint group and Luo-acupoint group.The first part is the correlation study about the sensitivity of upper limb distal acupoints and the region of neck pain in cervical spondylosis. Pain region assessment:the neck pain region was marked according to the traditional meridian pattern, the three main regional zone were left or right side of TaiYang, ShaoYang and YangMing zones. Distal acupoint assessment:Participant would then undergo the distal acupoint tenderness tolerance detection, pain tolerance of the 30 selected distal acupoints (they are left and right Ying-acupoints, Shu-acupoints, Jing-acupoints, Yuan-acupoints and Luo-acupoints in alternate meridian with respected to the three upper limb yang meridians) was measured by algometer. The two least tenderness tolerance acupoints in each subject are the individual sinsitive points. SPSS18.0 would be used to analysis data obtained, independent T-test analysis was used in comparing the differences in acupoint sensitivity between involving group and non-involving group correspoinding to certain meridian region; ANOVA was used in comparing the specificity of the 30 selected acupoints in different pain region combination. Result:1) Among the 119 participaints who had completed the distal and reginal pain assessment,60 participaints involving yangming region,51 participaints involving shaoyang region, and 90 participaints involving taiyang region. Therefore, Taiyang region is the most popular involving region in this study, with statistical signif icancy. 2) T-test analysis screened out 3 acupoints (SI2, SI5, SI4 from left side) in YangMing involved parties, and 5 acupoints (LI3, LI5, TE5, TE4, LI4 from the right side) in TaiYang involved parties which are in highest pain tolerance (i. e. least pain sensitivity). The most interesting thing is all of these acupoints are not on the same meridian as the pain involved zone. This finding apparently parallel to the Acupuncture Classics principle:sensitivity of distal acupoints elevate while the corresponding meridian was infected.3) ANOVA was used to analysis difference in sensitivity of distal acupoint among 7 possible pain region combinations. Comparing with other possible pain region combinations, we find that 11 acupoints (LI4, TE5, SI2, SI3 and SI5 in left side; LI2, LI3, LI5, TE5, TE4 and SI4 from right side) show extra sensitivity in ShaoYang-only involving group. In addition, SI2 and SI4 in left side show extra sensitivity in TaiYang-only involving group; LI5 from left side shows extra sensitivity in YangMing-mixed involving group; SI2 from right side shows extra sensitivity in YangMing-ShaoYang involving group, with statistical significant. Findings of this part is disorderly, but sensitive acupoints screened out from solo-shaoyang involving group is more than that in other pain region goup; and those sensitive acupoints are belongs to the three yang meridians. This finding is parallel to the fact that lateral neck region is the junction of the three upper limb yang meridians.The second part is about treatment. Participants were treated by acupuncture treatment under three different principles (the three treatment groups are: Sensitive-acupoint group, Shu-acupoint group and Luo-acupoint group). Treatment efficacy will be assessed by Visual Analogue Scale (VAS), Range of Moment of neck (ROM), Northwick Pain Questionnaire (NPQ) and McGill Pain Questionnaire (MPQ). Treatment point selection:individual sensitive acupoint (the two least pain tolerence acupoint on both upper limbs) would be used in Sensitive acupoint group participaints. For Shu-point group, shu acupoint of the corresponding infected meridian (s) would becomes the treatment acupoints, same as sensitive acupoint group, bilaterally taking two form each sides, four acupoints in total. For Luo-point group, treatment acupoints were select according to meridian-differentiation method marked in the first part, Luo-point in the corresponding ying meridian would be treatment acupoint, same as the other two treatment group, bilaterally taking two form each sides, four acupoints in total. Needle used in the study was unified as 0.25 x 25mm disposable sterilized acupuncture needles. Manipulation:Acupuncture treatment was followed by standard infection control. During the treatment, participants were instructed to practice neck muscle stretching exercise. Course of treatment:The course was composed of 4 treatment sessions, participants should come back for treatment in alternate or every second day, for the most it could be last for two weeks. Assessment tools:In very treatment session, indicators and questionnaire scoring was marked in detail before or (and) after the treatment. VAS and ROM were scored before and after the each treatment session, while NPQ and MPQ would scored once in each session. Data collected would be analyzed by SPSS18.0. T-test and ANOVA would be used in analyzing the correlation between distal acupoints and pain region, while ANOVA would be used in analyzing efficacy of the three treatment group. Results:The second part of the study is about therapeutic effect amount 3 treatment groups. Changes in VAS measure the level of pain relieve power, compare with the VAS score before the 1st treatment, VAS score shows decreased after the 2nd,3rd and 4th treatment in Sensitive-acupoint group and Shu-acupoint gorup. NPQ presents the QOL influenced by neck pain. In Sensitive-acupoint group and Shu-acupoint gorup, NPQ score was lowered after the 2nd,3rd and 4th treatment compared with that before treatment. For Luo-acupoint group, NPQ score was lowed after the 3rd and 4th treatment compared with that before treatment, with statistical significant. In MPQ measurement, Sensitive-acupoint group and Shu-point group showed decrease in MPQ score after the 2nd,3rd and 4th treatment compared with that before treatment. Comparing the total MPQ score changed between different treatment group shows greater effect in Sensitive-acupoint group than that in Luo-acupoint group, with statistical significant. ROM measure the 6 directions of neck movement. In flexion and extension direction, Sensitive-acupoint group showed improvement after the 3rd and the 4th treatment compare with that before treatment; Shu-acupoint group showed improvement after the 4th treatment, compare with that before treatment; comparision between groups shows that Shu-acupoint group performed greater total improvment in ROM than that of Luo-acoupoint group. In lateral bending direction, Shu-acupoint group showed improvement after the 2nd, 3rd and 4th treatment compared with that before treatment; comparision between groups shows that Shu-acupoint group performed greater total improvment in ROM than that of Sensitive-acoupoint group. In rotation direction, Sensitive-acupoint group and Shu-acupoint group showed improvement after the 2nd and 4th treatment compared with that before treatment; comparision between groups shows that Shu-acupoint group performed greater total improvment in ROM than that of Sensitive-acoupoint group, with statistical significance.ConclusionIn the study, there is no rules or pattern found in the correlation between distal acupoint and neck pain region. However, a piece of information indirectly pointing to the direction that distal acupoints of certain meridian show higher sensitivity than that of other meridians in disease status. About the efficacy of treatment, Sensitive-acupoint group and Shu-acupoint group showed privilege among different assessment tools. When focusing on pain measurement tools (including VAS, NPQ and MPQ), effect in Sensitive-acupoint group was slight better than that of Shu-acupoint group; while focusing on functional measurement (including flexing and extension direction, lateral bending and rotation in ROM), effect in Shu-acupoint group was better than that of Sensitive-acupoint group.