Clinical Observation Of Temperature Acupuncture Treatment Of Poststroke Shoulder-hand Syndrome

1. BACKGROUND AND OBJECTIVESCerebrovascular disease is one of the most prevalent medical conditions affecting the human body; it is also the leading cause of disability in China and around the world. After the acute phase of stroke, most survivors exhibit various forms of dysfunction. About 12-25% of the stroke patients suffered from the shoulder-hand syndrome, which is characterized by pain and swelling in the upper extremity, thus inhibiting joint movement. This syndrome is the main cause of physical disability in post-stroke patients. These patients lose the ability to care for themselves and they suffered a reduction in the quality of life. At the same time, they are also a heavy burden to their family and the society. Although there is a wide range of intervention methods such as physiotherapy, assisted movement exercise, oral analgesic to treat the shoulder-hand syndrome, none of these methods prove to be truly effective. Acupuncture-Moxibustion Therapy, also known as the Warm Needle Moxibustion is a therapy which combined the acupuncture and moxibustion. This therapy is effective in treating a wide range of indications, economical, convenient and has no toxic side effects.In this study, the principle of treatment is to improve the blood circulation and promote venous return by early Warm Needles Moxibustion, in order to reduce edema and relieve pain of patients with shoulder-hand syndrome.The objective of this research is to observe the therapeutic effect and safety of Warm Needle Moxibustion for shoulder-hand syndrome, to investigate more effective strategies and methods on treatment of post-stroke shoulder-hand syndrome, in order to relieve patients' symptoms and reduce the burden of health care.2. METHODSSixty patients with post-stroke shoulder-hand syndrome were all from the inpatient and outpatient department of Dong Fang Hospital. They were randomly divided into two groups, the treatment group accepted warmed needles moxibustion as main intervention, and the control group accepted acupuncture with normal needles. In both group, the needles were inserted perpendicularly into Jianyu (LI15), Jianliao (SJ14), Jianzhen(SI9), Quchi(LI11), Chize(LU5) with depth of 1.5 inches; for Hegu(LI4), Yangchi(SJ4) and Neiguan(P6), needles were inserted with depth of 0.5 inch. All the points were given medium manual stimulation until patients felt sour and swell with the needles. Duration of the session of treatment was 30 minutes. For the treatment group, after insertion of the needles,2 cm moxa sticks were placed at the top of each needle approximately 3cm away from skin and lighted. Both groups were treated once daily except weekend, the total duration of treatment is four weeks. Outcome measures included the Fugl-Meyer Assessment to upper limb motor function (FMA), the degree of hand edema and Visual Analogue Scale (VAS) pain index. The changes of symptoms and physical signs after treatment were also observed.3. RESULTSBaseline of FMA marks, VAS and hand edema were comparable in two groups, the change of FMA marks, VAS and hand edema before and after treatments were all significant in two groups(P<0.0001), while the differences between two groups in FMA marks change and pain index change before and after treatments became obvious (P<0.05), however the differences in hand edema index between two groups became no obvious(P=0.183). This result indicates that the effect was more evident to some of the symptoms in the treatment group.4. CONCLUSIONThe result of this study indicates that the warmed needle moxibustion have significant superior than normal acupuncture on relief of pain and improvement of limb function of patients with shoulder-hand syndrome. It seems to be more effective to used combination therapy of acupuncture and moxibustion on this disease. However, the effect differences on relief of hand edema between two treatments became no obvious. No adverse event occurred during the therapy.