| Purpose:According to traditional Chinese medicine theory,knee pain belongs to Bi syndrome.Bi refers to stiffness and obstruction of circulation of Qi and Blood in the meridians.Bi syndrome manifests as pain,numbness or heaviness in muscles,tendons,bones and joints in addition to mobility impairment or deformation of these structures.Arthritis pain from Bony Bi syndrome is one of the most common reasons for patients to look for treatment with acupuncture and herbs with or without the use of western therapeutics.Contralateral acupuncture is a needling technique where acupuncture points on the right side are selected for diseases on the left and vice versa to balance yin and yang and to activate meridians.This method acts through reflex regulation of nervous system,activate protective inhibition of cerebral cortex and cutoff of local malignant stimulation,leading to quick elimination of pain.The main purpose of contralateral acupuncture is to normalize the damaged streams of Qi and Blood through activating the acupoints on the relative healthy parts of the body under the condition that the conventional acupuncture given to the affected abnormal area would be less effective.However,there is little scientific evidence to validate the clinical effects of contralateral acupuncture in patients with knee pain.The aim of the present study was to examine the effects of contralateral acupuncture on pain,mobility,and quality of life measures in the patients having knee pain.Methods:The present study is a randomized controlled trial that was performed at the Imam Sajjad Hospital,Ramsar,Iran.Participants were enrolled from June 2017 to November 2017,and were randomly allocated to intervention(contralateral acupuncture)and control(ipsilateral acupuncture)groups.The inclusion criteria consisted of:1)Aged ? 20 years.2)Main symptom of knee pain with pain intensity of more than three points as measured on a visual analog scale(VAS)upon recruitment.3)Knee pain in one knee or mostly in one knee.4)No acupuncture therapy or other relative treatment has been received within the last seven days prior to study entry.5)Signed an in formed consent paper.The exclusion criteria consisted of:1)Complications of severe systematic diseases such as cardiovascular and cerebrovascular diseases,cancer,etc.2)Bilateral Knee pain with the same intensity.3)Pregnancy or lactation.4)Rejection or fear of acupuncture therapy.5)Use of any other treatments(medications,physical therapy,etc.)For this purpose,thirty(30)patients were rantdomized equally into two groups to receive either ipsilateral or contralateral acupuncture stimulation.For contralateral acupuncture treatment(n=15),the painful knee joint was palpated to find the tender points and their affected meridians.Next,the knee and elbow of opposite extremity to the diseased knee joint was palpated to find tender points on the same meridian and same-name meridian respectively.Then,needling of the tender points on knee and elbow of opposite extremity to the diseased knee joint was done.For the ipsilateral acupuncture group(n=15),needling of the tender points on the diseased knee joint was performed.In the contralateral group,during needle retention(30 min),needle manipulation was applied two times,one minute on knee points,and one minute on elbow points in each time.The patients were asked to move the diseased knee for one to three minutes during needle manipulation.In addition,thermal stimulation with infrared lamps on the lower abdomen(CV 4-6)was applied for 15 min during the treatment sessions in both groups.Acupuncture treatments were performed 2 times per week for 8 sessions.To assess the immediate pain relieving effect,knee pain was measured before and after each treatment sessions by Visual Analogue scale(VAS).To evaluate the short-term effect,The Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)and VAS were measured after 8 sessions of treatment;Two weeks after finishing the treatment,a follow-up effect was measured by WOMAC and VAS again.Results:In the intervention(contralateral acupuncture)group,the VAS score after each treatment session was reducecd significantly as compared to the VAS score before the treatment(P-value<0.05).In the control(ipsilateral acupuncture)group,the VAS score after treatment sessions of 1 to 6,was reduced significantly as compared to the VAS score before the treatment(P-value<0.05),however the reduction was not significant after the 7 and 8 sessions.Rapid changes of VAS before and after each treatment in the contralateral acupuncture group was higher than the ipsilateral acupuncture group significantly after 1st&8th sessions(P-value of<0.05)of treatment,however the difference behtween two groups was not significant after 2-7 sessions of treatment.(P-value>0.05).In the contralateral acupuncture group,the VAS score was decreased after 4 sessions(P-value =0.001),after 8 sessions(P-value = 0.001),and two weeks after the completion of treatment(P-value = 0.001)significantly as compared to the baseline.In the ipsilateral acupuncture group,the VAS score after 4 sessions(P-value = 0.002),after 8 sessions(P-value = 0.001)of treatment,and two weeks after the completion of treatment(P-value ?0.002)was decreased significantly as compared to the baseline.Changes of VAS from the baseline in the contralateral acupuncture group were significantly greater than the ipsilateral acupuncture group after 4session(P-value= 0.02),after 8 sessions,(P-value<0.01)of treatment and two weeks after the completion of the treatment.(P-value = 0.01).The WOMAC score after the treatment was reduced significantly as compared to the baseline,in both groups(Ipsilateral group:P-value = 0.001,Contralateralgroup =0.001),nevertheless,the changes of WOMAC from the baseline in the contralateral acupuncture group were higher significantly than the ipsilateral group after eight sessions of treatment and in two weeks.follow-up after the completion of treatment(P-value<0.01).Knee pain(a subgroup of the WOMAC questionnaire),was significantly decreased at the end of treatment course and two weeks after the treatment,in both groups(Ipsilateral group:P-value = 0.001,Contralateral group =0.001).but the changes of pain scale was more significantly two weeks after the completion o f treatment in the contralateral acupuncture group compared to the ipsilateral acupuncture group(P-value = 0.04)The knee stiffness was reduced significantly in both groups,however,changes of stiffness after the treatment course and two weeks after the completion of treatment,were significantly more in the ipsilateral acupuncture group(P-value = 0.024)than in the contralateral acupuncture group(P-value = 0.102)The knee function in both groups was improved significantly,but the knee function wassignificantly improved in the contralateral group compared to the ipsilateral group(P-value<0.001)Conclusion:In the present study,the immediate,short-term and follow-up effects of contralateral needling in comparison with ipsilateral needling for knee pain were evaluated using VAS and WOMAC questionnaire.The rapid changes of VAS before and after each treatment were significant in both groups,however the significant decrease of the scores in the contralateral group compared with ipsilateral group was only in the first and last sessions.Short-term(after 8 sessions of treatment)and follow-up(two weeks after completion of treatment course)changes of VAS and WOMACfrom the baseline were significant among both groups.In addition,the changes were more significant in the contralateral acupuncture group compared to the ipsilateral acupuncture group.Both groups showed a significant reduction in pain compared to before treatment,but the follow-up pain reduction effect of contralateral acupuncture was greater than ipsilateral acupuncture after two weeks.In conclusion,our results manifested that contralateral needling is generally superior to ipsilateral acupuncture for the treatment of knee pain. |
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