Clinical Observation On Acupuncture For Neck Pain Caused By Cervical Spondylosis Based On Muscle Region Theory

Background:This is a pilot randomized controlled trial(RCT)about comparing acupuncture based on muscle region theory with medication treatment in the neck pain caused by cervical spondylosis(CS).CS is defined as an age related degeneration of the vertebrae and discs in the neck region.This process happens for everybody during aging.One of the degenerative processes is that in edges of the vertebrae develop small and rough bone called osteophytes,also the discs become thinner.Unspecified degenerative changes of the muscles,tendons,joints and bones of the neck and shoulder usually lead to CS.CS is a common problem in middle and old age,50%of people more than 40 years old show degenerative changes in X-Ray imaging and these findings would be 85%in people over 60 years old.In these years the incidence of CS has increased among young people.The prevalence increases with age and it is more common in women than men.Thirty five percent of Canadian adults and 43%in Sweden have suffered of neck pain during their life.CS also is a common disease in china,it is reported about 3.8%-17.6%incidence in Chinese adults,especially in people older than 40 years.Overall the modern life style such as long time work by computer,less physical activity and increasing emotional stress and work pressure cause increasing morbidity rate about CS.But still aging is the major risk factor and in age 60 most people show signs of CS on X-Ray.According to TCM theory neck pain caused by CS belongs to the category of Bi-syndrome(painful obstruction syndrome).It is the result of Qi and blood blockage that obstructs the channels and local collaterals.The muscle regions(?? channel sinew),an important components in the channel system,correspond to the tendons,muscles(myofascia)and ligaments.Hegu ci(Triple directional needling technique)which is a kind of heavy stimulation technique to treat muscular Bi syndrome has been used in our study.Objective:To evaluate acupuncture intervention based on muscle region theory for neck pain caused by CS.Method and materials:Forty patients according to inclusion and exclusion criteria were chosen and randomly divided into two groups,acupuncture group and medication group.During the study,three patients were dropped from medication group and finally 17 patients were evaluated in this group.In acupuncture group,treatment sessions counted as eight totally(two per week).At first each patient in acupuncture group were palpated in occipital region,neck and shoulders area while sitting on a comfortable chair.Needling was performed at the local tender points and tightness.The technique of needling was so called Hegu ci(triple directional needling,chicken-claw needling method).Then patients were instructed to lie on the bed in order to determine tender points below knee and elbow along the affected muscle regions and other muscle regions related to it.These points also needled by Hegu ci method.Then acupoints Guanyuan(RN 4)and Qihai(RN 6)were needled and warmed with smokeless moxa for 15 minutes.All patients in the medication group were treated with celecoxib(200 mg two times per day),and amitriptyline(10 mg as a single dose before going to bed)for one month.In this study we applied two questionnaires for evaluating data,visual analogue scale(VAS)and northwick park questionnaire(NPQ).VAS questionnaire was filled in before and after first session of treatment,after last session treatment and two weeks later in acupuncture group.In medication group VAS was filled in before beginning treatment,one month later when treatment course finished and also two weeks after that time by patients.NPQ questionnaire in both groups(acupuncture group and medication group),was filled before beginning treatment,one month later(after last treatment session)and two weeks after that time.For analyzing data SPSS program(version 20)was used.In this study "paired samples T test" was used for evaluating alterations of VAS and NPQ scores in acupuncture and medication group lonely.For analysis the VAS and NPQ scores comparing between acupuncture and medication groups "independent-sample T test" were applied.Also"Pearson correlation coefficient" is calculated to evaluate relation between parameters.P-value less than 0.05 defined as significant statistical result.Results:In this study 37 patients were evaluated.20 patients in acupuncture group and 17 patients in medication group.In acupuncture group 12 patients(60%)were male with mean age of 54.75 years and 8 patients(40%)were female.with mean age of 56.5 years.Mean age in acupuncture group was totally 55.45 years.In medication group 8 patients(47.05)were male,with mean age of 53.12 years and 9 patients(52.95%)were female,with mean age of 54 years.Mean age of patients in medication group was totally 53.58 years.Mean value of pretreatment VAS score(6.400±1.391)has statistical significant difference compared with mean value of VAS score immediately after first session of treatment((3.550±1.538).which showed an immediate effect of acupuncture treatment on decreasing pain of neck in CS(p value<0.001).The mean VAS score of last session treatment(3.000±1.213)was lower than pretreatment mean VAS score(p-value<0.001).Mean VAS scores two weeks after last session of treatment(3.850±1.182)was lower than pretreatment(6.400±.391)in acupuncture group(p-value<0.001).In acupuncture group mean of VAS score,two weeks after last session of treatment(3.850±1.182)was higher than last session of treatment(3.850±1.182)which was statistical significant(p-value=0.001).In evaluating of pain intensity according to VAS score between two groups(acupuncture and medication),there were no statistical difference both before treatment and after ending course of treatment(p-value pretreatment=0.202,after ending treatment p-value=0.088).Difference in pain intensity two weeks after last treatment between two groups was statistically significant,for medication group mean VAS core(4.941 ±1.784)was higher than acupuncture group(3.850±1.182)which was statistical significant(p-value=0.041).In both groups the intensity of pain get higher by increasing the age(correlation coefficient before intervention was 0.505,after ending treatment was 0.320 and two weeks after ending treatment was 0.325).The analysis of NPQ scores in acupuncture group showed significant statistical difference before intervention and last session of intervention,mean NPQ score was lower in last session treatment,(before intervention Meant SD=15.900±3.059 and after last session treatment Mean±SD =9.100±4.089)which was statistically significant(p value<0.001).Mean of NPQ score two weeks after last session treatment(9.750±3.878)in compare with first session of treatment(15.900±3.059)significantly decreased(p value<0.001).Mean of NPQ score two weeks after last session of treatment(9.750±3.878)in compare with last session of treatment(Mean±SD =15.900±3.059)significantly increased(p value=0.039).Comparing changes of NPQ scores between two groups in each step of intervention,showed no significant statistical difference(before intervention p-value=0.127,at the end of treatment p-value=0.252 and two weeks after end of treatment p-value=0.151).There is a relation between age and quality of life,so that with increasing of age,NPQ scores increased,[Correlation coefficient before intervention(0.350),at the end of treatment course(0.212)and two weeks after treatment(0.302)].Conclusion:This study showed that among adult patients with neck pain of CS,acupuncture based on muscle region theory resulted in significantly great improvement in neck pain intensity and quality of life.Also our study showed that acupuncture based on muscle region theory is as effective as medication therapy and there is no priority between them.