Clinical Observation On The Effect Of Acupuncture Treatment On Bladder Dysfunction And Quality Of Life In Multiple Sclerosis Patients

Background:Multiple Sclerosis(MS)is an autoimmune disease of the central nervous system.According to WHO report,more than two million people in the world suffer from this disease.It is one of the most common causes of neurological disabilities in young adults between 20-40 years old with higher incidence in women.It is characterized by autoimmune destruction of central nervous system(CNS)myelin.Any CNS structure can be a potential target of MS,therefore,patient with MS can have a wide range of unpredictable symptoms and develop significant disabilities which depend on the location of the affected myelin sheaths.Common symptoms such as difficulty in walking,incontinence,impaired sexual function,depression,and pain,all leading to a poor quality of life(QOL).Bladder problems are very common in MS patient which affects at least 80 percent of them.In some patients it is the first sign of disease and has the adverse effect on the QOL which could lead to a constant disability.In advanced cases,patients with MS often experience problems in their social relationships.The underlying etiology and pathogenesis of the disease is not completely understood.Because of the lacking standard treatment and present side effects of common medications used,MS patients are encouraged to use complementary and alternative medicine to help manage their symptoms.Acupuncture as part of traditional Chinese medicine is one of the most searched among these patients.Although there is not enough evidence on its effectiveness,a few reports have addressed some benefits of this treatment on the quality of life in Relapse Remission Multiple Sclerosis(RRMS)patients.The aim of this study is to evaluate the effect of acupuncture on the urinary dysfunction and QOL of patients with RRMS undergoing immunomodulatory treatment,using standardized questionnaires to evaluate these effects.Objective:To evaluate the effect of acupuncture treatment on bladder dysfunction and quality of life in patients with RRMS.Methods:This randomized controlled trial was conducted on patients with the diagnosis of RRMS in remission stage without any relapse in the last 2 months.Patients were recruited from Iran's MS society which is in collaboration with Multiple Sclerosis Research Institution of Sina Hospital in Tehran,from April 2018 to December 2018.First all exclusion and inclusion criteria were evaluated in patients.They were included in study if they had all inclusion criteria and excluded if they had any excluded criteria.Patients signed and written informed consent that related to study.Totally 48 patients with MS participated in this study.They were randomly divided into two groups,experiment(acupuncture plus western medication)and control(western medication)group,by the use of random number table.Acupuncture treatment was done 2 or 3 times per week for 10 sessions(totally 4 weeks)in the experimental group.Patients in both groups received fourth generation of immunomodulators as their main western treatment.According to textbook,main selection acupoint for bladder dysfunction included Taixi(KI 3),Xuehai(SP 10),Shuidao(ST 28),Guanyuan(CV 4),Shuifen(CV 9),Mingmen(GV 4),Huangshu(KD 16),Fuliu(KD 7),Qugu(CV 2),Zhongji(CV 3),Shenshu(BL 23).Some individualized points were added according to the patients' symptoms and syndrome differentiation.Disposable sterile steel needles with 0.25 mm in diameter/40mm in length were used,the needle was inserted bilaterally at points.Needling technique was even method of manipulation for all the points used in this study.Standardized questionnaires were used to evaluate the effect of those treatments on bladder dysfunction and quality of life in patients.Bladder dysfunction was evaluated at baseline,2 and 4 weeks of treatment and assessed by International Prostate Symptom Score(I-PSS)and Quality of Life Due to Urinary Symptoms(QOLU).Quality of life patients were also evaluated at baseline,at the end of treatment with Multiple Sclerosis Quality of Life 54.Results:Totally 52 Multiple sclerosis patients have participated in this study,4 patients from control group left the study because of individual reasons.So,the data of 48 patients were included in the analysis.Baseline measurements showed,there was no significant differences in all baseline characteristic between 2 groups(P>0.05).The result of this study showed that the severity of the urinary bladder dysfunction(according to I-PSS,QOLU scores)was reduced in experimental group after 2 weeks of treatment and also after 4 weeks of treatment(P<0.001)but there were no significant differences in control group(P>0.05).Moreover,comparison between the two groups showed acupuncture plus medication was more effective than medication alone on reducing the symptoms of urinary bladder dysfunction(I-PSS,QOLU sores)after 2 weeks and 4 weeks of treatment(P<0.001).The quality of life(MSQOL,Physical function,Emotional status scores)improved after treatment compare to before treatment in both group(P<0.05).Comparing between the two groups,it showed that acupuncture plus medication had better effect than medication alone on improvement of emotional status(P<0.05),but not in MSQOL and physical function(P>0.05).Conclusion:According to this study,acupuncture is an effective treatment on reducing the symptoms of urinary bladder dysfunction in MS patients.Moreover,it can help to improve the quality of life,physical function and emotional status of MS patients.Thus,acupuncture could be used as an alternative treatment in MS patients.