Page 1
Page 2
Page 3
Page 4
Page 5
Page 6
Page 7
Page 8
Page 9
Page 10
Page 11
Page 12
Page 13
Page 14
Page 15
Page 16
Page 17
Page 18
Page 19
Page 20
Page 21
Page 22
Page 23
Page 24
Page 25
Page 26
Page 27
Page 28
Page 29
Page 30
Page 31
Page 32
Page 33
Page 34
Page 35
Page 36
Page 37
Page 38
Page 39
Page 40
Page 41
Page 42
Page 43
Page 44
Page 45
Page 46
Page 47
Page 48
Page 49
Page 50
Page 51
Page 52
Page 53
Page 54
Page 55
Page 56
Page 57
Page 58
Page 59
Page 60
Page 61
Page 62
Page 63
Page 64
Page 65
Page 66
Page 67
Page 68
Page 69
Page 70
Page 71
Page 72
Page 73
Page 74
Page 75
Page 76
12ALTERNATIVETHERAPIESsepoct2011VOL.17NO.5UseofAcu-TENSinChronicObstructivePulmonaryDiseaserehabilitationprogramwasreportedtobe120mL18butthechangecouldbeaslittleas20mL.19TheincreaseinabsolutevalueofFEV1intheacu-TENSgroupobservedinthiscurrentstudywasonly92mLwhichisbelowthesuggestedclinicallevelof200mLforclinicallysigniKcantbronchodilation.20Howevertheintentionofthisstudywastoinvestigatetheroleofacu-TENSasanadjunctmodalityinthemanagementofpatientswithCOPDandnottoreplacemedication.Apotenteffectonbronchodilationwasnotexpectedfromtheapplicationofasinglesessionofacu-TENS.TraditionalChineseMedicineoftenattributesadisturbanceofthefreeLowofqiwithinthebodytothecauseofadisease.Stimulationofacupuncturepointsisthoughttonormalizehealthbymaintainingthepatencyofqipathways.Itcanbeadminis-teredbyneedleacupuncture521-23acupressure2425ornonpunctureelectricalstimulationacu-TENS.89BasedonWesternpatho-physiologicalprinciplesitishypothesizedthattheimprovementinrespiratoryfunctionasaresultofacupuncturestimulationisassociatedwithalterationsinairwayresistance.2126Thelatterinturncouldbeaconsequenceofthereleaseofopioidsandmodu-lationoftheimmuneresponse.427TENSisannoninvasivemodalityoriginallydesignedforpainrelief.28Thewor7ingmechanismofTENShasbeenattribut-edtoactivationoftheAaandKbers.29Low-frequencyTENSwasreportedlyassociatedwithincreased-endorphinendomor-phineandmet-en7ephalinlevels1030-32throughanactiononm-andd-opioidreceptors.3334Animalstudieshaveshownthatopioid-receptorsinthemedullawheretherespiratoryrhythm-generatingcenterthepre-Btzingercomplexislocatedareassociatedwithrespiratorydepressionwhenstimulated.35-en-dorphinpreferentiallyactsonm-opioidreceptorswhichwhenstimulatedcanleadtoareductioninrespiratoryfrequency.3536Thecurrentstudyshowedthataraised-endorphinlevelwascorrelatedwithareductionofrespiratoryratesuggestingthattheimproveddyspneasensationcouldbeassociatedwiththeincreasein-endorphinlevelfoundinourparticipantswhoreceivedacu-TENS.Participantsinouracu-TENSgroupattainedanimprove-mentinFEV1andareductionofdyspneascoretogetherwithanincreasein-endorphinlevels.Incontrastadecreasein-en-dorphinlevelwasfoundintheplacebo-TENSgroup.SimilarKndingshavebeenreportedbyHughesandcowor7ers37whocomparedthelevelsof-endorphinafter30minutesofhighfre-quencyx13lowintensitylowfrequencyx13highintensityandplaceboTENS.TheyfoundthattheendorphinlevelincreasedinbothTENSgroupsindependentofthefrequencyofstimulationbutitdecreasedintheplacebo-TENSgroup.AcupuncturehasbeenshowntoreducethelevelofbloodinLammatorymar7ers.427WeanticipatedapossiblereductionindifferentialwhitebloodcellcountsTNF-aCRPandIL-8inourparticipantsafteracu-TENS.Howeverthiswasnotobservedinthepresentstudy.ThenegativeKndingcouldbeattributedtothefactthatasinglesessionof45minutesstimulationdidnotreachthetreatmentperiodrequiredtoinducetheanticipatedeffects.Indeedpreviousreportsdemonstratingpositiveeffectsinvolvedtreatmentprotocolswhichlastedforseveralwee7s.427Theeffectoflong-termacu-TENSontheimmunesystemwarrantsfurtherinvestigation.CONCLUSIONThisstudyshowedthat45minutesofacu-TENSproducedasigniKcantimprovementinFEV1PEFRandadecreaseinRRandDVAS.Thesechangeswereaccompaniedbyanincreaseinthe-endorphinlevel.NosigniKcantchangesininLammatorymar7erlevelsweredemonstratedwithasinglesessionofacu-TENS.Thelong-termeffectofacu-TENSwarrantsfurtherinvestigation.AcknowledgmentsThisstudywasconductedjustpriortotheMay122008Sichuanearthqua7e.Manyoftheseparticipantswereinthemostseverelyaffectedarea.Theauthorsaresincerelygratefultothepatientsfortheirparticipationinthisstudyandhopethattheyweresparedbythecatastrophe.REFERENCESx01.CalverleyPM.ExerciseanddyspnoeainCOPD.Eurx0Respirx0Rev.20061510072-79.2.NiciLDonnerCWoutersEetalATSERSPulmonaryRehabilitationWritingCommittee.AmericanThroacicSocietyEuropeanRespiratorySocietyStatementonPulmonaryRehabilitation.Amx0Jx0Respirx0Critx0Carex0Med.2006173121390-1413.3.ChengXDengLeds.Chinesex0Acupuncturex0andx0Moxibustion.5thed.BeijingChinaForeignLanguagesPress1999.4.JoosSSchottCZouHDanielVMartinE.Immunomodulatoryeffectofacupunctureinthetreatmentofallergicasthmaarandomizedcontrolledstudy.Jx0Alternx0Complementx0Med.200066519-525.5.MediciTCGrebs7iEWuJMHinzGWthrichB.Acupunctureandbronchialasth-maalong-termrandomizedstudyoftheeffectsofrealversusshamacupuncturecom-paredtocontrolsinpatientswithbronchialasthma.Jx0Alternx0Complementx0Med.200286737-750discussion751-754.6.JobstkChenJHMcPhersonketal.Controlledtrialofacupuncturefordisablingbreathlessness.Lancet.x0198628521-85221416-1419.7.Suzu7iMNamurakOhnoYetal.Theeffectofacupunctureinthetreatmentofchronicobstructivepulmonarydisease.Jx0Alternx0Complementx0Med.20081491097-1105.8.LaukSJonesAY.AsinglesessionofAcu-TENSincreasesFEV1andreducesdyspnoeainpatientswithchronicobstructivepulmonarydiseasearandomisedplacebo-con-trolledtrial.Austx0Jx0Physiother.2008543179-184.9.NgaiSPJonesAYHui-ChanCWkoFWHuiDS.EffectofAcu-TENSonpost-exerciseexpiratorylungvolumeinsubjectswithasthmaArandomizedcontrolledtrial.Respirx0Physiolx0Neurobiol.20091673348-353.10.WangJQMaoLHanJS.Comparisonoftheanticociceptiveeffectsinducedbyelec-troacupunctureandtranscutaneouselectricalnervestimulationintherat.Intx0Jx0Neurosci.1992951-4117-129.11.MillerMRHan7insonJBrusascoVetalATSERSTas7Force.Standardisationofspirometry.Eurx0Respirx0J.2005262319-338.12.CrapoROCasaburiRCoatesALetal.Guidelinesformethacholineandexercisechal-lengetesting1999.ThisofKcialstatementoftheAmericanThoracicSocietywasadopt-edbytheATSBoardofDirectorsJuly1999.Amx0Jx0Respirx0Critx0Carex0Med.20001611309-329.13.NgaiSPHui-ChanCWJonesAY.Ashortreviewofacupunctureandbronchialasth-max14WesternandtraditionalChinesemedicalconcepts.Hongx0Kongx0Physiotherx0J.20062428-38.14.CohenJ.Statisticalx0Powerx0Analysisx0forx0thex0Behavioralx0Sciences.2nded.HillsdaleNJLawrenceErlbaumAssociates1988.15.Noauthorslisted.Dyspnea.Mechanismsassessmentandmanagementaconsensusstatement.AmericanThoracicSociety.Amx0Jx0Respirx0Critx0Carex0Med.19991591321-340.16.ThorsteinssonGStonningtonHHStillwellGkElvebac7LR.Theplaceboeffectoftranscutaneouselectricalstimulation.Pain.19785131-41.17.RabekFHurdSAnzuetoAetalGlobalInitiativeforChronicObstructiveLungDisease.GlobalstrategyforthediagnosismanagementandpreventionofchronicobstructivepulmonarydiseaseGOLDexecutivesummary.Amx0Jx0Respirx0Critx0Carex0Med.20071766532-555.18.RiesALkaplanRMLimbergTMPrewittLM.Effectsofpulmonaryrehabilitationonphysiologicandpsychosocialoutcomesinpatientswithchronicobstructivepulmonarydisease.Annx0Internx0Med.199512211823-832.19.RiesALkaplanRMMyersRPrewittLM.Maintenanceafterpulmonaryrehabilita-tioninchroniclungdiseasearandomizedtrial.Amx0Jx0Respirx0Critx0Carex0Med.20031676880-888.20.PellegrinoRViegiGBrusascoVetal.Interpretativestrategiesforlungfunctiontests.Eurx0Respirx0J.2005265948-968.21.Tash7inDPBreslerDEkroeningRJkerschnerHkatzRLCoulsonA.Comparisonofrealandsimulatedacupunctureandisoprotereneolinmethacholine-inducedasthma.