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RELIEF OF PAIN BY ACUPUNCTURE
320 To verify this hypothesis, one will have to determine the blood-group P in patients and controls, checking for the presence of haemagglutinins anti-PI (IgM) in P2 persons and avian-antigen precipitins (IgG) in PI and P2 persons. This still does not explain the prevalence of s.S.P.E. in males. One can, in addition to determining the P group (a histocompatibility antigen), check for the frequency of other histocompatibility antigens in the patients and controls (males and females) to assess their genetic susceptibility or not, in association with the production of immunoglobulins against measles virus and avian antigens. Brown
University
Memorial Hospital,
Pawtucket, Rhode Island 02860, U.S.A.
F. ROLAND.
CHEMICAL IRRITATION OF NERVE-ROOT IN DISC PROLAPSE
SIR,-For more than a decade1 orthopaedic surgeons have considered the likelihood of chemical irritation of the nerve-root in association with disc prolapse as the cause of the very acute pain following injury. This view has arisen from the frequent finding at acute operation of a swollen inflamed nerve-root without bone pressure. The chemical content of the nerve-root lists glycoprotein as a constituent. Previously,3 we showed the carbohydrate capsule of the pneumococcus liberates histamine and other H substances from perfused organs much in the same way as venom. Direct tests of nucleus pulposus pharmacologically show the presence of 1-4 Vg. histamine per g., but no tryptamine and no slow-reacting substance or kinin. This, we believe, cannot account for the acute pain. However, extract of the glycoprotein from human nucleus pulposus releases considerable quantities of histamine (figs. 1 and 2), oedema fluid, protein, and another amine with four times the mobility of histamine (fig. 2) from the isolated perfused lung of the guineapig. This spot on the chromatogram corresponds to the amine spot we found in red wine, which we believe accounts for the severe pain in migrainous neuralgia. This substance is present in less amount than histamine, and this latter substance we have shown can 1. 2. 3. 4.
Marshall, L. L. The Lumbar Disc. Melbourne, 1971. Nayler, A. Orthop. Clin. N. Am. 1971, 2, 343. Trethewie, E. R. Aust. J. exp. Biol. 1947, 25, 291. Trethewie, E. R., Khaled, L. Br. med. J. 1972, iii, 290.
Fig. 1-Responses of the isolated guineapig jejunum suspended in Tyrode. At 1, 2, 3, 4, 5, 6, responses to 1 ml. perfusate before, 0-5, 5-15, 15-30, 30-60 min., 1-2 hr., respectively, after injection of pulposus extract (glycoprotein) into pulmonary artery of perfused guineapig lung. At H’ response to 0-1 g.; at H", 0-3 g., H"’, 0’4 (.Lg. histamine. The unlettered contractions are to 0-2 tJLg. histamine. At E, response to 10 mg. glycoprotein extract (amount in 1 ml.: sample 1). Time in min. at top right. Details in text.
Fig. 2-Chromatogram run in butanol-acetic water for 4 hours. At H 1 drop histamine 5 mg. per ml., at S 1 drop sample 3 of fig. 1 (concentrated-heat). Spot marked has four times mobility of histamine. Stained ninhydrin. account for the severe pain in pancreatitis. We consider acute pain in disc is due to local irritation of the nerveroot producing oedema and release of protein and H substances at the site of disc injury. Relief of pain by cortisone6
the
findings, since cortisone inhibits the response to H substances.7 Full details of these experiments will be published elsewhere.
accords with these
peripheral
Department of Physiology, University of Melbourne, Parkville, Victoria 3052, Australia.
LEON L. MARSHALL E. R. TRETHEWIE.
RELIEF OF PAIN BY ACUPUNCTURE
SIR,-Iwas interested in the article by Dr Mann and his colleagues (July 14, p. 57). To the problem of pain in chronic rheumatic diseases, acupuncture alone is not the It may easily cure the superficial myalgia in one answer. or two treatments, but in cases of chronic arthritis it must be associated with massage. Muscle or tissue pain is due to spasm, and this spasm is primarily due to a deficiency in the " nerve supply " or " nerve impulse " to the muscle fibrils. Stimulating the " tired impulse " at some distant point will immediately relax this spasm, so that beneficial massage can begin at once. I am glad that Dr Mann and his colleagues accept my view that the " trigger spots ", the cause of rheumatic are situated at the acupuncture points. Let me give a few examples where acupuncture needles or intradermal needles should be placed distally to get good results. (Small intestine 4), at the junction of the fifth metacarpal of hand and the ulna will immediately relax the deltoid muscle; and one at the junction of the ring and little finger will relax the cervical muscles at that side of the neck (Triple warmer 3). Needles placed 3 in. and 5 in. above the internal malleolus (kidney 5 and spleen 6) will relax spasm of the knee-joint and also spasm of the pectoral muscles. Needles placedin. in the mid-line of the popliteal crease at the back of the knee will almost at once relieve tension in the upper back muscles (bladder 54). Since 1954 the Chinese have concentrated treatment with acupuncture on anaesthesiaand the cure of deafness and on its use in animals. It seems that chronic arthritis is not a national scourge there as it is elsewhere, perhaps because the Chinese are short in stature and are not subjected to the strain of Western civilisation.
pain,
97
Harley Street, London W1.
5. 6. 7.
LOUIS MOSS.
Trethewie, E. R. Med. J. Aust. 1961, ii, 899. Mount, H. T. R. Can. med. Ass. J. 1971, 105, 1279. Trethewie, E. R. Aust. J. exp. Biol. 1958, 36, 275.
University
Memorial Hospital,
Pawtucket, Rhode Island 02860, U.S.A.
F. ROLAND.
CHEMICAL IRRITATION OF NERVE-ROOT IN DISC PROLAPSE
SIR,-For more than a decade1 orthopaedic surgeons have considered the likelihood of chemical irritation of the nerve-root in association with disc prolapse as the cause of the very acute pain following injury. This view has arisen from the frequent finding at acute operation of a swollen inflamed nerve-root without bone pressure. The chemical content of the nerve-root lists glycoprotein as a constituent. Previously,3 we showed the carbohydrate capsule of the pneumococcus liberates histamine and other H substances from perfused organs much in the same way as venom. Direct tests of nucleus pulposus pharmacologically show the presence of 1-4 Vg. histamine per g., but no tryptamine and no slow-reacting substance or kinin. This, we believe, cannot account for the acute pain. However, extract of the glycoprotein from human nucleus pulposus releases considerable quantities of histamine (figs. 1 and 2), oedema fluid, protein, and another amine with four times the mobility of histamine (fig. 2) from the isolated perfused lung of the guineapig. This spot on the chromatogram corresponds to the amine spot we found in red wine, which we believe accounts for the severe pain in migrainous neuralgia. This substance is present in less amount than histamine, and this latter substance we have shown can 1. 2. 3. 4.
Marshall, L. L. The Lumbar Disc. Melbourne, 1971. Nayler, A. Orthop. Clin. N. Am. 1971, 2, 343. Trethewie, E. R. Aust. J. exp. Biol. 1947, 25, 291. Trethewie, E. R., Khaled, L. Br. med. J. 1972, iii, 290.
Fig. 1-Responses of the isolated guineapig jejunum suspended in Tyrode. At 1, 2, 3, 4, 5, 6, responses to 1 ml. perfusate before, 0-5, 5-15, 15-30, 30-60 min., 1-2 hr., respectively, after injection of pulposus extract (glycoprotein) into pulmonary artery of perfused guineapig lung. At H’ response to 0-1 g.; at H", 0-3 g., H"’, 0’4 (.Lg. histamine. The unlettered contractions are to 0-2 tJLg. histamine. At E, response to 10 mg. glycoprotein extract (amount in 1 ml.: sample 1). Time in min. at top right. Details in text.
Fig. 2-Chromatogram run in butanol-acetic water for 4 hours. At H 1 drop histamine 5 mg. per ml., at S 1 drop sample 3 of fig. 1 (concentrated-heat). Spot marked has four times mobility of histamine. Stained ninhydrin. account for the severe pain in pancreatitis. We consider acute pain in disc is due to local irritation of the nerveroot producing oedema and release of protein and H substances at the site of disc injury. Relief of pain by cortisone6
the
findings, since cortisone inhibits the response to H substances.7 Full details of these experiments will be published elsewhere.
accords with these
peripheral
Department of Physiology, University of Melbourne, Parkville, Victoria 3052, Australia.
LEON L. MARSHALL E. R. TRETHEWIE.
RELIEF OF PAIN BY ACUPUNCTURE
SIR,-Iwas interested in the article by Dr Mann and his colleagues (July 14, p. 57). To the problem of pain in chronic rheumatic diseases, acupuncture alone is not the It may easily cure the superficial myalgia in one answer. or two treatments, but in cases of chronic arthritis it must be associated with massage. Muscle or tissue pain is due to spasm, and this spasm is primarily due to a deficiency in the " nerve supply " or " nerve impulse " to the muscle fibrils. Stimulating the " tired impulse " at some distant point will immediately relax this spasm, so that beneficial massage can begin at once. I am glad that Dr Mann and his colleagues accept my view that the " trigger spots ", the cause of rheumatic are situated at the acupuncture points. Let me give a few examples where acupuncture needles or intradermal needles should be placed distally to get good results. (Small intestine 4), at the junction of the fifth metacarpal of hand and the ulna will immediately relax the deltoid muscle; and one at the junction of the ring and little finger will relax the cervical muscles at that side of the neck (Triple warmer 3). Needles placed 3 in. and 5 in. above the internal malleolus (kidney 5 and spleen 6) will relax spasm of the knee-joint and also spasm of the pectoral muscles. Needles placedin. in the mid-line of the popliteal crease at the back of the knee will almost at once relieve tension in the upper back muscles (bladder 54). Since 1954 the Chinese have concentrated treatment with acupuncture on anaesthesiaand the cure of deafness and on its use in animals. It seems that chronic arthritis is not a national scourge there as it is elsewhere, perhaps because the Chinese are short in stature and are not subjected to the strain of Western civilisation.
pain,
97
Harley Street, London W1.
5. 6. 7.
LOUIS MOSS.
Trethewie, E. R. Med. J. Aust. 1961, ii, 899. Mount, H. T. R. Can. med. Ass. J. 1971, 105, 1279. Trethewie, E. R. Aust. J. exp. Biol. 1958, 36, 275.