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(538) Auricular point acupressure to manage symptom clusters of pain, fatigue, and disturbed sleep in breast cancer patients
S110
The Journal of Pain
H. Treatment Approaches (Complementary and Alternative) H01 Acupuncture (536) Cortical thickness increase following acupuncture therapy is associated with symptom improvement in idiopathic hand pain Y Maeda, N Kettner, J Kim, S Cina, C Malatesta, J Gerber, C McManus, A Libby, R Ong-Sutherland, P Mezzacappa, L Morse, J Audette, and V Napadow; Athinoula A. Martinos Center for Biomedical Imaging, Radiology, Massachusetts General Hospital, Charlestown, MA While patients with carpal tunnel syndrome (CTS) report pain and paresthesia in conjunction with decreased median nerve conduction velocities, patients with idiopathic hand pain (IHP) report similar symptoms but with normal nerve conduction. While brain plasticity has been reported for CTS, the effects of acupuncture on structural plasticity in either IHP or CTS are unknown. We evaluated 19 IHP patients, 21 CTS patients, and 13 healthy controls (HC) with structural T1weighted MRI at 3T (Siemens Trio) before and after 8weeks of acupuncture. Symptoms were evaluated with the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) before, after, and 3-months following acupuncture therapy. Acupuncture included 2Hz electrical stimulation at acupoints PC7 and TW5 near the affected wrist. Gray matter thickness data were contrast between IHP and CTS at baseline, and before versus after acupuncture. Difference maps were calculated, cluster corrected for multiple comparisons at p=0.05. Cortical thickness data were also correlated with BCTSQ change. BCTSQ symptoms decreased following acupuncture, retained at 3-month follow-up in both groups (IP; baseline: 2.760.6, mean6SD, post-acup: 1.960.5, 3-months: 1.760.5, CTS; baseline: 2.860.6, post-acup: 2.160.7, 3-months: 2.260.7, p<0.01). At baseline, cortical thickness in bilateral insulae was significantly greater in IHP compared to CTS (p<0.05), and both groups showed, on average, reduced thickness compared to HC. Following acupuncture in IHP, cortical thickness was significantly increased in bilateral insulae. Furthermore, insula thickness increase was negatively correlated with post-acupuncture symptom change (r=-0.53, p=0.05). Thus, greater thickness increase was associated with greater reduction in symptom severity. These changes were not seen for CTS. Symptoms were reduced by acupuncture and sustained during 3-months follow up. Increased insula thickness postacupuncture was correlated with symptom reduction for IHP. Thus, cortical thickness may be sensitive to improvements in symptomatology, but not when such symptoms are maintained by a peripheral lesion. Funded by NCCAM, NIH.
(537) Establishing an animal model for National Acupuncture Detoxification Association (NADA) Auricular Acupuncture Protocol n Concepcio n, and Z Melyan; V Kattalai Kailasam, L Musaelian, J Moro Columbia University Medical Center, New York, NY NADA acupuncture protocol is the most common form of acupuncture treatment for substance addiction in the US and Europe. This protocol has been utilized as an adjunctive therapy for addiction treatment, behavioral health, cancer and blood disorders. The protocol uses five ear points: shenmen, sympathetic, kidney, liver, and lung. Clinical studies had shown contradicting results regarding the efficacy of NADA protocol in controlling opioid-induced withdrawal and other craving-related symptoms. The mechanism by which it serves as a successful treatment remains inconclusive, therefore establishing an animal model of NADA acupuncture treatment is important. Repeated morphine administration in rodents has been shown to produce locomotor sensitization. In addition, discontinuation of morphine treatment results in withdrawal symptoms, including increased pain sensitivity. We administered rats with 10 mg/kg of morphine subcutaneously (SC) for 4 days. Following 6 days of abstinence, rats were challenged with 5 mg/kg of morphine SC to test for locomotor sensitization. Animals then received 6 days of NADA acupuncture treatment or sham (five points inserted along the helix of the ear). Rats which received acupuncture showed 35% (n=7) decrease in locomotor sensitization after the second 5 mg/kg challenge of morphine administered on the last acupuncture day. In contrast, the rats that received sham showed no decrease. In a different experiment, increased sensitivity to mechanical stimulation induced by discontinuation of morphine (10 mg/kg SC twice daily for 5 days) was reduced by adjunctive NADA acupuncture treatment up to 55% (n=3) compared to sham. These results are consistent with the positive effects shown by clinical trials, thus validating the animal model. This model could be utilized in studying molecular mechanisms of NADA acupuncture treatment, potentially aiding the appropriate usage in alleviating side effects of long-term use of opioids in the treatment of chronic pain. Supported by NIH R01 DA027460 to JMC
Abstracts
(538) Auricular point acupressure to manage symptom clusters of pain, fatigue, and disturbed sleep in breast cancer patients Yeh, L Chien, R Glick, G van Londen, and D Bovbjerg; University of Pittsburgh, Pittsburgh, PA Breast cancer patients often suffer an array of symptoms during cancer-treatment, which tend to appear in clusters. Few interventions have been tested in relief of specific symptom clusters. This open-pilot trial, with repeated observational research design, examined the feasibility of auricular point acupressure (APA) targeted to manage a specific symptom cluster comprising pain, fatigue, and sleep disturbance. Breast cancer patients undergoing adjuvant treatment (n = 31) were recruited (recruitment rate = 78%). Each participant received a 7-day APA treatment and was contacted daily by telephone to monitor symptom severity. All participants completed the entire study assessment (i.e., 100% retention and adherence rates). After 7 days of APA treatment, pain, fatigue, sleep, and other symptoms (including lack of appetite, distress, dry mouth, sadness, and numbness decreased by a clinically significant amount [symptom severity decrease $ 30%]). Three symptom clusters were identified at baseline (i.e., pain and fatigue; sleep, distress, and sadness; dry mouth and numbness) at baseline and after 7-day APA treatment. Symptoms within each cluster had similar patterns of decrease during the APA treatment. Analgesic use was associated with pain, fatigue, sleep distress, and sadness. Our results suggest that APA may provide an inexpensive and effective complementary approach for the management of specific symptom clusters for breast cancer patients receiving disease-modifying treatment, and further study is warranted.
(539) SP6 manual acupuncture reduces mechanical hyperalgesia in neurophatic pain M Duarte Da Silva, G Guginski, L Sanada, K Sluka, F Cidral, A Santos, and K Sato; UNIPAMPA, Uruguaiana, Rio Grande do Sul, Brazil Acupuncture is a procedure in which fine needles are insert into body points with the intent of relieving pain and other symptoms. Here we investigated the effects of manual acupuncture (MA) in SP6 acupoint on neuropathic pain. Experiments were conducted using adult male Swiss mice (25-35 g). To evaluate the effects of SP6 MA upon neuropathic pain we performed a partial nerve ligation. Surgical procedures were perform under anesthesia, by tying the distal third of the sciatic nerve. In sham operated mice, the nerve was exposed, but not ligated. Mechanical hyperalgesia was measured and calculated as the force (in grams) which elicited a 50% paw withdrawal threshold in response to application of different von Frey filaments. This injury produced a marked development of hyperalgesia on the ipsilateral side 7 days after the surgical procedure. The operated mice were treated with SP6 MA or a no acupoint (NA) in the 7 days after surgery. Animals treated five times with acupuncture had their brains removed after transcardial perfusion with 4% paraformaldehyde. The brain was cut intersection 20mm and immunohistochemically stained using standard procedures for the microglia and astrocyte marker, IBa1 and GFAP on primary / secondary motor cortex (M1/M2) and primary / secondary somatosensory cortex (S1/S2), cingulate, insula and prefrontal cortex. The animals were treated with acupuncture on alternate days, on days when the animals were treated with SP6 MA, hyperalgesia was significantly reduced. On the tenth day we evaluated the time course of fifth SP6 MA treatment and its effect remained for 6 hour after treatment, increase expression of microglia marker was observed in the prefrontal and S2 area on SP6 MA treatment.
The Journal of Pain
H. Treatment Approaches (Complementary and Alternative) H01 Acupuncture (536) Cortical thickness increase following acupuncture therapy is associated with symptom improvement in idiopathic hand pain Y Maeda, N Kettner, J Kim, S Cina, C Malatesta, J Gerber, C McManus, A Libby, R Ong-Sutherland, P Mezzacappa, L Morse, J Audette, and V Napadow; Athinoula A. Martinos Center for Biomedical Imaging, Radiology, Massachusetts General Hospital, Charlestown, MA While patients with carpal tunnel syndrome (CTS) report pain and paresthesia in conjunction with decreased median nerve conduction velocities, patients with idiopathic hand pain (IHP) report similar symptoms but with normal nerve conduction. While brain plasticity has been reported for CTS, the effects of acupuncture on structural plasticity in either IHP or CTS are unknown. We evaluated 19 IHP patients, 21 CTS patients, and 13 healthy controls (HC) with structural T1weighted MRI at 3T (Siemens Trio) before and after 8weeks of acupuncture. Symptoms were evaluated with the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) before, after, and 3-months following acupuncture therapy. Acupuncture included 2Hz electrical stimulation at acupoints PC7 and TW5 near the affected wrist. Gray matter thickness data were contrast between IHP and CTS at baseline, and before versus after acupuncture. Difference maps were calculated, cluster corrected for multiple comparisons at p=0.05. Cortical thickness data were also correlated with BCTSQ change. BCTSQ symptoms decreased following acupuncture, retained at 3-month follow-up in both groups (IP; baseline: 2.760.6, mean6SD, post-acup: 1.960.5, 3-months: 1.760.5, CTS; baseline: 2.860.6, post-acup: 2.160.7, 3-months: 2.260.7, p<0.01). At baseline, cortical thickness in bilateral insulae was significantly greater in IHP compared to CTS (p<0.05), and both groups showed, on average, reduced thickness compared to HC. Following acupuncture in IHP, cortical thickness was significantly increased in bilateral insulae. Furthermore, insula thickness increase was negatively correlated with post-acupuncture symptom change (r=-0.53, p=0.05). Thus, greater thickness increase was associated with greater reduction in symptom severity. These changes were not seen for CTS. Symptoms were reduced by acupuncture and sustained during 3-months follow up. Increased insula thickness postacupuncture was correlated with symptom reduction for IHP. Thus, cortical thickness may be sensitive to improvements in symptomatology, but not when such symptoms are maintained by a peripheral lesion. Funded by NCCAM, NIH.
(537) Establishing an animal model for National Acupuncture Detoxification Association (NADA) Auricular Acupuncture Protocol n Concepcio n, and Z Melyan; V Kattalai Kailasam, L Musaelian, J Moro Columbia University Medical Center, New York, NY NADA acupuncture protocol is the most common form of acupuncture treatment for substance addiction in the US and Europe. This protocol has been utilized as an adjunctive therapy for addiction treatment, behavioral health, cancer and blood disorders. The protocol uses five ear points: shenmen, sympathetic, kidney, liver, and lung. Clinical studies had shown contradicting results regarding the efficacy of NADA protocol in controlling opioid-induced withdrawal and other craving-related symptoms. The mechanism by which it serves as a successful treatment remains inconclusive, therefore establishing an animal model of NADA acupuncture treatment is important. Repeated morphine administration in rodents has been shown to produce locomotor sensitization. In addition, discontinuation of morphine treatment results in withdrawal symptoms, including increased pain sensitivity. We administered rats with 10 mg/kg of morphine subcutaneously (SC) for 4 days. Following 6 days of abstinence, rats were challenged with 5 mg/kg of morphine SC to test for locomotor sensitization. Animals then received 6 days of NADA acupuncture treatment or sham (five points inserted along the helix of the ear). Rats which received acupuncture showed 35% (n=7) decrease in locomotor sensitization after the second 5 mg/kg challenge of morphine administered on the last acupuncture day. In contrast, the rats that received sham showed no decrease. In a different experiment, increased sensitivity to mechanical stimulation induced by discontinuation of morphine (10 mg/kg SC twice daily for 5 days) was reduced by adjunctive NADA acupuncture treatment up to 55% (n=3) compared to sham. These results are consistent with the positive effects shown by clinical trials, thus validating the animal model. This model could be utilized in studying molecular mechanisms of NADA acupuncture treatment, potentially aiding the appropriate usage in alleviating side effects of long-term use of opioids in the treatment of chronic pain. Supported by NIH R01 DA027460 to JMC
Abstracts
(538) Auricular point acupressure to manage symptom clusters of pain, fatigue, and disturbed sleep in breast cancer patients Yeh, L Chien, R Glick, G van Londen, and D Bovbjerg; University of Pittsburgh, Pittsburgh, PA Breast cancer patients often suffer an array of symptoms during cancer-treatment, which tend to appear in clusters. Few interventions have been tested in relief of specific symptom clusters. This open-pilot trial, with repeated observational research design, examined the feasibility of auricular point acupressure (APA) targeted to manage a specific symptom cluster comprising pain, fatigue, and sleep disturbance. Breast cancer patients undergoing adjuvant treatment (n = 31) were recruited (recruitment rate = 78%). Each participant received a 7-day APA treatment and was contacted daily by telephone to monitor symptom severity. All participants completed the entire study assessment (i.e., 100% retention and adherence rates). After 7 days of APA treatment, pain, fatigue, sleep, and other symptoms (including lack of appetite, distress, dry mouth, sadness, and numbness decreased by a clinically significant amount [symptom severity decrease $ 30%]). Three symptom clusters were identified at baseline (i.e., pain and fatigue; sleep, distress, and sadness; dry mouth and numbness) at baseline and after 7-day APA treatment. Symptoms within each cluster had similar patterns of decrease during the APA treatment. Analgesic use was associated with pain, fatigue, sleep distress, and sadness. Our results suggest that APA may provide an inexpensive and effective complementary approach for the management of specific symptom clusters for breast cancer patients receiving disease-modifying treatment, and further study is warranted.
(539) SP6 manual acupuncture reduces mechanical hyperalgesia in neurophatic pain M Duarte Da Silva, G Guginski, L Sanada, K Sluka, F Cidral, A Santos, and K Sato; UNIPAMPA, Uruguaiana, Rio Grande do Sul, Brazil Acupuncture is a procedure in which fine needles are insert into body points with the intent of relieving pain and other symptoms. Here we investigated the effects of manual acupuncture (MA) in SP6 acupoint on neuropathic pain. Experiments were conducted using adult male Swiss mice (25-35 g). To evaluate the effects of SP6 MA upon neuropathic pain we performed a partial nerve ligation. Surgical procedures were perform under anesthesia, by tying the distal third of the sciatic nerve. In sham operated mice, the nerve was exposed, but not ligated. Mechanical hyperalgesia was measured and calculated as the force (in grams) which elicited a 50% paw withdrawal threshold in response to application of different von Frey filaments. This injury produced a marked development of hyperalgesia on the ipsilateral side 7 days after the surgical procedure. The operated mice were treated with SP6 MA or a no acupoint (NA) in the 7 days after surgery. Animals treated five times with acupuncture had their brains removed after transcardial perfusion with 4% paraformaldehyde. The brain was cut intersection 20mm and immunohistochemically stained using standard procedures for the microglia and astrocyte marker, IBa1 and GFAP on primary / secondary motor cortex (M1/M2) and primary / secondary somatosensory cortex (S1/S2), cingulate, insula and prefrontal cortex. The animals were treated with acupuncture on alternate days, on days when the animals were treated with SP6 MA, hyperalgesia was significantly reduced. On the tenth day we evaluated the time course of fifth SP6 MA treatment and its effect remained for 6 hour after treatment, increase expression of microglia marker was observed in the prefrontal and S2 area on SP6 MA treatment.