[Objective] To compare the efficacies of four types of acupuncture modalities on pain magnitude and disability due to chronic low back pain (LBP) in sciatica patients.
[Design] Single blind randomized controlled trial, 4 parallel arms.
[Setting] Outpatients of the Meiji University of Oriental Medicine Hospital.
[Subjects] Forty-four elderly patients (29 woman, 15 man; age range : 65-81 years) with LBP due to sciatica persisting for at least 6 months.
[Interventions] Subjects were randomly allocated to one of four groups. The standard acupuncture group (SA, n=9) received acupuncture on traditional acupoints used for treatment of LBP. Superficial trigger point acupuncture group (S-TrP, n=9) and deep trigger point acupuncture group (D-TrP, n=10) received superficial (S-TrP) or deep (D-TrP) needling of the trigger points. Sham acupuncture group (SM, n=9) was treated by mimicked needling without insertion of the needle in the trigger point. Acupuncture sessions were performed once a week for 3 weeks.
[Main Outcome Measures] Pain intensity (visual analogue scale : VAS) and QOL (Roland-Morris Disability Questionnaire : RDQ).
[Results] At the end of the treatment period, significant improvement was observed on pain intensity and QOL in the D-TrP group alone (p<0.01). Furthermore, the effects persisted during the 3-week follow-up (p<0.05) [Conclusion] These results suggest that trigger point acupuncture with deep needling provides effective treatment for low back pain in aged patients.

[Objective]To compare the efficacies of three types of acupuncture modalities on the pain magnitude and disability of chronic low back pain (LBP).
[Design]Single blind randomized controlled trial, three parallel arms.
[Setting]Outpatients of the Meiji University of Integrative Medicine Hospital.
[Subjects]Thirty-nine elderly patients (24 females, 15 males;age 71.2 ± 7.7) who suffered from LBP for at least six months.
[Interventions]Subjects were randomly allocated to one of three groups. Tender point group (TeP, n = 13) received to the tender point. Trigger point acupuncture group (TrP, n = 13) received to the trigger points. Sham acupuncture group (SM, n = 13) mimicked needling without insertion of the needle in the trigger point. Acupuncture sessions were performed once a week for five weeks.
[Main Outcome Measures]Pain intensity (visual analogue scale:VAS) and QOL (Roland-Morris Disability Questionnaire:RDQ).
[Results]At the end of the treatment period, significant improvement was observed on pain intensity and QOL in the TrP group alone (p < 0.01). However, there were significant differences in pain at the three month follow-up.
[Conclusion]These results suggest that trigger point acupuncture has a long-term effect on treatment for low back pain in aged patients.

[Objective] Although there is some evidence for the efficacy of trigger point acupuncture and tender point acupuncture treatments for chronic low back pain, differences between the therapeutic effect of trigger point needling and that of tender point needling remain unclear. We compared the therapeutic effects of trigger point acupuncture and tender point acupuncture treatment for chronic low pack pain in elderly patients.
[Design] Single-blind clinical controlled trial, quasi-randomized, 2 parallel arms.
[Methods] Nine patients, aged 65 or over, with chronic low back pain for at least 6 months were alternately allocated to the trigger point needling group (n=4) or tender point needling group (n=5). Patients received treatments once a week for five weeks. Outcome measures were pain intensity (Visual Analog Scale : VAS) and pain disability (Roland-Morris Disability Questionnaire : RDQ).
[Results] After the treatment period, VAS and RDQ values had improved significantly in the trigger point group, but there were no significant improvements in the tender point group.
[Conclusion] Differences in improvement between the trigger point and tender point groups seem to suggest that the trigger point needling was different from tender meridian point needling in respect to the therapeutic effect. Further studies are necessary to fully assess the efficacy of this treatment for chronic low back pain using a blinded or placebo control group.

[Objective] The purpose of this study was to compare the effectiveness of acupuncture and local injection for neck pain.
[Methods] A randomized controlled clinical trial was conducted in which 33 patients with neck pain were randomly allocated to either an acupuncture group or a local injection group. For the acupuncture group (n=16), a stainless steel needle was inserted to a depth of 10 to 20 mm and manually stimulated (sparrow pecking method) for 20 seconds. A 25 gauge needle was inserted to a depth of 10 to 20 mm and neovitacain (dibucaine hydrochloride 0.1%, sodium salicylate 0.3%, calcium bromide 0.2%) and neurotropin (non protein component extracted from the skin of rabbits treated with vaccinia virus) were injected for the local injection groups (n=17). Both groups received each treatment at the most painful points weekly for four weeks. Primary outcome measurement was intensity of the pain evaluated with a visual analogue scale (VAS). Secondary outcomes were the Neck Disability Index (NDI) and a standardized questionnaire of cervical root disease (developed by Tanaka et al. at Tohoku Univ.). The evaluations were independent from the therapists.
[Results] The acupuncture groups showed better results in all the outcome measurements than those in the local injection group for the effect immediately after the treatment, the effect of sequential treatment and the continuing effect after completion of treatment.
[Discussion] The result of this study suggested that acupuncture can be a useful treatment method compared with local injection. The difference in the effects between the two treatment methods may be due to the difference in the mechanism to suppress pain.

Epicodylitis humeri lateralis is common in indivisuals whose occupations require frequent rotatory motion of the forearm. An ache appears over the outer aspect of the elbow and is reffered into the forearm. The patients with epicodylitis humeri lateralis were often treated by acupuncture therapy. We treated the patients by means of acupuncture therapy with silver spike point therapy and streching of the extensors of the forearm, in Meiji College of Oriental Medicine Hospital. In order to clarify the effect of our therapy, we valuated clinical results by using pain scale score. We treated 13 patients (male 4, female 9, mean age 49.2 years). In our therpy, acupuncture points and SSP points, which were on the area from the lateral epicondyle to the extensors of the forearm, were used. And we made the patients to do streching of extensors of the forearm. The pain scale scale score improved from 10 points to 3.8 points after the treatments, 15% were excellent, 77% were good, and 8% fair. The results suggested that our therapy improves the symptoms of epicodylitis humeri lateralis.

Case Report : Acupuncture therapy for a fibromyalgia-like syndrome (FMS-like) patient. A 44-year-old woman complained of widespread pain, fatigue and poor quality sleep. Effects of acupuncture treatment were evaluated using a visual analogue scale (VAS), pain disability assessment scale (PDAS) and pressure pain thresholds (PPT) at tender sites of FMS. After 13 whole body acupuncture treatments PPT, VAS and PDAS were almost unchanged. However, three FMS-specific acupuncture treatments (eletroacupuncture at characteristic tender sites of FMS) increased PPT and improved VAS and PDAS. These results suggest that FMS-specific acu-puncture treatment may relieve widespread pain and fatigue symptoms in FMS-like patients.

[Objective] We analyzed the clinical findings in 5 patients with osteonecrosis in the medial condyle of the tibia. We also evaluated the usefulness of a tibial percussion test that we developed for examination of differences between the healthy and affected sides in percussion caused by knocking on the tibial rough surface.
[Methods] The subjects were 5 females, who consulted our hospital with a chief complaint of gonalgia and in whom conditions such as osteonecrosis in the medial condyle of the tibia were confirmed by MRI in 4 limbs. In addition to X-p, MRI findings, medical findings by interview, and findings by physical examination were evaluated as clinical findings. Furthermore, the tibial percussion test was performed.
[Results] The causes of pain in the knee joint were unclear in all patients. Pain was severe in 3 patients and marked in 2 patients. Physical examination showed marked tenderness in the medial articular gap and tenderness in the medial condyle of the tibia. In all patients, a difference in the percussion findings between the healthy and affected sides was confirmed by the tibial percussion test.
[Conclusions] These findings indicated that the tibia percussion test in addition to confirmation of characteristic clinical conditions, such as the initial condition of the disease and the severity of tenderness, is useful for the evaluation of conditions of this disease.

The effects of electrical acupuncture at the patellar tendon and electrical stimulation of the femoral nerve on patellar tendon blood flow were evaluated using laser Doppler flowmetry in anesthetized rats. In most subjects the blood flow in the patellar tendon rapidly decreased for 30 seconds after the start of local electrical acupuncture and then increased above baseline. Changes in blood flow did not necessarily follow changes in arterial blood pressure. Changes in tendon blood flow induced by electrical stimulation of the femoral nerve were similar to those induced by electrical acupuncture at the patellar tendon. Arterial blood pressure and heart rate were not affected by electrical stimulation of the femoral nerve. Phentolamine administration abolished the decreased patellar tendon blood flow seen after initiating electrical acupuncture at the patellar tendon, whereas atropine abolished the increased patellar tendon blood flow seen after terminating electrical acupuncture at the patellar tendon. Furthermore, atropine did not evoke increased blood flow following electrical stimulation of the femoral nerve. These results suggest that the decrease of blood flow seen after initiating electrical acupuncture may be controlled by sympathetic vasoconstrictor nerves and the increase of blood flow following electrical acupuncture may be controlled by cholinergic vasodilator nerves.