[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.

Four fibromyalgia syndrome (FMS) patients with complaints of widespread pain, fatigue and difficulty sleeping received acupuncture therapy. The effects of acupuncture treatment were evaluated using a visual analogue scale (VAS), and a pain disability assessment scale (PDAS). After whole body acupuncture treatments, VAS and PDAS values were almost unchanged. However, VAS and PDAS values improved following a 3-treatment course of FMS-specific acupuncture treatments (electroacupuncture at the characteristic tender points of FMS). These results suggest that FMS-specific acupuncture treatment of fibromyalgia patients may relieve their commonly reported symptoms of pain, and fatigue.

The nature of an experimental trigger point model produced by eccentric exercise was examined in seven healthy volunteers who gave their informed consent. Adjustable loads were set around the third finger and the subjects were asked to keep the position as long as possible. The loadings (about 10s) were continued until his all-out effort and were carried out 3 times interspersed with 5 min rest periods. Pressure pain thresholds (PPT) and deep pain thresholds (DPT) before exercise, and on the 2nd and 7th day after the exercise, were measured in the skin, fascia and muscles. On the 2nd day after the exercise, the PPT of the restricted area of the taut band was the minimum. A similar reduction of the DPT was observed only in the fascia of the restricted area. These results suggest that the present experimental model is useful for the further investigation of trigger points.

Electrical activities detected from the experimentally-induced trigger points in human subjects.
Objectives : To examine the pathogenic mechanisms of the trigger points, electrical activities were recorded from the experimentally-induced trigger points.
Methods : Nine healthy volunteers who gave informed consent were used. The adjustable loads were set around the third finger and repetitive eccentric contraction was loaded on the extensor digital muscles. The subjects were asked to keep the position as long as possible. The loadings (about 10s) were continued until his all-out effort and were repeated 3 times with 5 min resting periods. The electrical activities in the skin, fascia and muscle of the trigger point and non-tender region of palpable band and 10mm outside the band were recorded on the second day after the eccentric exercise.
Results : Repetitive eccentric exercise produced a trigger point within the palpable band, which developed on the second day after the exercise. Electrical activities were detected only when the electrode tip was located in or near the fascia of the trigger point and there were subjective dull pain sensations. When the radial nerve was blocked by lidocaine, the needle EMG activity could not be recorded.
Conclusions : These results suggest that the EMG activities are the result of nociceptive reflex, and the sensitized nociceptors in the fascia of the palpable band might be a substrate for the trigger point.

[Purpose] The characteristic of electrical activities recorded at the clinical trigger point was examined.
[Materials] A 26-year-old woman complained of chronic shoulder pain. She had a trigger point near GB 21 (Jianjing, Kensei). The electrical activities were recorded at the trigger point and a non- tender point.
[Results] Electrical activities were detected only when the electrode was located on the trigger point andthere was a subjective dull pain sensation. The amplitudes of electrical activities did not change during psychological stress. [ Conclusion ] These results suggest that the electrical activities were the result of nociceptive reflex.

[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.

The effects of acupuncture and moxibustion on lower back pain in clinical trials were reviewed. First, the effects of Western medicine on lower back pain, patients with specific and nonspecific lower back pain, were systematically reviewed based on online data, and possible mechanisms were discussed. Secondly, the role and potential of acupuncture and moxibustion on lower back pain were considered based on a review of research literature. Finally, the effectiveness of acupuncture and moxibustion on several kinds of lower back pain was systematically examined based on online data. These results suggest that acupuncture and moxibustion may be more effective on non-specific lower back pain.

In recent years, due to the rapid changing social structure, thedemands for medical services are also changing. There is a need to explore the future direction of acupuncture and moxibustion. Therefore, using the keyword "patient"as the focus of medicalservices, we discussed the question, "What is meant by 'patient-centered'Acupuncture and Moxibustion?"
Our results indicate that the numerous clinical treatments, education, and research that occurred throughout the long history of acupuncture and moxibustion in Japan were in fact all done "for the patient."However, we note that there is still room for improvement in verification method and cooperation between each field, and we confirmed that there is a need to build Acupuncture and Moxibustion methods that truly represent "patient-centered medicine."