[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.

Effect of thermal stimulation on the flexion reflex as a pain index was examined in healthy human subjects who gave informed consent (n=9, male, mean age 26 ± 8 years old). The evoked electromyogram (EMG) of biceps femoral muscle elicited by transcutaneous electrical stimulation of the sural nerve (5 trains of pulses at 100 Hz delivered at intervals of 13 sec) was successively recorded. The subjective pain sensation elicited by nerve stimulation was simultaneously recorded by the visual analogue scale (VAS) method. Significant correlation coefficients between the amplitudes of evoked EMGs and the stimulus intensity (r=0.791, P< 0.01), and the VAS value (r=0.724, P < 0.01) were observed. Conditioning hot water immersion of the hand (47 °C, 156s) tended to reduce the amplitudes of evoked EMGs, although change was not significant (P=0.678, Kruskal-Wallis test). However, C-statistics, a simple time series analysis method, demonstrated significant trends in several trials. These results suggest that the flexion reflex used in the present study is useful for pain research in human subjects and C-statistics are also useful for analyzing the effect on each individual.

Different intensities of pressure were applied to various tender or non-tender points and the suppressive effects on the flexion reflex were examined in 21 healthy humans (18-26 years), who gave informed consent. The sural nerve was stimulated transcutaneously with trains of 5 pulses at intervals of 13 sec (1.05-1.10x T, T : threshold) and evoked EMGs were recorded from the biceps femoralis muscle. Tender points in the contralateral forearm were detected by careful palpation, and conditioning pressure stimulation was applied at variousintensities by a push-pull gauge for 78 sec. Pressure applied to tender points induced slightly greater suppression of evoked EMGs than that to non-tender points (C statistics : time series analysis), although the difference was not significant (group comparison). Pressure intensities of ten and 50 % of pain tolerance pressure seemed to be adequate for suppression of EMGs in both tender and non-tender points. These results suggest that suppression of flexion reflex by pressure application in humans may be mediated by tactile and pain-related afferent fibers and the importance of adequate stimulus intensity for the induction of analgesic effects.