[Objective] We report a patient with restless legs syndrome (RLS) associated with chronic cold sensation in her lower legs. Both symptoms were successfully treated with acupuncture and moxibustion.[Patient] The patient was a 42-year-old female whose chief complaint was unpleasant abnormal sensation on the back of her lower legs that appeared when attempting to sleep. She had previously experienced the same sensation while she was pregnant, but it disappeared after childbirth. The unpleasant sensation appeared again in July, X year with no precipitating cause. The symptoms progressively worsened each day, eventually resulting in sleep disturbance. She was diagnosed as RLS in the department of neurology, but she did not want pharmacotherapy so she decided to start a treatment of acupuncture and moxibustion. She underwent the treatment once a week, with acupuncture in the triceps surae muscle of both lower legs, and an electronic moxibustion at acupoints BL57 and SP6 bilaterally. The International Restless Legs Syndrome Severity Rating Scale (IRLS) and the Numerical Rating Scale (NRS) were used for evaluation. [Result] The IRLS score gradually decreased from 26 to 2 by the 7th treatment. The NRS score also decreased from 8 to 0. The patient's chronic cold sensation also improved with reduction in RLS symptoms.[Discussion] Recently a dysfunction of the dorsoposterior hypothalamic dopaminergic A11 cell group has been implicated in the pathology of RLS. The dysfunction in this system induces an excessive sympathetic activity, which may cause microangiopathies resulting in the cold sensation. [Conclusion] RLS and cold sensation are shared pathologies relating to the dopaminergic and the autonomic nervous system, and our report suggests that acupuncture and moxibustion treatment may have acted upon these systems to improve symptoms.

[Objective] We report a case in which we unexpectedly encountered a patient with a transient ischemic attack (TIA) caused by severe stenosis of the left middle cerebral artery (MCA) during the course of acupuncture treatment.Patient: A 79-year-old man suffered from bilateral shoulder pain. He was diagnosed with a frozen shoulder at the orthopedic department and was referred to the acupuncture department.[Results] During the course of acupuncture treatment, the subject occasionally exhibited subtle behavioral features, such as difficulty in speech, holding incoherent conversations, and forgetting where he put things. The symptoms were observed repeatedly during treatment, so the acupuncturist referred the patient to the neurosurgical department for a consultation. Magnetic resonance imaging (MRI) of the brain showed an old cerebral infarction in the watershed area in the left paraventricular region, and MR angiography (MRA) revealed left middle cerebral artery stenosis. Single photon emission computed tomography showed decreased blood flow in the left MCA area. The symptoms could be considered TIA with motor and sensory aphasia. The administration of aspirin was started, and the symptoms disappeared.[Discussion and Conclusion] The acupuncturist has more opportunities to obtain information about the patient due to the longer time spent in acupuncture therapy compared to general outpatient treatment. Acupuncture can play an important role in medical partnership. It is also important that the acupuncturist has sufficient medical knowledge.

  Objective: Various psychosocial factors were exploratively investigated in order to specify items that influence on immediate effect of acupuncture among patients with chronic low back pain.  Method: Fifty-six outpatients with initial diagnosis of chronic low back pain, visiting the Acupuncture Department of Center for Integrative Medicine, Tsukuba University of Technology between August to December 2019 were included in the study. The baseline lumbar pain intensity of the patients evaluated using the Visual Analogue Scale (VAS) was >30 mm. Psychological scales viz., Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Pain Self-Efficacy Questionnaire (PSEQ), social factors (cohabitation family situation, final education, social participation status), lumbar dysfunction, and impression on acupuncture were recorded using a self-administered questionnaire during the first visit. Patients showing decreased VAS scale (≦30 mm) after the first acupuncture treatment as well as self-recognition of improvement in pain were classified as “high responders” while the others were treated as “low responders”. Physical and psychosocial factors were exploratively compared between high and low responders and logistic regression analysis of the two groups was performed using a dichotomous dependent variable.   Results and Discussion: The number of high and low responders were 22 and 34, respectively. On comparing these groups exploratively, positive (P＝0.001) and negative (P＝0.004) impression on acupuncture were the only items that showed statistical significance. Among items used as covariates in the logistic regression analysis, the PCS (OR: 0.886 (95% CI: 0.808 to 0.971); P＝0.010), positive impression on acupuncture (OR: 5.085 (95% CI: 1.724 to 15.002); P＝0.003), and number of people living together (OR: 0.355 (95% CI: 0.149 to 0.844); P＝0.019) showed statistical significance. Hence, it may be suggested that psychosocial factors influence the immediate effect of acupuncture among patients with chronic low back pain.

[Objective] To report reduction in frequency of headaches and use of medication and improvements in quality of daily life via C2 peripheral nerve field stimulation using electroacupuncture (EA-C2-PNfS) in a patient with migraines triggered by weather changes. [Case] A woman in her 60s complaining of headache.[Clinical History] Her headaches began to worsen in X-41 years. The OTC drug became ineffective from around X-15 years, and subject was diagnosed with migraine and overuse of headache medication by a neurosurgeon. Her headache was alleviated by the appropriate medications. She began a new job from August, X-1 year and headaches and over-medication increased in frequency. The acupuncture treatment was started in May, X year. The frequency of headaches was 8 times mo (month).[Subjective Symptoms] Throbbing pain occurred mainly in the frontal and occipital regions, often accompanied by nausea, vomiting, and optic/auditory hyperesthesia. The main trigger was weather changes.[Family History] Father, maternal grandmother and brothers have a history of headaches.[Diagnosis] Migraine.[Evaluation] Headache Diary (frequency of headache and medication), Headache Impact Test (HIT-6) (Quality of daily life).[Treatment] EA-C2-PNfS was performed once a week. Interval of the treatment was adjusted depending on the patient's condition. [Results] Though weather- related transient aggravations were occasionally observed, the frequencies of the headache and use of medication gradually decreased; The frequency of the headache was 8 times/mo at the start of the treatment, 6 times/mo after 12 weeks, 8 times/mo after 24 weeks, 3 times/mo after 36 weeks, once a mo after 48 weeks, 4 times mo after 54 weeks. The frequency of medication was 8 times/mo at the start of the treatment, 2 times/mo after 12 weeks, 6 times/mo after 24 weeks, 3 times mo after 36 weeks, once a mo after 48 weeks, 4 times/mo after 54 weeks. The score of HIT-6 also improved from 68 to 57. The treatment was concluded with patient satisfaction.[Discussion] In this case, migraine triggered by weather changes was remarkably alleviated. Recently an activation of the spinal trigeminal nucleus was implicated in the pathology of weather-associated headaches. EA-C2-PNfS may inhibit the abnormal activity of spinal trigeminal nucleus.

[Objective] In the past, we reported results focusing on the immediate effect of psychosocial factors that influence the effects of acupuncture on patients with chronic low back pain. In the present study, we conducted a retrospective analysis of the data before and after four weeks of acupuncture therapy.[Materials and Methods] Fifty-three patients with an initial diagnosis of chronic low back pain who visited the Acupuncture Department of the Center for Integrative Medicine, Tsukuba University of Technology between August and December 2019 and showed baseline lumbar pain intensity by Visual Analogue Scale (VAS) > 30 mm, were subjects of this study. Psychosocial scales viz, Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Pain Self-Efficacy Questionnaire (PSEQ), social factors (cohabitation family situation, final education, social participation status), Roland-Morris Disability Questionnaire (RDQ), and impression of acupuncture were recorded using a self-administered questionnaire at the first visit and at four weeks after the first acupuncture therapy. Based on VAS, RDQ, and anchor questions about low back pain before and four weeks after the acupuncture therapy, patients were classified into "effective group" and "non-effective group"; then, the logistic regression analysis was performed using this classification as a dependent variable. In addition, r repeated measures analysis of variance (rANOVA) was performed on the data before and after four weeks of acupuncture therapy.[Results and Discussion] The number of patients in the "effective group" and "non-effective group" were 24 and 29, respectively. Among items used as covariates in the logistic regression analysis, the PCS (OR: 0.924, P = 0.037) and age (OR: 0.418, P = 0.005) showed statistical significance. In the rANOVA, all the evaluated items showed statistically significant differences before and after four weeks; only VAS in motion showed a statistically significant difference (P = 0.046) regarding the presence or absence of an immediate effect. Therefore, it was suggested that it is important to focus on psychosocial factors from an early stage of therapy, and to make appropriate evaluations and judgments based on both physical and psychosocial aspects of patients to treat them effectively.

[Introduction] We report a case of patient with migraine that improved after acupuncture and additional treatment for comorbidities of dry eye.[Case presentation] Subject was a 59-year-old female patient who was 156 cm tall and 49 kg in weight (BMI: 20.1). Her blood pressure was 122/69 mmHg, and her pulse was 70 beats per minute. She had suffered from headaches for about ten years and had been previously diagnosed with migraine. Due to the worsening of the headaches, she began acupuncture treatments. Since the onset of the headaches, she was also diagnosed with dry eye.[Treatment] At the initial visit, the subject's Headache Impact Test (HIT-6) score was 65. Manual acupuncture in her back and neck area and C2 peripheral nerve field stimulation with electroacupuncture were performed for migraine. At week four of treatment, the HIT-6 score was 60 and the headaches appeared 14 times a month, which improved to 48 and 7, respectively, at week 12. However, her headaches worsened after treatment interruption. At week 40, the HIT-6 score and headache frequency worsened and increased to 60 and 13, respectively. Acupuncture treatment for migraine was resumed, and treatment for comorbidities of dry eye, that included manual acupuncture around the orbits and self-care, was also performed. Subsequently, her headaches ameliorated significantly. At week 56, the HIT-6 score was 48 and the headaches appeared only five times a month. Migraine relief persisted and the symptoms of dry eye also improved.[Discussion and Conclusion] The additional dry eye treatment had a positive effect in improving the symptoms of migraine. It has been speculated that the pathogenesis of both diseases is related to central sensitization of the optical and trigeminal nervous systems. If so, the improvement of dry eye symptoms may have had an effect on migraine relief as well.