Exercise-induced analgesia (EIA) refers to the elevation of pain thresholds and reduction in sensitivity to noxious stimuli achieved through exercise training. As a non-pharmacological treatment strategy, exercise therapy has demonstrated positive effects on both acute and chronic pain. Increasing evidence indicates that modulation of glial cell activity is an important mechanism underlying analgesia. Spinal glial cells contribute to the development and maintenance of pathological pain by promoting pain signal transmission through inflammatory responses and synaptic remodeling. Exercise can differentially regulate microglia and astrocyte activity, inhibiting multiple inflammatory signaling pathways, such as P2X4/P2X7 purinergic receptors, brain-derived neurotrophic factor (BDNF)/phosphatidylinositol 3-kinase (PI3K)/mammalian target of rapamycin (mTOR), interleukin (IL)-6/Janus kinase (JAK) 2/signal transducer and activator of transcription 3 (STAT3), p38-mitogen-activated protein kinases (MAPK), and Toll-like receptor 4 (TLR4)/nuclear factor-kappa B (NF-κB), thereby reducing the release of pro-inflammatory cytokines, decreasing inflammatory and nociceptive hypersensitivity, and alleviating pathological pain. This review also summarized the effects of different exercise intensities, durations, and frequencies on glial cell responses in order to provide a theoretical foundation for optimizing exercise-based interventions for pathological pain conditions.
Humans ; Microglia/metabolism* ; Astrocytes/metabolism* ; Exercise/physiology* ; Signal Transduction ; Analgesia/methods* ; Spinal Cord/cytology* ; Exercise Therapy ; Pain Management/methods* ; Animals ; Brain-Derived Neurotrophic Factor/metabolism*

OBJECTIVE: The analgesic effect of acupuncture has been widely accepted. Nevertheless, the mechanism behind its analgesic effect remains elusive, thus impeding the progress of research geared toward enhancing the analgesic effect of acupuncture. This paper investigated the role of acupuncture needle surface textures on acupuncture's analgesic effect by creating four experimental acupuncture needles with different patterns of surface augmentation. METHODS: Four types of acupuncture needles with different surface textures (the lined needle, circle needle, sandpaper needle, and threaded needle) were designed. Additionally, the force/torque measurement system used a robot arm and mechanical sensor to measure the force on the needle during insertion and manipulation. To perform acupuncture analgesia experiments, four experimental acupuncture needles and a normal needle were inserted into the Zusanli (ST36) acupoint of rats with inflammatory pain. By comparing the force and torque and the analgesic efficacy of the different acupuncture needles, these experiments tested the role of acupuncture needle body texture on acupuncture analgesia. RESULTS: The analgesic effects of different acupuncture needle body textures varied. Specifically, the force required to penetrate the skin with the lined needle was not greater than that for the normal needle; however, the needle with inscribed circles and the sandpaper-roughened needle both required greater force for insertion. Additionally, the torque of the lined needle reached 2 × 10^-4 N·m under twisting manipulation, which was four times greater the torque of a normal needle (5 × 10^-5 N·m). Furthermore, the lined needle improved pain threshold and mast cell degranulation rate compared to the normal needle. CONCLUSION Optimizing the texture of acupuncture needles can enhance acupuncture analgesia. The texture of our experimental acupuncture needles had a significant impact on the force needed to penetrate the skin and the torque needed to manipulate the needle; it was also linked to variable analgesic effects. This study provides a theoretical basis for enhancing the analgesic efficacy of acupuncture through the modification of needles and promoting the development of acupuncture therapy. Please cite this article as: Sun MZ, Wang X, Li YC, Liu YH, Yu Y, Ren LJ, Gu W, Yao W. Effects of acupuncture needle modification on acupuncture analgesia. J Integr Med. 2025; 23(1): 66-78.
Needles ; Acupuncture Analgesia/methods* ; Animals ; Rats ; Male ; Acupuncture Points ; Rats, Sprague-Dawley

BACKGROUND: Modern acupuncture anesthesia is a combination of Chinese and Western medicine that integrates the theories of acupuncture with anesthesia. However, some clinical studies of acupuncture anesthesia lack specific descriptions of randomization, allocation concealment, and blinding processes, with subsequent systematic reviews indicating a risk of bias. OBJECTIVE: Clinical trial registration is essential for the enhancement of the quality of clinical trials. This study aims to summarize the status of clinical trial registrations for acupuncture anesthesia listed on the World Health Organization International Clinical Trials Registry Platform (ICTRP). SEARCH STRATEGY: We searched the ICTRP for clinical trials related to acupuncture anesthesia registered between January 1, 2001 and May 31, 2023. Additionally, related publications were retrieved from PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Data. Registrations and publications were analyzed for consistency in trial design characteristics. INCLUSION CRITERIA: Clinical trials that utilized one of several acupuncture-related therapies in combination with pharmacological anesthesia during the perioperative period were eligible for this review. DATA EXTRACTION AND ANALYSIS: Data extracted from articles included type of surgical procedure, perioperative symptoms, study methodology, type of intervention, trial recruitment information, and publication information related to clinical enrollment. RESULTS: A total of 166 trials related to acupuncture anesthesia from 21 countries were included in the analysis. The commonly reported symptoms in the included studies were postoperative nausea and vomiting (19.9%) and postoperative pain (13.3%). The concordance between the publications and the trial protocols in the clinical registry records was poor, with only 31.7% of the studies being fully compatible. Inconsistency rates were high for sample size (39.0%, 16/41), blinding (36.6%, 15/41), and secondary outcome indicators (24.4%, 10/41). CONCLUSION The volume of acupuncture anesthesia clinical trials registered in international trial registries over the last 20 years is low, with insufficient disclosure of results. Postoperative nausea and vomiting as well as postoperative pain, are the most investigated for acupuncture intervention. Please cite this article as: Li Y, Liu YN, Guo Z, Gu ME, Wang WJ, Zhu Y, Zhuang XJ, Chen LM, Zhou J, Li J. Current situation of clinical trial registration in acupuncture anesthesia: A scoping review. J Integr Med. 2025; 23(3): 256-263.
Humans ; Acupuncture Analgesia ; Acupuncture Therapy ; Anesthesia ; Clinical Trials as Topic ; Registries

The evolution of acupuncture anesthesia (AA) has spanned six decades. Cardiothoracic surgery serves as a representative case study to illustrate this evolution. Reflecting on its historical development, the use of AA in cardiothoracic surgery has advanced from basic AA procedures in the 1960s to combined acupuncture and drug anesthesia techniques in the early 1980s. Since 2005, the innovative use of non-intubation AA combined anesthesia has been implemented extensively in cardiothoracic surgery. As the medical industry continues to evolve, the techniques applied in AA have expanded to encompass the entire perioperative period in cardiothoracic surgery, leading to the introduction of the concept of modern AA. The use of AA in cardiothoracic surgery exemplifies the ongoing advances and integration of traditional Chinese and Western medicine. Moving forward, it is imperative to enhance the theoretical framework of AA through the execution of rigorous multicenter clinical trials, to further strengthen the body of evidence supporting evidence-based medicine, and to finally explore the underlying mechanisms of AA. Please cite this article as: Wu XD, Wei XQ, Chen TY, Zhou WX, Wang K, Zhou J. From pioneering to innovation: A comprehensive review of acupuncture anesthesia in cardiothoracic surgeries. J Integr Med. 2025; 23(6):623-629.
Humans ; Acupuncture Analgesia/methods* ; Acupuncture Therapy/methods* ; Cardiac Surgical Procedures ; Anesthesia/methods* ; Thoracic Surgical Procedures

OBJECTIVE: To observe the effect of "Zhibian" (BL54)-toward-"Shuidao" (ST28) needling technique on the relative protein expression of the signaling pathway of nucleotide-binding oligomerization domain-containing protein 1 (NOD1)/ receptor-interacting protein 2 (RIP2)/nuclear factor kappa-B (NF-κB) and the expression of proinflammatory cytokines in the rats with primary dysmenorrhea (PD), so as to explore the underlying mechanism of this acupuncture technique for pain alleviation in PD. METHODS: Thirty female SD rats of SPF grade with normal estrous cycle were randomized into a blank group, a model group and an acupuncture group, 10 rats in each one. Using the intraperitoneal injection with estradiol benzoate combined with oxytocin, PD model was prepared in the model group and the acupuncture group. In the acupuncture group, during model preparation, the intervention with "Zhibian" (BL54)-toward-"Shuidao" (ST28) needling technique was delivered simultaneously, 20 min each time, once daily for consecutive 10 days. On day 11, within 30 min after the intraperitoneal injection with oxytocin, the writhing reaction (latency, frequency and score) was recorded; the morphology of uterine tissue was observed with HE staining, the contents of prostaglandin E₂ (PGE₂), prostaglandin F_2α (PGF_2α), interleukin (IL)-1β, IL-18, cyclooxygenase-2 (COX-2), and tumor necrosis factor-α(TNF-α) in the serum were detected using ELISA method; the relative protein expression of NOD1, RIP2, NF-κB p65, phosphorylation-NF-κB p65 (p-NF-κB p65) was detected in the uterine tissue using Western blot method; and the mRNA expression of NOD1, RIP2 and NF-κB p65 was detected with the quantitative real-time PCR employed. RESULTS: Compared with the blank group, in the model group, the writhing latency was prolonged (P<0.01), the writhing frequency and score increased (P<0.01) in the rats; the endometrial epithelial cells showed massive degeneration and necrosis, with severe endometrial edema and widespread shedding, combined with neutrophil infiltration; the serum PGE₂ content was dropped (P<0.01), while those of PGF_2α, IL-1β, IL-18, COX-2, and TNF-α elevated (P<0.01); the protein expression of NOD1, RIP2, NF-κB p65 and p-NF-κB p65, and the mRNA expression of NOD1, RIP2 and NF-κB p65 in uterine tissue increased (P<0.01). In comparison with the model group, in the acupuncture group, the writhing latency was prolonged (P<0.01), the writhing frequency and score were reduced (P<0.01) in the rats; there was less degeneration and necrosis of endometrial epithelial cells, with mild endometrial edema and very little neutrophil infiltration; the serum PGE₂ content increased (P<0.01), while those of PGF_2α, IL-1β, IL-18, COX-2, and TNF-α decreased (P<0.01); the protein expression of NOD1, RIP2, NF-κB p65 and p-NF-κB p65 and the mRNA expression of NOD1, RIP2 and NF-κB p65 in uterine tissue were dropped (P<0.05, P<0.01). CONCLUSION "Zhibian" (BL54)-toward-"Shuidao" (ST28) needling technique can alleviate the pain symptom of PD rats, and its action mechanism may be related to inhibiting the active expression of NOD1/RIP2/NF-κB signaling pathway in the uterine tissue, thereby reducing the inflammatory response.
Animals ; Female ; Rats, Sprague-Dawley ; Rats ; Signal Transduction ; Dysmenorrhea/metabolism* ; NF-kappa B/metabolism* ; Acupuncture Points ; Humans ; Acupuncture Analgesia ; Nod1 Signaling Adaptor Protein/metabolism* ; Receptor-Interacting Protein Serine-Threonine Kinase 2/metabolism* ; Acupuncture Therapy

The international dissemination of Chinese acupuncture represents a successful model of medical and cultural exchange between the East and the West, as well as an exemplary case of Chinese culture going global. In 1971, following the announcement by Xinhua News Agency that "acupuncture anesthesia technology had achieved success", American medical educator Professor Edmunds Grey Dimond became the first foreign doctor to visit China for an investigation of acupuncture anesthesia. His efforts significantly contributed to the promotion of Chinese acupuncture within western medical communities. From the perspective of acupuncture humanities, this article reviews and analyzes Dimond's academic background, his journey to study acupuncture anesthesia in China, and his unique insights into acupuncture, exploring how his open-minded and objective approach facilitated the acceptance and dissemination of acupuncture anesthesia and acupuncture techniques in the West.
China ; Humans ; History, 20th Century ; Acupuncture Therapy/history* ; Acupuncture/history* ; Acupuncture Analgesia/history* ; History, 21st Century

BACKGROUND AND OBJECTIVES

Neuraxial anesthesia, which includes techniques such as spinal anesthesia, traditional epidural, combined spinal-epidural (CSE), and dural puncture epidural (DPE), is considered the most effective, safe, and reliable method for providing pain relief during labor and delivery. The choice between DPE, CSE, and EPL depends on various factors, including the parturient’s labor, pain intensity, and preferences. This network meta-analysis (NMA) aimed to determine which analgesic technique among DPE, CSE, and pure epidural (EPL) techniques would be more effective in providing adequate analgesia and producing fewer adverse effects and/or complications for parturients undergoing labor.

In this study, the different analgesia techniques were assigned. DPE is assigned as group A, CSE as group B, and EPL as group C. This NMA combines direct and indirect evidence obtained from randomized controlled trials (RCTs). An electronic systematic search was done using electronic databases and online published RCTs. Critical appraisal of studies, collection, and extraction of data was facilitated by the primary investigator and a peer. A total of 31 journal articles were initially identified for screening and a total of 5 studies – 1 from database searches and 4 from citation chaining – were included in this meta-analysis after Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Outcome measures were pooled and analyzed using Review Manager Web version 5.4.1.

Among parturients, the likelihood of experiencing a rapid onset of analgesia was significantly greater among those on CSE, whereas the onset of DPE approximates that of EPL. Subsequent sensitivity analysis improved the onset of DPE over EPL, thus overall CSE > DPE > EPL. The odds of developing maternal hypotension were CSE > DPE. Overall, the comparative odds are as follows: CSE > EPL = DPE. The incidence of fetal bradycardia is almost equal for both interventions in studies comparing DPE versus CSE analgesia and DPE versus EPL although there is a greater likelihood of developing fetal bradycardia when parturients are on CSE > EPL, hence the comparative odds of developing fetal bradycardia are as follows: CSE > EPL = DPE.

Overall, these findings suggest that CSE may offer advantages for labor analgesia among parturients in labor, in terms of faster onset of analgesia, although potentially causing higher risk of maternal hypotension and fetal bradycardia when compared to DPE and EPL. Based on the results of the current NMA article, further studies are required to compare DPE, CSE, and EPL for labor analgesia, to fully evaluate the risks and benefits of each intervention, particularly in relation to maternal and fetal outcomes.

BACKGROUND AND OBJECTIVES

Neuraxial anesthesia, which includes techniques such as spinal anesthesia, traditional epidural, combined spinal-epidural (CSE), and dural puncture epidural (DPE), is considered the most effective, safe, and reliable method for providing pain relief during labor and delivery. The choice between DPE, CSE, and EPL depends on various factors, including the parturient’s labor, pain intensity, and preferences. This network meta-analysis (NMA) aimed to determine which analgesic technique among DPE, CSE, and pure epidural (EPL) techniques would be more effective in providing adequate analgesia and producing fewer adverse effects and/or complications for parturients undergoing labor.

In this study, the different analgesia techniques were assigned. DPE is assigned as group A, CSE as group B, and EPL as group C. This NMA combines direct and indirect evidence obtained from randomized controlled trials (RCTs). An electronic systematic search was done using electronic databases and online published RCTs. Critical appraisal of studies, collection, and extraction of data was facilitated by the primary investigator and a peer. A total of 31 journal articles were initially identified for screening and a total of 5 studies – 1 from database searches and 4 from citation chaining – were included in this meta-analysis after Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Outcome measures were pooled and analyzed using Review Manager Web version 5.4.1.

Among parturients, the likelihood of experiencing a rapid onset of analgesia was significantly greater among those on CSE, whereas the onset of DPE approximates that of EPL. Subsequent sensitivity analysis improved the onset of DPE over EPL, thus overall CSE > DPE > EPL. The odds of developing maternal hypotension were CSE > DPE. Overall, the comparative odds are as follows: CSE > EPL = DPE. The incidence of fetal bradycardia is almost equal for both interventions in studies comparing DPE versus CSE analgesia and DPE versus EPL although there is a greater likelihood of developing fetal bradycardia when parturients are on CSE > EPL, hence the comparative odds of developing fetal bradycardia are as follows: CSE > EPL = DPE.

Overall, these findings suggest that CSE may offer advantages for labor analgesia among parturients in labor, in terms of faster onset of analgesia, although potentially causing higher risk of maternal hypotension and fetal bradycardia when compared to DPE and EPL. Based on the results of the current NMA article, further studies are required to compare DPE, CSE, and EPL for labor analgesia, to fully evaluate the risks and benefits of each intervention, particularly in relation to maternal and fetal outcomes.

BACKGROUND AND OBJECTIVES

Neuraxial anesthesia, which includes techniques such as spinal anesthesia, traditional epidural, combined spinal-epidural (CSE), and dural puncture epidural (DPE), is considered the most effective, safe, and reliable method for providing pain relief during labor and delivery. The choice between DPE, CSE, and EPL depends on various factors, including the parturient’s labor, pain intensity, and preferences. This network meta-analysis (NMA) aimed to determine which analgesic technique among DPE, CSE, and pure epidural (EPL) techniques would be more effective in providing adequate analgesia and producing fewer adverse effects and/or complications for parturients undergoing labor.

In this study, the different analgesia techniques were assigned. DPE is assigned as group A, CSE as group B, and EPL as group C. This NMA combines direct and indirect evidence obtained from randomized controlled trials (RCTs). An electronic systematic search was done using electronic databases and online published RCTs. Critical appraisal of studies, collection, and extraction of data was facilitated by the primary investigator and a peer. A total of 31 journal articles were initially identified for screening and a total of 5 studies – 1 from database searches and 4 from citation chaining – were included in this meta-analysis after Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Outcome measures were pooled and analyzed using Review Manager Web version 5.4.1.

Among parturients, the likelihood of experiencing a rapid onset of analgesia was significantly greater among those on CSE, whereas the onset of DPE approximates that of EPL. Subsequent sensitivity analysis improved the onset of DPE over EPL, thus overall CSE > DPE > EPL. The odds of developing maternal hypotension were CSE > DPE. Overall, the comparative odds are as follows: CSE > EPL = DPE. The incidence of fetal bradycardia is almost equal for both interventions in studies comparing DPE versus CSE analgesia and DPE versus EPL although there is a greater likelihood of developing fetal bradycardia when parturients are on CSE > EPL, hence the comparative odds of developing fetal bradycardia are as follows: CSE > EPL = DPE.

Overall, these findings suggest that CSE may offer advantages for labor analgesia among parturients in labor, in terms of faster onset of analgesia, although potentially causing higher risk of maternal hypotension and fetal bradycardia when compared to DPE and EPL. Based on the results of the current NMA article, further studies are required to compare DPE, CSE, and EPL for labor analgesia, to fully evaluate the risks and benefits of each intervention, particularly in relation to maternal and fetal outcomes.

OBJECTIVE: To investigate the analgesic effect of locally injecting a "cocktail" analgesia containing a high-dose compound betamethasone during revision hip arthroplasty, and also to study the usage of opioid drugs. METHODS: A retrospective analysis was conducted on the clinical data of 180 patients who underwent revision hip arthroplasty due to aseptic loosening of the hip prosthesis between January 2015 and December 2021. Among them, 95 patients received intraoperative injection of "cocktail" analgesia containing high-dose compound betamethasone (group A), and 85 patients received intraoperative injection of traditional "cocktail" analgesia (group B). There was no significant difference in baseline data such as gender, age, body mass index, presence or absence of diabetes mellitus between the two groups ( P>0.05). The hospital stay, use of opioid drugs within 72 hours, and the incidence of adverse reactions within 72 hours after operation [including nausea and vomiting, insomnia, deep venous thrombosis (DVT), infection, etc.] were recorded and compared between the two groups. The pain relief of patients was evaluated using the static and dynamic visual analogue scale (VAS) scores at 12, 24, 48, and 72 hours after operation. The incidence of complications (including prosthesis re-loosening, hip joint dislocation, hip joint stiffness, limping, chronic pain, etc.) at 2 years after operation was recorded, and the Harris Hip Score (HHS) was used to evaluate the function at 2 years after operation. RESULTS: In group A, the utilization rate of opioid drugs within 72 hours after operation was significantly lower than that in group B ( P<0.05). However, there was no significant difference between the two groups in terms of hospital stay, as well as the incidence of adverse reactions such as nausea and vomiting, insomnia, DVT, and infection within 72 hours after operation ( P>0.05). The VAS scores of both groups decreased with time, and the differences between different time points were significant ( P<0.05). The static and dynamic VAS scores of group A were significantly lower than those of group B at 12, 24, and 48 hours after operation ( P<0.05), but there was no significant difference in static and dynamic VAS scores between the two groups at 72 hours after operation ( P>0.05). All patients in both groups were followed up 2-8 years, with an average of 5.73 years. At 2 years after operation, no significant difference was found between the two groups in the incidence of complications and HHS score ( P>0.05). CONCLUSION "Cocktail" analgesia containing a high-dose compound betamethasone for early analgesia after revision hip arthroplasty can effectively reduce postoperative pain and the use of opioid drugs, but will not increase the incidence of infection and DVT after operation.
Humans ; Arthroplasty, Replacement, Hip/adverse effects* ; Betamethasone/therapeutic use* ; Retrospective Studies ; Male ; Female ; Analgesics, Opioid/administration & dosage* ; Pain, Postoperative/prevention & control* ; Middle Aged ; Reoperation ; Aged ; Analgesia/methods* ; Adult ; Pain Measurement ; Pain Management/methods* ; Prosthesis Failure ; Hip Prosthesis