[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] 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.

[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] To examine the effect of moxibustion treatment for reducedpain during activity due to hallux valgus.
[Methods] The subjects were five young females with pain due to hallux valgus. Indirect moxibustion treat-ment was carried out on the region of maximum pain to relieve pain. Moxibustion was performed once per day for 2 weeks, for a total of 14 times. Evaluation used the number of side steps performed and the pain (Numerical Rating Scale) at the time of a side step.
[Results] After moxibustion treatment, pain improvement was observed in all subjects at the time of a side step. At the same time, the number of side steps increased. Repeated measurements before and after moxibustion indicated that there was no significant learning effect.
[Discussion and Conclusion] It became clear that the pain due to hallux valgus is mitigated by moxibustion over a fixed period, while athletic ability with respect to side steps is also improved. These results suggested the pain during activity due to hallux valgus is controllable with moxibustion treatment. By controlling pain, moxibustion treatment also temporarily improves athletic ability.

We applied electrical acupuncture to the spinal nerve root by inserting needles under x-ray control in two cases with radicular sciatica as a non-pharmacological substitute for the lumbar spinal nerve block. In both cases, symptoms were markedly reduced after electrical acupuncture to the spinal nerve root. The sustained effect was noticeably longer than that of caudal anesthesia previously performed one time on one of the cases. We suggest that descending inhibitory control, inhibitory control at the spinal level, or changes in nerve blood flow may be involved in the mechanism of the effect of electrical acupuncture to the spinal nerve root. These results suggest that electrical acupuncture to the spinal nerve root may be superior to lumbar spinal nerve block or caudal anesthesia when it is applied appropriately in certain cases of radicular sciatica, taking into consideration of patient age, severity of symptoms and duration of the disorder.

[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] 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.

[Purpose] Elderly patients with chronic low back pain have often been treated by acupuncture andmoxibustion therapy, using the traditional acupoints for low back pain. But there are some patients who do not get a clinical effect. Therefore, we tried to treat three such patients with three sessions of trigger point acupuncture therapy, instead of using the traditional acupoints for low back pain.
[Methods] The patients were aged 74, 71 and 66, and had low back pain for at least 6 months. They hadround backs, but there were no extraordinary findings in their neurological examinations.
[Results] During and after the previous therapy using the traditional acupoints for low back pain, there wereno remarkable clinical effects on low back pain. But during and after the present therapy using trigger points, there were remarkable clinical effects on low back pain, as evaluated by the visual analogue scale (VAS) and the pain disability assessment scale (PDAS).
[Conclusion] These results suggest that the trigger point acupuncture therapy may be more effective on lowback pain in elderly patients than acupuncture therapy which uses the traditional acupoints.

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.