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      A randomized pilot study of electro-acupuncture treatment for hysterosalpingography pain relief and related anxiety

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          Abstract

          Objective:

          To investigate the effect of acupuncture on reducing pain and anxiety related to hysterosalpingography (HSG).

          Materials and Methods:

          A total of 107 patients planned to undergo HSG were randomly separated into 3 groups; the acupuncture group (n=36), intramuscular diclofenac sodium group (n=35), and control group (n=37). In the acupuncture group, electro-acupuncture was applied to specified points for 20 mins before the procedure. In the intramuscular diclofenac sodium group, an intramuscular injection of 75 mg diclofenac sodium was applied 30 mins before the procedure. No analgesics were administered to the patients in the control group before intervention. Pain was evaluated with a Visual Analog scale (VAS) and anxiety with the State-trait Anxiety inventory -state (STAI-S), preoperatively and at specified times postoperatively.

          Results:

          The VAS scores at 1 and 5 minutes after HSG were similar in acupuncture group and intramuscular diclofenac sodium group, and significantly lower than in the control group. At 30 mins postoperatively, there was no significant difference between the 3 groups in respect of the VAS scores. The STAI-S scores at 1 hour preoperatively were similar in all the groups (p=0.563). In the comparisons of the STAI-S values at preoperative 5 mins, following acupuncture in acupuncture group and the diclofenac injection in intramuscular diclofenac sodium group, and at postoperative 30 mins, the acupuncture group values were determined to be statistically significantly lower than those of the other groups (p<0.001, p<0.001).

          Conclusion:

          Acupuncture has similar effects on the reduction of pain as other analgesics and reduces anxiety. It can therefore be used in HSG in suitable clinics.

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          Most cited references27

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          Acupuncture modulates the limbic system and subcortical gray structures of the human brain: evidence from fMRI studies in normal subjects.

          Acupuncture, an ancient therapeutic technique, is emerging as an important modality of complementary medicine in the United States. The use and efficacy of acupuncture treatment are not yet widely accepted in Western scientific and medical communities. Demonstration of regionally specific, quantifiable acupuncture effects on relevant structures of the human brain would facilitate acceptance and integration of this therapeutic modality into the practice of modern medicine. Research with animal models of acupuncture indicates that many of the beneficial effects may be mediated at the subcortical level in the brain. We used functional magnetic resonance imaging (fMRI) to investigate the effects of acupuncture in normal subjects and to provide a foundation for future studies on mechanisms of acupuncture action in therapeutic interventions. Acupuncture needle manipulation was performed at Large Intestine 4 (LI 4, Hegu) on the hand in 13 subjects [Stux, 1997]. Needle manipulation on either hand produced prominent decreases of fMRI signals in the nucleus accumbens, amygdala, hippocampus, parahippocampus, hypothalamus, ventral tegmental area, anterior cingulate gyrus (BA 24), caudate, putamen, temporal pole, and insula in all 11 subjects who experienced acupuncture sensation. In marked contrast, signal increases were observed primarily in the somatosensory cortex. The two subjects who experienced pain instead of acupuncture sensation exhibited signal increases instead of decreases in the anterior cingulate gyrus (BA 24), caudate, putamen, anterior thalamus, and posterior insula. Superficial tactile stimulation to the same area elicited signal increases in the somatosensory cortex as expected, but no signal decreases in the deep structures. These preliminary results suggest that acupuncture needle manipulation modulates the activity of the limbic system and subcortical structures. We hypothesize that modulation of subcortical structures may be an important mechanism by which acupuncture exerts its complex multisystem effects.
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            A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain.

            Acupuncture is a popular complementary and alternative treatment for chronic back pain. Recent European trials suggest similar short-term benefits from real and sham acupuncture needling. This trial addresses the importance of needle placement and skin penetration in eliciting acupuncture effects for patients with chronic low back pain. A total of 638 adults with chronic mechanical low back pain were randomized to individualized acupuncture, standardized acupuncture, simulated acupuncture, or usual care. Ten treatments were provided over 7 weeks by experienced acupuncturists. The primary outcomes were back-related dysfunction (Roland-Morris Disability Questionnaire score; range, 0-23) and symptom bothersomeness (0-10 scale). Outcomes were assessed at baseline and after 8, 26, and 52 weeks. At 8 weeks, mean dysfunction scores for the individualized, standardized, and simulated acupuncture groups improved by 4.4, 4.5, and 4.4 points, respectively, compared with 2.1 points for those receiving usual care (P .05). Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture's purported mechanisms of action. It remains unclear whether acupuncture or our simulated method of acupuncture provide physiologically important stimulation or represent placebo or nonspecific effects.
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              Auricular acupuncture in the treatment of acute pain syndromes: A pilot study.

              This pilot study used a randomized controlled clinical trial design to compare the effects of standard emergency medical care to auricular acupuncture plus standard emergency medical care in patients with acute pain syndromes. Eighty-seven active duty military personnel and their dependents with a diagnosis of acute pain completed the study, which was conducted in the emergency room (ER) at Malcolm Grow Medical Center, Andrews Air Force Base, Maryland. The primary outcome measure was change in pain level from baseline, as measured by the Numerical Rating Scale. Participants in the acupuncture group experienced a 23% reduction in pain before leaving the ER, while average pain levels in participants in the standard medical care group remained basically unchanged. (p < 0.0005). However, both groups experienced a similar reduction in pain 24 hours following treatment in the ER. More research is needed to elucidate treatment effects and to determine mechanisms.
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                Author and article information

                Journal
                Turk J Obstet Gynecol
                Turk J Obstet Gynecol
                TJOG
                Turkish Journal of Obstetrics and Gynecology
                Galenos Publishing
                2149-9322
                2149-9330
                December 2020
                10 December 2020
                : 17
                : 4
                : 253-258
                Affiliations
                [1 ]Private Clinic, Kahramanmaraş, Turkey
                [2 ]Bolu Abant İzzet Baysal University Faculty of Medicine, Department of Physical Therapy and Rehabilitation, Bolu, Turkey
                [3 ]Kahramanmaraş Sütçü İmam University Faculty of Medicine, Department of Obstetrics and Gynecology, Kahramanmaraş, Turkey
                [4 ]Kahramanmaraş Sütçü İmam University Faculty of Medicine, Department of Anesthesiology and Reanimation, Kahramanmaraş, Turkey
                [5 ]Kahramanmaraş Sütçü İmam University Faculty of Medicine, Department of Histology and Embriyology, Kahramanmaraş, Turkey
                [6 ]Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Adana, Turkey
                Author notes
                * Address for Correspondence: Kahramanmaraş Sütçü İmam University Faculty of Medicine, Department of Obstetrics and Gynecology, Kahramanmaraş, Turkey Phone: +90 532 551 21 42 E-mail: muratbakacak46@ 123456gmail.com
                Author information
                https://orcid.org/0000-0002-6746-0939
                https://orcid.org/0000-0002-2974-8560
                https://orcid.org/0000-0003-4398-7055
                https://orcid.org/0000-0002-0657-7578
                https://orcid.org/0000-0003-2360-5320
                https://orcid.org/0000-0002-0262-9385
                https://orcid.org/0000-0002-4658-1336
                https://orcid.org/0000-0003-3032-5861
                https://orcid.org/0000-0002-2355-4212
                Article
                42490
                10.4274/tjod.galenos.2020.66592
                7731605
                33343971
                9b439fe2-07c1-4559-8ce4-6337b846d5ca
                ©Copyright 2020 by Turkish Society of Obstetrics and Gynecology | Turkish Journal of Obstetrics and Gynecology published by Galenos Publishing House.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 March 2020
                : 18 July 2020
                Categories
                Clinical Investigation

                acupuncture,anxiety,hysterosalpingography,pain relief
                acupuncture, anxiety, hysterosalpingography, pain relief

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