Acupuncture Continuing Education

Acupuncture Painkilling Relief For Shingles Found

Acupuncture relieves pain due to shingles, reduces the need for painkillers, speeds the healing of herpes zoster lesions, and reduces the incidence of postherpetic neuralgia (PHN). Tianjing University of Traditional Chinese Medicine researchers combined acupuncture with standard drug therapy. Patients receiving both drug therapy and acupuncture in a combined treatment protocol had superior patient outcomes compared with patients using only drug therapy.

 

Jiaji acupoint applied to human 

 

Three month follow-up examinations determined that the incident rate of postherpetic neuralgia plummeted to 3.33% in the group receiving acupuncture plus drug therapy. The group receiving only drug therapy had a PHN incident rate of 30%. The addition of acupuncture to the treatment protocol decreased the PHN rate by 26.67%.

The VAS (Visual Analogue Scale) scores in the acupuncture plus drugs group were significantly better. The addition of acupuncture to drug therapy decreased pain levels, patients required less painkillers, and herpetic lesions healed faster. The researchers conclude that the combination of acupuncture plus drug therapy is safe and effective for the treatment of acute herpes zoster (shingles).

The study design was as follows. A total of 78 patients were randomly distributed into a control group and a treatment group, each consisting of 39 cases. The control group received drug therapy. The treatment group received acupuncture plus the same drug therapy administered to the control group. All patients were diagnosed with acute herpes zoster between June 2014 and December 2015.

The statistical breakdown for each randomized group was as follows. The average age in the treatment group was 54.21 (±24.07) years. The average course of disease in the treatment group was 2.46 (±0.84) days. The average age in the control group was 54.72 (±24.16) years. The average course of disease was 2.41 (±0.89) days. There were no significant statistical differences in terms of age, gender, and course of disease relevant to patient outcome measures.

Patients from both groups consumed 0.5 g of oral famciclovir tablets (3 times per day, for 7 consecutive days), as well as 1–2 tablets of oral tramadol (3 times per day, for 10–12 consecutive days). Famciclovir is a guanosine analogue antiviral drug used for the treatment of herpes zoster. Tyring et al. note, “Oral famciclovir . . . is an effective and well-tolerated therapy for herpes zoster that decreases the duration of the disease's most debilitating complication, postherpetic neuralgia.” Tramadol is an opioid pain reliever used to treat moderate to severe pain. In addition, the patients received a neurotropin injection, once per day, for 10–12 days. Neurotropin is a drug made from inoculated, inflamed rabbit skin that is used for the treatment of neuropathic pain. The treatment group received acupuncture in addition to the aforementioned drug therapy. The primary acupoints selected for the treatment group were the following:

  • Ashi (skin lesion areas)
  • LI4 (Hegu)
  • LI11 (Quchi)
  • Jiaji (extra)

Additional acupoints were administered based on differential diagnostic patterns. For hyperactivity of liver fire, the following acupuncture points were added:

  • TB6 (Zhigou)
  • LV3 (Taichong)

For dampness and heat in the spleen and stomach, the following acupuncture points were added:

  • SP6 (Sanyinjiao)
  • SP10 (Xuehai)

For qi stagnation and blood stasis, the following acupuncture point was added:

  • BL17 (Geshu)

For Ashi acupoints, a 0.22 mm × 25 mm needle was inserted, rotated, lifted, and thrust with a moderate force. After achieving a deqi sensation, a 30 minute needle retention time was observed. For Jiaji acupoints, needles were inserted 0.5 inches lateral to the spine, to a depth of 0.3 inches. The reducing technique was applied after achieving a deqi sensation. For acupoints LI4, SP10, TB6, SP6, LI11, and LV3, needles were rotated, lifted, and thrust rapidly after insertion to achieve a deqi sensation. A 20–30 minute needle retention time was observed. Acupuncture treatments were administered once per day, for 7 consecutive days.

All patients underwent Visual Analogue Scale (VAS) assessment before and after their treatments. VAS is a measurement instrument that measures pain intensity levels experienced by patients. The total dosage of painkillers used by all participants and lesion healing times were also calculated. Compared with the control group, the treatment group displayed a significant decrease in VAS scores. The patients in the treatment group used less painkillers and had shorter healing times. There is a statistically significant difference between the two groups. The researchers also conducted a follow up survey three months after treatment completion. They found that the incident rate of PHN in the treatment group was 3.33%. The incident rate of PHN in the control treatment group was 30.00%.

This is not the only study confirming the efficacy of acupuncture for the treatment of shingles. There is a continuing acupuncture education investigation into clinical outcomes. The research of Wei et al. (Hubei Medicine College) produced similar findings. Acupuncture plus herbs produced a 100% total effective rate for the treatment of shingles. A control group receiving a combination of oral and topical acyclovir plus methylcobalamin has an 82.86% total effective rate.

Patients receiving acupuncture plus herbs had a significantly faster recovery rate. Eradication of the herpes zoster lesions was faster for patients receiving acupuncture plus herbs than for patients taking acyclovir. Acupuncture plus herbs had a faster effective action for the relief of pain. In addition, the acupuncture plus herbs group had a 17.14% greater total effective rate than the drug therapy group.

The Hubei Medicine College researchers employed the use of a surround acupuncture procedure. Placement of acupuncture needles surrounded the areas of the herpes zoster lesions. The needles were separated from each other by 2 – 5 cm. Jiaji acupoints were added at corresponding levels of lesion presentations. Total needle retention time was 30 minutes per acupuncture session. The herbal formula administered to all patients in the form of a decoction included the following Chinese medicinal herbs:

  • Jin Yin Hua 60 – 100 g
  • Liao Qiao 10 g
  • Xuan Shen 10 g
  • Dang Gui 10 g
  • Gan Cao 10 g
  • Dang Shen 20 g
  • Bing Tang 10 g

In a related study, Dongfeng General Hospital researchers determined that acupuncture plus herbs has a 98.6% total effective rate when combined with acyclovir drug therapy. This was a significant improvement over a control group receiving only acyclovir drug therapy. Acupuncture was applied to corresponding Jiaii and Ashi acupoints. Upon the arrival of deqi, needle retention time ranged from 15–30 minutes. Acupuncture was administered once per day for 15 days. The following herbal formula was administered to patients twice per day as a decoction:

  • Sheng Di Huang 20 g
  • He Shou Wu 15 g
  • Sang Ye 15 g
  • Ku Shen 15 g
  • Ban Feng He 10 g

Research indicates that acupuncture is an effective means of alleviating herpes zoster pain. Acupuncture contributes to faster healing times. The combination therapy of drugs plus acupuncture demonstrates clinically superior patient outcomes to patients receiving only drug therapy. Based on the evidence, patients are best served with an integrated treatment protocol of acupuncture, herbal medicine, and drug therapy.

 

 

References:
1. Wang Y. Acupuncture Combined with Western Medication for the Treatment of Acute Herpes Zoster and for the Prevention of Postherpetic Neuralgia: A Clinical Study [J]. Tianjing University of Traditional Chinese Medicine. Journal of China Prescription Drug, 2016, 14(9):96–97.

2. Chen JS et al. Clinical Observation of Acupuncture Combined with Drugs Treatment of Acute Herpes Zoster and Prevention of Postherpetic Neuralgia [J]. Journal of Modern Hospital, 2013, 13(9):8–10.

3. KUNG Y Y, CHEN F P, HWANG S J. The Different Immunomodulation of Indirect Moxibustion on Normal Subjects and Patients with Systemic Lupus Erythematosus [J]. American Journal of Chinese Medicine, 2006, 34( 1) : 47.

4. Ishikawa, Toshizo, Seiko Yasuda, Seiji Minoda, Takae Ibuki, Kayoko Fukuhara, Yasutake Iwanaga, Toru Ariyoshi, and Hironori Sasaki. "Neurotropin® Ameliorates Chronic Pain via Induction of Brain-Derived Neurotrophic Factor." Cellular and molecular neurobiology 35, no. 2 (2015): 231-241.

5. Tyring, Stephen, Rick A. Barbarash, James E. Nahlik, Anthony Cunningham, John Marley, Madalene Heng, Terry Jones, Ted Rea, Ron Boon, and Robin Saltzman. "Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia: a randomized, double-blind, placebo-controlled trial." Annals of Internal Medicine 123, no. 2 (1995): 89-96.

6.Wei JD, Chen JM & Wang LS. (2014). Clinical Observation of Surround Acupuncture and Simiaoyon’an Decoction on Herpes Zoster. Journal of Hubei University of Chinese Medicine. 16(2).

7. Yi JK, Tang ZZ & Yang JL. (2015). Efficacy and Safety of TCM Combined with Acupuncture Treatment for Herpes Zoster Neuralgia. 31(8).

8. Yi GQ & Zhou HJ. (2014). Acupuncture combined with cupping therapy in treating herpes zoster neuralgia: 25 cases. Journal of External Therapy of Traditional Chinese Medicine. 23(3): 36-37.

 


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