Clinical study on abdominal acupuncture for osteoporotic vertebral compression fracture

Zhang Wei (張偉), Qiu Xiu-yun (邱秀云), Wang Juan (王娟)

Acupuncture and Rehabilitation Department of Suining Municipal Hospital of Traditional Chinese Medicine, Sichuan 629000, China

Clinical study on abdominal acupuncture for osteoporotic vertebral compression fracture

Zhang Wei (張偉), Qiu Xiu-yun (邱秀云), Wang Juan (王娟)

Acupuncture and Rehabilitation Department of Suining Municipal Hospital of Traditional Chinese Medicine, Sichuan 629000, China

Objective:To explore the efficacy of abdominal acupuncture in treating patients with osteoporotic vertebral compression fracture (OVCF).

Acupuncture Therapy; Abdominal Acupuncture; Osteoporosis; Fractures, Compression; Thoracic Vertebrae

Pathologic compression fracture is the most common complication of osteoporosis, commonly affecting the thoracic and lumbar vertebrae, leading to lumbar and back pain in old people. Vertebral compression fracture in people aged over 60 is majorly caused by falling or happens spontaneously. Currently, most scholars still support conservative treatment for this medical condition[1]. According to investigation, surgery brings a higher risk and economic burden than conservative treatment, while their long-term therapeutic effects are equivalent[2]. The conservative treatment mainly targets symptoms and osteoporosis. Generally, through 2-week to 3-month integrated treatment, pain can be relieved, and the follow-up study, 3 months to 5.5 years, showed satisfactory result[3]. Nevertheless, conservative treatment has its shortcomings such as consuming longer time to release the pain and improve the activities of daily living (ADL). Regarding this, we observed the effects of abdominal and body acupuncture based on the conservative treatment in treating osteoporotic vertebral compression fracture (OVCF). The report is given as follows.

1 Clinical Materials

1.1 Diagnostic criteria

The diagnosis of OVCF was according to theDiagnostic and Treatment Guidelines of Osteoporotic Fracture[4]: vertebral compression fracture caused by primary osteoporosis, accompanied by unrelieved, persistent pain; osteoporosis proved by bone density detected (dual energy X-ray absorptiometry), and vertebral compression fracture detected by X-ray imaging; without any clinical manifestations and imaging results of spinal cord injury or nerve root injury; onset in the recent week, and the affected vertebra should be thoracic segment.

1.2 Inclusion criteria

Conforming to the above diagnostic criteria; aged between 55 and 80 years, regardless of gender; incomplete rupture of the posterior wall of vertebra; magnetic resonance imaging (MRI) revealed low signal intensity on T1W1 and high signal intensity on T2W1; no history of primary diseases such as coronary heart disease, diabetes, and chronic pulmonary disease.

1.3 Exclusion criteria

Pathological compression fracture caused by tumor invasion; OVCF without pain; general or topical infectious disease; disturbance of blood coagulation; severe diseases involving the heart, brain, lung or kidney that would influence abdominal acupuncture treatment; blowout fracture of vertebra; vertebral compression degree ＜25% or ＞60%.

1.4 Statistical method

All data were processed using SPSS 11.5 version statistical software. The measurement data were expressed asand the intra-group comparison was performed byt-test, while inter-group comparison was by One-way ANOVA. The enumeration data were analyzed using Chi-square test.P＜0.05 indicated a statistical significance.

1.5 General data

The 45 eligible OVCF subjects were from the Inpatient Department of our hospital during March and June of 2014. They were divided into an abdominal acupuncture (AA) group, a body acupuncture (BA) group and a medication group by using the random number generated by SPSS software, 15 in each group. There were no significant inter-group differences in comparing the general data (P＞0.05), indicating the comparability (Table 1).

Table 1. Comparison of general data

2 Treatment Methods

2.1 AA group

2.1.1 Medication

The treatment principle was to modulate the calcium and phosphate metabolism, supplement calcium, and promote the calcium absorption and deposition.

Ossotide injection 50 mg mixed in 0.9% normal saline 250 mL, by intravenous injection, once a day; Caltrate 1 200 mg and Alfacalcidol 0.25 μg, oral administration, once a day; Salcatonin injection 50 IU, muscular injection, once every day at the first week and then once every other day during the 2nd and 3rd weeks. During the first week, Diclofenac Sodium could be used for intensive pain.

2.1.2 Abdominal acupuncture

Acupoints: Yinqiguiyuan [Zhongwan (CV 12), Xiawan (CV 10), Qihai (CV 6) and Guanyuan (CV 4)], Shuifen (CV 9) and Huaroumen (ST 24).

Method: The patient took a supine position. The filiform needles of 0.22 mm in diameter and 40 mm in length were selected to puncture the above points in order, avoiding pores. The heaven and earth points [Zhongwan (CV 12) and Guanyuan (CV 4)] were punctured deeply; Xiawan (CV 10) and Shuifen (CV 9)were punctured by moderate depth; Huaroumen (ST 24) was punctured superficially. After qi arrived, the needling depth was regulated by sequence, better to achieve mild painless needling sensation (mild pulling or distending sensation). The needles were manipulated for 5 min and then retained for 45 min. Afterwards, the needles were removed by the sequence of puncturing and the needling holes were pressed using dry cotton balls to prevent subcutaneous bleeding.

2.2 BA group

In addition to the same medications given to the AA group, the patients in the BA group received body acupuncture.

Acupoints: Jiaji (EX-B 2, superior and inferior to the affected area) points, Ashi points, Weizhong (BL 40) and Chengshan (BL 57).

Method: The patient took a prone position. Filiform needles of 0.22 mm in diameter and 40-60 mm in length were selected to puncture the above points, by 1.5 cun at Jiaji (EX-B 2) points and Ashi points, and 2 cun at Weizhong (BL 40) and Chengshan (BL 57). After qi arrived, even reinforcing-reducing manipulations were applied to the needles for 5 min, and then the needles were retained for 45 min. Afterwards, the needles were removed by the sequence of puncturing and the needling holes were pressed using dry cotton balls to prevent subcutaneous bleeding.

2.3 Medication group

The medication group only received the same medications given to the other two groups following the same instructions and dosages.

2.4 Treatment duration

For the two acupuncture groups, acupuncture treatment was given once a day, 6 times a week, with a 1-day interval, totally for 3 weeks. The medication group received 3-week treatment.

3 Therapeutic Observation

3.1 Observed measurements

The following measurements were evaluated before treatment, respectively after 1-week, 2-week, and 3-week treatment.

3.1.1 Visual analogue scale (VAS)

VAS was adopted to evaluate pain degree using a ruler marked from 0 to 10 cm (0 representing painless and 10 representing the most intensive pain). The patients were asked to mark on the ruler according to their pain degree, and the distance from 0 to the mark was taken as the VAS score.

3.1.2 Barthel index (BI)

BI was used to evaluate the ADL. The total score should be 100 points, BI ≤40 points representing highly dependent, BI ＞40 points but ≤60 points for moderately dependent, BI ＞60 points but ≤99 points for mildly dependent, and BI＝100 points for independent.

3.2 Results

During this study, there were no dropouts in the three groups.

3.2.1 Change of VAS score

Prior to treatment, there was no significant intergroup difference in comparing VAS score (P＞0.05). After treatment, VAS scores decreased gradually in the three groups, and the decrease in the AA group was the most significant. After 1-week treatment, the VAS scores of AA group and BA group were both significantly different from that of the medication group (P＜0.01); the difference between the AA group and BA group was also statistically significant (P＜0.05). After 2-week treatment, there was a significant difference in comparing the VAS score between the AA group and the BA group (P＜0.05), and the VAS scores in the two acupuncture groups were significantly different from that in the medication group (P＜0.05); after 3-week treatment, there was no significant difference in comparing the VAS score between the two acupuncture groups (P＞0.05). At each time point (respectively after 1-week, 2-week, and 3-week treatment) during the treatment, the VAS scores of the two acupuncture groups were always significantly different from that of the medication group (P＜0.05). The results indicated that abdominal acupuncture was efficient in easing pain (Table 2).

3.2.2 Change of BI

Before treatment, there were no significant differences in comparing BI score among the three groups (P＞0.05). After treatment, BI score increased gradually in all three groups. After 1-week treatment, there was a significant difference in comparing BI score between the AA group and BA group (P＜0.05); after 2-week treatment, there was no significant difference between the two acupuncture groups (P＞0.05); after 3-week treatment, the difference was statistically significant between the two acupuncture groups(P＜0.05). At the same time points, there was no significant difference in comparing BI score between the BA group and medication group (P＞0.05); while the difference between the AA group and medication group was statistically significant (P＜0.05). The results showed that abdominal acupuncture can produce the most significant effect in improving ADL (Table 3).

3.3 Adverse events and side effects

During the study, patients all took a prone or supine position and no people faint during acupuncture; during the first treatment week, 2 subjects in the medication group was prescribed with Diclofenac Sodium; in the AA group. Subcutaneous bleeding and mild bruise occurred on abdomen of a patient; in the BA group, two patients had subcutaneous bleeding and mild bruise.

Table 2. Comparison of VAS score

Table 2. Comparison of VAS score

Note: Intra-group comparison, 1) P＜0.05; compared with the medication group at the same time point, 2) P＜0.01; compared with the BA group at the same time point, 3) P＜0.05

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Table 3. Comparison of BI score

Table 3. Comparison of BI score

Note: Intra-group comparison, 1) P＜0.05; compared with the medication group at the same time point, 2) P＜0.05; compared with the BA group at the same time point, 3) P＜0.05

Group n Pre-treatment 1-week treatment later 2-week treatment later 3-week treatment later AA 15 54.00±5.07 75.66±6.511)2)3) 85.00±7.551)2) 93.66±3.511)2)3)BA 15 54.66±4.80 67.06±8.641) 80.00±6.261) 85.66±7.031)Medication 15 54.50±5.05 56.66±7.231) 76.00±6.031) 83.66±8.751)

4 Discussion

Factors contributing to OVCF include trauma, age, nutritional state, frequency and amplitude of doing sports, living habits and genetic factors, and 1/3 of the sufferers experience chronic pain[5]. It’s reported that OVCF is majorly treated by surgery, but it may cause nerve or spinal cord injury, or leakage of bone cement[6]. Besides, despite the high cost, surgery cannot address the radical cause, osteoporosis. Because of the limitation of surgery in treating OVCF, medications have become the common treatment for osteoporosis and the secondary compression fracture, for regulating the calcium and phosphate metabolism, supplementing calcium, and promoting the absorption and deposition of calcium[7].

Abdominal acupuncture is a novel acupuncture method invented by professor Bo Zhi-yun by taking Shenque (CV 8) regulation as the core[8]. Abdominal acupuncture can produce a satisfactory effect in treating osteoarthritis and osteoporosis by regulating Zang-fu organs and meridians. The acupoints selected in this study were based on the theory of abdominal acupuncture. Qihai (CV 6) and Guanyuan (CV 4) were chosen as the monarch points to tonify the kidney since the kidney dominates bone. Deep puncturing at Zhongwan (CV 12) and Xiawan (CV 10) can regulate the spleen. The above four points were combined to induce qi to the origin, i.e. to reinforce the prenatal by supplementing the postnatal. Huaroumen (ST 24) was selected as the assistant point as it works to up-transport and distribute essential qi and keep meridians and collaterals to work smoothly; Shuifen (CV 9) was selected as the courier point and punctured superficially to ease pain by regulating the meridian qi in the topical area of thoracic vertebra since it’s located right opposed to the thoracic vertebra. All the points were used together to promote the generation and circulation of qi and blood, and cease pain by unblocking collaterals.

To some extent, the conventional body acupuncture is effective for back pain caused by osteoporosis[9]. It’s found in experimental study that acupuncture can inhibit the increase of weight, up-regulate estrodiol (E2), and modulate alkaline phosphatase (ALP), bone gla-protein (BGP) and tartrate resistant acid phosphatase (TRAP) in ovariectomized rats. Therefore, acupuncture is plausibly effective in preventing and treating osteoporosis[10].

In this study, we adopted abdominal acupuncture to treat OVCF, and the results showed that there was a significant difference in VAS score between the two acupuncture groups respectively after the first and second treatment week (P＜0.05); while at the end of the 3rd treatment week, there was no significant difference in VAS score but in BI score (P＜0.05) between the two groups. It indicates that abdominal acupuncture plus medication is efficient and effective in treating OVCF, and body acupuncture plus medication can also produce a more significant effect than medication alone in treating OVCF. Therefore, it’s reasonable to add acupuncture into medication treatment for OVCF.

Conflict of Interest

The authors declared that there was no conflict of interest in this article.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in this study.

Received: 6 January 2015/Accepted: 15 February 2015

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Translator:Hong Jue (洪玨)

腹針療法治療骨質(zhì)疏松椎體壓縮性骨折臨床研究

目的：探索腹針療法治療骨質(zhì)疏松椎體壓縮性骨折(osteoporotic vertebral compression fracture, OVCF)患者的臨床療效。方法：符合納入標準的45例OVCF患者, 根據(jù)SPSS 11.5軟件產(chǎn)生的隨機數(shù)字隨機為腹針組、體針組和藥物組, 每組15例。藥物組患者予以骨肽注射液靜滴、鈣爾奇、阿法骨化醇軟膠囊口服及鮭降鈣素注射液肌注。腹針組患者在接受與藥物組相同的藥物治療基礎上接受針刺引氣歸元(中脘、下脘、氣海、關元)、水分、滑肉門治療; 體針組患者在接受與藥物組相同的藥物治療基礎上接受針刺患處上下夾脊穴、阿是穴、委中和承山治療。腹針組及體針組患者均每日針刺1次, 每星期治療6 d, 休息1 d, 共治療3星期。于治療前及治療1、2、3星期后進行疼痛視覺模擬量表(visual analogue scale, VAS)及Barthel指數(shù)(Barthel index, BI)評分, 分別評價患者的疼痛程度及日常生活能力(activities of daily living, ADL)。結(jié)果：治療后, 三組VAS評分及BI評分均與本組治療前有統(tǒng)計學差異(P＜0.05)。治療1、2、3星期后, 腹針組及體針組VAS及BI評分均與同期藥物組評分有統(tǒng)計學差異(P＜0.01)。治療1、2星期后, 腹針組VAS及BI評分改善程度優(yōu)于體針組(P＜0.05); 治療3星期后, 腹針組與體針組的VAS評分差異無統(tǒng)計學意義(P＞0.05), BI評分具有統(tǒng)計學差異(P＜0.05)。結(jié)論：腹針療法在改善OVCF患者VAS及BI評分方面優(yōu)于體針及單純藥物治療, 且具有起效快, 痛苦小的特點。

針刺療法; 腹針; 骨質(zhì)疏松癥; 骨折, 壓縮性; 胸椎

R246.2 【

】A

Author: Zhang Wei, master of medicine, attending physician of traditional Chinese medicine.

E-mail: zhangwei73@126.com

Methods:Forty-five eligible OVCF patients were randomized into an abdominal acupuncture (AA) group, a body acupuncture (BA) group and a medication group according to the random numbers generated by the SPSS 11.5 version software, 15 subjects in each group. Patients in the medication group were intervened by Ossotide injection (intravenous injection), Caltrate (oral administration), Alfacalcidol (oral administration), and Salcatonin injection (muscular injection). In addition to the intervention given to the medication group, patients in the AA group additionally received acupuncture at Zhongwan (CV 12), Xiawan (CV 10), Qihai (CV 6), Guanyuan (CV 4), Shuifen (CV 9), and Huaroumen (ST 24); while patients in the BA group additionally received acupuncture at Jiaji (EX-B 2, superior and inferior to the affected area) points, Ashi points, Weizhong (BL 40) and Chengshan (BL 57). For the AA and BA groups, the acupuncture treatment was given once a day, 6 d per week, for 3 weeks in total. Prior to the intervention, and respectively after 1-week treatment, 2-week treatment and 3-week treatment, visual analogue scale (VAS) and Barthel index (BI) were adopted to evaluate pain degree and activities of daily living (ADL).

Results:After intervention, the VAS and BI scores were significantly changed in the three groups (P＜0.05). Respectively after 1-week, 2-week and 3-week treatment, the VAS and BI scores in the two acupuncture groups were significantly different from those in the medication group at the same time point (P＜0.01). After 1-week and 2-week treatment, the improvements of VAS and BI scores in the AA group were more significant than those in the BA group(P＜0.05); after 3-week treatment, there was no significant difference in comparing the VAS score between the two acupuncture groups (P＞0.05), but a significant difference was found in comparing the BI score (P＜0.05).

Conclusion:Abdominal acupuncture can produce a more significant effect in improving VAS and BI scores in OVCF patients than body acupuncture and pure medication treatment, and it’s efficient and causes few sufferings.