Intensive stimulation tuina at tender points plus medication for cervical intervertebral disc herniation

Wen Xin-gao (聞鑫高), Yan Ying-ju (嚴(yán)櫻菊), Wu You-lu (吳有魯)

1 Orthopedics Department of Yuhang District No.2 People’s Hospital, Hangzhou, Zhejiang 311121, China

2 Urology Department of Hangzhou First People’s Hospital, Zhejiang 310006, China

Intensive stimulation tuina at tender points plus medication for cervical intervertebral disc herniation

Wen Xin-gao (聞鑫高)1, Yan Ying-ju (嚴(yán)櫻菊)2, Wu You-lu (吳有魯)1

1 Orthopedics Department of Yuhang District No.2 People’s Hospital, Hangzhou, Zhejiang 311121, China

2 Urology Department of Hangzhou First People’s Hospital, Zhejiang 310006, China

Objective:To observe the clinical efficacy of tuina with intensive stimulation at tender points plus medication in treating cervical intervertebral disc herniation (CIDH).

Tuina; Massage; Cervical Spondylosis; Intervertebral Disc Displacement; Neck Pain; Myalgia

Cervical intervertebral disc herniation (CIDH) is a common medical condition caused by postero-laterally herniated cervical disc compressing spinal nerve root or spinal cord[1]. Patients with this condition may experience soreness, pain, limited movement, numbness of upper limb, headache, and dizziness[2]. Because of the change of working style in modern society, the incidence of CIDH has been increasing year by year. Long-term discomfort in neck and limited movement brought by CIDH will damage the patients’quality of life[3]. To seek an effective treatment protocol for CIDH, we had adopted tuina with intensive stimulation at the tender points plus oral administration of Meloxicam tablets to treat CIDH between January 2012 and March 2015. The report is given as follow.

1 Clinical Materials

1.1 Diagnostic criteria

According to the diagnostic criteria of cervical spondylosis in theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicinestipulated by the State Administration of Traditional Chinese Medicine[4]: major symptoms including dizziness, pain, heaviness, numbness in neck, back and arm; cervical MRI examination showing degeneration and herniation of intervertebral disc, and compression of dural sac or spinal cord.

1.2 Inclusion criteria

In conformity with the above diagnostic criteria; aged 18 to 65 years old; having signed the informed consent form.

1.3 Exclusion criteria

The herniated disc is comparatively big, accompanied by paralysis of lower limbs or urinary and fecal incontinence; aged over 65 or below 18 years old; presenting hypertension or other severe internal diseases during the intervention; with abnormal imaging findings, but without symptoms of cervical spondylosis; pregnant women; those with poor compliance.

1.4 Statistical methods

The SPSS 16.0 statistical software was adopted for data analyses. The measurement data were expressed by mean ± standard deviation (x±s) and analyzed byt-test; the enumeration data were analyzed by Chi-square test. APvalue of less than 0.05 indicated a statistical significance.

1.5 General data

The 158 CIDH patients were recruited from the Orthopedics Department of Yuhang District No.2 People’s Hospital, Hangzhou from January 2012 to March 2015. By their visiting sequence, they were randomized into an observation group and a control group, 79 cases in each group. In the observation group, the patients were aged between 27 and 63 years old, with disease duration ranged from 1 to 72 months. In the control group, the patients were aged between 29 and 63 years old, with disease duration ranged from 1 to 71 months. Of all the cases, cervical MRI showed that the herniation majorly occurred at C5-C6and C6-C7. There were no significant differences in comparing the data of gender, age, disease duration and the location of disc herniation (allP＞ 0.05), indicating the comparability (Table 1).

Table 1. Comparison of general data

2 Treatment Methods

2.1 Observation group

2.1.1 Tuina

Location of tender points: Beginning point of trapezius; attachment points of multifidus and spinal rotators of the affected vertebrae; attachment points of splenius capitus and semispinalis capitus at laminae of cervical vertebrae; the endpoint of musculi levator scapulae; trapezius between neck and shoulder[5-6].

Operation and key points: The tender points were pressed by the tip of the thumb with the thumb and index finger of the operator opposed to each other, and the force should be increased gradually but within the patient’s tolerance to reach the profound layer of the muscles. The force should be performed perpendicularly to the muscles, tendons or nerves, with a rhythmic pause. The treatment lasted 15-30 s for each tender point. While with the increased treatment sessions and decreased pain intensity, the treatment time for each tender point could be shortened but no less than 15 s. The tuina treatment was given once a day, successively for 14 d. It could be terminated ahead of the time if the symptoms were substantially gone.

2.1.2 Medication

Oral administration of Meloxicam tablets, 7.5 mg for each dose after meals, once a day, successively for 14 d.

2.2 Control group

Patients in the control group only took Meloxicam tablets, with the same dose and course as those in the observation group.

3 Observation of Therapeutic Efficacy

3.1 Pain evaluation

Visual analogue scale (VAS) was adopted to evaluate the pain intensity. A 10 cm straight line was marked with 0 and 10 respectively at the two ends. 0 stood for no pain, while 10 for the most intensive pain. The patients were asked to make a mark on the line, and the distance between the left end and the mark was taken as the pain level (cm).

Pain intensity grading: 0 for no pain; 0.1-3.9 for mild pain; 4-6.9 for severe pain; and 7-10 for extreme pain.

3.2 Criteria of therapeutic efficacy[4]

Markedly effective: Neck and shoulder pain was gone, and numbness in the upper limbs disappeared or was substantially reduced.

Effective: Neck and shoulder pain and the numbness in the upper limbs were reduced, while discomfort and weakness was still left in the neck.

Invalid: Pain and numbness were slightly improved or remained the same.

3.3 Treatment results

3.3.1 Comparison of clinical efficacy

There were no dropouts in the two groups. After 14-day treatment, the markedly effective rate and total effective rate were respectively 60.8% and 92.4% in the observation group, versus 45.6% and 81.0% in the control group, and the between-group differences were statistically significant (P＜0.01, P＜0.05), indicating that the therapeutic efficacy of the observation group was more significant than that of the control group (Table 2).

Table 2. Comparison of clinical efficacy (case)

3.3.2 Comparison of VAS score

After treatment, VAS scores dropped markedly in both groups (both P＜0.01), and there was a significant difference between the two groups (P＜0.01), indicating that the improvement of pain in the observation group was more significant than that in the control group (Table 3).

Table 3. Comparison of VAS score

Table 3. Comparison of VAS score

Note: Intra-group comparison, 1) P＜0.01; compared with the control group after treatment, 2) P＜0.01

Group n Pre-treatment Post-treatment Observation 79 6.98±2.05 2.06±0.531)2)Control 79 6.90±1.97 3.28±1.151)

4 Discussion

CIDH belongs to the scope of nape Bi-impediment in traditional Chinese medicine[7], pathologically caused by excessive pathogens and deficient healthy qi. The deficiency is primarily in the liver, kidney, qi, and blood; the excessive pathogens are externally contracted cold and dampness. Pathogenic cold is featured by contracting and blocking, and thus leads to qi-blood stagnation in meridians and collaterals of neck. Sudden sprain or injury may also lead to the qi-blood stagnation in neck. Stagnation brings along pain. Therefore, CIDH should be treated by unblocking collaterals and promoting blood circulation, expelling pathogens and killing pain.

An-pressing with intensive stimulation at tender points is a unique tuina manipulation developed by professor Xuan Zhe-ren[6]. This manipulation is based on his specific understanding about the pathogenesis and development of the pain in head, neck, shoulder, and waist. The action mechanism of the manipulation accords with the theory that pain exists when the soft tissues are not relaxed and the pain can be treated by relaxing the soft tissues[6]. Tender points are not restricted by any fixed acupoint, but where the body is affected, also named Ashi points. Dang JJ, et al revealed that the affected location in cervical spondylosis is closely related to the tender points[8], and it’s effective by acupuncture-moxibustion, tuina, and medicinal blocking at tender points for cervical spondylosis. As a unique tuina manipulation, intensively pressing the tender points can treat the whole by stimulation at the points and work efficiently[6,8-9].

The current study indicates that intensive stimulation at the tender points plus oral administration of Meloxicam tablets can produce a more significant efficacy than taking the medication alone. Meloxicam is commonly used in treating osteoarthritis and rheumatoid arthritis, as well as CIDH, as it can produce a strong anti-inflammation effect, a lasting effect in releasing inflammatory pain, and a significant antipyretic effect[10]. Severe CIDH patients usually suffer from unbearable pain and the subsequent sleep disorders. The slow action of ordinary tuina treatment often weakens patients’ confidence in the treatment. It can quickly relieve the pain and promote patients’compliance when Meloxicam is combined with tuina treatment. However, long-term use or large amount use of Meloxicam can lead to anemia, headache, palpitations, and indigestion[10]. In this study, intensive stimulation at tender points combined with Meloxicam can properly address the conflict between therapeutic efficacy and adverse reactions. Despite the small dose of Meloxicam, 7.5 mg each time, once a day, it still effectively released the cervical discomfort and pain. Nevertheless, the stimulation should be kept within the patient’s tolerance as the stimulation is very strong. It’s normal that some patients may feel the topical pain aggravated after the first treatment. The practitioner should inform the patients ahead to prevent any negative emotions.

Generally speaking, combined intensive stimulation at the tender points with Meloxicam is more effective than medication alone, especially in releasing severe pain. It’s worth promoting in clinic, since it’s effective and easy-to-operate.

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: 1 June 2015/Accepted: 28 June 2015

[1] Zheng XH, Wu HP, Duan HP. Clinical observation of integrated traditional Chinese and Western medicine in treating cervical disc herniation. Zhongguo Zhongyi Gushangke Zazhi, 2014, 22(7): 33-35.

[2] Tong YG, Li XL. Sixty-five lateral cervical intervertebral disc herniation treated by conservative integrated medicine. JETCM, 2014, 23(5): 979-980.

[3] Liao XF. Tuina with abrupt explosive force plus electroacupuncture for cervical intervertebral disc herniation. Zhongyiyao Daobao, 2014, 20(12): 95-96.

[4] State Administration of Traditional Chinese Medicine. Criteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine. Nanjing: Nanjing University Press, 1994:136.

[5] Jia W, Zhao HY. Summary of Chinese medicine in treating cervical intervertebral disc herniation. Henan Zhongyi, 2013, 33(3): 375-377.

[6] Xuan ZR. Xuan Zhe-ren’s Soft Tissue Surgery. Shanghai: Wenhui Press, 2002: 416-419.

[7] Fan ZY, Zha HP, Wang WQ, Li SM. Manipulations for acute cervical intervertebral disc herniation. Zhejiang Zhongyiyao Daxue Xuebao, 2012, 36(2): 194-196.

[8] Dang JJ, Cheng HY, Li Q, Qi L, Wang L, Wang JW. Clinical observation of the correlation between the interspace and tender points in cervical spondylosis. Jing Yao Tong Zazhi, 2012, 33(5): 370-372.

[9] Zhang ZX, Zhu H, Wang RH, Du X, Qu HY. Tuina for leg length discrepancy and lumbosacral pain due to sacroiliac joint subluxation. J Acupunct Tuina Sci, 2014, 12(4): 241-245.

[10] Feng XJ, Li ZS, Wang ZQ. Study on the antipyretic and analgesic effect of Meloxicam tablets. Shanghai Xumu Shouyi Tongxun, 2014, 4(4): 10-11.

Translator:Hong Jue (洪玨)

壓痛點強刺激推拿配合藥物治療頸椎間盤突出癥

目的：觀察壓痛點強刺激推拿配合藥物治療頸椎間盤突出癥的臨床療效。方法：將 158例頸椎間盤突出癥患者按就診順序隨機分為觀察組和對照組, 每組 79例。對照組口服美洛昔康片治療, 每次 7.5 mg, 每日 1次。觀察組在對照組基礎(chǔ)上加用壓痛點強刺激推拿治療, 每日1 次。兩組均連續(xù)治療14 d后觀察療效。結(jié)果：觀察組總有效率為92.4%, 高于對照組的81.0% (P＜0.05)。治療后, 兩組疼痛視覺模擬量表(visual analogue scale, VAS)評分均較本組治療前明顯下降(均P＜0.01), 且觀察組VAS評分明顯低于對照組(P＜0.01)。結(jié)論：壓痛點強刺激推拿結(jié)合口服美洛昔康片治療頸椎間盤突出癥的療效優(yōu)于單純口服美洛昔康片治療, 值得臨床推廣應(yīng)用。

推拿; 按摩; 頸椎病; 椎間盤移位; 頸痛; 肌痛

R244.1 【

】A

Author: Wen Xin-gao, bachelor, attending physician.

E-mail: wzlfwjb@163.com

Methods:Totally 158 CIDH patients were randomized into an observation group and a control group by their visit sequence, 79 cases in each group. The control group was intervened by oral administration of Meloxicam tablets, 7.5 mg for each dose, once each day. The observation group was additionally intervened by tuina with intensive stimulation at tender points based on the treatment given to the control group, once each day. The therapeutic efficacy was evaluated after successive 14-day treatment for the two groups.

Results:The total effective rate was 92.4% in the observation group, significantly higher than 81.0% in the control group (P＜0.05). The visual analogue scale (VAS) scores dropped significantly after the treatment in both groups (bothP＜0.01), and the VAS score of the observation group was significantly lower than that of the control group (P＜0.01).

Conclusion:Tuina with intensive stimulation at tender points plus oral administration of Meloxicam tablets can produce a more significant efficacy in treating CIDH than taking Meloxicam alone, thus worth promoting in clinic.