針灸遠處取穴治療肌筋膜疼痛症

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题名:	針灸遠處取穴治療肌筋膜疼痛症 Effective of Remote Acupuncture in Treating Myofascial Pain Syndrome
作者:	周立偉;Li-Wei Chou
贡献者:	中醫學系博士班
关键词:	針灸;終板雜訊電位;肌激痛點;疼痛控制;遠處效應;Acupuncture;Endplate Noise;Myofascial Trigger Point;Pain Control;Remote Effects
日期:	2013-07-30
上传时间:	2013-10-02 09:45:41 (UTC+8)
出版者:	中國醫藥大學
摘要:	目的：評估針灸治療的遠處效應對上斜方肌肌激痛點的疼痛強度和興奮性之影響。實驗設計：四十五個病患被平均分到三組：「控制（安慰）組」患者接受偽針治療；「留針組」患者接受簡單針灸治療；以及「改良式針灸組」接受改良式針灸治療（以旋進旋出方式、進行多處針刺誘發局部抽搐反應）。針刺點為外關穴和曲池穴。效果評估工具包括主觀疼痛強度（自述疼痛指數），壓力疼痛閾值，頸部的側彎角度和肌激痛點的終板雜訊電位平均振幅變化。結果：觀察「留針組」和「改良式針灸組」兩組受試者接受針灸治療之後的立即效果，在所有的評估參數中都有明顯改善，而在「控制（安慰）組」中沒有。同時，「改良式針灸組」在所有參數的變化都較「留針組」明顯。結論：肌激痛點的興奮性可以透過遠處針灸治療來抑制。「改良式針灸組」遠處針灸穴位似乎比「留針組」在減少疼痛強度和終板雜訊電位之平均振幅以及增加壓力疼痛閾值上有更好的效果。更進一步，我們證實了終板電位的下降和疼痛的減低有很好的相關性。 Objective: To investigate the remote effect of acupuncture (AcP) on the pain intensity and the irritability of the myofascial trigger point (MTrP) in the upper trapezius muscle. Design: Forty-five patients were equally divided into 3 groups: patients in the “placebo control (PC)” group received sham AcP; “simple needling (SN)” group was treated with simple needling, and “modified acupuncture (MAcP)” received AcP with the rapid “screwed in-and-out” into multiple sites to elicit local twitch responses. The acupoints of Wai-guan and Qu-chi were treated. The outcome assessments included changes in subjective pain intensity (PI), pressure pain threshold (PPT), range of motion (ROM) and mean amplitude of endplate noise (EPN) in the MTrP region. Results: Immediately after acupuncture, all measured parameters improved significantly in the SN and MAcP groups, but not in the PC group. There were significantly larger changes in all parameters in the MAcP group than that in the SN group. Conclusions: The MTrP irritability could be suppressed after a remote acupuncture treatment. It appears that needling to the remote AcP points with multiple needle insertions of MAcP technique is a better technique than simple needling insertion of SN technique in terms of the decrease in pain intensity and prevalence of EPN and the increase in PPT in the needling sites (represented either AcP points and or MTrPs). We have further confirmed that the reduction in EPN showed good correlation with a decreased in pain.
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