|
INTRODUCTION
Pain alongwith, fatique, hunger and thirst, represents Man's
most frequently discomforts. It is natures earliest sign of morbidity. It
stands prominent among all the sensory experience by which a person judges
the existance of disease within himself. There is hardly any disease which
does not have a painfull phase. In fact, the diagnosis of many disease is
based upon presence and character of pain. yet, when severe or persistant,
it is capable of playing psychological havoc and would force the sufferer
to the submit himself to any remedial measure to get relief. Acupuncture
ranks amongest one of oldest remedies used for relief of pain.
There is
no known painful disorder for which acupuncture is not used. The aim of
this paper is to assess the efficiency of acupuncture in various painful
disorders.
MATERIAL AND
METHODS
The material of this work
consists of 1054 cases of various painful disorders treated at Indian
Acupuncture Research & Training Centre, Raipur, INDIA ever a period of
11/2 years from June 1979 to Dec. 1980. The various painful conditions
included tension headache, migraine, trigeminal neuralgia, cervical
spondylitis, lumbago, sciatica, osteo arthritis knee, calcannean spure and
plantar fascitis.
Standard acupuncture points were used for
treatment in 'Clinical Pratice of Acupuncture' by Agrawal A.L. and Sharma,
G.N. Acupuncture Foundation of India, raipur 1980.
Each course
consisted of 10 sittings with an interval of 10 days. Three such course
were given. Response to treatment was absessed after each course. The
response was graded as follows
:
Excellent :
Complete relief from
pain.
Good
: Partial relief from pain with occasional need for
analgesics.
Poor
: Unsatifactory relief from
pain.
OBSERVATION
The incidence of various painful disorders is given in Table
No. 1
Table No. 1.
Showing incidence of painful
disorders treated with Acupuncture:
| S.No. |
Disease |
No. of Cases |
Percentage |
| 1 |
Tension Headache |
144 |
13.60
|
| 2 |
Migraine |
36 |
4.30
|
| 3 |
Trigeminal Neuralgia |
24 |
2.20
|
| 4 |
Cervical Spondylitis |
98 |
9.20
|
| 5 |
Frozen shoulder |
84 |
8.00
|
| 6 |
Myalgia chest |
28 |
2.60
|
| 7 |
Rheumatoid
arthritis |
170 |
16.00
|
| 8 |
Lumbago |
76 |
7.20
|
| 9 |
Sciaticn |
124 |
11.17
|
| 10 |
Csteoarthritis
Knee |
210 |
18.70
|
| 11 |
Calcanean spur |
32 |
3.20
|
| 12 |
Plantar fascitis |
28
|
2.60
|
|
Total |
1054 |
100.00 |
The common conditions treated were osteoarthritis knee,
rheumatoid arthritis, tension headache and sciatica.
The response to
treatment after first course and the final response after 3 course are
shown in Table No. 2 and 3
Table No. 2
Table showing response to treatment
after first course
| S.No. |
Diseases |
No. Of Cases |
|
|
Response after 1st course |
|
|
|
| |
|
|
Excellent |
|
Good |
|
Poor |
|
| |
|
|
Cases |
% |
Cases |
% |
Cases |
% |
| 1 |
Tension Headache |
144 |
121 |
84.00 |
15 |
10.4 |
8 |
5.50 |
| 2 |
Migraine |
36 |
30 |
83.4 |
3 |
8.30 |
3 |
8.30 |
| 3 |
Trigeminal neuragia |
24 |
12 |
50.0 |
8 |
33.30 |
4 |
16.70 |
| 4 |
Cervical Spondylitis |
98 |
60 |
61.2 |
30 |
30.60 |
8 |
8.20 |
| 5 |
Frozen shoulder |
84 |
59 |
70.3 |
15 |
17.80 |
10 |
11.90 |
| 6 |
Myalgia Chest |
28 |
24 |
85.1 |
3 |
14.30 |
0 |
0.00 |
| 7 |
Rheumatoid arthritis |
170 |
110 |
64.7 |
41 |
24.10 |
19 |
11.20 |
| 8 |
Lumbago |
76 |
51 |
67.1 |
19 |
25.00 |
6 |
7.90 |
| 9 |
Sciaticasp |
124 |
76 |
61.3 |
32 |
25.80 |
16 |
12.90 |
| 10 |
O.A.Knee |
210 |
152 |
72.3 |
39 |
18.50 |
19 |
9.20 |
| 11 |
Celcanel spur |
32 |
21 |
65.6 |
6 |
18.7 |
5 |
15.7 |
| 12 |
Plantar fascitia |
28 |
22 |
78.6 |
4 |
14.2 |
2 |
7.1 |
| |
Total |
1054 |
738 |
|
216 |
|
100 |
|
The best response was obtained in tension headache. Response
was highly satisfactory also is myalgia chest, frozen shoulder, migraine
and painful disprders of the lower limb.
In tension headache,
migraine, myalgia chest, and plaster fascitis the response was quick and
was seen after the first course. In other corditions the response was
slightly delayed.
TABLE No. 03
Table showing final response to
treatment
| S.No. |
Diseases |
Total No. Cases |
Excellent |
% |
Good |
% |
Poor |
% |
| 1 |
Tension Headache |
144 |
130 |
90.3 |
10 |
6.9 |
4 |
2.8 |
| 2 |
Migraine |
36 |
30 |
83.4 |
5 |
3.8 |
1 |
2.8 |
| 3 |
Trigeminal
neuralgia |
24 |
17 |
70.8 |
5 |
20.8 |
2 |
8.4 |
| 4 |
Cervical spondylitis |
98 |
70 |
71.4 |
33 |
22.4 |
6 |
6.2 |
| 5 |
Forzen shoulder |
84 |
72 |
85.6 |
8 |
9.9 |
4 |
4.8 |
| 6 |
Myagia chest |
28 |
25 |
89.3 |
3 |
10.7 |
0 |
0.0 |
| 7 |
Rheumatoid arthritis |
170 |
130 |
76.4 |
32 |
18.8 |
8 |
4.0 |
| 8 |
Lumbago |
76 |
60 |
78.9 |
11 |
14.4 |
5 |
6.4 |
| 9 |
Sciatica |
124 |
102 |
82.3 |
14 |
11.3 |
8 |
6.4 |
| 10 |
Osteo-arthritis- knee |
210 |
173 |
82.3 |
26 |
12.3 |
11 |
5.4 |
| 11 |
Calacanea |
32 |
26 |
81.2 |
4 |
12.5 |
2 |
6.3 |
| 12 |
Plantar fascitis |
28 |
23 |
82.2 |
5 |
17.8 |
0 |
0.0 |
| Total |
|
|
858 |
|
145 |
|
51 |
|
The response to treatment in relation to the duration of
illness was asseased irrespective of the underlying disease. This is shown
in Table No. 4
TABLE NO. 4
Response to treatment in relation
to the duration of illness.
| Duration of illness |
No. of Cases |
|
|
Response to treatment |
|
|
|
|
|
Excellent |
% |
Good |
% |
Poor |
% |
| 1 -Month |
29 |
25 |
86.3 |
3 |
10.3 |
1 |
3.4 |
| 1- 3 Months |
108 |
94 |
87.1 |
9 |
8.3 |
5 |
4.7 |
| 4 - 6 Months |
84 |
62 |
73.8 |
18 |
21.4 |
4 |
4.7 |
| 7- 12 Months |
93 |
65 |
69.8 |
22 |
23.6 |
6 |
6.6 |
| 1- 3 Years |
421 |
356 |
84.5 |
51 |
12.1 |
14 |
3.4 |
| - 3 Years |
319 |
256 |
80.3 |
42 |
13.1 |
21 |
6.6 |
There was no signification difference in responce to therapy
in relation to duration of illness.
The assess the effect of age
and sex on response to acupuncture the four common condition i.e. tension
headache, sciatica, oseto arthritis knee and rheumatoid, arthritis, were
subdivided according to age and sex. The finding are presented in Table
No. 5 and Table No.6.
TABLE NO. 5
Sex incidence and response to
treatment
| Disease |
Sex |
No. of Cases |
|
|
Response to treatment |
|
|
|
|
|
|
Excellent |
% |
Good |
% |
Poor |
% |
| Tension headache (144) |
Male |
82 |
72 |
87.8 |
7 |
8.5 |
3 |
3.7 |
|
Female |
62 |
68 |
93.6 |
3 |
4.8 |
1 |
1.6 |
| Sciatica (124) |
Male |
72 |
59 |
81.9 |
8 |
11.2 |
6 |
6.0 |
|
Female |
52 |
43 |
82.7 |
6 |
11.5 |
3 |
5.8 |
| O.A.Knee(210) |
Male |
132 |
108 |
81.8 |
16 |
12.1 |
8 |
6.1 |
|
Female |
78 |
65 |
83.3 |
10 |
12.8 |
3 |
3.9 |
| Rheumatoid arthritis |
Male |
68 |
53 |
77.9 |
12 |
17.6 |
3 |
4.8 |
|
Female |
102 |
77 |
75.4 |
20 |
19.2 |
5 |
4.9 |
There was no significant difference in
response in relation to sex.
TABLE NO. 6
Age incidence and response to
treatment
| Disease |
|
|
|
|
|
Age Group(Years) |
|
|
|
|
|
|
| |
|
-30 |
|
|
31-40 |
|
|
41-50 |
|
|
-50 |
|
|
T |
F |
% |
T |
F |
% |
T |
F |
% |
T |
F |
% |
| Tension headache(144) |
42 |
0 |
0 |
55 |
1 |
1.9 |
27 |
2 |
5.4 |
12 |
1 |
0.1 |
| Sciatic (124 |
3 |
1 |
33 |
11 |
5 |
45.4 |
42 |
2 |
4.8 |
68 |
0 |
0.1 |
| O.A.Knee(210) |
0 |
- |
- |
6 |
1 |
16.6 |
36 |
3 |
8.3 |
168 |
7 |
4.2 |
| Rheumatoid |
55 |
0 |
0 |
81 |
3 |
9.6 |
24 |
3 |
12.5 |
9 |
2 |
22.2 |
There was no significant difference
in response to age im cases of tension headache. In sciatica and
csteoarthritis of knee the failure rate was more in younger patients and
in rhumatoid arthritis it was more in older patiens.
DISCUSSION:
The efficacy of acupuncture in painful conditions is well
documented. Various theories have been offered to expalin how relief of
pain is achieved with acupuncture. Some of the theories which are more
popular include gate control theory of Melzack and wall, Endorphin release
theory pf pomeranz, thalamic neurone theory etc. Eaxh theory has some
pitfalls. It was observed that response was quicker and better in
conditions without an organic damage e.g. tension headache. Probably in
these patients cortical stimulation is more than the thalmic one. Reaction
to pain is more than the pain itself. Though psychological effect of
acupuncture can not be denied absolutely our observations do not support
the hyponosis theory because quite good results were obtained in organic
conditions also.
In younger patients of sciatica and osteoarthritis
knee acupuncture worked less satisfactorily. the underlying cause in
younger patients of sciatica and osteoarthritis of knee was more often a
prolapsed intervertebral disc or underlying bone deformity respectively
disease.
Similarly already patients of rhumatoid arthritis had more
organic damage to their joints and acupuncture was less effective in these
These points favour the gate control theory. Where organic damage is the
cause of ain it acts as a compets with and sometimes overpower the
impulses generated by acupuncture. Such competitor to acupuncture is
absent in 'functional' painful disorders.
Ah-ahi points were used
in all the cases. They are located at the site of the disease. Their
stimulation results in releases of endorphine which trigger & neural
reflexes to produce snslgesia and other healing effect.
In those
condition where muscular spasm in a prominent feature, acupuncture also
acts by breaking the vicions cycle of pain-spasm-pain.
In diseases
like rheumatoid arthritis acupuncture possibly affords additional benefit
by its homeostatic effect.
Acording to ancient thories
acupuncturein creases the flow or OI which helps to rectify its
imbalance.
Moxibustion was also tried in 120 randomly selected
casses. It was used in place of electrical stimulation. The results were
comparable. Moxibustion acts by reducation of heat whih cause auugmented
blood supply which helps in flushing out chemical mediators of pain, like
aerotonine, bradykini, acctylcholine, histamine and
prostaglaudias.
These points reemphasise the fact that effectiveness
of acupuncture can not be explained on the basis of any one theory alon.
Basically the system of acupuncture is based on different principle which
c can not be comapred with modern medical
principles. |