Philip A.M. Rogers MRCVS

AP in Pain and Painful Conditions


Bonebrake_AR; Fernandez JE; Dahalan JB; Marley RJ (1993) A treatment for carpal tunnel Syndrome: results of a follow-up study. J Manipulative Physiol Ther Mar-Apr 16(3):125-139. National Inst of Clin AP, Wichita, KS 67208. This study was a follow-up evaluation of carpal tunnel Syndrome (CTS) subjects based on objective and subjective measures utilizing a conservative treatment method. It was hypothesized that the CTS individuals would maintain their improvements over the course of a 6-mo period after treatments. The design used was a case-control study in which the improvements of the CTS subjects were compared within themselves and with a matched comparison group. The treatments were performed at a private chiropractic clinic, and the objective and subjective measures were independently taken in an industrial engineering Lab. All CTS subjects were volunteers from a random sample. 43 individuals were evaluated at the pretreatment period and in the 6-mo follow-up. Only 22 subjects returned for reevaluation. The treatment duration was not controlled. CTS subjects had maintained improvements in most objective measures and pain and distress ratings over the pretreatment level.

Bülow_HH; Christensen BV; Wilbek H; Iuhl IU; Dreijer NC; Rasmussen HF (1992) Predictive value of subjective and objective evaluation before AP treatment. AJCM 20(1):17-23. Anaesthes Dept, Central Hospital, Nyk F, Denmark. To evaluate if it is possible to predict the outcome of AP treatment in patients with knee osteoarthrosis, 6 treatments were given during a 3 wk period. Follow-up time was 9-17 wk. 7 parameters were evaluated to examine if they had any influence on the outcome of treatment: Age, duration of disease, pain, range of knee movement, analgesic consumption, knee score (an objective and subjective evaluation of the knees) and x-ray changes. 29 patients were included with a total of 42 osteoarthritic knees waiting for a total knee replacement. The median age was 69.2 yr, and median duration of disease was 4.2 yr. 85% of the participants reported a subjective effect, and in 88% an objective effect was found. Although there were some significant differences when you looked at the 7 parameters above, the pattern was not a consistent one. Follow up results also indicated that those with the best immediate results, not necessarily were the ones with the best long-term effect. AP treatment of osteoarthritic knees has an unpredictable outcome. Immediate results do not indicate long-term results; AP research must include a follow-up period.

Chacon_SC; Huguenin MTC; Lopez HS; Trigos GM; Vila AMB (1996) Dysplasia of the Hip in a Dog: EAP. Point Vet Feb 27(173):8. SC Chacon, Fac Med Vet, Mexico City, DF, Mexico.

Christensen_BV; Juhl IU; Vilbek H; Bulow HH; Dreijer NC; Rasmussen HF (1992) AP treatment of severe knee osteoarthrosis: A long-term study. Acta Anaesthesiologica Scandinavica Aug 36(6):519-525. Dept of Anaesthesiol, Central Hospital, Nykobing-Falster, Denmark. (Also reported in Ugeskr Laeger 6 Dec 1993 155(49):4007-4011). Effects of AP treatment were studied for 49 wk in patients waiting for arthroplastic surgery. 29 patients with osteoarthritic knees (42 knees) were randomized to 2 groups (A=AP treatment; B=untreated control). Analgesic consumption, pain and objective measurements were registered. All objective measures were done by investigators who were "blinded" as to Group A & B. After 9 wk (part 2 of the study), Group B (17 patients), as well as group A, was treated once/mo. Registration of analgesic consumption, pain and objective measurements continued. Compared with group B, AP significantly reduced pain, analgesic consumption and most objective measures in the first 9 weeks. In part 2 of the study (both groups on AP-treatment) both groups reported 80% subjective improvement, and range of movement of the knee increased significantly, especially in the worst knees. Results were significantly better in those who had not been ill for a long time. AP can ease the discomfort while waiting for an operation. Part 2 of the study showed that AP can be maintain the improvements over long periods, and perhaps even serve as an alternative to surgery. 7 patients responded so well that at present they do not want surgery. (9000 US$ saved/operation).

Fargas-Babjak_AM; Pomeranz B; Rooney PJ (1992) AP-like Stimulation with Codetron for rehabilitation of Patients with Chronic Pain Syndrome and Osteoarthritis. AETRIJ 17(2):95-105. AP is one of the oldest healing methods which is used in TCM. In the Mod Med, we are witnessing a renaissance of this ancient treatment applied mainly in the management of chronic pain. Many modern technological changes are being applied to replace, or modify, classical AP. They include a new, non-habituating form of TENS, the CODETRON. This delivers AP-like stimulation in a random order. It had been evaluated clinically in a multidisciplinary pain clinic; that was an uncontrolled trial in patients who came for AP therapy over a period of 2 yr. Here, we present results from a later 6-wk double-blind randomized placebo controlled pilot trial in osteoarthritis of the hip/knee. The beneficial effect confirmed our initial results. Other indications, efficacy and experiences of CODETRON are discussed.

Faure_Antonietti_F; Antonietti C; Estanove S; Ninet J; Vigneron M; Champsaur G (1992) [Treatment of early scapulohumeral pain by traditional Chinese AP after heart surgery (letter)]. Presse Med 27 Jun 21(24):1130. In French.

Haker_E1; Lundeberg T (1990) AP treatment in epicondylalgia: a comparative study of two AP techniques [see comments]. Clin J Pain Sep 6(3):221-226. Dept of Physiol II, Karolinska Inst, Stockholm, Sweden. The purpose of this study was to compare the pain-alleviating effect of classical AP with superficial needle insertion in 82 patients suffering from lateral epicondylalgia. Sessions were 20 min long, 2-3 times/wk with 10 treatments in all. 5 AP points were treated: LI10,11,12, LU05 and TH05. After 10 treatments significant differences were observed between the groups favouring the classical AP technique in relation to subjective and objective outcome. No such difference was observed at follow-ups after 3 mo and 1 yr. Classical "deep" AP was better than shallow needle insertion in short-term symptomatic treatment of lateral epicondylalgia, but not at the 3-mo and 12-mo follow-up.

Haker_E2; Lundeberg T (1990) Laser treatment applied to AP points in lateral humeral epicondylalgia: A double-blind study. Pain Nov 43(2):243-247. Dept of Physiol II, Karolinska Inst, Stockholm, Sweden. 49 patients suffering from lateral humeral epicondylalgia were enrolled in a double-blind study to observe the effects of Ga-As laser applied to AP points. The Mid 1500 IRRADIA laser machine was used, wavelength: 904 nm, mean power output: 12 mW, peak value: 8.3 W; frequency: 70 Hz (pulse train). Localization of points: LI10,11,12, LU05 and TH05. Each point was treated for 30 s, giving a dose of 0.36 J/point. The patients were treated 2-3 times/wk for 10 sessions. Follow-ups were done after 3 mo and 1 yr. No significant differences were observed between the laser and the placebo group in relation to the subjective or objective outcome after 10 treatments or at the follow-ups.

Hauzeur_JP (1995) Role of conservative treatment in impingement Syndromes of the shoulder. Rev Med Brux Jul-Aug 16(4):171-177. Service de Rhumatologie, Hopital Erasme, Bruxelles. The impingement Syndrome of the shoulder is primary when the origin is abnormalities of the coracoacromial arch, or secondary when the problem concerns the tendons, the hyperlaxity of the joint or an imbalance between the different muscles. In all cases, treatment has to be initially conservative, including analgesics, anti-inflammatory drugs and rehabilitation. These therapeutic procedures are reviewed.

Hu_Ja2 (1991) How to treat tennis elbow with AP?. JTCM Dec 11(4):302. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC.

Huang_W (1996) Analysis on Therapeutic Effects of 46 Cases of Periarthritis of Shoulder Treated by Needling JianSanZhen (NA15) With Magnetic Pole Needle and Massage. Affiliated Concord Hospital of Tongji Med Univ, 430022, PRC. Adapted from WWW. Experimental Group E (n=46) of periarthritis of shoulder was treated by needling NA15 with magnetic pole needle and massage; cure rate was 93% and effective rate was 100%. AP Control Group 1 (n=23) received needle AP and massage; the effective rate was 91%. Comparison of the therapeutic effects between groups E and 1 showed X23D4.12 p<.05. AP Control Group 2 (n=23) received needle AP at ST38 through BL57; the effective rate was 83%. Comparison of the therapeutic effects between groups E and 2 showed X23D8.492, p<.01. The therapeutic effect in group E was superior to that in control groups 1 and 2. The methods used in control groups 1 and 2 are still amongst the most effective methods treating this disease at present.

Jia_H; Li Q (1993) Treatment of periomarthritis with scalp AP therapy: a report of 210 cases. JTCM Sep 13(3):199-201. People's Hospital, Dongming County, Shandong Province, PRC.

Li_X; Mu-D (1992) Massage and AP in 58 cases of superior clunial neuralgia. JTCM Dec 12(4):288-289. Affiliated Hospital of Changchun College of TCM, Jilin Province, PRC.

Lin_ML3; Huang CT; Lin JG; Tsai SK (1994) A comparison between the pain relief effect of EAP, regional nerve block and EAP plus regional nerve block in frozen shoulder. Acta Anaesthesiol Sin Dec 32(4):237-242. Dept of Anaesthesiology, Taipei Municipal Chung-Hsing Hospital, ROC. Frozen shoulder is a kind of spontaneous, progressive periarthritis over the shoulder joint. The etiology is not yet clear. Traditional treatments for frozen shoulder included conservative Med therapy, physical therapy, nerve block and AP and so on. The purpose of our study is to determine the pain relief effect of EAP, regional nerve block (RNB) and the combination of EAP + RNB for frozen shoulder. 150 patients with fresh frozen shoulder were, assigned at random to 3 groups: 1=RNB with stellate ganglion block and suprascapular nerve block by 10 ml of 1% xylocaine (n=50); 2=EAP at local AP points LI15, GB21, Chien-Nei-Ling, AhShi point (n=50); 3=EAP+RNB, with AP first, followed by the regional nerve block (n=50). 6 vectors of movements were checked in all methods. Bromage score (4 grades) was used to assess pain: 1=no pain; 2=slight pain (e.g. pain on motion); 3=moderate pain (e.g. pain in silence); 4=severe pain (e.g. request analgesics). The range of shoulder joint was recorded also. Patients were offered a second treatment if pain recurred. The onset (time from injection to maximal pain relief), duration (time from injection to grade 3), Bromage score and side effects were recorded. EAP, or RNB, alone gave pain relief in frozen shoulder, but the combination of both methods (EAP + RNB) gave significantly better pain control, longer duration and better range of movement of the shoulder joint.

Marr_CM; Love S; Boyd JS; McKellar Q (1993) Factors Affecting the Clinical Outcome of Injuries to the Superficial Digital Flexor Tendon in National Hunt and Point-to-Point Racehorses. Vet Rec 8 May 132(19):476-479. CM Marr, Univ Cambridge, Dept Clin Vet Med, Madingley Rd, Cambridge CB3 0ES, UK. The severity of injuries to the superficial digital flexor tendon in 73 National Hunt or point-to-point racehorses was defined by ultrasonography and the factors influencing the outcome of the cases were examined. 46% returned to work with a mean time out of training of 13.5 mo. Recurrence rate of the injury was 35%. The severity of the lesions was related to the outcome; 100% of mildly affected horses worked and 63% of them raced in a mean time of 10.2 mo; 50% of moderately affected horses worked and 30% raced with a mean time out of training of 11 mo; 30% of the severely affected horses worked and 23% raced with a mean time out of training of 18 mo. Differences in outcome between unilateral and bilateral injuries within each severity group were not statistically significant. 67% of horses treated with polysulphated glycosaminoglycans worked, compared with 46% of conservatively managed horses and 50% of horses treated with laser therapy but these differences were not statistically significant and the rate of recurrence of the injury in the horses treated with polysulphated glycosaminoglycans was 50% compared with only 31% in the conservatively managed horses. 70% of mares and 47% of geldings were retired from racing.

Molsberger_A; Hille E (1994) The analgesic effect of AP in chronic tennis elbow pain. Brit J of Rheumatol Dec 33(12):1162-1165. Orthopadische Klinik, Universitat Dusseldorf, Germany. The immediate analgesic effect of a single non-segmental AP stimulation treatment on chronic tennis elbow pain was studied with placebo-controlled single-blind trial completed by 48 patients. Before and after treatment, all patients were examined physically by an unbiased independent examiner. 11-point box scales were used for pain measurement. Patients in the true group were treated at non-segmental distal points (homolateral leg) for elbow pain following Chinese AP rules. Patients in the placebo group were treated with placebo AP avoiding penetration of the skin with an AP needle. Overall reduction in the pain score was 56% (S=2.95) in the true group and 15% (S=2.77) in the placebo group. After one treatment 19/24 patients in the true group (79%) reported pain relief of at least 50% (placebo group: 6/24). The mean duration of analgesia after one treatment in the true group was 20.2 h (S=21.5) and in the placebo group 1.4 h (S=3.5). The results were statistically significant (p <.01). Non-segmental AP had intrinsic analgesic effects, which exceeded that of placebo AP, in the treatment of clinical tennis elbow pain.

Takeda_W; Wessel J (1994) AP for the treatment of pain of osteoarthritic knees. Arthritis Care Res Sep 7(3):118-122. The aim was to determine whether AP was more effective than sham AP in the reduction of pain in persons with osteoarthritis (OA) of the knee. 40 subjects (20 men, 20 women) with radiographic evidence of OA of the knee were stratified by gender and assigned at random to two groups: 1=AP therapy and; 2=Sham AP therapy. Subjects were treated 3 times/wk for 3 wk and evaluated at 3 test sessions. Outcome measures were: 1.        the Pain Rating Index of the McGill Pain Questionnaire; 2.        the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, and 3) pain threshold at 4 sites at the knee. The analyses of variance showed that both real and sham AP significantly reduced pain, stiffness, and physical disability in the OA knee, but that there were no significant differences between groups. AP was not more effective than sham AP to treat OA pain.

Tekeoglu_I; Adak B; Ercan M (1996) Suppression of Experimental Pain by Ear-pressure. Adapted from WWW. In a controlled trial at a Univ Clinic of Physical Therapy and Rehab, healthy student volunteers were given Ear-pressure to study its analgesic effect. There were 2 study groups, each containing 30 volunteers. The first group was given Ear-pressure to the toe somatic point on the ear, with pressure sensitivity being measured on the skin of the toe with an algometer device before and after ear stimulation. The controls had the same measurements with placebo stimulation to the ear. Ear-pressure gave a statistically significant increase in pain threshold; no significant change occurred in the placebo controls. Ear-pressure is a useful method to suppress post-traumatic somatic pain.

Thomas_M1; Eriksson SV; Lundeberg T (1991) A comparative study of diazepam and AP in patients with osteoarthritis pain: a placebo controlled study. AJCM 19(2)95-100. Dept of Physiol II, Karolinska Inst, Stockholm, Sweden. 44 patients with chronic cervical osteoarthritis took part in this study. Patients were treated with AP, sham-AP, diazepam or placebo-diazepam in randomized order. Pain was rated on visual analogue scales before, during, and after treatment. 2 scales were separately used to rate the intensity (sensory component) and the unpleasantness (affective component) of pain. Diazepam, placebo-diazepam, AP and sham-AP have a more pronounced effect on the affective than on the sensory component of pain. AP was significantly more effective than placebo-diazepam (p <.05), but not significantly more effective than diazepam or sham-AP.

Wang_J; Wang W; Wang S (1993) Treatment of periarthritis humeroscapularis with AP and acupoint blocking. JTCM Dec 13(4):262-263. Changchun College of TCM, Jilin Province, PRC.

Wang_W; Yin X; He Y; Wei J; Wang J; Di F (1990) Treatment of periarthritis of the shoulder with AP at the Zuzhongping (L 14) extrapoint in 345 cases. JTCM Sep; 10(3): 209-12. Beijing Garrison Hospital, PRC.

Zhang_F; Miao Y (1990) AP treatment for sprains of the ankle joint in 354 cases. JTCM Sep 10(3):207-208. PLA Hospital of 86515 Troops, PRC.

Zhang_M (1991) Treatment of periomarthritis with AP at GB34. JTCM Mar 11(1):9-10. Dept of AP, Hospital for Mental Diseases Jiangdu County, Jiangsu Province, PRC.

Zhong_J (1991) AP treatment in 96 cases of superior cluneal nerve injury. JTCM Dec 11(4):259-260. Hai'an County Hospital, Jiangsu Province, PRC.

Zwolfer_W1; Grubhofer G; Cartellieri M; Spacek A (1992) AP in gonarthrotic pain: "Bachmann's knee program". AJCM 20(3-4):325-329. Dept of Anaesthesia and Intensive Care, Univ of Vienna, Austria. In a retrospective study 35 patients with gonarthrotic pain were treated with AP at the outpatient unit of the Dept of Anaesthesia and Intensive Care in the Univ of Vienna. The subjective effectiveness of the treatment using a standard method on the knee showed that patients reported an explicit improvement of their ailments. We can unreservedly recommend this program, which was only augmented through additive "locus dolendi" treatment if indicated.