Acupuncture Modulates Facial Warm Sensory Thresholds

Aims: To assess the effects of four- and six-point acupuncture on facial sensory detection thresholds to thermal and electrical stimuli. Methods: Ten healthy volunteers underwent four-point acupuncture at ST6 and LI4 bilaterally for 15 minutes. A further 10 subjects underwent six-point acupuncture by adding needling at ST2 bilaterally. Sensory testing to thermal and electrical stimuli applied to mental and infraorbital nerve dermatomes was performed at baseline, 10 minutes, 1 hour, and 1 day after needling. Results: In the mental and infraorbital nerve dermatomes, six-point acupuncture significantly increased warm threshold by a peak mean of 1.1 degrees C to 1.4 degrees C (repeated measures ANOVA P = .001) and this effect was significant at all time points relative to baseline (P < .05). No significant effects were observed by the four-point acupuncture on warm thresholds, and neither four- nor six-point acupuncture significantly altered electrical detection thresholds. Conclusion: A dose effect, related to the number of points employed, may be present when employing acupuncture.

A -fibers;C-fibers;electrical thresholds;warm thresholds

1.Barnes PM, Bloom B, Nahin RL. CDC National Health Statistics Report #12. Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007. Washington, DC: Centers for Disease Control, 2008:1–24.

2.DeBar LL, Vuckovic N, Schneider J, Ritenbaugh C. Use of complementary and alternative medicine for temporomandibular disorders. J Orofac Pain 2003;17:224–236.

3.Myers CD. Complementary and alternative medicine for persistent facial pain. Dent Clin North Am 2007;51:263–274.

4.Rosted P, Bundgaard M, Pedersen AM. The use of acupuncture in the treatment of temporomandibular dysfunction: An audit. Acupunct Med 2006;24:16–22.

5.Hopton A, Macpherson H. Acupuncture for chronic pain: Is acupuncture more than an effective placebo? A systematic review of pooled data from meta-analyses. Pain Pract 2010;10:94–102.

6.Witt CM, Pach D, Brinkhaus B, et al. Safety of acupuncture: Results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Forsch Komplementmed 2009;16:91–97.

7.Ernst E. Homeopathic prophylaxis of headaches and migraine? A systematic review. J Pain Symptom Manage 1999; 18:353–357.

8.Cho SH, Whang WW. Acupuncture for temporomandibular disorders: A systematic review. J Orofac Pain 2010;24: 152–162.

9.La Touche R, Angulo-Diaz-Parreno S, de-la-Hoz JL, et al. Effectiveness of acupuncture in the treatment of temporomandibular disorders of muscular origin: A systematic review of the last decade. J Altern Complement Med 2010;16:107–112.

10.Ernst E, Pittler MH. The effectiveness of acupuncture in treating acute dental pain: A systematic review. Br Dent J 1998;184: 443–447.

11.Melchart D, Linde K, Fischer P, et al. Acupuncture for idiopathic headache. Cochrane Database Syst Rev 2001;(1):CD001218.

12.Melchart D, Thormaehlen J, Hager S, Liao J, Linde K, Weidenhammer W. Acupuncture versus placebo versus sumatriptan for early treatment of migraine attacks: A randomized controlled trial. J Intern Med 2003;253:181–188.

13.Coeytaux RR, Kaufman JS, Kaptchuk TJ, et al. A randomized, controlled trial of acupuncture for chronic daily headache. Headache 2005;45:1113–1123.

14.Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for tension-type headache. Cochrane Database Syst Rev 2009;(1):CD007587.

15.Melchart D, Streng A, Hoppe A, et al. Acupuncture in patients with tension-type headache: Randomised controlled trial. BMJ 2005;331:376–382.

16.Melzack R, Wall PD. Pain mechanisms: A new theory. Science 1965;150:971–979.

17.Foster JM, Sweeney BP. The mechanisms of acupuncture analgesia. Br J Hosp Med 1987;38:308–312.

18.Cheng RS, Pomeranz BH. Electroacupuncture analgesia is mediated by stereospecific opiate receptors and is reversed by antagonists of type I receptors. Life Sci 1980;26:631–638.

19.Fields HL, Basbaum AI. Brainstem control of spinal pain-transmission neurons. Annu Rev Physiol 1978;40:217–248.

20.Dubner R, Bennett GJ. Spinal and trigeminal mechanisms of nociception. Annu Rev Neurosci 1983;6:381–418.

21.Sessle BJ, Hu JW, Dubner R, Lucier GE. Functional properties of neurons in cat trigeminal subnucleus caudalis (medullary dorsal horn). II. Modulation of responses to noxious and nonnoxious stimuli by periaqueductal gray, nucleus raphe magnus, cerebral cortex, and afferent influences, and effect of naloxone. J Neurophysiol 1981;45:193–207.

22.Sheng LL, Nishiyama K, Honda T, Sugiura M, Yaginuma H, Sugiura Y. Suppressive effects of Neiting acupuncture on toothache: An experimental analysis on Fos expression evoked by tooth pulp stimulation in the trigeminal subnucleus pars caudalis and the periaqueductal gray of rats. Neurosci Res 2000; 38:331–339.

23.Cheng RS, Pomeranz B. Electroacupuncture analgesia could be mediated by at least two pain-relieving mechanisms; endorphin and non-endorphin systems. Life Sci 1979; 25:1957–1962.

24.Langevin HM, Churchill DL, Cipolla MJ. Mechanical signaling through connective tissue: A mechanism for the therapeutic effect of acupuncture. Faseb J 2001;15:2275–2282.

25.Langevin HM, Churchill DL, Fox JR, Cipolla MJ. Biomechanical response to acupuncture needling in humans. J Appl Physiol 2001;91:2471–2478.

26.Zhao CH, Stillman MJ, Rozen TD. Traditional and evidencebased acupuncture in headache management: Theory, mechanism, and practice. Headache 2005;45:716–730.

27.Bing Z, Villanueva L, Le Bars D. Acupuncture and diffuse noxious inhibitory controls: Naloxone-reversible depression of activities of trigeminal convergent neurons. Neuroscience 1990;37:809–818.

28.Yonehara N, Sawada T, Matsuura H, Inoki R. Influence of electro-acupuncture on the release of substance P and the potential evoked by tooth pulp stimulation in the trigeminal nucleus caudalis of the rabbit. Neurosci Lett 1992;142:53–56.

29.Chaitow L. The Acupuncture Treatment of Pain. Rochester: Healing Arts, 1990:94–113.

30.Stux G, Pomeranz B. Basics of Acupuncture. Berlin: Springer, 1998:109–110.

31.Goddard G, Karibe H, McNeill C, Villafuerte E. Acupuncture and sham acupuncture reduce muscle pain in myofascial pain patients. J Orofac Pain 2002;16:71–76.

32.Schmid-Schwap M, Simma-Kletschka I, Stockner A, et al. Oral acupuncture in the therapy of craniomandibular dysfunction syndrome: A randomized controlled trial. Wien Klin Wochenschr 2006;118:36–42.

33.Shen YF, Goddard G. The short-term effects of acupuncture on myofascial pain patients after clenching. Pain Pract 2007;7:256–264.

34.Benoliel R, Birenboim R, Regev E, Eliav E. Neurosensory changes in the infraorbital nerve following zygomatic fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:657–665.

35.Eliav E, Teich S, Nitzan D, et al. Facial arthralgia and myalgia: Can they be differentiated by trigeminal sensory assessment?Pain 2003;104:481–490.

36.Angst MS, Tingle M, Phillips NG, Carvalho B. Determining heat and mechanical pain threshold in inflamed skin of human subjects. J Vis Exp 2009;(23)doi:10.3791/1092.

37.Gracely RH, Lota L, Walter DJ, Dubner R. A multiple random staircase method of psychophysical pain assessment. Pain 1988;32:55–63.

38.Eliav E, Gracely RH, Nahlieli O, Benoliel R. Quantitative sensory testing in trigeminal nerve damage assessment. J Orofac Pain 2004;18:339–344.

39.Yarnitsky D, Sprecher E. Thermal testing: Normative data and repeatability for various test algorithms. J Neurol Sci 1994;125:39–45.

40.Eliav E, Gracely RH. Measuring and assessing pain. In: Sharav Y, Benoliel R (eds). Orofacial Pain and Headache. Edinburgh: Mosby-Elsevier, 2008:45–56.

41.Benoliel R, Biron A, Quek SY, Nahlieli O, Eliav E. Trigeminal neurosensory changes following acute and chronic para nasal sinusitis. Quintessence Int 2006;37:437–443.

42.Kalladka M, Proter N, Benoliel R, Czerninski R, Eliav E. Mental nerve neuropathy: Patient characteristics and neurosensory changes. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:364–370.

43.Leung AY, Kim SJ, Schulteis G, Yaksh T. The effect of acupuncture duration on analgesia and peripheral sensory thresholds. BMC Complement Altern Med 2008;8:18.

44.Wang N, Hui-Chan C. Effects of acupoints TENS on heat pain threshold in normal subjects [in English]. Chin Med J 2003;116:1864–1868.

45.Downs NM, Kirk K, MacSween A. The effect of real and sham acupuncture on thermal sensation and thermal pain thresholds. Arch Phys Med Rehabil 2005;86:1252–1257.

46.Buettner HM, Shreiber DI, Langevin HM. Acupuncture tissue mechanisms. Sci Med 2005;10:81–83.

47.Dung HC. Acupuncture points of the cranial nerves. Am J Chin Med 1985;12:80–92.

48.Langevin HM, Yandow JA. Relationship of acupuncture points and meridians to connective tissue planes. Anat Rec 2002;269:257–265.

49.Kim HY, Wang J, Lee I, Kim HK, Chung K, Chung JM. Electroacupuncture suppresses capsaicin-induced secondary hyperalgesia through an endogenous spinal opioid mechanism. Pain 2009;145:332–340.

50.Zheng Z, Feng SJ, Costa C, Li CG, Lu D, Xue CC. Acupuncture analgesia for temporal summation of experimental pain: A randomised controlled study. Eur J Pain 2010;14:725–731.

51.Barlas P, Ting SL, Chesterton LS, Jones PW, Sim J. Effects of intensity of electroacupuncture upon experimental pain in healthy human volunteers: A randomized, double-blind, placebo-controlled study. Pain 2006;122:81–89.

52.aguchi T, Taguchi R. Effect of varying frequency and duration of electroacupuncture stimulation on carrageenan-induced hyperalgesia. Acupunct Med 2007;25:80–86.

53.Shen YF, Younger J, Goddard G, Mackey S. Randomized clinical trial of acupuncture for myofascial pain of the jaw muscles. J Orofac Pain 2009;23:353–359.

54.La Touche R, Angulo-Diaz-Parreno S, de-la-Hoz JL, et al. Effectiveness of acupuncture in the treatment of temporomandibu-lar disorders of muscular origin: A systematic review of the last decade. J Altern Complement Med 2010;16:107–112.

55.List T, Helkimo M, Karlsson R. Pressure pain thresholds in patients with craniomandibular disorders before and after treatment with acupuncture and occlusal splint therapy: A controlled clinical study. J Orofac Pain 1993;7:275–282.

56.Eliav E, Teich S, Benoliel R, et al. Large myelinated nerve fiber hypersensitivity in oral malignancy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:45–50.