Low back pain in athletes can be controlled with acupuncture by a catecholaminergic pathway: clinical trial

Abstract

Background:

Activation of the sympathetic nervous system attenuates inflammation via catecholamines. Recent evidence has shown that electroacupuncture (EA) activates neuronal networks involved in the release of dopamine and norepinephrine that control systemic inflammation. In muscle, catecholamines are related to cyclic adenosine monophosphate (cAMP). This signaling molecule has been implicated in recovery from sustained contractile activity, which may induce muscular pain, such as that which occurs during low back pain (LBP).

Objective:

Our aim was to evaluate the effects of EA used for the control of LBP on the activation of the sympathetic nervous system in a randomized controlled clinical trial in athletes.

Methods:

Two groups of athletes with acute or chronic low back pain were studied. EA, sham EA and pharmacological treatment (diclofenac sodium) were evaluated. The outcome measures included a pain score represented by a visual analogue scale (VAS) and serum levels of catecholamines quantified by enzyme-linked immunosorbent assay. In addition, blood was collected into chilled heparin tubes, placed in 96-well cell culture plates and incubated with an equal volume of Roswell Park Memorial Institute (RPMI) medium, with lipopolysaccharide (LPS) alone or with catecholamines. Tumor necrosis factor (TNF)-α levels in the supernatants were analyzed.

Results:

The results indicated that the initial pain ratings did not differ between the groups analyzed. EA induced epinephrine secretion but not norepinephrine or dopamine secretion. Although EA and pharmacological treatment did not differ in terms of pain relief, in vitro epinephrine and norepinephrine reduced TNF-α production in response to LPS stimuli.

Conclusion:

EA activates the sympathetic nervous system and induces the release of epinephrine, which could ameliorate inflammation and protect muscular tissue in addition to relieving pain.

Keywords

acupuncture low back pain non-steroidal anti-inflammatory drugs pain management physical therapy sports medicine

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References

Eskinazi

Jobst

KA.

National Institutes of Health Office of Alternative Medicine-Food and Drug Administration workshop on acupuncture. J Altern Complement Med 1996; 2(1): 3–6.

Kagitani

Uchida

Hotta

Afferent nerve fibers and acupuncture. Auton Neurosci 2010; 157(1–2): 2–8.

Torres-Rosas

Yehia

Pena

, et al. Dopamine mediates vagal modulation of the immune system by electroacupuncture. Nat Med 2014; 20(3): 291–295.

Gorth

Shapiro

Risbud

MV.

Discovery of the drivers of inflammation induced chronic low back pain: from bacteria to diabetes. Discov Med 2015; 20(110): 177–184.

Sbriccoli

Solomonow

Zhou

, et al. Static load magnitude is a risk factor in the development of cumulative low back disorder. Muscle Nerve 2004; 29(2): 300–308.

Jaumard

Welch

Winkelstein

BA.

Spinal facet joint biomechanics and mechanotransduction in normal, injury and degenerative conditions. J Biomech Eng 2011; 133(7): 071010.

Vida

Pena

Deitch

, et al. α7-cholinergic receptor mediates vagal induction of splenic norepinephrine. J Immunol 2011; 186(7): 4340–4346.

van Westerloo

Giebelen

Florquin

, et al. The vagus nerve and nicotinic receptors modulate experimental pancreatitis severity in mice. Gastroenterology 2006; 130(6): 1822–1830.

Levy

Fishman

, et al. Parasympathetic stimulation via the vagus nerve prevents systemic organ dysfunction by abrogating gut injury and lymph toxicity in trauma and hemorrhagic shock. Shock 2013; 39(1): 39–44.

10.

Rabbi

Labis

, et al. Central cholinergic activation of a vagus nerve-to-spleen circuit alleviates experimental colitis. Mucosal Immunol 2014; 7(2): 335–347.

11.

Kox

van Eijk

Zwaag

, et al. Voluntary activation of the sympathetic nervous system and attenuation of the innate immune response in humans. Proc Natl Acad Sci U S A 2014; 111(20): 7379–7384.

12.

Whittle

Richards

Husni

, et al. Opioid therapy for treating rheumatoid arthritis pain. Cochrane Database Syst Rev 2011(11): CD003113.

13.

Buch

Emery

New therapies in the management of rheumatoid arthritis. Curr Opin Rheumatol 2011; 23(3): 245–251.

14.

Hawker

Mian

Kendzerska

, et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken) 2011; 63(Suppl. 11): S240–S252.

15.

Melzack

Wall

PD.

Acupuncture and transcutaneous electrical nerve stimulation. Postgrad Med J 1984; 60(710): 893–896.

16.

Pomeranz

Chiu

Naloxone blockade of acupuncture analgesia: endorphin implicated. Life Sci 1976; 19(11): 1757–1762.

17.

Le Bars

Dickenson

Besson

. Diffuse noxious inhibitory controls (DNIC). I. Effects on dorsal horn convergent neurones in the rat. Pain 1979; 6(3): 283–304.

18.

Goldman

Chen

Fujita

, et al. Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nat Neurosci 2010; 13(7): 883–888.

19.

Tsuchiya

Sato

Inoue

, et al. Acupuncture enhances generation of nitric oxide and increases local circulation. Anesth Analg 2007; 104(2): 301–307.

20.

Zhao

Zhang

, et al. Electroacupuncture reduces the expression of proinflammatory cytokines in inflamed skin tissues through activation of cannabinoid CB2 receptors. Eur J Pain 2012; 16(5): 624–635.

21.

da Silva

Bobinski

Sato

, et al. IL-10 cytokine released from M2 macrophages is crucial for analgesic and anti-inflammatory effects of acupuncture in a model of inflammatory muscle pain. Mol Neurobiol 2015; 51(1): 19–31.

22.

Oke

Tracey

KJ.

The inflammatory reflex and the role of complementary and alternative medical therapies. Ann N Y Acad Sci 2009; 1172: 172–180.

23.

Vas

Aranda

Modesto

, et al. Acupuncture in patients with acute low back pain: a multicentre randomised controlled clinical trial. Pain 2012; 153(9): 1883–1889.

24.

Brinkhaus

Witt

Jena

, et al. Acupuncture in patients with chronic low back pain: a randomized controlled trial. Arch Intern Med 2006; 166(4): 450–457.

25.

Foster

Bishop

Bartlam

, et al. Evaluating Acupuncture and Standard carE for pregnant women with Back pain (EASE Back): a feasibility study and pilot randomised trial. Health Technol Assess 2016; 20(33): 1–236.

26.

Dong

Gong

, et al. Effect of electroacupuncture at Zusanli (ST36) and Sanyinjiao (SP6) acupoints on adrenocortical function in etomidate anesthesia patients. Med Sci Monit 2014; 20: 406–412.

27.

van der Poll

Jansen

Endert

, et al. Noradrenaline inhibits lipopolysaccharide-induced tumor necrosis factor and interleukin 6 production in human whole blood. Infect Immun 1994; 62(5): 2046–2050.

28.

Hartmann

Radermacher

Wepler

, et al. Non-hemodynamic effects of catecholamines. Shock 2017; 48(4): 390–400.

29.

Grabovoi

AN.

[Morphologic and histochemical changes of skin nervous apparatus in wound healing following local action of noradrenaline and acetylcholine]. Morfologiia 1999; 115(3): 68–72.

30.

Demoulin

Crielaard

Vanderthommen

Spinal muscle evaluation in healthy individuals and low-back-pain patients: a literature review. Joint Bone Spine 2007; 74(1): 9–13.

31.

Dehner

Schmelz

Volker

, et al. Intramuscular pressure, tissue oxygenation, and muscle fatigue of the multifidus during isometric extension in elite rowers with low back pain. J Sport Rehabil 2009; 18(4): 572–581.

32.

Abboud

Lardon

Boivin

, et al. Effects of muscle fatigue, creep, and musculoskeletal pain on neuromuscular responses to unexpected perturbation of the trunk: a systematic review. Front Hum Neurosci 2016; 10: 667.

33.

Elfellah

Dalling

Kantola

, et al. Beta-adrenoceptors and human skeletal muscle characterisation of receptor subtype and effect of age. Br J Clin Pharmacol 1989; 27(1): 31–38.

34.

Goldfarb

Bruno

Buckenmeyer

. Intensity and duration of exercise effects on skeletal muscle cAMP, phosphorylase, and glycogen. J Appl Physiol 1985 1989; 66(1): 190–194.

35.

Soderling

Hickenbottom

Reimann

, et al. Inactivation of glycogen synthetase and activation of phosphorylase kinase by muscle adenosine 3ʹ,5ʹ-monophosphate-dependent protein kinases. J Biol Chem 1970; 245(23): 6317–6328.

36.

Emrick

Sadilek

Konoki

, et al. Beta-adrenergic-regulated phosphorylation of the skeletal muscle Ca(V)1.1 channel in the fight-or-flight response. Proc Natl Acad Sci U S A 2010; 107(43): 18712–18717.

37.

Clausen

Na+-K+ pump regulation and skeletal muscle contractility. Physiol Rev 2003; 83(4): 1269–1324.

38.

Berdeaux

Stewart

cAMP signaling in skeletal muscle adaptation: hypertrophy, metabolism, and regeneration. Am J Physiol Endocrinol Metab 2012; 303(2): E1–17.

39.

Jager

Putnick

Bornstein

MH.

II . More than just convenient: the scientific merits of homogeneous convenience samples. Monogr Soc Res Child Dev 2017; 82(2): 13–30.