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Acupuncture treatment for plantar fasciitis: a randomized controlled trial with six months follow-up.

Zhang SP, Yip TP, Li QS - Evid Based Complement Alternat Med (2011)

Bottom Line: Secondary outcome measures included a VAS for activity pain, overall pain rating as well as pressure pain threshold using algometry.Significant differences in reduction in pain scores, favoring the treatment group, were seen at one month for morning pain (22.6 ± 4.0 versus 12.0 ± 3.0, mean ± SEM), overall pain (20.3 ± 3.7 versus 9.5 ± 3.6) and pressure pain threshold (145.5 ± 32.9 versus -15.5 ± 39.4).No serious adverse event was observed in either group.

View Article: PubMed Central - PubMed

Affiliation: School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China.

ABSTRACT
Plantar fasciitis is a common cause of heel pain. It has been suggested that some acupoints have a specific effect on heel pain. The aim of this study was to determine the efficacy and specificity of acupuncture treatment for plantar fasciitis. Subjects were randomly assigned to the treatment group (n = 28) or control group (n = 25). The treatment group received needling at the acupoint PC 7, which is purported to have a specific effect for heel pain. The control group received needling at the acupoint Hegu (LI 4), which has analgesic properties. Treatment was administered five times a week for 2 weeks, with an identical method of manual needling applied to the two acupoints. The primary outcome measure was morning pain on a 100-point visual analog scale (VAS) at one month post-treatment. Secondary outcome measures included a VAS for activity pain, overall pain rating as well as pressure pain threshold using algometry. Significant differences in reduction in pain scores, favoring the treatment group, were seen at one month for morning pain (22.6 ± 4.0 versus 12.0 ± 3.0, mean ± SEM), overall pain (20.3 ± 3.7 versus 9.5 ± 3.6) and pressure pain threshold (145.5 ± 32.9 versus -15.5 ± 39.4). No serious adverse event was observed in either group. The results indicate that acupuncture can provide pain relief to patient with plantar fasciitis, and that PC 7 is a relatively specific acupoint for heel pain.

No MeSH data available.


Related in: MedlinePlus

A hypothetical diagram illustrating the possible mechanism of acupuncture treatment for plantar fasciitis. Repeated stimulation from inflammation and tissue irritation of the heel will sensitize neurons in the thalamus and habituate them to a state of hyperexcitability, leading to a state of chronic pain. Repeated stimulation from specific acupoints will send input to the same thalamic focus and normalize the excitability of hyperexcitable neurons.
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Related In: Results  -  Collection


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fig6: A hypothetical diagram illustrating the possible mechanism of acupuncture treatment for plantar fasciitis. Repeated stimulation from inflammation and tissue irritation of the heel will sensitize neurons in the thalamus and habituate them to a state of hyperexcitability, leading to a state of chronic pain. Repeated stimulation from specific acupoints will send input to the same thalamic focus and normalize the excitability of hyperexcitable neurons.

Mentions: Although traditional acupuncture theory includes a point selection principle of using points of the upper extremity to treat disease of the lower extremity, and vice versa, no specific acupoint has been proposed for treatment of heel pain from this theory. The underlying mechanism for the specific effect observed is not at all clear. The slow onset and gradual time course of the effects appear to rule out any important contribution of the endogenous opioid system or the DNIC mechanism, as both mechanisms are fast but short acting [9, 41]. In the Chinese literature there are many examples of using individual distal acupoints for pain or inflammation, such as the use of Yaotongdian (EX-UE7) at the hand for acute low back pain, the use of Er Bai (EX-UE2) at the lower arm for hemorrhoids and the use of Quchi (LI 11) for refractory uraemic pruritus [17, 27]. Our results support the purported theory that there exist specific acupoints for the corresponding pain or inflammatory conditions. It has been proposed that prolonged or repeated stimulation habituates neurons in the thalamus to a state of hyperexcitability, leading to a state of chronic pain [42], and stimulation of specific acupoints may adjust the excitability of hyperexcitable neurons in the thalamic focus (Figure 6). In this regard, it is interesting to note that the center of the wrist crease on the palmar side, where PC7 is located, is an anatomical mirror site of the heel. The exact reason for the possible corresponding effect is worthy of further investigation. Functional brain imaging studies may provide insight into mechanisms of the neural network underlying the specificity of acupoints [43].


Acupuncture treatment for plantar fasciitis: a randomized controlled trial with six months follow-up.

Zhang SP, Yip TP, Li QS - Evid Based Complement Alternat Med (2011)

A hypothetical diagram illustrating the possible mechanism of acupuncture treatment for plantar fasciitis. Repeated stimulation from inflammation and tissue irritation of the heel will sensitize neurons in the thalamus and habituate them to a state of hyperexcitability, leading to a state of chronic pain. Repeated stimulation from specific acupoints will send input to the same thalamic focus and normalize the excitability of hyperexcitable neurons.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3094706&req=5

fig6: A hypothetical diagram illustrating the possible mechanism of acupuncture treatment for plantar fasciitis. Repeated stimulation from inflammation and tissue irritation of the heel will sensitize neurons in the thalamus and habituate them to a state of hyperexcitability, leading to a state of chronic pain. Repeated stimulation from specific acupoints will send input to the same thalamic focus and normalize the excitability of hyperexcitable neurons.
Mentions: Although traditional acupuncture theory includes a point selection principle of using points of the upper extremity to treat disease of the lower extremity, and vice versa, no specific acupoint has been proposed for treatment of heel pain from this theory. The underlying mechanism for the specific effect observed is not at all clear. The slow onset and gradual time course of the effects appear to rule out any important contribution of the endogenous opioid system or the DNIC mechanism, as both mechanisms are fast but short acting [9, 41]. In the Chinese literature there are many examples of using individual distal acupoints for pain or inflammation, such as the use of Yaotongdian (EX-UE7) at the hand for acute low back pain, the use of Er Bai (EX-UE2) at the lower arm for hemorrhoids and the use of Quchi (LI 11) for refractory uraemic pruritus [17, 27]. Our results support the purported theory that there exist specific acupoints for the corresponding pain or inflammatory conditions. It has been proposed that prolonged or repeated stimulation habituates neurons in the thalamus to a state of hyperexcitability, leading to a state of chronic pain [42], and stimulation of specific acupoints may adjust the excitability of hyperexcitable neurons in the thalamic focus (Figure 6). In this regard, it is interesting to note that the center of the wrist crease on the palmar side, where PC7 is located, is an anatomical mirror site of the heel. The exact reason for the possible corresponding effect is worthy of further investigation. Functional brain imaging studies may provide insight into mechanisms of the neural network underlying the specificity of acupoints [43].

Bottom Line: Secondary outcome measures included a VAS for activity pain, overall pain rating as well as pressure pain threshold using algometry.Significant differences in reduction in pain scores, favoring the treatment group, were seen at one month for morning pain (22.6 ± 4.0 versus 12.0 ± 3.0, mean ± SEM), overall pain (20.3 ± 3.7 versus 9.5 ± 3.6) and pressure pain threshold (145.5 ± 32.9 versus -15.5 ± 39.4).No serious adverse event was observed in either group.

View Article: PubMed Central - PubMed

Affiliation: School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China.

ABSTRACT
Plantar fasciitis is a common cause of heel pain. It has been suggested that some acupoints have a specific effect on heel pain. The aim of this study was to determine the efficacy and specificity of acupuncture treatment for plantar fasciitis. Subjects were randomly assigned to the treatment group (n = 28) or control group (n = 25). The treatment group received needling at the acupoint PC 7, which is purported to have a specific effect for heel pain. The control group received needling at the acupoint Hegu (LI 4), which has analgesic properties. Treatment was administered five times a week for 2 weeks, with an identical method of manual needling applied to the two acupoints. The primary outcome measure was morning pain on a 100-point visual analog scale (VAS) at one month post-treatment. Secondary outcome measures included a VAS for activity pain, overall pain rating as well as pressure pain threshold using algometry. Significant differences in reduction in pain scores, favoring the treatment group, were seen at one month for morning pain (22.6 ± 4.0 versus 12.0 ± 3.0, mean ± SEM), overall pain (20.3 ± 3.7 versus 9.5 ± 3.6) and pressure pain threshold (145.5 ± 32.9 versus -15.5 ± 39.4). No serious adverse event was observed in either group. The results indicate that acupuncture can provide pain relief to patient with plantar fasciitis, and that PC 7 is a relatively specific acupoint for heel pain.

No MeSH data available.


Related in: MedlinePlus