Comments on: Acupuncture, Adenosine and Cycling Fish http://bodyinmind.org/acupuncture-adenosine-and-cycling-fish/ Research into the role of the brain in chronic pain Tue, 07 Feb 2012 09:36:16 +0000 hourly 1 http://wordpress.org/?v=3.2.1 By: Acupuncture and chronic shoulder pain - CAM or Sham? http://bodyinmind.org/acupuncture-adenosine-and-cycling-fish/#comment-12245 Acupuncture and chronic shoulder pain - CAM or Sham? Mon, 11 Oct 2010 20:55:46 +0000 http://bodyinmind.com.au/?p=3873#comment-12245 [...] TweetHaving written a number of posts on acupuncture (see here, here, and here) I guess my particular biases are reasonably apparent. So imagine my surprise when a large RCT [...] [...] TweetHaving written a number of posts on acupuncture (see here, here, and here) I guess my particular biases are reasonably apparent. So imagine my surprise when a large RCT [...]

]]> By: Richmond Stace http://bodyinmind.org/acupuncture-adenosine-and-cycling-fish/#comment-7185 Richmond Stace Thu, 10 Jun 2010 07:53:25 +0000 http://bodyinmind.com.au/?p=3873#comment-7185 Agreed. The effects of placebo and other higher centre modulatory effects such as past experience, desire for success with treatment, belief that it will work because Aunty Mabel had acupuncture and it relieved her pain etc (which of course can tie into placebo) are likely to be big players in the end result. I, as many others, do embrace the placebo effect generally and look to facilitate this mode of relief in combination with a variety of cognitive and enviromental 'manipulations' (e.g. just being interested in someone's story for example!). From a modern pain perspective, if the acupuncture/dry needling brings about relief then the brain is clearly feeling less threatened by the context. Maybe attentional, distraction, tactile discriminination or all of the above, essentially all methods that I & others use commonly in the clinic. It's a great debate! Agreed. The effects of placebo and other higher centre modulatory effects such as past experience, desire for success with treatment, belief that it will work because Aunty Mabel had acupuncture and it relieved her pain etc (which of course can tie into placebo) are likely to be big players in the end result. I, as many others, do embrace the placebo effect generally and look to facilitate this mode of relief in combination with a variety of cognitive and enviromental ‘manipulations’ (e.g. just being interested in someone’s story for example!).
From a modern pain perspective, if the acupuncture/dry needling brings about relief then the brain is clearly feeling less threatened by the context. Maybe attentional, distraction, tactile discriminination or all of the above, essentially all methods that I & others use commonly in the clinic.
It’s a great debate!

]]> By: Neil O'Connell http://bodyinmind.org/acupuncture-adenosine-and-cycling-fish/#comment-7006 Neil O'Connell Fri, 04 Jun 2010 06:24:21 +0000 http://bodyinmind.com.au/?p=3873#comment-7006 Blimey Richmond that is some response! I don't want to say too much as I have a larger post (written before this adenosine caper) arriving on BIM soon. The problem is not so much the study (although it is debatable whether there are good reasons to hunt down specific mechanisms for acupuncture at this stage) but the interpretation. The information on adenosine and its actions is interesting but the way it has been spun, not just by the media but also in the press release (and to a degree in the intro and discussion of the paper), with little consideration of the existing evidence is misleading. Patients and therapists understandably want treatments to work and want to believe they are underpinned by science and will grab hold of this kind on news with both hands. In terms of "slamming", I reckon active debate and critique underpin good science and hopefully will ultimately lead to more reliable information being bandied about (he said optimistically). Blimey Richmond that is some response! I don’t want to say too much as I have a larger post (written before this adenosine caper) arriving on BIM soon.

The problem is not so much the study (although it is debatable whether there are good reasons to hunt down specific mechanisms for acupuncture at this stage) but the interpretation. The information on adenosine and its actions is interesting but the way it has been spun, not just by the media but also in the press release (and to a degree in the intro and discussion of the paper), with little consideration of the existing evidence is misleading. Patients and therapists understandably want treatments to work and want to believe they are underpinned by science and will grab hold of this kind on news with both hands.

In terms of “slamming”, I reckon active debate and critique underpin good science and hopefully will ultimately lead to more reliable information being bandied about (he said optimistically).

]]> By: Richmond Stace http://bodyinmind.org/acupuncture-adenosine-and-cycling-fish/#comment-6986 Richmond Stace Thu, 03 Jun 2010 14:50:42 +0000 http://bodyinmind.com.au/?p=3873#comment-6986 There's nothing quite like an article to provoke a huge debate, and in essence this is a great thing! We do seem to default to 'slamming' others work so if some good can be found then we will all be happier and tweak our immune systems.... So indeed it does seem that sticking a needle into tissue (anywhere?) can cause the release of adenosine. We understand that this purine nucleoside is involved in many physiological processes including suppressing inflammation (Manjunath & Sakhare, 2009), stimulating angiogenesis (Fedholm, 2007), wound closure (Montesinos et al., 2002), inhibition of immune cells (Sitkovsky et al., 2003), its formation triggered by injury or stress. Clearly inserting a needle covers both of these and therefore any trauma could be expected to stimulate a similar local response. Therefore it is questionable that this is a specific reaction to acupuncture or needling. In fact, as far as I understand it, there are no known specific responses to these techniques. Obviously the clarification of the application type is essential in any analysis, i.e. is this traditional acupuncture using the recognised points or dry needling where other thought systems are in process? From a scientific viewpoint it seems sensible to look at possible effects of creating a local albeit small trauma upon the neuraxis in its entirety, i.e. top-down and bottom-up. How does the brain perceive this overall interaction (thought of the technique understanding, past experience, views of significant others, how it is explained & applied, cultural effects, the environment, timing of the day in relation to biorhythms, anxiety & fear, expectation etc etc) and the threat value? A defensive reaction will be incurred as one would expect and clearly this includes attention to the area being treated, perhaps some local pain or discomfort, various chemicals released through the nervous system, modulation in the SC and higher centres according to some of the mentioned factors. Within this thinking there is ample room for integrating the placebo effect and the underpinning physiology of this system. Pain is a multisystem output and although this can be daunting it does give us a variety of ‘ins’ to modulate the activity in the pain matrix. Techniques and interventions need to take into account of the state of the nervous system, how we can influence the neuroimmune interactions, affect the functioning of the SNS to name but a few. Acupuncture could be one of these modalities and we do often see and hear about the relief after treatment. However, as scientists and clinicians we should want to know why and how and this is the problem. We don’t really know if there are any specific actions with so many variables including those aforementioned. So where does that leave us? Should we use acupuncture/needling or forget it? There is some really good work in the paper in terms of looking at the release of adenosine and what happens when the receptors are played with, essentially offering a treatment angle without the need for acupuncture. There’s nothing quite like an article to provoke a huge debate, and in essence this is a great thing! We do seem to default to ‘slamming’ others work so if some good can be found then we will all be happier and tweak our immune systems….
So indeed it does seem that sticking a needle into tissue (anywhere?) can cause the release of adenosine. We understand that this purine nucleoside is involved in many physiological processes including suppressing inflammation (Manjunath & Sakhare, 2009), stimulating angiogenesis (Fedholm, 2007), wound closure (Montesinos et al., 2002), inhibition of immune cells (Sitkovsky et al., 2003), its formation triggered by injury or stress. Clearly inserting a needle covers both of these and therefore any trauma could be expected to stimulate a similar local response. Therefore it is questionable that this is a specific reaction to acupuncture or needling. In fact, as far as I understand it, there are no known specific responses to these techniques. Obviously the clarification of the application type is essential in any analysis, i.e. is this traditional acupuncture using the recognised points or dry needling where other thought systems are in process?
From a scientific viewpoint it seems sensible to look at possible effects of creating a local albeit small trauma upon the neuraxis in its entirety, i.e. top-down and bottom-up. How does the brain perceive this overall interaction (thought of the technique understanding, past experience, views of significant others, how it is explained & applied, cultural effects, the environment, timing of the day in relation to biorhythms, anxiety & fear, expectation etc etc) and the threat value? A defensive reaction will be incurred as one would expect and clearly this includes attention to the area being treated, perhaps some local pain or discomfort, various chemicals released through the nervous system, modulation in the SC and higher centres according to some of the mentioned factors. Within this thinking there is ample room for integrating the placebo effect and the underpinning physiology of this system.
Pain is a multisystem output and although this can be daunting it does give us a variety of ‘ins’ to modulate the activity in the pain matrix. Techniques and interventions need to take into account of the state of the nervous system, how we can influence the neuroimmune interactions, affect the functioning of the SNS to name but a few. Acupuncture could be one of these modalities and we do often see and hear about the relief after treatment. However, as scientists and clinicians we should want to know why and how and this is the problem. We don’t really know if there are any specific actions with so many variables including those aforementioned.
So where does that leave us? Should we use acupuncture/needling or forget it? There is some really good work in the paper in terms of looking at the release of adenosine and what happens when the receptors are played with, essentially offering a treatment angle without the need for acupuncture.

]]> By: Neil O'C http://bodyinmind.org/acupuncture-adenosine-and-cycling-fish/#comment-6976 Neil O'C Thu, 03 Jun 2010 06:27:12 +0000 http://bodyinmind.com.au/?p=3873#comment-6976 More excellent coverage of this can be found here: http://www.dcscience.net/?p=3136 http://scienceblogs.com/insolence/2010/06/when_what_an_acupuncture_study_shows_is.php http://www.sciencebasedmedicine.org/?p=5452 http://www.theness.com/neurologicablog/ Oh and if you've got too much time on your hands I've begun to reluctantly tweet! @neiloconnell More excellent coverage of this can be found here:

http://www.dcscience.net/?p=3136
http://scienceblogs.com/insolence/2010/06/when_what_an_acupuncture_study_shows_is.php
http://www.sciencebasedmedicine.org/?p=5452
http://www.theness.com/neurologicablog/

Oh and if you’ve got too much time on your hands I’ve begun to reluctantly tweet! @neiloconnell

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