Stimulated by Arriaga-Pizano et al 2020.
This paper was published online on 20th May, and it took me a while before I had a closer look and discovered that it is really quite unique. It was a subsequent paper published a week later, a systematic review of acupuncture in low back pain (LBP), that led me to considering devoting a blog to the topic.
Having looked a bit closer at Arriaga-Pizano et al, I am quite excited to tell you why this is such a unique paper. It is relatively small (n=36 plus n=24) and focuses or rather healthy males (athletes), but it includes lots of different aspects: electroacupuncture (EA) vs sham; EA vs diclofenac; treatment of induced LBP; treatment of chronic LBP; release of catecholamines after EA; and assessment of the potential anti-inflammatory effect of those catecholamines released by EA. So, it packs quite a lot into a single paper.
We don’t get so many papers submitted from Mexico, and that made me peruse the author list. There I saw a name that is etched into my memory from 2014. The last author is the same Rafael Torres-Rosas that published on the effect of EA in a mouse model of septic shock with Luis Ulloa in Nature Medicine. I subsequently invited Luis to speak at a BMAS meeting, and then bumped into Rafael presenting in Munich a few years later.
Just to remind you, this paper from Nat Med demonstrated that EA seemed to prevent mice dying of septic shock. In that set of experiments, dopamine appeared to be the key catecholamine, but in the current paper it is adrenaline aka epinephrine. Adrenaline is produced from noradrenaline (norepinephrine NE), which in turn is produced from dopamine, dihydroxyphenylalanine (aka levodopa), tyrosine and originally phenylalanine.
Arriaga-Pizano et al recruited 24 athletes with chronic LBP and randomised them to daily sessions of EA for 5 days, or 12 hourly diclofenac 100mg for the same time period. The athletes performed their normal training sessions each day, and their pain was evaluated using a visual analogue score (VAS).
Another group of athletes (n=36), who initially had no LBP, were randomised to three groups. One group (n=12) trained normally and were given 5 days of EA. They had blood samples taken at three time points to measure catecholamines. The remaining athletes (n=24) were subjected to a hard training regime designed to induce acute LBP. As soon as their LBP reached a moderate level the extra training was stopped and they either received EA or sham EA for 5 days. The sham was a superficial off-meridian technique with leads attached but no electrical stimulation applied.
And there’s more!
As well as measuring catecholamines in the blood of healthy, normally training athletes subjected to 5 days of EA, the research team took the same blood and cultured it in a standard medium or in lipopolysaccharide (LPS) for 3 hours before measuring tumour necrosis factor (TNF). They studied the effect of increasing doses of NE, epinephrine and dopamine in inhibiting production of leucocyte-derived TNF.
What did they find?
EA was better than sham in reducing acute LBP, EA was similar to diclofenac in reducing chronic LBP. EA resulted in increased blood levels of epinephrine, no increase in NE, and dopamine was not detected. NE and epinephrine were associated with a reduction in LPS-stimulated TNF in the athletes peripheral blood.
The bottom line is that EA may have both a pain relieving and anti-inflammatory effect in both acute (training-induced) and chronic LBP in athletes.
1 Arriaga-Pizano L, Gómez-Jiménez DC, Flores-Mejía LA, et al. Low back pain in athletes can be controlled with acupuncture by a catecholaminergic pathway: clinical trial. Acupunct Med Published Online First: 20 May 2020. doi:10.1177/0964528420912251
2 Li Y-X, Yuan S, Jiang J, et al. Systematic review and meta-analysis of effects of acupuncture on pain and function in non-specific low back pain. Acupunct Med Published Online First: 27 May 2020. doi:10.1136/acupmed-2017-011622
3 Torres-Rosas R, Yehia G, Peña G, et al. Dopamine mediates vagal modulation of the immune system by electroacupuncture. Nat Med 2014;20:291–5. doi:10.1038/nm.3479