Volume 9, Number 2 | Summer 2014

Japanese Acupuncture – Current Research
Japanese Traditional Medicine Text (12) –Orthopedic Medicine

Keisho Ishimaru

Professor
Department of Health Sciences
Ryotokuji University

St36, appeared to provide similar analgesic effects
for post chest and abdominal surgery patients.
Please refer to Figure 8 for these clinically usefulresults. (Table 8)2-8)

Potentially relevant publications originallyidentified and screened for retrieva（l n＝126）

B. Post-operative Pain
Post-operative

specific point and treatment area, notably, LI4 andadvances

inanesthetic

management have been shown to decrease theNot RCTs （n＝61）

incidence of post anesthesia pain and complications.
However, the remaining challenges are to minimize

No postoperative pain measurements
reported（n＝39）

the side effects and over-reliance on pain relief drugs,
such as morphine. In recent years, there has been

TENS at no acupuncture points（n＝2）

interest domestically to inhibit post-operative painand complications. To this end, numerous reports
from the of practices complementary and alternative

Paediatric studies（n＝1）

medicine (CAM) using acupuncture analgesia which
may activate the descending pain inhibitory system

Trials where control intervention wasneither placebo control nor shamcontro（l n＝8）

as a means to reduce reliance on morphine.
1. The current situation of Clinical research abroad
We conducted a PubMed search using theRCTs suitable for inclusion（n＝15）

keywords “postoperative pain” and “acupuncture” for
RCTs included in systematic review but
excluded from meta─analysis becauseof unsuitable data presentation（n＝5）

all post-operative pain research up until 2010 andfound 174 relevant references. Several reports
included SR and RCT evidence based research. Sunet al.1) of Duke University discusses the details ofRCTs suitable for inclusion（n＝15）

post-operative pain relief through acupuncture in asurvey style systematic review of 15 papers (FigureFigure 7 Systematic Review of Acupuncture for Post7). The articles referring to acupuncture treatment

operative pain by Sun Y et al.

for post-operative pain included 8 papers on chest
and abdominal surgeries, 4 on general orthopedic

2. Current Situation of Clinical Research in Japansurgeries and the last 3 focused on oral surgeries.

We searched relevant medical search engines for

Various acupuncture methods were used fromthe key words “Neuropathic pain” and ”Acupunctureauriculartoand Moxibustion treatment” for references between

stimulation

1983 and 2010 and extracted 44 references. However,(TEAS). These researchers found reductions inmost of these reports were case studies and only one

numbers of postoperative complaints, amounts of

was an RCT5). It is clear that most Japanese

analgesics requested and noted the pain-relieving

acupuncture

effects of these modalities. Excluding the effects ofmanagement uses electro-acupuncture and TEAS

the auricular acupuncture, the aim of using arather than auricular acupuncture.

andtranscutaneous

2electro-acupuncture

electricalacupoint

research

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

forpost-operativepain

Volume 9, Number 2 | Summer 2014

Additionally, in a consensus statement issued by
the United States National Institute of Health (NIH)
it was concluded that acupuncture is effective for

3. Management challenges for the application ofacupuncture analgesia for post- operative pain
Post-operative pain following abdominal andchemotherapy-chest surgeries may vary with incision length,

induced nausea and vomiting and postoperative

invasiveness of the procedure, length of timedental pain (1997). With a few references omitted,

required for the procedure. Pain management begins

published literature is presented providing evidencewith preoperative epidural anesthesia (pre-emptivethatanalgesia)

postoperative

pain

acupunctureinisgeneral,effectiveforchestand(leadinganalgesic)

and

is

thenabdominal post-operative pain (Table 8). Many ofsupplemented with postoperative intravenous painthese reports on acupuncture analgesia use electro

medication controlled by the patient with a button

acupuncture at distal points on the arms or legs. The(patient controlled analgesia PCA)6). These methods

mechanism advocated by many researchers refers toare quite stable way to manage pain. PCA methods,

the descending pain inhibitory system, thereby

combined with the application of acupuncture

stimulating endorphins, and other endogenous

analgesia,

analgesia mechanisms. Clinical efforts to reduce themanagement needs to be better understood in an

amount of analgesics, such as morphine, especiallyanticipation of reducing the dose of analgesics

in the early post-operative stages, to reduce theinjected into the epidural. Further research isincidence of such as gastrointestinal motility bynecessary to investigate the potential of effectively

postoperative ileus4). We compared acupuncture

reducing postoperative complications such as POVN

analgesia for pain management after abdominal

and PI by implementing complementary, alternative

surgery with a “no-intervention” control groupand integrative medicines.

including

perioperative

anesthetic(Table 9). Ten of the 11 subjects in the control grouprequired normal doses of analgesics, whereas for the11 subjects in the acupuncture treatment group(Table 10) only one was not to reduce the amount ofnecessary analgesics. We attribute these results tothe involvement ofβ endorphins5).

Table 8

Acupuncture Analgesia for Chest and Abdominal Post-Operative Pain Management

Researcher (year)

Treatment area

Acupoint stimulation area

Wang2) (1997)
Chen3) (1998)

Lower abdomen (digestive organs)
Lower abdomen (uterus)

LI4
ST36

Ishimaru5) (1999)

Abdominal area (digestive organs)LI4, ST36

Kotani4) (2001)

Abdominal area (digestive organs)

Urinary bladder channel(BL17 ─ 26)

Lin6) (2002)

Lower abdomen (uterus)

ST36Sim7) (2002)

Lower abdomen (uterus)

LI4Wang8) (2006)

Chest/trunk area (lungs)

LI4, GB34 etc.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Acupuncture pain
management (minutes)
TEAS (30 minutes)
TEAS (30 minutes)

Electro-acupuncture(3 hours)
Embedded needles(4 day retention)
Electro-acupuncture(20 minutes)
Electro-acupuncture(45 minutes)
Electro-acupuncture(20-30 minutes)

3Volume 9, Number 2 | Summer 2014

Table 9Relationship between the Degree of Postoperative Pain and Analgesic UseNoAgeSex

163M

Surgical procedure
SubtotalAnesthesiatime(minutes)Rightafter
operaton

150

2gastrectomy
268

M

Colorectal

high2251150

2anterior resection
370

M

Colorectal

highanterior resection

3 hours
after
operation
26 hours after
operation
3pentazocine 1A1

12diclofenac sodium

9 hours after
operation

12 hours
after
operation

10

1

1

10

10

350mg

458174

M
M

Cholecystectomy

120

Subtotal

215

2

2

3pentazocine 1A

2gastrectomy

32

2diclofenac

1sodium 25mg
671

M

Colorectal

lower

210

2anterior resection

312diclofenac

1sodium 25mg
7874

31M

M

Total gastrectomy

Subtotal

225

180133pentazocine

diclofenac sodium

1A25mg2diclofenac sodium

2gastrectomy

2200001022325mg

980

F

Cholecystectomy

50

232diclofenac sodium
25mg

1069

M

Subtotal

290

1gastrectomy

32diclofenac sodium
25mg

1170

F

Subtotal

205

2

gastrectomy

32diclofenac sodium
50mg

Post Surgical Pain Evaluation

40: no pain,

1: low degree of pain,

2: persistent pain,

3: persistent pain and analgesic use.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 9, Number 2 | Summer 2014

Table 10

Relationship between the use of acupuncture analgesia for post-operative pain and the use ofanalgesics
NoAgeSex

Surgical procedure

Anesthesia
time(minutes)

Rightafter
operaton

167

M

Choledochojejunos

220

2

170

2-tomy
271

M

Right

hemi-

cholectomy

3 hours
after
operation

Elctroacupuncture
6 hours after
operation

9 hours
after
operation

12 hours
after
operation

1000

1100371

M

Total gastrectomy

395

20000457

M

Cholecystectomy

160

20000567

M

Cholecystectomy

75

11000641M

Subtotal

175

21100210

21001000100000001100

gastrectomy
757

M

Subtotalgastrectomy

3diclofenac
sodium 50mg

865

M

Colorectal

high

166

1225

2200

2

anterior resection
988

F

Abdominalperineal resection

1082

M

Subtotalgastrectomy

andcholecystectomy
1153

F

Subtotal

166

2

gastrectomy
Post Surgical Pain Evaluation

0: no pain,

1: low degree of pain,

2: persistent pain,

3: persistent pain and analgesic use.

References

requirement, and sympathoadrenal responses.

1) Sun Y, Gan TJ, Dubose JW, et al.: Acupuncture

Anesthesiology 95: 349─ 356, 2001

and related techniques for post-operative pain: a5) Keisho Ishimaru, Kenji Imai et al.: Effect ofsystematic review of randomized controlled

acupuncture analgesia for post-operative pain

trials. Br J Anaesth 101: 151─ 160, 2008

following abdominal surgery – peripheral blood2) Wang B, Tang J, White PF, et al : Effect of theβ-endorphin and ACTH as indicators ─. Journal

intensity of transcutaneous acupoint electricalof the Japanese Pain Clinic Society 1 (6): 10─16,stimulation on the postoperative analgesic

1999

requirement. Anesth Analg 85: 406─ 413, 1997
3) Chen L, Tang J: The effect of location of6) Lin JG, Lo MW: The effect of high and low
frequency electroacupuncture in pain after lower

transcutaneous electrical nerve stimulation onabdominal surgery. Pain 99: 509─ 514, 2002

postoperative opioid analgesic requirement:

7) Sim CK, Xu PC: Effects of electroacupuncture on

acupoint

versusnonacupoint

stimulation.

N,Hashimoto

H:andpostoperativeanalgesic

requirement. Acupunct Med 20: 56─65, 2002

Anesth Analg 87: 1129─1134, 1998
4) Kotani

intraoperative

Pre-operative8) WongRH,Lee

TW:

Analgesic

effectof

intradermal acupuncture reduces postoperativeelectroacupuncture in post-thoracotomy pain: apain,

prospective randomized trial. Ann Thorac Surg

nauseaandvomiting,analgesic

81: 2031─ 2036, 2006

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

5