Observation on Warm Needling Therapy for Third Lumbar Vertebra Transverse Process Syndrome

Community Health Service Centre, Sandun Town, Xihu District, Hangzhou, Zhejiang Province, Hangzhou 310007, China

CLINICAL STUDY

Observation on Warm Needling Therapy for Third Lumbar Vertebra Transverse Process Syndrome

Zou Chang-li

Community Health Service Centre, Sandun Town, Xihu District, Hangzhou, Zhejiang Province, Hangzhou 310007, China

Author: Zou Chang-li, bachelor, attending physician.

E-mail: wzzyong@126.com

Objective: To observe the effect of warm needling therapy plus acupuncture on third lumbar vertebra transverse process syndrome.

Methods: Sixty cases of third lumbar vertebra transverse process syndrome were randomly divided into a warm needling group or an acupuncture group, 30 cases in each group. Cases in the acupuncture group were treated by routine points and needle sticking manipulation, while those in the warm needling group were treated by moxibustion plus needling as same as the acupuncture group. Japanese orthopedic association scores (JOA) in the two groups were observed and compared after 2 treatment courses.

Results: After treatment, the JOA score in the warm needling group was higher than that in the acupuncture group (P＜0.01); subjective symptom, clinical syndromes, activity of daily living (ADL) in the warm needling group were all higher than those in the acupuncture group (allP＜0.05); the score of pain in the warm needling group was significantly lower than that in the acupuncture group (P＜0.01); the total effective rate in the warm needling group was 76.7%, versus 70.0% in the acupuncture group, showing a statistically significant difference (P＜0.05).

Conclusion: Warm needling therapy is more effective than normal acupuncture in treating third lumbar vertebra transverseprocess syndrome.

Acupuncture Therapy; Acupuncture-moxibustion Therapy; Warm Needling Therapy; Third Lumbar Vertebrae Syndrome; Low Back Pain

Third lumbar vertebra transverse process syndrome is a common disease in department of orthopedics and traumatology. Patients may experience chronic low back pain due to the tissue damage around the third lumbar vertebrae. This disease is mainly characterized by notable tenderness in the third lumbar vertebrae, which is also called the third lumbar vertebra transverse process slippery bursa phlogistic or the third lumbar vertebra transverse process surrounding inflammation. Surveys showed that the third lumbar vertebra transverse process accounted for 1/3-1/2 of patients with lumbocrural pain[1], even 50%-60% in clinic[2]. Severe cases with obstinate refractory low back pain were affected normal work and life activities and may consume huge medical resources. Acupuncture and moxibustion were used a lot in treating the third lumbar vertebra transverse process in clinic.

In order to seek a better treatment method for third lumbar vertebra transverse process syndrome, I treated 60 cases with acupuncture and warm needling therapy, now the results are summarized as follows.

1 Clinical Materials

1.1 Diagnostic criteria

The diagnostic criteria referred to the diagnostic criteria of third lumbar vertebra transverse process syndrome in theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[3]: with a history of sudden sprain due to bending, or long-term chronic strain or getting cold in the low back, young or middle-aged blue-collar workers are susceptible to this disease; chronic low back pain on one side, getting worse in the morning or when bending over, difficulty sitting up straight, sometimes the pain radiating to the lower limb and knees; notable tenderness and palpable hard nodules in the third lumbar vertebra transverse process; X-ray examination indicating extended or asymmetric third lumbar vertebra transverse process.

1.2 Inclusion criteria

Those who met the above diagnostic criteria; aged between 20 and 60 years old; not accepting any other treatment in recent; willing to participate in the study and having signed the informed consent, willing to obey the arrangement of the doctor, and cooperate with treatment and follow-up.

1.3 Exclusion criteria

Pregnant women; those suffering from cardiovascular and/or cerebrovascular diseases, autoimmune disease, hematopathy, hepatopathy, nephropathy, and severe infections; those younger than 20 or older than 60 years old.

1.4 Rejection criteria

Not in conformity with the above diagnostic and inclusion criteria; those who cannot complete the treatment; those who failed to stick to the treatment protocol.

1.5 Statistical method

The SPSS 13.0 version statistical software was used for statistical analysis. The measurement data met the normal distribution were processed byt-test, which did not meet normal distribution was processed by Wilcoxon rank sum test.P＜0.05 indicated a statistical significance.

1.6 General data

A total of 60 eligible patients were randomly divided into an acupuncture group or a warm needling group with 30 cases in each. There were no statistical differences between the two group in gender, age, duration and diseased region (P＞0.05), indicating that the two groups were comparable (Table 1).

Table 1. Between-group comparison of general data

2 Treatment Methods

2.1 Acupuncture group

Points: Jiaji (EX-B 2) points of the first and second lumbar vertebra on the affected side, tender point of the third lumbar vertebra transverse process.

Operation: The locations of points are based on theLocation of Points(National Standard of the People’s Republic of China, GB12346-90)[4]. Bilateral points were selected for pain on both sides. Ask the patients to take a prone position. Disposable acupuncture needles of 0.30 mm in diameter and 75 mm in length were routinely sterilized. Then twirled the needles in a single direction slowly with index finger forward and thumb backward until the needles were stuck so as to strengthen the needling sensation and made it reach the third lumbar vertebra transverse process. Then, the same size needle was obliquely inserted into the tender point of the third lumbar vertebra transverse process with 60° angle until the tip of needle reached the tip of the third lumbar vertebra transverse process. Reducing manipulation with lifting-thrusting and twirling was performed for 1 min after qi arrival and the needles were retained for 30 min. Treatment was given once a day, 10 times as a course, with a 2-day interval between two courses, the patients were treated for 2 courses in total.

2.2 Warm needling group

Points: Same points as those in the acupuncture group.

Operation: Same acupuncture methods as those in the acupuncture group were used for the patients in the warm needling group. After the needles were inserted into the points, a moxa cone of 1.5-2 cm in length was stuck on the handle of the needle at the tender point on L3transverse process. When a moxa cone was burnt to end, another one would be put on. The treatment was given once a day, 10 times as a course, with a 2-day interval between two courses; the patients were treated for 2 courses in total.

3 Therapeutic Efficacy Observation

3.1 Major index

The scale for lower back pain of Japanese Orthopedic Association scores (JOA)[5]including three parts: subjective symptoms (9 points), clinical signs (6 points) and activity of daily living (ADL, 14 points). The highest global score is 29 points and the lowest total score is 0 point. The lower the score, the more serious the illness.

3.2 Secondary index

Tenderness was evaluated with visual analogue scale (VAS)[6]. VAS is a measurement instrument with pain expression and marked with 1-10 to express the degree of pain, 0 for painless, 1-3 for mild pain, 4-6 for moderate pain, 7-9 for severe pain, 10 for extreme pain. Patients marked on the line the point that they felt representing their perception of their current pain severity. The VAS score was determined by measuring the distance from 0 to the point that the patient marked.

3.3 Therapeutic evaluation

Therapeutic efficacy was evaluated by the improvement rate according to the total score of JOA before and after treatment.

Improvement rate ＝ (Total score of JOA after treatment － Total score of JOA before treatment) ÷ (29 － Total score of JOA before treatment) × 100%.

Cure: Improvement rate was 100%.

Marked effect: Improvement rate ＞60%, but＜100%.

Improvement: Improvement rate ≥25%, but≤60%.

Failure: Improvement rate ＜25%.

3.4 Results

Of the 60 cases enrolled, all patients completed the treatment, and none of them dropped out.

3.4.1 Between-group comparison of JOA score before and after treatment

Before treatment, there were no statistically significant differences in subjective symptoms, clinical signs, ADL and JOA scores between the two groups (allP＞0.05). After treatment, subjective symptoms, clinical signs, ADL and JOA scores in both groups were substantially improved (allP＜0.01), indicating that both methods are effective. After treatment, JOA global score in the warm needling group was significantly higher than that in the acupuncture group (P＜0.01); also, the subjective symptoms, clinical signs and ADL score in the warm needling group were all higher than those in the acupuncture group (P＜0.05), indicating a better effect in the warm needling group (Table 2).

Table 2. Between-group comparison of indexes before and after treatment (point)

Table 2. Between-group comparison of indexes before and after treatment (point)

Note: Intra-group comparison, 1) P＜0.01; compared with the acupuncture group after treatment, 2) P＜0.05，3) P＜0.01

3.4.2 Between-group comparison of VAS score before and after treatment

Before treatment, there was no between-group statistically significant difference in VAS score (P＞0.05). After treatment, VAS scores in both groups were significantly decreased (P＜0.01), indicating that the two methods can both alleviate the pain syndrome. Also, VAS score in the warm needling group significantly lower than that in the acupuncture group, indicating a better effect in improvement of pain in the warm needling group (Table 3).

3.4.3 Between-group comparison of clinical effect

The total effective rate in the warm needling group was 76.7%, versus 70.0% in the acupuncture group, showing a statistically significant difference (P＜0.05), indicating a better effect in the warm needling group (Table 4).

Table 3. Between-group comparison of VAS score (point)

Table 3. Between-group comparison of VAS score (point)

Note: Intra-group comparison, 1) P＜0.01; compared with the acupuncture group after treatment, 2) P＜0.01

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Table 4. Between-group comparison of clinical effect (case)

4 Discussion

Acute or chronic lumbar injury is the main cause of third lumbar vertebra transverse process syndrome. The changes of blood vessels around the tip of the third lumbar vertebra transverse process and local tissue can cause or aggravate the pathological change of local tissue around the tip of the third lumbar vertebra transverse process[7]. Left untreated, acute injury or chronic strain may cause tension of lumbar dorsal fascia or muscle, make the ipsilateral or contralateral torn and soft tissue damage, and leakage, bleeding, edema around the tip of the transverse process, and then cause the pathological changes such as adhesion and thickening of surrounding soft tissue of transverse process. Plus, the nerve and blood vessels are then compressed by inflammatory stimuli and mechanical extrusion also, thus causing pain.

The results showed that the two methods can both effectively improve the JOA score, symptoms, signs and ADL of patients, and obviously alleviate the pain of the tenderness around the third lumbar vertebra transverse process. This study found that warm needling therapy is more effective than acupuncture therapy alone.

Pain transmission inhibition of acupuncture on the spinal cord level varies by tissue of points; the richer the tissue, the better the effect[8]. Moreover, direction, angle, and depth of the needle all affect the analgesia effect of acupuncture. In general, for treat soft tissue pain, it would be better to find the most painful point, acupuncture obliquely to a proper depth[9]. Therefore, in this research, the sticking needling technique was used to strengthen the needle sensation and release the soft tissue adhesions. For the scar and adhesion formed by the deep tissue injury, this technique can puncture on the lesions directly, which can not be reached by massage therapy. The sticking needling technique can also make up the disadvantage that massage therapy can just press closely to the bone, but could not work on the area away from bone[10-12].

Warm needling therapy delivers the heating effect to the diseased region along with the needle, which can promote the local blood circulation and diminish aseptic inflammation quickly, then make the partial peripheral nerve stimulation to reduce or disappear. Clinical research found that warm needling therapy produces both analgesic effect of acupuncture and warming, dredging and anti-inflammatory effect of moxibustion, thus obtaining remarkable effects on third lumbar vertebra transverse process syndrome[13-14]. Compared with the acupuncture therapy, heating effect of warm needling therapy can directly improve the blood circulation around the tip of the transverse process and effectively support the tissues, thus improved the pathological changes around the tip of the third lumbar vertebra transverse process. That’s why warm needling therapy is more effective than acupuncture alone.

Although acupuncture is a promising therapy for the third lumbar vertebra transverse process syndrome, there are too many different points and various operating manipulations and no uniform standard. It is urgent to explore a set of scientific, standardized treatment protocol. Most clinical researches only report the clinical effect without studying mechanism of acupuncture, which needs to be done in the future.

Conflict of Interest

The author declared that there was no potential conflict of interest.

Acknowledgments

This work was supported by the Community Health Service Centre, Sandun Town, Xihu District, Hangzhou.

Statement of Informed Consent

All of the patients in the study signed the informed consent.

[1] Li PS, Kang ZC. Comprehensive treatment of 30 cases with third lumbar vertebra transverse process syndrome. Zhongguo Shiyong Yiyao, 2008, 3(34): 86-87.

[2] Wang WD, Wang YL. China Acupotomy Clinical Essential. Beijing: People's Medical Publishing Press, 2009: 287.

[3] State Administration of Traditional Chinese Medicine. Criteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine. Nanjing: Nanjing University Press, 1994: 203.

[4] China State Bureau of Technical Supervision. Location of Point (GB/T 12346-90). Standards Press of China, 1991.

[5] Guo CQ, Li SL, Qiao JL, Dong FH, Liu NG, Jiang ZX, Chen ZL, Zhu HZ. Multicenter and randomized controlled clinical trial of acupotomy therapy in treatment of third lumbar vertebra transverse process syndrome. Chengdu Zhongyiyao Daxue Xuebao, 2012, 35(1): 20-23.

[6] Guo CQ, Qiao JL, Dong FH, Li SL, Jiang ZX, Liu NG, Chen ZL, Zhu HZ. Effects of acupotomy therapy on local tenderness point in patients with third lumbar vertebra transverse process syndrome: a randomized controlled clinical trial. Zhonghua Zhongyiyao Xuekan, 2012, 30(6): 1191-1193.

[7] Ni CM, He JJ, Zhao A. The base and clinical study on the syndrome of third lumbar vertebra transverse process. Zhongguo Gushang, 1998, 11(2): 23-24.

[8] Li CM. Central and peripheral mechanisms of hand needle in the process of analgesia. Guowai Yixue: Zhongyiyao Fence, 1995, 17(5): 9-11.

[9] Fan GQ, Zhao Y, Fu ZH. Acupuncture analgesia and the direction, angle and depth of needle insertion. Zhongguo Zhenjiu, 2010, 30(11): 965-968.

[10] Kong XF. Observations on the efficacy of sticking of needle in treating shoulder periarthritis. Shanghai Zhenjiu Zazhi, 2009, 28(11): 648-649.

[11] Liang YA, Wang LL. Therapeutic observation on “green tortoise probing cave” operation plus stuck needle method in treating transverse process syndrome of the third lumbar vertebra. J Acupunct Tuina Sci, 2009, 7(5) 286-287.

[12] Lu CM. Therapeutic observation of the treatment of periarthritis of shoulder with needle-sticking therapy on motion-triggered tenderness points. Shanghai Zhenjiu Zazhi, 2014, 33(2): 162-164.

[13] Xu F. Needle warming therapy for the treatment of the transverse process of the third lumbar vertebra. Zhongguo Gushang, 2010, 23(6): 440-443.

[14] Li XL. Warm needling therapy for third lumbar vertebra transverse process syndrome: a randomized controlled trial. J Acupunct Tuina Sci, 2011, 9(3): 196-198.

Translator: Yang Ling

R246.2

: A

Date: April 20, 2014