La acupuntura desde la perspectiva experimental
Palabras clave:
acupuntura, estudios clínicos, investigación básica, placeboResumen
En el presente artículo se describe el estado actual de la acupuntura desde la perspectiva de la investigación clínica y experimental. Se hace hincapié en las variables intrínsecas al tratamiento con acupuntura, la planificación del tratamiento según la Medicina Tradicional China y su participación en ensayos clínicos. Asimismo, se revisa la relación del placebo con los efectos de la acupuntura, así como la controversia del “control viable” en los estudios clínicos que señalan efectos inespecíficos. Por otra parte, se reseñan algunas evidencias experimentales obtenidas en modelos animales que muestran los efectos de la acupuntura y la electroacupuntura en diferentes órganos corporales. Finalmente se describe la importancia de establecer vínculos entre la investigación básica y la clínica para establecer el alcance del tratamiento con acupuntura.
Citas
AHN, AC et al., “Electrical properties of acupuncture points and meridians: a systematic review”, Bioelectromagnetics, 2008, núm. 29, pp. 245-256.
AIRD, M., M. Coyle, D.M. Cobbin, C. Zaslawski, “A study of the comparative accuracy of two methods of locating acupuncture points”, Acupuncture in Medicine, 2000, núm. 18, pp. 15–21.
AKAISHI, T., A. Kimura, A. Sato, A. Suzuki, “Responses of neurons in the nucleus basalis of Meynert to various afferent stimuli in rats”, Neuroreport, 1990, núm. 1, pp. 37-39.
BARNES, P.M., B. Bloom, R.L., Nahin, “Complementary and alternative medicine use among adults and children: United States, 2007”, Natl Health Stat Report, 2008, núm. 10, pp. 1-23.
CAMPBELL, A. “Point specificity of acupuncture in the light of recent clinical and imaging studies”, Acupunct Med, 2006, núm. 24, pp. 118-122.
CHANG, SL., et al., “An insulin-dependent hypoglycaemia induced by electroacupuncture at the Zhongwan (CV12) acupoint in diabetic rats”, Diabetologia, 1999, núm. 42, pp. 250-255.
CHERKIN, D.C., et al., “A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain”. Arch Intern Med, 2009, núm. 169, pp. 858-866.
COLQUHOUN, D., S.P. Novella, “Acupuncture is theatrical placebo”, Anesth Analg, 2013, núm. 116, pp. 1360-1363.
COLLOCA, L. F. Benedetti, “Placebos and painkillers: is mind as real as matter?” Nat Rev Neurosci, 2005, núm. 6, pp. 545-552.
COYLE, M. et al., “The cun measurement system: an investigation into its suitability in current practice”, Acupuncture in Medicine, 2000, núm. 18, pp. 10–14.
CRISOSTOMO, M.M. et al., “Nociceptin in rVLM mediates electroacupuncture inhibition of cardiovascular reflex excitatory response in rats”, J Appl Physiol, 1985, núm. 98, pp. 2056-2063.
ELSENBRUCH, S. “How positive and negative expectations shape the experience of visceral pain”, Handb Exp Pharmacol, 2014, núm. 225, pp. 97-119.
ENCK, P. et al., “The placebo response in medicine: minimize, maximize or personalize?”, Nat Rev Drug Discov, 2013, núm. 12, pp. 191-204.
ERNST, E., “Acupuncture a critical analysis”, J Intern Med, 2006, núm. 259, pp. 125-137.
EVERS, A.W., D.J. Bartels, A.I. van Laarhoven, “Placebo and nocebo effects in itch and pain”, Handb Exp Pharmacol, 2014, núm. 225, pp. 205-214.
FU, S.P. et al., “Acupuncture promotes angiogenesis after myocardial ischemia through H3K9 acetylation regulation at VEGF gene”, PLoS One, 2014, núm. 9, pp. e94604, doi: 10.1371.
GIANCOTTI, F.G., E. Ruoslahti, “Integrin signaling”, Science, 1999, núm. 285, pp. 1028-1032.
HAAKE, M. et al., German “Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups”, Arch Intern Med, 2007, núm. 167, pp. 1892-1898.
HOTTA, H. et al., “Stimulation of lumbar sympathetic trunk produces vasoconstriction of the vasa nervorum in the sciatic nerve via alpha-adrenergic receptors in rats”, Neurosci Lett, 1991, núm. 133, pp. 249-252.
INOUE, M., Hojo, T., Yano, T., Katsumi, Y. “Effects of lumbar acupuncture stimulation on blood flow to the sciatic nerve trunk—an exploratory study”, Acupunct Med, 2005, núm. 23, pp. 166-170.
ISA, T., M. Kurosawa, A. Sato, R.S. Swenson, “Reflex responses evoked in the adrenal sympathetic nerve to electrical stimulation of somatic afferent nerves in the rat”, Neurosci Res, 1985, núm. 3, pp. 130-144.
JIN, H.O., et al., “Inhibition of acid secretion by electrical acupuncture is mediated via beta-endorphin and somatostatin”, Am J Physiol, 1996, núm. 271, pp. G524-530.
KAGITANI, F., S. Uchida, H. Hotta, “Afferent nerve fibers and acupuncture”, Auton Neurosci, 2010, núm. 157, pp. 2-8.
KIM, H.W. et al., “Low-frequency electroacupuncture suppresses carrageenan-induced paw inflammation in mice via sympathetic post-ganglionic neurons, while high-frequency EA suppression is mediated by the sympathoadrenal medullary axis”, Brain Res Bull, 2008, núm. 75, pp. 698-705.
KIM, Y.J. et al., “Validation of the Korean version of the Acupuncture Expectancy Scale”, Acupunct Med, 2014, núm. 32, pp. 51-55.
LANGEVIN, H.M., D.L. Churchill, M.J. Cipolla, “Mechanical signaling through connective tissue: a mechanism for the therapeutic effect of acupuncture”, FASEB J, 2001, núm. 15, pp. 2275-2282.
LANGEVIN, H.M. et al., “Paradoxes in acupuncture research: strategies for moving forward”, Evid Based Complement Alternat Med., doi: 10.1155/2011/180805.
LANGEVIN, HM., J.A. Yandow, “Relationship of acupuncture points and meridians to connective tissue planes”, Anat Rec, 2002, núm. 269, pp. 257-265.
LERMAN, IR., et al., “Novel High-Frequency Peripheral Nerve Stimulator Treatment of Refractory Postherpetic Neuralgia: A Brief Technical Note”, Neuromodulation, 2015, doi: 10.1111/ner.12281.
LI, XP., et al., “Effect of electroacupunture on gastric mucosal intestinal trefoil factor gene expression of stress-induced gastric mucosal injury in rats”, World J Gastroenterol, 2006, núm. 12, pp. 1962-1965.
LIAO, JM., et al., “Electroacupuncture-induced pressor and chronotropic effects in anesthetized rats”, Auton Neurosc, 2006, núm. 30, pp. 18-25.
LIU, X.G. et al., “Long-term depression of C-fibre- evoked spinal field potentials by stimulation of primary afferent A delta-fibres in the adult rat”, Eur J Neurosci, 1998, núm. 10, pp. 3069-3075.
LONGHURST, J.C. “Defining meridians: a modern basis of understanding”, J Acupunct Meridian Stud, 2010, núm. 3, pp. 67-74.
LUND, I., J. Näslund, T. Lundeberg, “Minimal acupuncture is not a valid placebo control in randomised controlled trials of acupuncture: a physiologist's perspective”, Chin Med, 2009, núm. 4, pp. 1749-8546.
LUX, G. et al., “Acupuncture inhibits vagal gastric acid secretion stimulated by sham feeding in healthy subjects”, Gut, 1994, núm. 35, pp. 1026-1029.
MACKLIN, EA. et al., “Stop Hypertension with the Acupuncture Research Program (SHARP): results of a randomized, controlled clinical trial”, Hypertension, 2006, núm. 48, pp. 838-845.
MACPHERSON, H. et al., “STRICTA Revision Group. Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT statement”, PLoS Med, 2010, núm. 7, pp. e1000261.
MILLAN, M.J., “Descending control of pain”, Prog Neurobiol, 2002, núm. 66, pp. 355-474.
PEETS, J.M. y B. Pomeranz, “CXBK mice deficient in opiate receptors show poor electroacupuncture analgesia”, Nature, 1978, núm. 273, pp. 675-676.
PORRO, C.A., “Open your mind to placebo conditioning”, Pain, 2009, núm. 145, pp. 2-3.
QIAN, L., L.J. Peters, J.D. Chen, “Effects of electroacupuncture on gastric migrating myoelectrical complex in dogs”, Dig Dis Sci, 1999, núm. 44, pp. 56-62.
QUIROZ-GONZÁLEZ, S., B. Segura-Alegría, J.C. Guadarrama-Olmos, I. Jiménez-Estrada, I. “Cord dorsum potentials evoked by electroacupuncture applied to the hind limbs of rats”, J Acupunct Meridian Stud, 2014, núm. 7, pp. 25-32.
QUIROZ-GONZÁLEZ, S., I. Jiménez-Estrada, “Acupuncture points and their relation with cutaneous receptive fields of neurons”, Complementary therapies in medicine (2015) (enviado).
QUIROZ-GONZÁLEZ, S., B. Segura-Alegría, I. Jiménez-Estrada, “Depressing effect of electroacupuncture on the spinal non-painful sensory input of the rat”, Exp Brain Res, 2014, núm. 232, pp. 2721-2729.
RAMEY, D.W., “Acupuncture points do not exist”, Sci Rev Altern Med, 2001, núm. 5, pp. 140–145.
SANDKÜHLER, J., J.G. Chan, G. Cheng, M. Randić, “Low-frequency stimulation of afferent Adelta-fibers induces long term depression at primary afferent synapses with subtantiagelatinosa neurons in the rat”, J Neurosci, 1997, núm. 17, pp. 6483-6491.
SATO, A., Y. Sato, R.F., Schmidt, “Heart rate changes reflecting modifications of efferent cardiac sympathetic outflow by cutaneous and muscle afferent volleys”, J Auton Nerv Syst, 1981, núm. 4, pp. 231-247.
________, “The impact of somatosensory input on autonomic functions”, Rev Physiol Biochem Pharmacol, 1997, núm. 130, pp. 1-328.
SATO, A., Y. Sato, S. Uchida, “Blood flow in the sciatic nerve is regulated by vasoconstrictive and vasodilative nerve fibers originating from the ventral and dorsal roots of the spinal nerves”, Neurosci Res, 1994, núm. 21, pp. 125-133.
SAVIGNY, P., et al., Low Back Pain: early management of persistent non-specific low back pain, London: National Collaborating Centre for Primary Care and Royal College of General Practitioners, 2009.
SMITH, C., C. Crowther, J. Beilby, “Acupuncture to treat nausea and vomiting in early pregnancy: a randomized controlled trial”, Birth, 2002, núm. 29, pp. 1-9.
STENER-VICTORIN, E., R. Kobayashi, M. Kurosawa, “Ovarian blood flow responses to electro-acupuncture stimulation at different frequencies and intensities in anaesthetized rats”, Auton Neurosci, 2003, núm. 108, pp. 50-56.
STENER-VICTORIN, E. et al., “Effect of electro-acupuncture stimulation of different frequencies and intensities on ovarian blood flow in anaesthetized rats with steroid-induced polycystic ovaries”, Reprod Biol Endocrinol, 2004, núm. 2, pp. 16.
SUZUKI, M. et al., “A randomized, placebo-controlled trial of acupuncture in patients with chronic obstructive pulmonary disease (COPD): the COPD-acupuncture trial (CAT)”, Arch Intern Med, 2012, núm. 172, pp. 878-886.
TOMINAGA, A., et al., “Repeated application of low-frequency electroacupuncture improves high-fructose diet-induced insulin resistance in rats”, Acupunct Med, 2011, núm. 29, pp. 276-283.
UCHIDA, S., F. Kagitani, A. Suzuki, Y. Aikawa, “Effect of acupuncture-like stimulation on cortical cerebral blood flow in anesthetized rats”, Jpn J Physiol, 2000, núm. 50, pp. 495-507.
UCHIDA, S., H. Hotta, “Acupuncture affects regional blood flow in various organs”, Evid Based Complement Alternat Med., 2008, núm. 5, pp. 145-51.
UVNAS-MOBERG, K., T. Lundeberg, G. Bruzelius, P. Alster, “Vagally mediated release of gastrin and cholecystokinin following sensory stimulation”, Acta Physiol Scand, 1992, núm. 146, pp. 349-356.
VINCENT, C., G. Lewith, “Placebo controls for acupuncture studies”, J R Soc Med, 1995, núm. 88, pp. 199-202.
WANG, J., et al., “Electroacupuncture suppresses surgical trauma stress-induced lymphocyte apoptosis in rats”, Neurosci Lett, 2005, núm. 383, pp. 68-72.
WANG, R., et al., “The time course effects of electroacupuncture on promoting skeletal muscle regeneration and inhibiting excessive fibrosis after contusion in rabbits”, Evid Based Complement Alternat Med, doi: 10.1155/2013/869398.
WHITE, A., M. Cummings, “Does acupuncture relieve pain?”, BMJ., 2009, núm. 338, doi:10.1136/bmj.a2760.
WHITE, Peter, Brenda Golianu, Chris Zaslawski y Choi Seung-Hoon, “Estandarización de la nomenclatura en la investigación sobre acupuntura”, Evid. Based Complement. Altern. Med., june 2007, núm. 4, pp. 267-270.
XIA, Y., F. Zhou, D. Huang, (2010). “Neuroanatomic Basis of Acupuncture Points”, en Acupuncture therapy for neurological diseases: a neurobiological view, Xia, Y., Cao, X., Wu, G., Cheng, J. (eds.) Tsinghua University Press, Beijing Heidelberg. Springer: 32-80.
XING, G.G. et al., “Long-term synaptic plasticity in the spinal dorsal horn and its modulation by electroacupuncture in rats with neuropathic pain”, Exp Neurol, 2007, núm. 208, pp. 323-332.
XU, G.Y., J.H. Winston, J.D. Chen, “Electroacupuncture attenuates visceral hyperalgesia and inhibits the enhanced excitability of colon specific sensory neurons in a rat model of irritable bowel syndrome”, Neurogastroenterol Motil, 2009, núm. 21, pp. 1302-e125.
YUAN, J., et al., “Effectiveness of acupuncture for low back pain: a systematic review”, Spine, 2008, núm. 33, pp. E887-900.
ZHANG, R.X. et al., “Electroacupuncture attenuates inflammation in a rat model”, J Altern Complement Med, 2005, núm. 11, pp. 135-142.
ZHANG, Z.J., X.M. Wang, G.M. McAlonan, “Neural acupuncture unit: a new concept for interpreting effects and mechanisms of acupuncture”, Evid Based Complement Alternat Med, 2012, doi: 10.1155/2012/429412.
ZHAO, Z.Q., “Neural mechanism underlying acupuncture analgesia”, Prog Neurobiol, 2008, núm. 85, pp. 355-375.
ZHOU, F., D. Huang, Y. Xia, “Neuroanatomic basis of acupuncture points”, en: Xia, Y. et al., (eds.) Acupuncture therapy for neurological diseases: a neurobiological view, Berlin: Springer, 2010, pp. 32–80.
ZHOU, J. et al., “Logical thinking in pattern differentiation of traditional Chinese medicine”, J Tradit Chin Med, 2013, núm. 33, pp. 137-140.
ZHOU, W. et al., “Afferent mechanisms underlying stimulation modality-related modulation of acupuncture-related cardiovascular responses”, J Appl Physiol, 1985, núm. 98, pp. 872-880.
ZHOU, W., S.C., Tjen-A-Looi, P. Li, “Longhurst, JC. Regulation of sympathoexcitatory cardiovascular responses to gastric distension in rats: role of stimulation modality, frequency and acupoint location”, FASEB J, 2004, núm. 18, pp. A649.
ZHU, D., Y. Gao, J. Chang, J. Kong, “Placebo acupuncture devices: considerations for acupuncture research”, Evid Based Complement Alternat Med, 2013, doi: 10.1155/2013/628907.
ZHU, L., et al., “The effect of neonatal capsaicin on acupuncture analgesia--to evaluate the role of C fibers in acupuncture analgesia”, Zhen Ci Yan Jiu, 1990, núm. 15, pp. 285-291.
Publicado
Número
Sección
Licencia
Derechos de autor 2017 Revista Digital Universitaria

Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.

Revista Digital Universitaria es editada por la Universidad Nacional Autónoma de México se distribuye bajo una Licencia Creative Commons Atribución-NoComercial 4.0 Internacional. Basada en una obra en http://revista.unam.mx/.