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논문 기본 정보

자료유형
학술저널
저자정보
Yeow Leng Tan (Department of Rehabilitation Medicine Singapore General Hospital Singapore)
저널정보
대한약침학회 Journal of Acupuncture & Meridian Studies Journal of Acupuncture & Meridian Studies Vol.14 No.5
발행연도
2021.10
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173 - 175 (3page)

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Dear Editor, I read with interest the case report titled “Acupuncture in Post-Stroke Shoulder Pain Syndrome with Multiple Sclerosis: A Case Study” by Gan and Santorelli [1] and would like to comment regarding the use of acupuncture in central poststroke pain (CPSP). First, it is an excellent consideration by Gan et al to choose acupuncture as a non-pharmacological modality to treat CPSP. CPSP leads to disabling pain, which can be spontaneous or evoked. It is well-established even in multiple sclerosis without cerebral vascular infarct that the central pain can cause disabling symptoms with a prevalence of approximately 30% [2]. While the pathophysiology of CPSP remains incompletely understood with central disinhibition and complex involvement of the spinothalamocortical pathway leading to allodynia or dysesthesia, the analgesic role of acupuncture cannot be underestimated [3]. The pain reduction in this case report illustrated the analgesic effects of acupuncture and I applaud the success in pain treatment and functional improvement observed at 6 weeks. Therefore, for patients diagnosed with CPSP, the use of acupuncture coupled with physical therapy and oral analgesics might be a useful combined treatment strategy. On the research front, I agree future high-quality randomized control trials with the three arms of acupuncture, i.e., acupuncture with conventional therapy, sham acupuncture with conventional therapy, and only conventional therapy, might further reveal the therapeutic effectiveness of acupuncture in reducing pain and restoring upper limb function. Second, I support the authors’ decision for not using the four acupoints in consideration of the patient’s safety. Having said so, it is important for acupuncturists to realize that very few strict contraindications have been documented for the use of acupuncture for various therapeutic aims. Therefore, it is paramount that acupuncturists exercise appropriate clinical judgement in conducting the acupuncture treatment and the choice of the acupuncture points [4]. Despite the lack of strict contraindications, the authors did exercise appropriate clinical judgement and adopt a flexible approach in choosing the acupuncture points, seeking the contralateral side of the body as an alternative acupuncture treatment site. Contralateral acupuncture is also known as opposite needling or cross needling. At present, evidence pertaining to the use of contralateral acupuncture being superior to ipsilateral acupuncture in terms of the overall treatment outcome of post-stroke hemiplegic patients remains limited. To reduce the risk of hypoesthesia of stroke with use of acupuncture in limbs, scalp acupuncture can be considered and has been repor ted in t he use of CPSP [5]. Sca lp acupuncture points described include the Ding zone and Dingqian zone. The application of electroacupuncture at the contralateral limb could also be considered for the treatment of neuropathic pain [5]. Electroacupuncture points used previously include LI15, SI9, SI11, and LE14 [5]. It might be possible to consider the use of scalp acupuncture points and limb electroacupuncture in future cases and assess if these strategies lead to more reduction in pain scores pre- and posttreatments. I congratulate the authors for their success in treating this clinically challenging case and publication of this case report.

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