Clinical Effectiveness And Neurobiological Mechanism Of Electroacupuncture On Discogenic Sciatica

Objective:1.Taking patients with discogenic sciatica as the research object to evaluate the clinical effectiveness of electroacupuncture(EA)in the pain treatment of discogenic sciatica patients.2.Taking the model rats of discogenic sciatica as the research object to elaborate the action mechanism of EA from the three dimensions of behavior,molecular biology and neuroelectrophysiology.Methods:1.Clinical study:One hundred patients who meet the diagnostic criteria for discogenic sciatica will be randomized into EA treatment group and control group with 50 patients,respectively.The EA group was treated with EA intervention for 2 consecutive weeks,six times per week.The control group adopted the treatment of celecoxib capsules.The survey of visual simulation score(VAS),Japan orthopedic association pain score(JOA Scores),Oswestry dysfunction score(ODI),overall impression improvement score(PGIC)were collected at the time before EA treatment,at the end of 2 weeks treatment,and at the end of 2 weeks and 6 weeks of follow-up period.Through the statistical analysis of sores between two groups,the clinical effectiveness of the EA intervention to alleviate discogenic sciatica pain was evaluated.2.Animal experiment:50 male SD rats were randomly divided into sham operation group(FM),model group(M),electroacupuncture group(EA),electroacupuncture sham point group(NA)and sham operation electroacupuncture group(SEM),with 10 rats in each group.The operation diary is recorded as Day 1.From Day 2 to Day 28,bilateral plantar mechanical pain threshold test was performed every even Day.Electroacupuncture intervention is performed every odd Day.5 rats were randomly selected from each group.After treatment for 7 days,the rats were subjected to electrophysiological experiments.DRG tissues were taken out for cryo-preservation for later analysis.The other 5 rats were subjected to electrophysiological test after intervention for 28 days and DRG tissues were then preserved for subsequent test.Results:Clinical study:1.Comparison between groups:JOA,VAS,PGIC and ODI scores of the two groups were compared by t-test.The results showed that the EA treatment group was significantly higher than the control group,and the difference was statistically significant(p<0.05);2.Intra-group comparison:VAS,JO A,PGIC and ODI scores of the two groups before and after treatment were compared by t-test.The results showed that both of control group and EA group were better after treatment with statistic significant difference(p<0.05)comparing with those before treatment,and the clinical efficacy of the EA treatment group after treatment was improved greatly than that of the control group(p<0.05).Animal experiment results:1.Behavior study:There was no significant difference in the mechanical pain threshold of left and right plantar of rats in each group on Day1.The mechanical pain threshold of plantar of rats in each group showed a decreasing trend(p<0.01),and the decreasing range of pain threshold in M group,EA group and NA group was much greater than that in FM group and SEA group(p<0.001)on Day2.From Day 10 to Day 28,the plantar mechanical pain threshold of rats in M group,EA group and NA group began to rise,but it was still significantly lower than that in FM group and SEA group(p<0.001);There was no significant difference between EA group,M group and NA group.From Day 20 to Day 28,the plantar mechanical pain threshold of rats in FM group and SEA group recovered to the preoperative level(p=1.000).The plantar mechanical pain threshold of rats in EA group increased significantly(p<0.05).On the Day 28,there was no significant difference in plantar mechanical pain threshold between EA group,FM group and SEA group.2.Molecular biology study:On Day 7,the relative expression levels of TNF-α,PLA2,PGE2 and NLRP3 in DRG of each group had no statistical difference,while the relative expression levels of IL-1β and IL-6 in M,NA and EA groups were significantly higher than those in FM and SEA groups(p<0.001).On Day 28,there was no significant difference on the relative expression of TNF-α in DRG of each group.The relative expression levels of IL-1β,IL-6,PLA2 and NLRP3 in M group,NA group and EA group were significantly higher than those in FM and SEA groups(p<0.001).Compared with FM group,EA group and SEA group,the relative expression of antiinflammatory factor PGE2 in M group and NA group decreased significantly(p<0.001).3.Neuroelectrophysiology:On Day 7,the discharge rate of sensory neurons in the dorsal horn of the spinal cord on the operative side of rats in each group were determined.The discharge rate of neurons in FM group and SEA group was maintained at 10 times/10 seconds,and the neurons in EA,NA and M groups were more active.On Day 28,the neurons in FM group remained silent throughout the recording time,while the neuronal firing rating of M group and NA group remained at 20～30 times/10 seconds,showing an active discharge state.The discharge rate of rats in EA group significantly decreased during the intervention.Conclusions:1.The results of VAS,JOA,ODI and PGIC scores in clinical study show that both the EA treatment and medicine treatment are safe and effective in the treatment of discogenic sciatica.For the pain relief degree of patients and the improvement of lumbar functional activities,the clinical efficacy of EA treatment group is better than that of medicine treatment group.For the improvement of quality of life and treatment overall impression,EA treatment group is better than that of medicine treatment group.2.EA intervention can improve the abnormal sensitization of plantar mechanical pain threshold in model rats with discogenic sciatica,affect the expression level of inflammationrelated factor protein,and effectively reverse the abnormal excitability of sensory neurons in the dorsal horn of the spinal cord,which indicated EA treatment for sciatica has a good analgesic effect,and the EA analgesic effect may be the result of a combined effect by relieving the inflammation factors around the DRG and regulating the activity of the dorsal horn neurons in the spinal cord.