| 1. BackgroundPain is the eternal subject of medical research,which Chinese and Western medicine have made unremittingly hard exploration for its diagnosis and treatment. In terms of Chinese medicine, there are classic theories, for example, pain due to blockage. In the field of modern medicine such theories are specific pain theory, pattern pain theory and gate control theory.Nerve endings tension pain refers to lesions of the fascia, tendon, ligament, periosteum, joint capsule and skin, which increase the local tension and change chemical properties of the micro-environment, for example, damaged tissues emit histamine, hydroxytryptamine, bradykinin, prostaglandin and potassium ion and other kinds of pain-causing materials acting on free never endings, resulting in harmful stimulation so that the inputting impulse will be triggered, and pain can be felt through central nervous system. According to Chinese medicine, nerve endings tension pain belongs to the category of pain arthralgia. Clinically, Pi zhen has been used gradually to treat nerve endings tension pain because of its mild trauma, minimal injury, quick recovery, accurate orientation and good effect.However, pain is the body defense mechanism generated by coupling work of receptor, transmission nerve and central pain system. So, harmful stimulation such as mechanical stimulation, temperature changes and chemical materials could cause local tissue lesions resulting in release of PK,5-HT, K+, bradykinin and other materials that can degrade pain thresholds. Such harmful stimulation affects receptors of the skin, muscles, visceral organs and joints and is transmitted to the pain center through fiber A-δ and fiber C. But how do these receptors feel the harmful stimulation? In what ways could we reduce such stimulation? All of these questions haven’t been studied widely, and relevant documents can not be found easily, namely, knowing the pain is the hot major but mechanism of feeling the pain hasn’t been explored thoroughly.Clinically, Chinese medicine develops its own distinguished methods of treating pain, especially in neck, shoulders, lower back and legs. Therapeutic methods such as scraping, cupping, acupuncture and moxibustion, small needle-knife and strapping have obvious effects on decreasing pain levels. Professor Dong Fu-hui has made numerous researches systematically and clinically and applied Pi Zhen to treat nerve endings tension pain. How does the mechanism work? Is it the regional function or system reflect action? Is it the physical change or chemical reaction? All of these unknown factors impel future study on pain sensor mechanism to help us obtain lab technics supporting of easing pain in the field of TCM (Traditional Chinese Medicine). The fundamental experiments of this paper are based on "nerve endings tension pain project" sponsored by the National Natural Science Fund, combining mechanics and biochemics methods to initially investigate the mechanism of nerve endings tension pain.2. Objective2.1Fundamental experiment:Health rabbits are injected with carrageenin to form the rabbits model of local tissue tension pain in deep fascia. Loosing tension by applying Pi Zhen, acupuncture and dripping painkiller locally on the operative sites respectively. After that, each group would be injected a certain amount of saline into the sites between shallow and deep fascia, then we extracted solution of each to test5-HT, ergamine and bradykinin levels, in the meantime, soft tissue tension would be recorded so that the treatment mechanism of nerve endings tension pain can be discussed.2.2Clinical research:To explore the treatment effect of Pi Zhen and Hao Zhen on superior clunial nerve endings tension pain.3. Methods3.1Fundamental research:Forty-two healthy male big ear white rabbits were divided into5groups randomly:normal group (5rabbits), model group (7rabbits), Pi Zhen group (10), Hao Zhen group (10), and drug group (10). There was no operation in normal group. Local tension pain models were made by injecting with10ml carrageenin on deep fascia via20ml syringes, then using the lid of ground-glass stoppered flask to cover the operative site for1minutes to shape the tension-increasing model of local fascia soft tissues. Pi Zhen group, Hao Zhen group, drug group were interfered with Pi Zhen, Hao Zhen and2%lidocaine hydrochloride respectively.1ml saline was injected to the operative site between the shallow and deep fascia in each rabbit first and then draw out at5,10,20,30,40,50,60minutes(min) after operation. Those samples were stored in different EP tubes and labeled clearly, and kept in a refrigerator at temperatures below20℃. The levels of5-HT, ergamine and bradykininin extracting solution of different groups were determined with ELISA method. Measurement data were recorded (x±s).Comparisons among groups were tested by One-Way ANOVA analysis and LSD test.Local tension and displacement variables were recorded by the soft tissue tension apparatus in normal group, model group, Pi Zhen group, Hao Zhen group, drug group respectively at5,10,20,30,40,50,60minutes(min) after operation and we analyzed the variables when the tension reached50g and made comparisons among different groups. Data collecting method was as follows:we kept the testing part flat, with the distal end of tension apparatus aiming at the tender point, then lowered it according to the indicator to read the meter. After treatment we used the tension apparatus whose related parts had been disinfected to collect the data following the pre-treatment method. Average value was gathered after testing1-2times at each time. Statistical method was introduced to analyze the results. P<0.05as with stalactical significance.3.2Clinical research:130qualified patients with superior clunial nerve tension pain were divided into test group and control group randomly with each65patients. Test group used Pi Zhen, one time/week,3-5times for one course treatment while control group used Hao Zhen,2times per week,3～5times for the treatment process. Patients of each group finished physical examinations and were recorded case history, pain levels and local tension, filling out a form (CRF) at the same time. Statistical methods were used to analyze the results. Measurement data were recorded (x±s). T test and rank sum test were chosen alternatively according to the homogeneity of variance. Chi-square test and Bonferroni were also employed in the study to make comparisons between different data.4. Results:4.1Fundamental experiment4.1.1Pi Zhen intervention can reduce the5-HT level of extracting solution in operative sites, and with the increase of time, the level of5-HT was gradually reduced. The level of5-HT in Pi Zhen group was significantly lower than that of model group at different time points(P<0.01). The level of5-HT in Pi Zhen group was significantly higher than that of normal group at5min(P<0.01); The level of5-HT in Pi Zhen group was lower than that of normal group at40,50,60min(P<0.05);The level of5-HT in Pi Zhen group was significantly higher than that of drug group at5,10,20,30,40min(P<0.01; The level of5-HT in Pi Zhen group was significantly lower than that of Hao Zhen group at20,30,40,50,60min(P<0.01). There was no difference at other time points.4.1.2Pi Zhen intervention cannot reduce the ergamine and bradykinin levels of extracting solution in operative sites. It was meaningless between group comparison(P>0.05).4.1.3According to the related data of soft tissue tension, model group was lower than Hao Zhen group, followed by drug group, and then normal group in light of average displacement with adding same load force.4.2Clinical trial4.2.1Soft tissue tension index was293.67±10.33after Pi Zhen intervention compared with211.34±9.87before treatment; Soft tissue tension index was238.31±11.94after Hao Zhen intervention compared with203.75±11.58before treatment, comparative difference between the2groups was meaningful as well (P<0.01).4.2.2Soft tissue pain index was0.93±0.21after Pi Zhen intervention compared with6.28±0.30before treatment; Soft tissue pain index was1.95±0.16after Hao Zhen intervention compared with6.72±0.23before treatment.comparative difference between the2groups was meaningful as well (P<0.01). 5. Conclusions5.1Fundamental experiment5.1.1Pi Zhen reduced the release of5-HT more significantly than the Hao Zhen group when used to treat nerve endings tension pain, which signified decreased pain levels were closely related to the5-HT. It proved that Pi Zhen can degrade the tension and was better than Hao Zhen in terms of alleviating the pain.5.1.2Drug can obviously reduce the levels of ergamine and bradykinin in tissues while Pi Zhen and Hao zhen cannot do so during the test. It showed that there was no marked relationship between alleviating pain and the level of ergamine and bradykinin after Pi Zhen intervention. It also proved that Pi Zhen and Hao Zhen couldn’t affect the release of bradykinin, though degrade the tension.5.1.3Pi Zhen intervention can reduce the tissue tension so therapeutical purpose of alleviating nerve endings tension pain can be achieved.5.2Clinical trial5.2.1Pi Zhen can help symptoms caused by the superior clunial nerves tension pain, whose treatment effect was better than Hao Zhen, and its long-term therapeutical effect was confirmed after follow-up3months later.5.2.2Pi Zhen can enhance the visual analogy score (VAS) of patients with superior clunial nerves tension pain and ease the pain.5.2.3Pi Zhen can reduce the soft-tissue tension which is better than Hao Zhen.5.2.4Pi Zhen is better than Hao Zhen in respect of total effective rate of easing superior clunial nerves tension pain.Innovation point:6.1Study on treatment mechanism of nerve endings tension pain.6.2Rabbit model of nerve endings tension pain for experimental research. |
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