Clinical Efficacy Evaluation And Mechanism Study Of Silver Needle Thermal Conduction In The Treatment Of Lumbar Disc Herniatio

Objective:To evaluate the clinical effect of silver needle thermo-conduction in the treatment of lumbar disc herniation(LDH),and to provide evidence-based evidence for the treatment of LDH.To observe the behavioral effects of intramuscular(I.M.)heating needle stimulation(n.s)on LDH model rats,and to explore the time window of I.M.heating n.s treatment and its mechanism in the down regulation of pain,so as to provide theoretical basis for silver needle thermo-conduction treatment of LDH.Methods:In the clinical study section,108 cases of patients with LDH were randomly divided into treatment group 1,treatment group 2 and control group,36 cases in each group.The treatment group 1 was treated with silver needle thermo-conduction for 20 min,the treatment group 2 with silver needle thermo-conduction for 30 min,and the control group with silver needle for 20 min.The visual analogue score(VAS),Japanese Orthopaedics Association(JOA)score,Roland-Morris disability questionnaire(RMDQ),Oswestry dysfunction index score(ODI),clinical efficacy and treatment safety were observed before,2 weeks and 1 month after treatment in the two groups.In the first part of the experimental study,SD male rats were randomly divided into 10 groups:normal group,n.s 45 min normal group,n.s 45 min tail-transection group,I.M.heating n.s 15 min tail-transection group,I.M.heating n.s 30 min tail-transection group,I.M.heating n.s 45 min tail-transection group,n.s 45 min model group,I.M.heating n.s 15 min model group,I.M.heating n.s 30 min model group and I.M.heating n.s 45 min model group,each group 10 rats.Normal feeding was carried out in the rats in each group and 43℃ I.M.heating n.s was given to the tail-transection group and the model group 14 days later.The bilateral paw withdrawal mechanical threshold(PWMT)and paw withdrawal thermal latency(PWTL)were measured respectively.In the second part of the experimental study,SD male rats were randomly divided into 10 groups:model group,0.9%saline(VM nucleus)model group,0.9%saline(MD nucleus)model group,0.5 nmol WAY-100635(VM nucleus)model group,1 nmol WAY-100635(VM nucleus)model group,2 nmol WAY-100635(VM nucleus)model group,0.5 nmol WAY-100635(MD nucleus)model group,1 nmol WAY-100635(MD nucleus)model group,2 nmol WAY-10063 5(MD nucleus)model group and 1 nmol 8-OH-DPAT(MD nucleus)model group,10 rats in each group.One day after I.M.heating n.s,bilateral VM and MD nuclei were microinjected with 0.9%saline,5-HT1A receptor antagoni st WAY-10063 5 and 5-HT1A receptor agoni st 8-OH-DPAT,respectively.The bilateral PWMT and PWTL were measured respectively.Results:After treatment,VAS score,JOA score,RMDQ score and ODI score in the three groups were lower than those before treatment,while JOA score was higher,with statistically significant differences(all P<0.01).After one month of treatment,the difference of VAS score in treatment group 2 was lower than that of treatment group 1(P<0.01)and lower than that of control group(P<0.05);the difference of JOA score was higher than that in treatment group 1 and control group(P<0.05);the difference of RMDQ score was lower than that in treatment group 1 and control group(P<0.01);the difference of ODI score was lower than that in treatment group 1 and control group(P<0.01).Differences in VAS score,JOA score,RMDQ score and ODI score before and after treatment in group 1 were not statistically significant compared with the control group(P>0.05).Compared the clinical efficacy of the three groups,the difference was statistically significant(P<0.01);the treatment group 2 was better than the treatment group 1(P<0.05),but also better than the control group(P<0.01);There was no significant difference between the treatment group 1 and the control group.And no adverse reactions occurred in this clinical trial.After n.s,the bilateral PWMT and the bilateral PWTL in the n.s 45 min normal group were not significantly different from those before n.s(P>0.05).Compared with that before I.M.heating n.s,the PWTL in the I.M.heating n.s 30 min and 45 min tail-transection group was prolonged at 1-5 days and 1-7 days respectively after 43℃ thermal stimulation(P<0.05).Compared with the n.s 45 min tail-transection group,the PWTL in the I.M.heating n.s 30 min and 45 min tail-transection group was prolonged at 1-5 days and 1-7 days respectively after 43℃ thermal stimulation(P<0.05).Compared with that before I.M.heating n.s,the PWMT was increased and the PWTL was prolonged in the I.M.heating n.s 30 min and 45 min model group at 1-7 days after 43℃ thermal stimulation(all P<0.05).Compared with the n.s 45 min model group,the PWMT was increased and the PWTL was prolonged in the I.M.heating n.s 30 min and 45 min model group at 1-7 days after 43℃ thermal stimulation(all P<0.05).Compared with that one day after I.M.heating n.s before microinjection,the PWTL was shortened and the thermal pain response was increased in the 0.5 nmol WAY-100635(VM nucleus)model group at 2-3 hours after microinjection,and in the lnmol and 2nmol WAY-10063 5(VM nucleus)model groups at 1-3 hour after microinjection(P<0.05).Compared with the model group,the PWTL was shortened in the 0.5 nmol WAY-100635(VM nucleus)model group at 2-3 hours after microinjection,and in the lnmol and 2nmol WAY-100635(VM nucleus)model groups at 1-3 hour after microinjection(P<0.05).There was no significant difference in the PWMT and PWTL among the 0.9%saline(MD nucleus)model group and the 0.5 nmol and lnmol and 2 nmol WAY-100635(MD nucleus)model group compared with that before microinjection one day after I.M.heating n.s(P>0.05).There was no significant difference in the PWMT and PWTL between the 0.9%saline(MD nucleus)model group and the 1 nmol 8-OH-DPAT(MD nucleus)model group compared with that before microinjection one day after I.M.heating n.s(P>0.05).Conclusions:Silver needle thermo-conduction for 20 min,30 min and Silver needle treatment of LDH could effectively relieve pain,improve the patients’ lower back dysfunction,promote the recovery of patients’ lumbar function,ameliorate the impact of LDH on patients’ daily life.The effect of silver needle thermo-conduction for 30 min was better than that of silver needle thermo-conduction for 20 min and silver needle,while the effect of silver needle thermo-conduction for 20 min was equivalent to that of silver needle.The results showed that 20 min thermo-conduction of silver needle failed to play a role of thermal effect.It was suggested that the thermo-conduction time of silver needle should be 30 min.30 min and 45 min of innocuous heating needle stimulation could effectively reduce the mechanical hyperalgesia and thermal pain response of LDH model rats,the effect between them was equivalent,but 15 min of innocuous heating needle stimulation had no such effect.Therefore,30 minutes is the best time for innocuous heating needle stimulation.Innocuous heating needle stimulation for 30 min initiated 5-HT mechanism in VM nucleus of thalamus to reduce the thermal pain response,while MD nucleus did not participate in this process.