Acupuncture For Raynaud's Syndrome In Glasgow

Acupuncture For Raynaud's Syndrome | Glasgow

About Raynaud’s phenomenon

Raynaud’s phenomenon is caused by episodic vasospasm and ischaemia of the extremities (especially the fingers and toes) in response to a fall in
temperature (even taking a cold milk bottle out of the fridge or a cool wind on a hot beach (RSA 2012)) or an emotional stimulus.(Goundry 2012) This response
results in a characteristic colour change in the extremities from white, to blue, to red. In about 89% of people, Raynaud’s occurs in direct response to a
stimulus and there is no known underlying cause. In the other 11%, it results from an underlying condition, most commonly a connective tissue disease
such as systemic sclerosis, mixed connective tissue disease.(Goundry 2012)


Around 3-12.5% of men and 6-20% of women have reported symptoms of Raynaud’s phenomenon in non-population based studies.(Fraenkel 2002) The prevalence varies
widely across countries and populations, but is higher in colder climates. In women, it is often associated with a family history, oestrogen exposure, and emotional
stress.(Fraenkel 2002) In men, smoking and hand arm vibration syndrome are more commonly implicated.(RSA 2012; Palmer 2000)
There are few conventional treatments on offer. Lifestyle modifications such as regular exercise and stopping smoking, and reducing exposure to triggers (e.g. cold,
emotional stress) can help. Nifedipine is currently the only drug licensed in the UK for use in Raynaud’s phenomenon, although other drugs are under investigation. Very
rarely, surgery is indicated.

References

Fraenkel L. Raynaud’s phenomenon: epidemiology and risk factors. Curr Rheumatol Rep 2002; 4: 123-8.
Goundry B et al. Diagnosis and management of Raynaud’s phenomenon, BMJ 2012; 344: e289 doi:
10.1136/bmj.e289
Palmer K et al. Prevalence of Raynaud’s phenomenon in Great Britain and its relation to hand transmitted vibration: a
national postal survey. Occup Environ Med 2000; 57: 448-52.
Reynaud’s and Scleroderma Association. Coping with Raynaud’s. [online] Available: http://www.raynauds.org.uk/

How acupuncture can help

This Factsheet focuses on the evidence for acupuncture in the treatment of Raynaud’s phenomenon. Overall, very little research has been published on the
effects of acupuncture in patients with Raynaud’s phenomenon. There are no systematic reviews looking specifically at acupuncture, but one that assessed the
evidence of the effectiveness of non-surgical symptomatic interventions in general concluded that more high-quality, well-designed trials are needed to assess the
effects of acupuncture in Raynaud’s phenomenon.(Huisstede 2011)
Two randomised trials have been published, with conflicting results. One found that a specific vasospasmolytic effect of acupuncture could not be proven.(Hahn 2004) The
other found that traditional Chinese acupuncture may be a reasonable alternative treatment for patients with primary Raynaud's syndrome.(Appiah 1997). The
contrasting outcomes may primarily be due to the different types of control groups employed. So-called placebo controls (as in Hahn 2004) are usually modified, and at
least partially active, forms of acupuncture, making the results difficult to interpret. An uncontrolled study found that auricular electroacupuncture appears to reduce
symptoms by reducing the frequency and severity of attacks in primary Raynaud’s phenomenon, but not to influence skin perfusion and skin temperature.(Schlager 2011)

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes
influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.

  • Research has shown that acupuncture treatment may specifically help to relieve the symptoms of Raynaud’s by:
  • Increasing local microcirculation (Komori 2009);
  • Regulating endothelium-derived vasoconstrictors (endothelin-1) and vasodilators (calcitonin gene-related peptide, nitric oxide and nitric oxide synthase) (Wang 2011a; Wang 2011b; Pan 2010; Kim 2006);
  • Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007)
  • Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);
  • Increasing the release of adenosine, which has antinociceptive properties (Goldman 2010).

About traditional acupuncture

Acupuncture is a tried and tested system of traditional medicine, which has been used in China and other eastern cultures for thousands of years to restore, promote
and maintain good health. Its benefits are now widely acknowledged all over the world, and in the past decade traditional acupuncture has begun to feature more
prominently in mainstream healthcare in the UK. In conjunction with needling, the practitioner may use techniques such as moxibustion, cupping, massage or electroacupuncture. They may also suggest dietary or lifestyle changes.

Traditional acupuncture takes a holistic approach to health and regards illness as a sign that the body is out of balance. The exact pattern and degree of imbalance is
unique to each individual. The traditional acupuncturist’s skill lies in identifying the precise nature of the underlying disharmony and selecting the most effective
treatment. The choice of acupuncture points will be specific to each patient’s needs. Traditional acupuncture can also be used as a preventive measure to strengthen the
constitution and promote general wellbeing.

An increasing weight of evidence from Western scientific research (see overleaf) is demonstrating the effectiveness of acupuncture for treating a wide variety of
conditions. From a biomedical viewpoint, acupuncture is believed to stimulate the nervous system, influencing the production of the body’s communication substances
- hormones and neurotransmitters. The resulting biochemical changes activate the body's self-regulating homeostatic systems, stimulating its natural healing abilities
and promoting physical and emotional wellbeing.

About the British Acupuncture Council

With over 3000 members, the British Acupuncture Council (BAcC) is the UK’s largest professional body for traditional acupuncturists. Membership of the BAcC guarantees
excellence in training, safe practice and professional conduct. To find a qualified traditional acupuncturist, contact the BAcC on 020 8735 0400 or visit
www.acupuncture.org.uk

Acupuncture For Raynaud's Syndrome

The evidence

Research Conclusion
Systematic reviews
Huisstede BM et al. Effectiveness of
interventions for secondary Raynaud's
phenomenon: a systematic review.
Arch Phys Med Rehabil 2011; 92:
1166-80.
A systematic review that evaluated the evidence of the
effectiveness of nonsurgical symptomatic interventions to treat
secondary Raynaud's phenomenon. In all, five reviews and 19
randomised controlled trials were included. One of the
randomised controlled trial studied acupuncture, and the
reviewers concluded that no clear favourable effects were
found. They concluded that more high-quality, well-designed
trials are needed to assess the effects of acupuncture in
Raynaud’s phenomenon.
Randomised controlled trials
Hahn M et al. Is there a
vasospasmolytic effect of acupuncture
in patients with secondary Raynaud
phenomenon? J Dtsch Dermatol Ges
2004; 2: 758-62.
A small double-blind randomised controlled trial that compared
the effects of ‘real’ acupuncture with placebo acupuncture in
patients with secondary Raynaud’s phenomenon. Patients kept
diaries of their symptoms and, while an improvement was
detected in both groups, there was no significant effect on
clinical symptoms recorded (average number of attacks daily
before and after treatment: with ‘real’, 1.9 vs. 1.4 and, with
placebo, 2.8 vs. 1.9; duration of attacks: with ‘real’, 15 vs. 12
and, with placebo, 31 vs. 16; not significant) or on skin
microcirculation measured by local cold testing. The
researchers concluded that a specific vasospasmolytic effect of
acupuncture could not be proven.
Appiah R et al. Treatment of primary
Raynaud's syndrome with traditional
Chinese acupuncture. J Intern Med
1997; 241: 119-24.
A randomised controlled trial that assessed the effects of
acupuncture vs. no acupuncture in 33 patients with primary
Raynaud's syndrome. All the patients kept a diary throughout
the observation period, noting daily frequency, duration and
severity of their vasospastic attacks. A local cooling test
combined with nailfold capillaroscopy was performed at
baseline and in weeks 12 and 23, which recording flowstop
reactions of the nailfold capillaries. The acupuncture-treated
patients showed a significant decrease in the frequency of
attacks from 1.4 to 0.6 daily (p<0.01), while there was a
nonsignficant decrease in the control group from 1.6 to 1.2
(p=0.08). The overall reduction of attacks was 63% with
acupuncture (vs. 27% in the control group, p=0.03). The mean
duration of the capillary flowstop reaction decreased from 71 to
24 seconds (week 1 vs. week 12, P = 0.001) and 38 seconds
(week 1 vs. week 23, P = 0.02), respectively with acupuncture.
In the control group the changes were not significant. The
researchers concluded that their findings suggest that
traditional Chinese acupuncture is a reasonable alternative
treatment for patients with primary Raynaud's syndrome.
Uncontrolled trial
Schlager O et al. Auricular
electroacupuncture reduces frequency
and severity of Raynaud attacks. Wien
Klin Wochenschr 2011; 123: 112-6.
A non-blinded uncontrolled trial that assessed the effects of
auricular electroacupuncture (EA) on the symptoms in primary
Raynaud's phenomenon (PRP) in 26 patients with the
condition. After 3, 6 and 24 weeks, attack frequency and
severity were re-evaluated using standardised questionnaires
and a visual analogue scale (VAS). Skin temperature was
assessed by infrared thermography and laser Doppler
perfusion imaging was used to determine skin perfusion.
Compared to baseline, there was a significant reduction in
attack frequency at 3 (p=0.001) and 6 weeks (p<0.001). This
improvement sustained after treatment was stopped (at 24
weeks; p<0.001). Furthermore, attack-associated pain was
reduced at 3 (p=0.003), 6 (p=0.003) and 24 weeks (p=0.001) of
treatment, while skin temperature and skin perfusion did not
change significantly throughout the study period. The
researchers concluded that auricular electroacupuncture
appears to reduce symptoms by reducing the frequency and
severity of attacks in primary Raynaud’s phenomenon, but
does not seem to influence on skin perfusion and skin
temperature.
Possible mechanisms of acupuncture
Wang L et al. Effects of reinforcing and
reducing methods by twirling and
rotating the needle on contents of
CGRP and NO in rats with stressinduced hypertension [Article in
Chinese]. Zhongguo Zhen Jiu 2011a;
31: 337-41.
A randomised controlled animal study that found acupuncture
increased the contents of calcitonin gene-related peptide
(CGRP) and nitric oxide (NO) in rats with stress-induced
hypertension, thereby causing a fall in blood pressure.
Wang JY et al. Effect of moderate
acupuncture-stimulation of "Taichong"
(LR 3) on blood pressure and plasma
endothelin-1 levels in spontaneous
hypertension rats [Article in Chinese].
Zhen Ci Yan Jiu 2011b; 36: 36-9.
A randomised controlled animal study that found moderatestimulation of Liv 3 can lower blood pressure and plasma
endothelin (ET-1) levels in rats with spontaneous hypertension.
The reduced level of plasma ET-1 may be one of its
mechanisms underlying improving hypertension.
Pan P et al. Effects of electroacupuncture on endothelium-derived
endothelin-1 and endothelial nitric
oxide synthase of rats with hypoxiainduced pulmonary hypertension. Exp
Biol Med 2010; 235: 642-8.
An animal study that investigated whether electro-acupuncture
on bladder-13 and -15 points can protect against chronic
hypoxia-induced pulmonary hypertension (PH) by regulating
endothelium-derived endothelin (ET)-1 and endothelial nitric
oxide synthase (eNOS). The results indicated that treatment
with electro-acupuncture could protect against hypoxia-induced
PH, possibly by regulating the balance of endothelium-derived
vasoconstrictors and vasodilators.
Goldman N et al. Adenosine A1
receptors mediate local antinociceptive effects of acupuncture. Nat
Neurosci 2010; May 30.
A study showing that the neuromodulator adenosine, which
has anti-nociceptive properties, was released during
acupuncture in mice, and that its anti-nociceptive actions
required adenosine A1 receptor expression. Direct injection of
an adenosine A1 receptor agonist replicated the analgesic
effect of acupuncture. Inhibition of enzymes involved in
adenosine degradation potentiated the acupuncture-elicited
increase in adenosine, as well as its anti-nociceptive effect.
The researchers concluded that their observations indicate that
adenosine mediates the effects of acupuncture and that
interfering with adenosine metabolism may prolong the clinical
benefit of acupuncture.
Hui KK et al. Acupuncture, the limbic
system, and the anticorrelated
networks of the brain. Auton Neurosci
2010; 157: 81-90.
Studies have shown that acupuncture stimulation, when
associated with sensations comprising deqi, evokes
deactivation of a limbic-paralimbic-neocortical network, as well
as activation of somatosensory brain regions. These networks
closely match the default mode network and the anti-correlated
task-positive network. The effect of acupuncture on the brain is
integrated at multiple levels, down to the brainstem and
cerebellum and appears to go beyond either simple placebo or
somatosensory needling effects. Needling needs to be done
carefully, as very strong or painful sensations can attenuate or
even reverse the desired effects. Their results suggest that
acupuncture mobilises the functionally anti-correlated networks
of the brain to mediate its actions, and that the effect is
dependent on the psychophysical response. They discuss
potential clinical application to disease states including chronic
pain, major depression, schizophrenia, autism, and Alzheimer's
disease.
Hui K.K.-S. The salient characteristics
of the central effects of acupuncture
needling: limbic-paralimbic-neocortical
network modulation. Human Brain
Mapping 2009; 30: 1196-206.
This study assessed the results of fMRI on 10 healthy adults
during manual acupuncture at 3 acupuncture points and a
sham point on the dorsum of the foot. Although certain
differences were seen between real and sham points, the
hemodynamic and psychophysical responses were generally
similar for all 4 points. Acupuncture produced extensive
deactivation of the limbic-paralimbic-neocortical system.
Clusters of deactivated regions were seen in the medial
prefrontal cortex, the temporal lobe and the posterior medial
cortex. The sensorimotor cortices, thalamus and occasional
paralimbic structures such as the insula and anterior middle
cingulate cortex showed activation. The researchers concluded
that their results provided additional evidence that acupuncture
modulates the limbic-paralimbic-neocortical network. They
hypothesised that acupuncture may mediate its analgesic, antianxiety, and other therapeutic effects via this intrinsic neural
circuit that plays a central role in the affective and cognitive
dimensions of pain.
Komori M et al. Microcirculatory
responses to acupuncture stimulation
and phototherapy. Anesth Analg 2009;
108: 635-40.
Experimental study on rabbits in which acupuncture stimulation
was directly observed to increase diameter and blood flow
velocity of peripheral arterioles, enhancing local
microcirculation.
Kavoussi B, Ross BE. The
neuroimmune basis of antiinflammatory acupuncture. Integr
Cancer Ther 2007; 6: 251-7.
Review article that suggests the anti-inflammatory actions of
traditional and electro-acupuncture are mediated by efferent
vagus nerve activation and inflammatory macrophage
deactivation.
Kim DD et al. Acupuncture reduces
experimental renovascular
hypertension through mechanisms
involving nitric oxide synthases.
Microcirculation 2006; 13: 577-85
An animal study that found electroacupuncture on St 36 in a
hamster model reduced blood pressure by activating nitric
oxide synthase signalling mechanisms.


Terms and conditions
The use of this fact sheet is for the use of British Acupuncture Council members and is subject to the strict conditions imposed by the British Acupuncture Council details of which can be found in the members area of its website www.acupuncture.org.uk.

For more information about acupuncture and how it can help with raynaud’s syndrome, contact Elaine Collins at 0141 585 7904 or fill in our Contact form, and we will get back to you.