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Minimal immunoreactive plasma β-endorphin and decrease of cortisol at standard analgesia or different acupuncture techniques

Published online by Cambridge University Press:  01 April 2007

H. Harbach ,
B. Moll ,
R.-H. Boedeker ,
U. Vigelius-Rauch ,
H. Otto ,
J. Muehling ,
G. Hempelmann  and
P. Markart
H. Harbach
Affiliation:
University of Giessen, Department of Anaesthesiology, Intensive Care, Pain Therapy, Palliative Medicine, Germany
B. Moll
Affiliation:
Justus-Liebig-University, Rudolf-Buchheim-Institute for Pharmacology, Germany
R.-H. Boedeker
Affiliation:
Justus-Liebig-University, Institute of Medical Statistics and Informatics, Germany
U. Vigelius-Rauch
Affiliation:
University of Giessen, Department of Anaesthesiology, Intensive Care, Pain Therapy, Palliative Medicine, Germany
H. Otto
Affiliation:
University of Giessen, Department of Anaesthesiology, Intensive Care, Pain Therapy, Palliative Medicine, Germany
J. Muehling
Affiliation:
University of Giessen, Department of Anaesthesiology, Intensive Care, Pain Therapy, Palliative Medicine, Germany
G. Hempelmann
Affiliation:
University of Giessen, Department of Anaesthesiology, Intensive Care, Pain Therapy, Palliative Medicine, Germany
P. Markart
Affiliation:
University of Giessen, Department of Internal Medicine, Medical Clinic II, Giessen, Germany
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Summary

Background and objective

Acupuncture has been claimed to be associated with activation of the endogenous antinociceptive system. The analgesic effects of acupuncture have been ascribed to β-endorphin interacting with opioid receptors. However, firstly, the release of β-endorphin into the blood has been proven to be induced by stress, i.e. under dysphoric conditions, and, secondly, if released under stress, β-endorphin has been shown not to be analgesic. Our aim was to test whether β-endorphin immunoreactive material is released into the cardiovascular compartment during acupuncture comparing the most frequently used types of acupuncture with standard pain treatment under apparently low stress conditions.

Methods

This prospective study included 15 male patients suffering from chronic low back pain. β-Endorphin immunoreactive material and cortisol were measured in the plasma of patients who underwent, in randomorder, therapy according to a standard pain treatment, traditional Chinese acupuncture, sham acupuncture, electro acupuncture and electro acupuncture at non-acupuncture points before, at and after the treatment. Statistical analysis was performed using two-way ANOVA with repeated measures.

Results

A decrease in plasma cortisol concentration measured over the five treatment protocols was highly significant (P < 0.001). The β-endorphin immunoreactive material concentrations in plasma were minimal at all times and in all treatment conditions. The influence of treatments by various acupuncture procedures on cortisol and β-endorphin immunoreactive material plasma concentrations over the three time points was not significantly different.

Conclusions

β-endorphin immunoreactive material in blood is not released by any type of acupuncture as tested under low stress conditions.

Keywords

ACUPUNCTUREACUPUNCTURE ANALGESIALOW BACK PAINSTRESSβ-ENDORPHINCORTISOL
Type
Research Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 4 , April 2007 , pp. 370 - 376
Copyright
Copyright © European Society of Anaesthesiology 2006

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References

1.Manheimer, E, White, A, Berman, B, Forys, K, Ernst, E. Meta-analysis: acupuncture for low back pain. Ann Intern Med 2005; 142: 651–663.CrossRefGoogle ScholarPubMed
2.He, L. Involvement of endogenous opioid peptides in acupuncture analgesia. Pain 1987; 31: 99–121.Google Scholar
3.Han, JS. Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends Neurosci 2003; 26: 17–22.CrossRefGoogle ScholarPubMed
4.Pintov, S, Lahat, E, Alstein, M, Vogel, Z, Barg, J. Acupuncture and the opioid system: implications in management of migraine. Pediatr Neurol 1997; 17: 129–133.CrossRefGoogle ScholarPubMed
5.Harber, VJ, Sutton, JR. Endorphins and exercise. Sport Med 1984; 1: 154–171.CrossRefGoogle ScholarPubMed
6.Droste, C, Greenlee, MW, Schreck, M, Roskamm, H. Experimental pain thresholds and plasma beta-endorphin levels during exercise. Med Sci Sports Exer 1991; 23: 334–342.CrossRefGoogle ScholarPubMed
7.Wen, HL, Ho, WK, Wong, HK, Mehal, ZD, Ng, YH, Ma, L. Changes in adrenocorticotropic hormone (ACTH) and cortisol levels in drug addicts treated by a new and rapid detoxification procedure using acupuncture and naloxone. Comp Med East West 1979; 6: 241–245.Google ScholarPubMed
8.Wen, HL, Ho, WK, Ling, N, Mehal, ZD, Ng, YH. Immunoassayable beta-endorphin level in the plasma and CSF of heroin addicted and normal subjects before and after electroacupuncture. Am J Chin Med 1980; 8: 154–159.CrossRefGoogle ScholarPubMed
9.Nappi, G, Facchinetti, F, Bono, G et al. . Plasma opioid levels in post-traumatic chronic headache and trigeminal neuralgia: maintained response to acupuncture. Headache 1982; 22: 276–279.CrossRefGoogle ScholarPubMed
10.Clement-Jones, V, Tomlin, S, Rees, LH, McLoughlin, L, Besser, GM, Wen, HL. Increased beta-endorphin but not met-enkephalin levels in human cerebrospinal fluid after acupuncture for recurrent pain. Lancet 1980; 2: 946–948.CrossRefGoogle Scholar
11.Szczudlik, A, Lypka, A. Plasma concentration of immunoreactive beta-endorphin in healthy persons during pinpoint stimulation of receptors (acupuncture). Neurol Neurochir Pol 1983; 17: 535–540.Google ScholarPubMed
12.Szczudlik, A, Lypka, A. Plasma immunoreactive beta-endorphin and enkephalin concentration in healthy subjects before and after electroacupuncture. Acupunct Electrother Res 1983; 8: 127–137.CrossRefGoogle ScholarPubMed
13.Han, JS. Acupuncture and stimulation produced analgesia. In: Herz, A, ed. Opioids II. Berlin, Germany: Springer Verlag, 1993: 105–125.CrossRefGoogle Scholar
14.Stener-Victorin, E, Lindholm, C. Immunity and {beta}-endorphin concentrations in hypothalamus and plasma in rats with steroid-induced polycystic ovaries; effect of low frequency electro-acupuncture. Biol Reprod 2004; 70: 329–333.CrossRefGoogle Scholar
15.Malizia, E, Andreucci, G, Paolucci, D, Crescenzi, F, Fabbri, A, Fraioli, F. Electroacupunture and peripheral b-endorphin and ACTH levels. Lancet 1979; 2: 535–536.CrossRefGoogle Scholar
16.Zhang, AZ, Pan, XP, Xu, SF, Cheng, JS, Mo, WY. Endorphins and acupuncture analgesia. Chinese Med J 1980; 93: 673–680.Google ScholarPubMed
17.Abbate, D, Santamaria, A, Brambilla, A, Panerai, AE, Di Giulio, AM. Beta-endorphin and electroacupuncture. Lancet 1980; 2: 1309.CrossRefGoogle ScholarPubMed
18.Kiser, RS, Khatami, MJ, Gatchel, RJ, Huang, XY, Bhatia, K, Altshuler, KZ. Acupuncture relief of chronic pain syndrome correlates with increased plasma met-enkephalin concentrations. Lancet 1983; 2: 1394–1396.CrossRefGoogle ScholarPubMed
19.Masala, A, Satta, G, Alagna, S, Zolo, TA, Rovasio, PP, Rassu, S. Suppression of electroacupuncture (EA)-induced beta-endorphin and ACTH release by hydrocortisone in man. Absence of effects on EA-induced anaesthesia. Acta Endocrinol (Copenh) 1983; 103: 469–472.Google ScholarPubMed
20.Kenyon, JN, Knight, CJ, Wells, C. Randomised double-blind trial on the immediate effects of Naloxone on Classical Chinese Acupuncture therapy for chronic pain. Acupuncture Electro Res 1983; 8: 17–24.CrossRefGoogle ScholarPubMed
21.Lundeberg, T, Eriksson, S, Lundeberg, S, Thomas, M. Acupuncture and sensory thresholds. Am J Chin Med 1989; 17: 99–110.CrossRefGoogle ScholarPubMed
22.Moret, V, Forster, A, Laverriere, MC et al. . Mechanism of analgesia induced by hypnosis and acupuncture: is there a difference? Pain 1991; 45: 135–140.CrossRefGoogle ScholarPubMed
23.Kho, HG, Kloppenborg, PW, van Egmond, J. Effects of acupuncture and transcutaneous stimulation analgesia on plasma hormone levels during and after major abdominal surgery. Eur J Anaesthesiol 1993; 10: 197–208.Google ScholarPubMed
24.Andersson, GB. Epidemiological features of chronic low-back pain. Lancet 1999; 354: 581–585.CrossRefGoogle ScholarPubMed
25.Saur, P, Hildebrandt, J, Pfingsten, M et al. . Multidisciplinary treatment program for chronic low back pain, part 2. Somatic aspects. Schmerz 1996; 10: 237–253.CrossRefGoogle ScholarPubMed
26.Hildebrandt, J, Pfingsten, M, Franz, C, Saur, P, Seeger, D. Multidisciplinary treatment program for chronic low back pain, part 1. Overview. Schmerz 1996; 10: 190–203.CrossRefGoogle ScholarPubMed
27.Foley, KM, Kourides, IA, Inturrisi, CE et al. . Beta-Endorphin: analgesic and hormonal effects in humans. Proc Natl Acad Sci USA 1979; 76: 5377–5381.CrossRefGoogle ScholarPubMed
28.Harbach, H, Hell, K, Gramsch, C, Katz, N, Hempelmann, G, Teschemacher, H. Beta-endorphin (1–31) in the plasma of male volunteers undergoing physical exercise. Psychoneuroendocrinol 2000; 25: 551–562.CrossRefGoogle ScholarPubMed
29.Melby, JC, Spink, WW. Comparative studies on adrenal cortical function and cortisol metabolism in healthy adults and in patients with shock due to infection. J Clin Invest 1958; 37: 1791–1798.CrossRefGoogle ScholarPubMed
30.Werder, K. Substitutionstherapie mit Hydrocortison bei primärer und sekundärer Nebenniereninsuffizienz. Glandula 1998; 8: 18–20.Google Scholar
31.White, AR, Filshie, J, Cummings, TM. Clinical trials of acupuncture: consensus recommendations for optimal treatment, sham controls and blinding. Complement Ther Med 2001; 9: 237–245.CrossRefGoogle ScholarPubMed
32.van Tulder, M, Malmivaara, A, Esmail, R, Koes, B. Exercise therapy for low back pain: a systematic review within the framework of the cochrane collaboration back review group. Spine 2000; 25: 2784–2796.CrossRefGoogle ScholarPubMed
33.Kampik, G. Propädeutik der Akupunktur. Stuttgart, Germany: Hippokrates MVS-Verlag, 1998.Google Scholar
34.MacPherson, H, White, A, Cummings, M, Jobst, K, Rose, K, Niemtzow, R. Standards for reporting interventions in controlled trials of acupuncture: The STRICTA recommendations. Standards for reporting interventions in controlled trails of acupuncture. Acupunct Med 2002; 20: 22–25.CrossRefGoogle ScholarPubMed
35.Doenicke, A, Praetorius, B, Schmid, M. Veränderung blutchemischer Parameter bei gesunden Versuchspersonen. Anaesthesist 1976; 25: 235–238.Google Scholar
36.Wiedemann, K, Teschemacher, H. Determination of beta-endorphin and fragments thereof in human plasma using high-performance liquid chromatography and a multiple radioimmunoassay system. Pharmaceut Res 1986; 3: 142–149.CrossRefGoogle Scholar
37.Schulz, A, Harbach, H, Katz, N, Geiger, L, Teschemacher, H. Beta-endorphin immunoreactive material and authentic beta-endorphin in the plasma of males undergoing anaerobic exercise on a rowing ergometer. Int J Sports Med 2000; 21: 513–517.CrossRefGoogle ScholarPubMed
38.Harbach, H, Hempelmann, G. Proopiomelanocortin and exercise. In: Kraemer, W, Rogol, AD, eds. The Endocrine System in Sports and Exercise. London, UK: Blackwell Publishing, 2005: 134–155.CrossRefGoogle Scholar
39.Matejec, R, Harbach, HW, Bodeker, RH, Hempelmann, G, Teschemacher, H. Plasma levels of corticotroph-type pro-opiomelanocortin derivatives such as beta-lipotropin, beta-endorphin(1–31), or adrenocorticotropic hormone are correlated with severity of postoperative pain. Clin J Pain 2006; 22: 113–121.CrossRefGoogle ScholarPubMed
40.Matejec, R, Schulz, A, Harbach, HW, Uhlich, H, Hempelmann, G, Teschemacher, H. Effects of tourniquet-induced ischemia on the release of proopiomelanocortin derivatives determined in peripheral blood plasma. J Appl Physiol 2004; 97: 1040–1045.CrossRefGoogle ScholarPubMed
41.Matejec, R, Ruwoldt, R, Bodeker, RH, Hempelmann, G, Teschemacher, H. Release of beta-endorphin immunoreactive material under perioperative conditions into blood or cerebrospinal fluid: significance for postoperative pain? Anesth Analg 2003; 96: 481–486, table.Google ScholarPubMed
42.Cabioglu, MT, Ergene, N. Changes in levels of serum insulin, C-peptide and glucose after electroacupuncture and diet therapy in obese women. Am J Chin Med 2006; 34: 367–376.CrossRefGoogle ScholarPubMed
43.Cabioglu, MT, Ergene, N. Changes in serum leptin and beta endorphin levels with weight loss by electroacupuncture and diet restriction in obesity treatment. Am J Chin Med 2006; 34: 1–11.CrossRefGoogle ScholarPubMed
44.Cabyoglu, MT, Ergene, N, Tan, U. The treatment of obesity by acupuncture. Int J Neurosci 2006; 116: 165–175.CrossRefGoogle ScholarPubMed
45.Cabyoglu, MT, Ergene, N, Tan, U. The mechanism of acupuncture and clinical applications. Int J Neurosci 2006; 116: 115–125.CrossRefGoogle ScholarPubMed
46.Karst, M, Scheinichen, D, Rueckert, T et al. . Effect of acupuncture on the neutrophil respiratory burst: a placebo-controlled single-blinded study. Complement Ther Med 2003; 11: 4–10.CrossRefGoogle ScholarPubMed
47.Yang, QG, Hang, YN, Sun, DJ. Effect of combined drug-acupuncture anesthesia on hypothalamo-pituitary-adrenocortical axis response and glucose metabolism in open-heart surgery patients. Zhongguo Zhong Xi Yi Jie He Za Zhi 2001; 21: 729–731.Google ScholarPubMed
48.Zalewska-Kaszubska, J, Obzejta, D. Use of low-energy laser as adjunct treatment of alcohol addiction. Lasers Med Sci 2004; 19: 100–104.CrossRefGoogle ScholarPubMed
49. Pomeranz B. Wissenschaftliche Belege fu"r die Rolle der Endorphine in der Akupunkturanalgesie. In: Stux G, Stiller N, Pomeranz B, eds. Akupunktur – Lehrbuch und Atlas. Berlin, Germany: Springer, 1993: 11–49.Google Scholar
50.Almay, BGL, Johansson, F, von Knorring, L, Terenius, L, Wahlström, A. Endorphins in chronic pain. I. Differences in CSF endorphin levels between organic and psychogenic pain syndromes. Pain 1978; 5: 153–162.CrossRefGoogle ScholarPubMed