Physiologische Mechanismen der analgetischen Akupunkturwirkung – ein Update im klinischen Kontext
Physiologische Wirkungen der Akupunktur in der Behandlung von Schmerzen sind Gegenstand von über drei Jahrzehnten Forschung. Aktuelle Übersicht über die Wirkmechanismen der Akupunktur-induzierten Analgesie Es wurde eine ausführliche Recherche auf der Basis relevanter Übersichtsarbeiten der letzten J...
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| Veröffentlicht in: | Deutsche Zeitschrift für Akupunktur (Heidelberg, Germany : 1977) Jg. 60; H. 1; S. 9 - 15 |
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| Format: | Journal Article |
| Sprache: | Deutsch |
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2017
Springer Medizin Springer Nature B.V |
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| ISSN: | 0415-6412, 1439-4359 |
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| Abstract | Physiologische Wirkungen der Akupunktur in der Behandlung von Schmerzen sind Gegenstand von über drei Jahrzehnten Forschung.
Aktuelle Übersicht über die Wirkmechanismen der Akupunktur-induzierten Analgesie
Es wurde eine ausführliche Recherche auf der Basis relevanter Übersichtsarbeiten der letzten Jahre, deren Sekundärliteratur („Schneeballrecherche”) und MEDLINE-Recherchen zu den einzelnen Unterpunkten mithilfe gängiger Suchwörter durchgeführt.
Die Studienergebnisse wurden entsprechend der folgenden Teilbereiche zusammengefasst: 1Bedeutung der Endorphine und Aktivierung der absteigenden Schmerzhemmung2Wirkung auf das autonome Nervensystem3Veränderte zerebrale Schmerzverarbeitung4Segmentale Inhibition5Lokale Mechanismen
Die Endorphinfreisetzung als anti-nozizeptiver Mechanismus der Akupunktur ist gut belegt. Es bestehen Hinweise auf einen Einfluss der Stimulationsfrequenz im Rahmen der Elektrostimulationsakupunktur (ESA). Belege für die Beteiligung verschiedener Neuromodulatoren – v. a. Serotonin und Noradrenalin – bei der Aktivierung der absteigenden Schmerzhemmung liegen vielfach vor. Wirkungen der Akupunktur auf das autonome Nervensystem scheinen möglich, aber sind noch weitgehend ungeklärt. Die Beeinflussung der zerebralen Schmerzverarbeitung durch Akupunktur ist dagegen gut untersucht, ebenso wie die Aktivierung der segmentalen Hemmung. Gut beschrieben ist die periphere Ausschüttung verschiedenster Neurotransmitter als potenzieller Wirkmechanismus der Akupunkturanalgesie.
Die Akupunktur-induzierte Analgesie beruht auf einem komplexen Zusammenspiel peripherer, spinaler und zerebraler Effekte. Dies ist durch eine große Anzahl an Grundlagenstudien belegt. Offen bleibt, zu welchen Anteilen die einzelnen Mechanismen zur schmerzlindernden Wirkung der Akupunktur beitragen, und auf welche Weise sie zusammenwirken. Erforderlich sind Studien zur Punktspezifität, zum Einfluss verschiedener Stimulationsarten und -intensitäten, sowie insbesondere human-experimentelle Grundlagenstudien, um die Übertragbarkeit der Ergebnisse aus tierexperimentellen Studien zu überprüfen.
Physiological mechanisms of pain relief achieved by acupuncture are subject to three decades of intensive research.
To give an overview about the current knowledge on mechanism underlying acupuncture induced analgesia
An extensive literature search based on significant reviews of the last years was performed. Secondary literature was reviewed and Medline searches using respective keywords were carried out. Results were summarized in the following sections: 1Importance of endogenous opioids and descending pain inhibitory circuits2Effects on the autonomous nervous system3Impacts on central pain processing4Segmental inhibition5Local mechanisms
There is substantial evidence for the release of endorphins as a central anti-nociceptive mechanism of acupuncture. With regard to electroacupuncture (EA) it has been suggested that stimulation frequency impacts on treatment outcome. The decisive role of further neuromodulators of the descending pain inhibitory circuits, primarily serotonin and norepinephrine, is well established. Effects of acupuncture on the autonomous nervous system seem likely, but remain largely unclear. In contrast, the impact of acupuncture on central pain processing is well characterized, as well as the activation of segmental inhibition occurring in the spinal cord. The peripheral release of various neuromodulators is also fairly well described as a potential mechanism contributing to acupuncture analgesia.
Acupuncture induced analgesia is based on a complex interplay of peripheral, spinal and central mechanisms. A large number of basic science and clinical studies support this notion. However it remains largely unclear how these different mechanisms are interwoven and how their contributions to the analgesic acupuncture effect compare to each other. Future studies need to address the specificity of acupuncture points or point regimens and the impact of different types and intensities of needle stimulation. In addition, it needs to be clarified whether the mechanisms identified through animal studies apply to acupuncture in humans as well. |
|---|---|
| AbstractList | Physiologische Wirkungen der Akupunktur in der Behandlung von Schmerzen sind Gegenstand von über drei Jahrzehnten Forschung.
Aktuelle Übersicht über die Wirkmechanismen der Akupunktur-induzierten Analgesie
Es wurde eine ausführliche Recherche auf der Basis relevanter Übersichtsarbeiten der letzten Jahre, deren Sekundärliteratur („Schneeballrecherche”) und MEDLINE-Recherchen zu den einzelnen Unterpunkten mithilfe gängiger Suchwörter durchgeführt.
Die Studienergebnisse wurden entsprechend der folgenden Teilbereiche zusammengefasst: 1Bedeutung der Endorphine und Aktivierung der absteigenden Schmerzhemmung2Wirkung auf das autonome Nervensystem3Veränderte zerebrale Schmerzverarbeitung4Segmentale Inhibition5Lokale Mechanismen
Die Endorphinfreisetzung als anti-nozizeptiver Mechanismus der Akupunktur ist gut belegt. Es bestehen Hinweise auf einen Einfluss der Stimulationsfrequenz im Rahmen der Elektrostimulationsakupunktur (ESA). Belege für die Beteiligung verschiedener Neuromodulatoren – v. a. Serotonin und Noradrenalin – bei der Aktivierung der absteigenden Schmerzhemmung liegen vielfach vor. Wirkungen der Akupunktur auf das autonome Nervensystem scheinen möglich, aber sind noch weitgehend ungeklärt. Die Beeinflussung der zerebralen Schmerzverarbeitung durch Akupunktur ist dagegen gut untersucht, ebenso wie die Aktivierung der segmentalen Hemmung. Gut beschrieben ist die periphere Ausschüttung verschiedenster Neurotransmitter als potenzieller Wirkmechanismus der Akupunkturanalgesie.
Die Akupunktur-induzierte Analgesie beruht auf einem komplexen Zusammenspiel peripherer, spinaler und zerebraler Effekte. Dies ist durch eine große Anzahl an Grundlagenstudien belegt. Offen bleibt, zu welchen Anteilen die einzelnen Mechanismen zur schmerzlindernden Wirkung der Akupunktur beitragen, und auf welche Weise sie zusammenwirken. Erforderlich sind Studien zur Punktspezifität, zum Einfluss verschiedener Stimulationsarten und -intensitäten, sowie insbesondere human-experimentelle Grundlagenstudien, um die Übertragbarkeit der Ergebnisse aus tierexperimentellen Studien zu überprüfen.
Physiological mechanisms of pain relief achieved by acupuncture are subject to three decades of intensive research.
To give an overview about the current knowledge on mechanism underlying acupuncture induced analgesia
An extensive literature search based on significant reviews of the last years was performed. Secondary literature was reviewed and Medline searches using respective keywords were carried out. Results were summarized in the following sections: 1Importance of endogenous opioids and descending pain inhibitory circuits2Effects on the autonomous nervous system3Impacts on central pain processing4Segmental inhibition5Local mechanisms
There is substantial evidence for the release of endorphins as a central anti-nociceptive mechanism of acupuncture. With regard to electroacupuncture (EA) it has been suggested that stimulation frequency impacts on treatment outcome. The decisive role of further neuromodulators of the descending pain inhibitory circuits, primarily serotonin and norepinephrine, is well established. Effects of acupuncture on the autonomous nervous system seem likely, but remain largely unclear. In contrast, the impact of acupuncture on central pain processing is well characterized, as well as the activation of segmental inhibition occurring in the spinal cord. The peripheral release of various neuromodulators is also fairly well described as a potential mechanism contributing to acupuncture analgesia.
Acupuncture induced analgesia is based on a complex interplay of peripheral, spinal and central mechanisms. A large number of basic science and clinical studies support this notion. However it remains largely unclear how these different mechanisms are interwoven and how their contributions to the analgesic acupuncture effect compare to each other. Future studies need to address the specificity of acupuncture points or point regimens and the impact of different types and intensities of needle stimulation. In addition, it needs to be clarified whether the mechanisms identified through animal studies apply to acupuncture in humans as well. EinleitungPhysiologische Wirkungen der Akupunktur in der Behandlung von Schmerzen sind Gegenstand von über drei Jahrzehnten Forschung.ZielsetzungAktuelle Übersicht über die Wirkmechanismen der Akupunktur-induzierten AnalgesieMethodikEs wurde eine ausführliche Recherche auf der Basis relevanter Übersichtsarbeiten der letzten Jahre, deren Sekundärliteratur („Schneeballrecherche“) und MEDLINE-Recherchen zu den einzelnen Unterpunkten mithilfe gängiger Suchwörter durchgeführt.Die Studienergebnisse wurden entsprechend der folgenden Teilbereiche zusammengefasst: 1. Bedeutung der Endorphine und Aktivierung der absteigenden SchmerzhemmungWirkung auf das autonome NervensystemVeränderte zerebrale SchmerzverarbeitungSegmentale InhibitionLokale MechanismenErgebnisseDie Endorphinfreisetzung als anti-nozizeptiver Mechanismus der Akupunktur ist gut belegt. Es bestehen Hinweise auf einen Einfluss der Stimulationsfrequenz im Rahmen der Elektrostimulationsakupunktur (ESA). Belege für die Beteiligung verschiedener Neuromodulatoren — v. a. Serotonin und Noradrenalin — bei der Aktivierung der absteigenden Schmerzhemmung liegen vielfach vor. Wirkungen der Akupunktur auf das autonome Nervensystem scheinen möglich, aber sind noch weitgehend ungeklärt. Die Beeinflussung der zerebralen Schmerzverarbeitung durch Akupunktur ist dagegen gut untersucht, ebenso wie die Aktivierung der segmentalen Hemmung. Gut beschrieben ist die periphere Ausschüttung verschiedenster Neurotransmitter als potenzieller Wirkmechanismus der Akupunkturanalgesie.SchlussfolgerungenDie Akupunktur-induzierte Analgesie beruht auf einem komplexen Zusammenspiel peripherer, spinaler und zerebraler Effekte. Dies ist durch eine große Anzahl an Grundlagenstudien belegt. Offen bleibt, zu welchen Anteilen die einzelnen Mechanismen zur schmerzlindernden Wirkung der Akupunktur beitragen, und auf welche Weise sie zusammenwirken. Erforderlich sind Studien zur Punktspezifität, zum Einfluss verschiedener Stimulationsarten und -intensitäten, sowie insbesondere human-experimentelle Grundlagenstudien, um die Übertragbarkeit der Ergebnisse aus tierexperimentellen Studien zu überprüfen. Zusammenfassung Einleitung Physiologische Wirkungen der Akupunktur in der Behandlung von Schmerzen sind Gegenstand von über drei Jahrzehnten Forschung. Zielsetzung Aktuelle Übersicht über die Wirkmechanismen der Akupunktur-induzierten Analgesie Methodik Es wurde eine ausführliche Recherche auf der Basis relevanter Übersichtsarbeiten der letzten Jahre, deren Sekundärliteratur („Schneeballrecherche“) und MEDLINE-Recherchen zu den einzelnen Unterpunkten mithilfe gängiger Suchwörter durchgeführt. Die Studienergebnisse wurden entsprechend der folgenden Teilbereiche zusammengefasst: 1. Bedeutung der Endorphine und Aktivierung der absteigenden Schmerzhemmung Wirkung auf das autonome Nervensystem Veränderte zerebrale Schmerzverarbeitung Segmentale Inhibition Lokale Mechanismen Ergebnisse Die Endorphinfreisetzung als anti-nozizeptiver Mechanismus der Akupunktur ist gut belegt. Es bestehen Hinweise auf einen Einfluss der Stimulationsfrequenz im Rahmen der Elektrostimulationsakupunktur (ESA). Belege für die Beteiligung verschiedener Neuromodulatoren — v. a. Serotonin und Noradrenalin — bei der Aktivierung der absteigenden Schmerzhemmung liegen vielfach vor. Wirkungen der Akupunktur auf das autonome Nervensystem scheinen möglich, aber sind noch weitgehend ungeklärt. Die Beeinflussung der zerebralen Schmerzverarbeitung durch Akupunktur ist dagegen gut untersucht, ebenso wie die Aktivierung der segmentalen Hemmung. Gut beschrieben ist die periphere Ausschüttung verschiedenster Neurotransmitter als potenzieller Wirkmechanismus der Akupunkturanalgesie. Schlussfolgerungen Die Akupunktur-induzierte Analgesie beruht auf einem komplexen Zusammenspiel peripherer, spinaler und zerebraler Effekte. Dies ist durch eine große Anzahl an Grundlagenstudien belegt. Offen bleibt, zu welchen Anteilen die einzelnen Mechanismen zur schmerzlindernden Wirkung der Akupunktur beitragen, und auf welche Weise sie zusammenwirken. Erforderlich sind Studien zur Punktspezifität, zum Einfluss verschiedener Stimulationsarten und -intensitäten, sowie insbesondere human-experimentelle Grundlagenstudien, um die Übertragbarkeit der Ergebnisse aus tierexperimentellen Studien zu überprüfen. |
| Author | Bäumler, P.I. Irnich, D. |
| Author_xml | – sequence: 1 givenname: P.I. surname: Bäumler fullname: Bäumler, P.I. email: Petra.Baeumler@med.uni-muenchen.de – sequence: 2 givenname: D. surname: Irnich fullname: Irnich, D. email: Dominik.Irnich@med.uni-muenchen.de |
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| Keywords | autonomes Nervensystem autonomous nervous system Elektrostimulationsakupunktur Endorphine endorphin Schmerzhemmung Adenosintriphosphat Nociception, pain inihibition segmentale Inhibition adenosine 5'triphosphate Nozizeption Neurotransmitter segmental inhibition electroacupuncture Nociception pain inihibition adenosine 5’triphosphate |
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| PublicationSubtitle | German Journal for Acupuncture and related techniques |
| PublicationTitle | Deutsche Zeitschrift für Akupunktur (Heidelberg, Germany : 1977) |
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Aktuelle Übersicht über die... Zusammenfassung Einleitung Physiologische Wirkungen der Akupunktur in der Behandlung von Schmerzen sind Gegenstand von über drei Jahrzehnten Forschung.... EinleitungPhysiologische Wirkungen der Akupunktur in der Behandlung von Schmerzen sind Gegenstand von über drei Jahrzehnten Forschung.ZielsetzungAktuelle... |
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| SubjectTerms | Acupuncture adenosine 5'triphosphate Adenosintriphosphat Analgesics autonomes Nervensystem autonomous nervous system Complementary & Alternative Medicine electroacupuncture Elektrostimulationsakupunktur endorphin Endorphine Medicine Medicine & Public Health Nervous system Neurotransmitter Nociception, pain inihibition Nozizeption Originalia | Original Articles Pain Pain Medicine Physiology Schmerzhemmung segmental inhibition segmentale Inhibition |
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