The overall goals of this proposed project are 1) to develop Dr. Alexandra Dimitrova into an independent complementary and alternative physician researcher~ and 2) To conduct a clinical research study of acupuncture, assessing its effects on the peripheral nerves. Dr. Dimitrova will develop her knowledge base, experience and skills in 5 key areas through mentored training:1) EMG/Nerve Conduction Studies and Quantitative Sensory Testing~ 2) Clinical research: methodology, biostatistics, epidemiology, grant and paper preparation~ 3) Acupuncture~ 4) Somatosensory Evoked Potentials~ 5) Microneurography. The long-term goal of the research training plan is to master electrophysiologic techniques which will be used in the assessment of acupuncture's effect on the peripheral and central nervous system and thus characterize and quantify acupuncture's effect and its mechanism of action. As a first step, the proposed research study will serve to assess the local effects of three widely-used acupuncture modalities on two anatomically distinct nerves in the arm (Median and Ulnar) and two nerves in the leg (Tibial and Deep Peroneal). Our central hypothesis is that acupuncture to points overlying a peripheral nerve causes nerve-specific changes in nerve conduction studies (NCS) and quantitative sensory testing (QST) only in that nerve, as the needles deliver mechanical and electrical stimulation on the peri-neural tissues. We expect to observe greater physiologic changes in diseased nerves, compared to healthy ones, due to their baseline abnormalities. In a mechanistic study of acupuncture, 36 subjects with carpal tunnel syndrome will be randomized to manual acupuncture, low-and high-frequency electroacupuncture groups. Following baseline measurements of NCS and QST of the Median and Ulnar nerves, each group will undergo acupuncture to the Median nerve (Pericardium channel points) and to the Ulnar nerve (Heart channel points), one week apart, order counterbalanced, followed by repeat NCS and QST measurements. An analogous study will be performed in the Tibial nerve (using Kidney channel points) and Deep Peroneal nerve (using Stomach channel points) in the leg.
The specific aims are to 1: Characterize the effects of acupuncture on QST (cold and vibration sensation thresholds) and nerve conduction parameters in the Median and Ulnar nerves. 2: Compare the effects of acupuncture on a diseased nerve (Median) to those of a healthy nerve (Ulnar), using QST (cold and vibration sensation thresholds) and NCS parameters. 3: Compare the effects of manual acupuncture to those of low-frequency and high-frequency electroacupuncture. 4: Conduct an analogous study using NCS and QST to assess the local effects of acupuncture on the Tibial and Deep Peroneal Nerves in the leg, in subjects with peripheral neuropathy. This research is expected to increase our understanding of acupuncture's mechanism of action and capture, characterize and quantify its effect in a way, which has not been accomplished to-date.
This research is important to public health because in spite of acupuncture's wide use and proven efficacy for numerous medical conditions, its mechanism of action remains unclear and there are wide variations in its practices. Characterizing acupuncture's local and nerve-specific effects on the peripheral nerves will increase our understanding of this CAM modality. Furthermore, techniques introduced in this research may be used in future studies to explore acupuncture's efficacy at various acupuncture points and could help develop standardized and efficient treatment protocols.