2013_korea sul_acup (com injec. sc. veneno abelha em acup.pts.)_r._dor pós-avc

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Complementary Therapies in Medicine (2013) 21, 155—157

Available online at www.sciencedirect.com

j ournal homepage: www.elsevierheal th.com/ journals/ct im

SHORT COMMUNICATION

Bee venom acupuncture point injection for central

post stroke pain: A preliminary single-blind

randomized controlled trial

Seung-Yeon Cho, Joo-Young Park, Woo-Sang Jung, Sang-Kwan Moon,Jung-Mi Park, Chang-Nam Ko, Seong-Uk Park ∗

Department of Cardiology and Neurology of Korean Medicine, College of Korean Medicine, Kyung Hee University, Seoul,

Republic of Korea

Available online 13 March 2013

KEYWORDS

CPSP;Stroke;Bee venom;Apipuncture;Post stroke

Summary

Objective:Weinvestigated apipuncture, or acupuncture point injection with diluted bee venom,

as a promising new treatment for central post stroke pain (CPSP).

Methods: Bee venom, diluted to 0.005% in normal saline, was administered to the treatment

group, and normal saline given to control group as twice-weekly injections for three weeks.

The points were LI15, GB21, LI11, GB31, ST36 and GB39 of the affected side and the amount of

injection was 0.05ml at each point.

Results: Eight patients in each group were included in the analysis. After three weeks therewere significant decreases in visual analogue pain scores compared with baseline in both groups

and the treatment group improved more significantly than the control group ( p= 0.009).

Conclusion: Apipuncture significantly improved CPSP in this pilot trial. Further studies of its

mechanisms and a larger and long-term follow-up trial will be needed to determine more

definitely the efficacy of apipuncture and to elucidate duration of improvement.

© 2013 Elsevier Ltd. All rights reserved.

Introduction

Central post stroke pain (CPSP), a neuropathic pain syn-drome that can occur after a cerebrovascular accident, isdue to a lesion of the somatosensory pathways within thecentral nervous system.1,2 The prevalence of CPSP is knownto be between 1% and 12%, and treatment methods suchas pharmacologic agents and neurostimulation therapy do

∗ Corresponding author at: Department of Cardiology and Neurol-ogyof Korean Medicine,KyungHeeUniversity Hospital atGangdong,#149 Sangil-dong, Gangdong-gu, Seoul 134-727, Republic of Korea.Tel.: +82 2 440 6217; fax: +82 2 440 6217.

E-mail address: [email protected] (S.-U. Park).

not work well in many patients.2—4 Apipuncture, the subcu-taneous injection of diluted bee venom into an acupoint,is used mainly to relieve pain produced by inflammatorydiseases such as rheumatoid arthritis and osteoarthritis.4

Previous studies have shown analgesic activity in a neuro-

pathic pain model,5,6 and there was a case report of CPSPusing apipuncture.4 In this study, we intended to investigatethe possibility of apipuncture, acupuncture point injectionwith diluted bee venom, as a new promising treatment forcentral post stroke pain (CPSP).

Methods

This study was performed in accordance with the ethicalstandards of the Helsinki Declaration. The protocol was

0965-2299/$ — see front matter © 2013 Elsevier Ltd. All rights reserved.http://dx.doi.org/10.1016/j.ctim.2013.02.001



156 S.-Y. Cho et al.

approved by the Institutional Review Board of our university

hospital (KHNMC-OH-IRB 2008-018).

Twenty inpatients, who complained of CPSP with a visual

analogue scale (VAS) score of >4, were randomly divided

into two groups by block randomization (block size 4).

The subjects were blinded to group allocation. Treatment

and control group algorithms were enclosed in a series of

sequentially numbered opaque envelopes. One Korean med-

ical doctor injected diluted bee venom to the treatmentgroup and normal saline to the control group twice a week

for three weeks, after informed consent was obtained. A

total of 0.05ml of diluted bee venom or normal saline was

injected into each acupoint, LI15, GB21, LI11, GB31, ST36

and GB39 of the affected side, using short needle insulin

syringes (30 Gauge×8mm, Becton, Dickinson and Company,

Franklin Lakes, NJ, USA). The selected acupoints, which

were some of the ‘‘Seven Points of Stroke’’ as described in

the literature,7 are frequently used to treat stroke, includ-

ing post stroke pain. Freeze-dried bee venom (Yumil Farm,

Korea) was diluted with normal saline at the Kyung Hee Uni-

versity Hospital at Gangdong. The minimum effective dose

of 0.05ml of bee venom diluted to 0.005% for each point

has been determined not to cause allergic reactions. Never-

theless, skin tests were performed to determine whether

each subject was allergic to bee venom. For this test,

an injection of 0.05ml bee venom diluted to 0.005% in

normal saline was performed at LI11; production of a wheal

>5mm, a rash >11mm in diameter, or severe itching at the

site within 15—20min were considered signs of bee venom

allergy and the subject was excluded from the study. The

control group also received a test injection using normal

saline. The outcomemeasurewas visual analogue scale (VAS)

score of pain severity. All patients maintained medications

and physical therapy from two weeks before the study until

the end.

Results

Ten patients were allocated to the treatment group and

10 to the control group. Two patients dropped out of the

treatment group, one due to itching and another was dis-

charged from the hospital before follow-up assessment. In

the control group, two patients left the hospital before

follow-up assessment. Therefore, data from eight patients

in each groupwho completed the follow-up assessmentwere

included in the primary analysis.

There were no significant differences in age, sex, dura-

tion of CPSP and visual analogue scale (VAS) scores between

the two groups at baseline. After three weeks there weresignificant decreases in VAS scores compared with base-

line in both groups. Median VAS score decreased by 36.50

points in the treatment group, and by 11.50 points in

the control group (treatment group: baseline vs. after

three weeks: median 72.00, IQR[57.25—80.25] vs. 35.50,

IQR[9.50—46.50], p= 0.007, control group: baseline vs. after

three weeks: median 64.50, IQR[44.75—82.25] vs. 53.00,

IQR[34.75—82.25], p =0.013, by Wilcoxon signed rank test).

In between-group analysis, the treatment group improved

significantly more than the control group ( p= 0.009 by

Mann—Whitney U test). There were no serious adverse

events (Fig. 1).

Figure 1 Box plots of central post stroke pain VAS scores.

There were significant changes compared with baseline by

Wilcoxon signed ranks tests in both groups (bee venom group

p = 0.007, normal saline group p = 0.013). But, there was a signif-

icant difference between the bee venom and the normal saline

acupoint injection groups by Mann—Whitney U test ( p= 0.009).

VAS, visual analogue scale.

Discussion

Our data indicate that apipuncture significantly improves

CPSP, but this is a small preliminary study. Therefore, we

cannot make concrete conclusions yet. In the mechanism

underlie this action, an antinociceptive effect may occur

by activation of 2 adrenergic and serotonergic components

of the descending pain inhibitory system of apipuncture

according to the results of previous studies,5,8,9 but it

remains unclear. Further studies of its mechanisms and

larger and longer-term follow-up double-blind trials are

needed to determine the efficacy of apipuncture and to

elucidate its duration of effect.

Conflict of interest statement

No author has any conflict of interest in this work.

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