IN-DEPTH: COMPLEMENTARY MEDICINE


They used acupuncture sensitivity on palpation and clinically diagnosed 86 (9.4%) horses with stifle syn- drome. Twenty-two (25.6%) of the 86 horses with stifle syndrome underwent ultrasonography and/or radiography, and lesions were detected in 21 (95.5%) horses. The diagnostic points for stifle syndrome included BL-20, BL-21, local stifle points, GB-27, SP-13, ST-30, and the sacral AP BL-54. They con- cluded that AP sensitivity for diagnosis of stifle dis- ease may be considered a reliable diagnostic method and suggested it be included in routine clinical examination of horses and in reference textbooks as a lameness diagnostic modality. And finally, an equine practitioner from South Africa has reported identifying soft tissue injuries and pain in horses using diagnostic points associated the GB Channel with good clinical results.19,20


4. Acupuncture for General Pain Management and Mechanism


A recent publication reported that acupuncture an- algesia mediated through increasing substances in the body including 5-HT, which increased the pain threshold, also improved the absorption of pain in- ducing inflammatory substances.21 Another study indicated that low-level laser acupuncture can im- prove the pain threshold of rabbits, goats, pigs, mice, and dogs, and increases the concentration of 5-HT in cerebral spinal fluid which suppresses the evoked cortical potential, thereby inhibiting pain.22 EA using 2.0 Hz, continuous wave, 6 volts, 30 minutes once per day for 4 weeks was stimulated at acu- points SP-10, ST-34, ST-35, Nei-xi-yan, ST-36, and GB-34 in rabbit knee osteoarthritis models. Re- sults showed that EA reduced the levels of inf- lammatory factors including interleukin (IL)-1, tu-


mor necrosis factor (TNF)-, and prostaglandin E2 to alleviate the inflammation reaction and also no- table pain relief.23 The effect of different frequencies (2 Hz, 40 Hz, 60


Hz, 100 Hz) of EA on the pain threshold has also been studied using the goat as a model.24 Two pairs of acupoints Bai-hui and Qi-jia, Er-gen and San-yang-luo were stimulated with EA for 30 min- utes. Their results showed that of the frequencies studied, EA with 60 Hz had the best effect for pain relief. Follow-up studies confirmed that EA also had an aftereffect of pain relief.25 This study indi- cated that after being stimulated via EA with 60 Hz for 30 minutes the pain threshold of goats increased and reached its peak at hour 0, i.e., at the end of EA stimulation. The pain tolerance then decreased gradually to the baseline by hour 5; however, by hour 6 the pain threshold began to rebound and reached a second peak at hour 8, and then gradually fell again reaching baseline at hour 12. The mean pain threshold during the time from 0 to 12 hours after EA was higher (P  .05) than that at 0.5 hours before EA, which showed that the EA-induced anal- gesic aftereffect lasted for at least 12 hours in goats.25


322 2018  Vol. 64  AAEP PROCEEDINGS The efficacy of various frequencies of EA for pain


relief in 22 horses was systematically reviewed in a clinical trial.11 Focused radiant light/heat was used as a noxious stimulus and was directed onto the equine pastern to elicit the classic flexion- withdrawal reflex. Hoof withdrawal reflex latency (HWRL) was defined as the time (in seconds) be- tween lamp illumination and the withdrawal of the hoof. The results indicate that theHWRLis a valid measurement to assess pain perception and to doc- ument pain relief from acupuncture. The results also suggest that EA treatments at high frequencies (120 Hz) with 30 minutes induce a stronger analge- sic effect than EA treatments at low frequencies (20 Hz) with 30 minutes in local regions; however, EA treatments at lower frequencies induced longer analgesia. A double 33 Latin Square design was applied in studying experimental lameness in six horses. Lameness was produced in each subject by tighten- ing a setscrew against the sole of the hoof.10 Lame- ness grading scores of 0, 1, 2, and 3 were used to evaluate the severity of lameness. Three types of stride length were measured: total stride length, front half stride length (FHSL), and back half stride length (BHSL). The difference between FHSL and BHSL was defined as difference front/back (DFB). The DFB increased significantly when the horse was lame suggesting that the DFB could be used as an objective parameter to measure lameness in horses. EA reduced the lameness score significantly in this study. Plasma concentrations of -endorphin, ACTH, and cortisol were measured in both of the above experiments. In addition EA significantly increased the HWRL and reduced the lameness score, and simultaneously increased the plasma -endorphin concentration. These results indicate that the release of -endorphin may be the pathway in which acupuncture relieves experimental pain. None of the acupuncture treatments altered the ACTH concentrations which indicates that ACTH is not involved in EA analgesia. A different result was reported, however, in a pilot


study that indicated that acupuncture treatment had no effect on pain in horses.26 Nine horses of palmar heel pain with lameness scale varied from 1 to 3 were randomly assigned to an acupuncture and control group. Twice-weekly visits on nonsucces- sive days were made to each horse. Horses in the treatment group received 20 minutes of DN and EA at each visit; horses in the control group received no treatment. The same APs were applied to each horse in the treatment group (n  5): Bai-hui, BL- 11, BL-13, PC-1, HT-9, LU-1, and LU-11 with the dry needle; and SI-9 and LI-11 bilaterally with EA of 2 to 5 Hz. The researchers found with observa- tional grading that all four horses in the control group maintained the same grade of lameness through the duration of the study or improved on one or both limbs by no more than 1 grade of lame- ness. Of the five horses in the treatment group,


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