循经推拿刮痧法防治腰背痛的机制研究
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摘要
目的:探讨腰背痛患者使用循经推拿刮痧法治疗的效果及其致痛物质含量的变化。方法:选取腰背痛患者60例,随机分为对照组、推法组和刮痧组,每组20例,分别给予不同的推拿处理方法。比较各组患者的总体疗效及致痛物质含量的变化。结果:治疗前3组VAS评分、ODI指数、IL-6、TNF-α、SP比较,差异均无统计学意义(P>0.05);3组治疗后VAS评分、ODI指数、IL-6、TNF-α、SP与组内治疗前比较,差异均有统计学意义(P<0.05);与对照组治疗后比较,推法组及刮痧组的VAS评分、ODI指数、IL-6、TNF-α、SP均显著下降(P<0.05);治疗后推法组VAS评分、ODI指数、IL-6、TNF-α、SP与刮痧组比较,差异均无统计学意义(P>0.05)。结论:推法与刮痧法均能有效降低腰背痛患者的VAS评分及ODI指数,改善腰背痛患者的疼痛与功能障碍,其作用机制与降低致痛物质的表达,改善局部的炎症反应有关。
Objective: To investigate the therapeutic effect and the change of pain induced substance in patients with low back pain treated with massage and scrapping along meridian method. Methods: Sixty patients with low back pain were randomly divided into control group, massage group and scraping group, 20 cases in each group. Each group was given different manipulation methods. The overall curative effect and the change of the content of pain-causing substances in each group were compared. Results: There was no significant difference in VAS scores, ODI indexes, IL-6, TNF-αand SP among the three groups before treatment(P>0.05); after treatment, VAS scores, ODI indexes, IL-6, TNF-αand SP in the three groups were significantly different from those before treatment(P<0.05); after treatment, VAS scores, ODI indexes, IL-6, TNF-α and SP in the pushing group and scraping group were significantly lower than those in the control group(P<0.05). There was no significant difference in VAS scores, ODI indexes, IL-6, TNF-α, SP between pushing group and scraping group after treatment(P>0.05). Conclusion: Both massage and scrapping method can effectively reduce the VAS scores and ODI indexes of patients with low back pain, and improve the pain and dysfunction of patients with low back pain. Its mechanism is related to reducing the expression of pain-causing substances and improving local inflammatory response.
Objective: To investigate the therapeutic effect and the change of pain induced substance in patients with low back pain treated with massage and scrapping along meridian method. Methods: Sixty patients with low back pain were randomly divided into control group, massage group and scraping group, 20 cases in each group. Each group was given different manipulation methods. The overall curative effect and the change of the content of pain-causing substances in each group were compared. Results: There was no significant difference in VAS scores, ODI indexes, IL-6, TNF-αand SP among the three groups before treatment(P>0.05); after treatment, VAS scores, ODI indexes, IL-6, TNF-αand SP in the three groups were significantly different from those before treatment(P<0.05); after treatment, VAS scores, ODI indexes, IL-6, TNF-α and SP in the pushing group and scraping group were significantly lower than those in the control group(P<0.05). There was no significant difference in VAS scores, ODI indexes, IL-6, TNF-α, SP between pushing group and scraping group after treatment(P>0.05). Conclusion: Both massage and scrapping method can effectively reduce the VAS scores and ODI indexes of patients with low back pain, and improve the pain and dysfunction of patients with low back pain. Its mechanism is related to reducing the expression of pain-causing substances and improving local inflammatory response.
引文
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[12]赵国敏,尹金淑.P物质及其受体神经激肽1受体与疼痛的相关性研究[J].医学综述,2015,21(16):2890-2893.
[13]Avila ED,Molon RS,Godoi GD,et al.Relationship between levels of neuropeptide Substance P in periodontal disease and chronic pain:a literature review[J].Investig Clin Dent,2014,5(2):91-97.
[14]Jarcho JM,Feier NA,Bert A,et al.Diminished neurokinin-1 receptor availability in patients with two forms of chronic visceral pain[J].PAIN,2013,154(7):987-996.
[15]刘宿,刘怀琼.细胞因子和神经肽调控外周组织的疼痛[J].实用疼痛学杂志,2005,1(4):241-244.
[16]Valledjo R,Tilley D M,Vogel L,et al.The role of gliand the immune system in the development and maintenance of neuropathic pain[J].Pain Pract,2010,10(3):167-184.
[17]John D Loeser,Ronald Melzack.Pain:an overview[J].Lancet,1999,353(8):1607-1609.
[18]张鸿嫣,杜世正,石秦川,等.刮痧对腰背痛干预效果的系统评价[J].时珍国医国药,2015,26(12):3047-3050.(收稿日期:编辑:罗英姣)
[2]WOOLF A D,PFLEGER B.Burden of major musculoskeletal conditions[J].Bull World Health Organ,2003,81(9):646-656.
[3]Fletcher R,Fletcher S,Wagner E.Clinical Epidemiology:The Essentials.Baltimore[M].Md:Williams&Wilkins,1996.
[4]Furlan AD,Brosseau L,Imamura M,et al.Massage for low back pain:A systematic review within the framework of the Cochrane Collaboration Back Review Group[J].Spine,2002,27(17):1896.
[5]丁献军.非特异性下背痛保守治疗的疗效分析[D].杭州:浙江大学,2004.
[6]谢凌,李义凯.脊柱推拿治疗腰背痛疗效的研究进展[J].中医外治杂志,2014,23(4):49-52.
[7]李洁,姜荣荣,徐桂华.刮痧法治疗腰椎间盘突出症的研究进展[J].陕西中医,2013,34(1):118.
[8]姜荣荣.刮痧治疗腰椎间盘突出症大鼠作用机制的实验研究[D].南京:南京中医药大学,2013.
[9]陈博,詹红生,石印玉,等.腰背痛的致病机理及中医学对腰背痛的认识[J].中国中医骨伤科杂志,2010,18(6):62-64.
[10]Curtis W Slipman,Zacharia Isaac,David A Lenrow,et al.Clinical Evidence of Chemical Radiculopathy[J].Pain Physician,2002,5(3):260-265.
[11]Churg A,Dai J,Tai H,et al.Tumor necrosis factoralphawas central to acute cigarette smoke-induced inflammation and connective tissue breakdown[J].Am JRespir Crit Care Med,2002(166):849-854.
[12]赵国敏,尹金淑.P物质及其受体神经激肽1受体与疼痛的相关性研究[J].医学综述,2015,21(16):2890-2893.
[13]Avila ED,Molon RS,Godoi GD,et al.Relationship between levels of neuropeptide Substance P in periodontal disease and chronic pain:a literature review[J].Investig Clin Dent,2014,5(2):91-97.
[14]Jarcho JM,Feier NA,Bert A,et al.Diminished neurokinin-1 receptor availability in patients with two forms of chronic visceral pain[J].PAIN,2013,154(7):987-996.
[15]刘宿,刘怀琼.细胞因子和神经肽调控外周组织的疼痛[J].实用疼痛学杂志,2005,1(4):241-244.
[16]Valledjo R,Tilley D M,Vogel L,et al.The role of gliand the immune system in the development and maintenance of neuropathic pain[J].Pain Pract,2010,10(3):167-184.
[17]John D Loeser,Ronald Melzack.Pain:an overview[J].Lancet,1999,353(8):1607-1609.
[18]张鸿嫣,杜世正,石秦川,等.刮痧对腰背痛干预效果的系统评价[J].时珍国医国药,2015,26(12):3047-3050.(收稿日期:编辑:罗英姣)