Cutaneous innervation before and after one treatment period of acupuncture.
BACKGROUND
The effect of acupuncture on nociceptive pain is well documented, but effects on nociceptive itch have been contradictory.


OBJECTIVE
To evaluate possible effects of acupuncture on the occurrence, distribution and function of sensory nerve fibres in human skin.


METHODS
Ten subjects were treated by inserting 10 acupuncture needles subcutaneously at the upper lateral aspect of one buttock. The subjects were recruited from an acupuncture clinic and were undergoing specific acupuncture treatment for their disorders. The needles were stimulated (rotated to and fro) twice during the twice-weekly 25-min sessions over 5 weeks. Skin biopsies, diameter 3 mm, were taken before and 3-6 days after local acupuncture. Antibodies to the pan-neuronal marker protein gene product 9.5 (PGP 9.5), calcitonin gene-related peptide (CGRP), vanilloid receptor 1 (VR1) and mu- and delta-opioid receptors were employed to study sensory unmyelinated nerve fibres that transmit nociceptive pain and itch. A histamine prick test using planimetry was used to record experimental itch after acupuncture on the treated area and on the corresponding control skin, and a visual analogue scale was used to evaluate itch.


RESULTS
The mean +/- SEM number of CGRP-immunoreactive nerve fibres per biopsy section was reduced from 36.0 +/- 3.3 to 21.3 +/- 4.0 (P = 0.05) after the treatment. PGP 9.5-immunoreactive nerve fibres were found both in the epidermis and in the subpapillary dermis. The mean +/- SEM total number of PGP 9.5-immunoreactive nerve fibres decreased from 249.8 +/- 16.7 to 211.8 +/- 12.0 (P = 0.03). The PGP 9.5-immunoreactive nerve fibres occurring in the dermis appeared more fragmented after the acupuncture compared with pretreatment. VR1 immunoreactivity was found both in the free nerve fibres and in kite-like formations, possibly mast cells, throughout the dermis, sometimes occurring around hair follicles. The mean +/- SEM number of VR1-immunoreactive elements was not significantly influenced by acupuncture, at 33.5 +/- 4.6 vs. 43.0 +/- 4.4 (P = 0.09). No immunoreactivity was found in the skin against mu- and delta-opioid receptors with the antibodies used in this study. Neither histamine-induced itch nor cutaneous responses were influenced by acupuncture.


CONCLUSIONS
The present data indicate an effect of acupuncture on neuropathic itch but not histamine-mediated itch. Our findings support the opinion that the pain-relieving effects of acupuncture partly depend on its effect on the peripheral innervation.
Carlsson
C P
CP
Clinical Science, Department of Neurosurgery, Lund University, University Hospital, Lund, Sweden.
Sundler
F
F
Wallengren
J
J
D015667:Acupuncture Analgesia / Q000379:methods; D015670:Acupuncture Therapy / Q000379:methods*; D000328:Adult; D000368:Aged; D001706:Biopsy; D015740:Calcitonin Gene-Related Peptide / Q000378:metabolism; D005260:Female; D006632:Histamine; D006801:Humans; D008875:Middle Aged; D009412:Nerve Fibers / Q000378:metabolism / Q000473:pathology; D009475:Neurons, Afferent / Q000378:metabolism / Q000473:pathology; D011537:Pruritus / Q000473:pathology / Q000628:therapy; D012867:Skin / Q000294:innervation* / Q000473:pathology; D043222:Ubiquitin Thiolesterase / Q000378:metabolism
C482860:UCHL1 protein, human; D006632:Histamine; D043222:Ubiquitin Thiolesterase; D015740:Calcitonin Gene-Related Peptide