La práctica clínica diaria nos demuestra que el tratamiento con acupuntura de los síndromes de dolor osteomuscular suele producir buenos resultados terapéuticos. Ahora bien, no está claro si este efecto se obtiene tan sólo por la aplicación de la acupuntura en puntos acupunturales específicos, o si también se puede conseguir mediante un tratamiento de acupuntura no específico pero limitado a la zona afectada. Examinaremos este interrogante con el ejemplo de la epicondilitis lateral crónica del codo. Los parámetros de valoración fueron la intensidad del dolor (dolor en reposo, dolor en movimiento, dolor en carga, intensidad del dolor en el momento del interrogatorio, duración del dolor y frecuencia; puntuación 0-30), fuerza isométrica máxima de los músculos extensores del antebrazo y limitaciones funcionales (utilizando la versión en alemán del cuestionario «Disability of Arm, Shoulder and Hand», DASH; 0-100). Se evaluaron 54 pacientes con epicondilitis lateral crónica del codo y se asignaron aleatoriamente a 2 grupos para recibir, o bien un tratamiento en los puntos clásicos acupunturales según las normas de la medicina tradicional china (acupuntura verdadera o real), o un tratamiento en unos puntos no propiamente acupunturales localizados en el mismo segmento (acupuntura de control). La profundidad de inserción de las agujas y la forma de manipulación de éstas fueron idénticas en ambos grupos. En total se realizaron 10 tratamientos con una frecuencia de 2 tratamientos a la semana. Se registraron los criterios de valoración antes del inicio del tratamiento, así como a las 2 semanas y a los 2 meses de su conclusión. Tanto los pacientes como los investigadores eran «ciegos» con respecto al tratamiento respectivo. Dos semanas después de finalizar el tratamiento la puntuación total del dolor del grupo tratado con acupuntura verdadera fue, con un valor de 8,03 ± 1,23, significativamente inferior a la del grupo de referencia (12,28 ± 1,07), p = 0,005. La fuerza máxima, con 128,20 ± 11,14 N, fue significativamente mayor en el grupo de acupuntura verdadera en comparación con el grupo de referencia (92,76 ± 8,99 N), p = 0,012, y las limitaciones funcionales fueron significativamente inferiores en el grupo de acupuntura verdadera; con un resultado de 14,38 ± 2,50 frente a 25,19 ± 3,52 en el grupo de referencia, p = 0,009. Dos meses después de concluir el tratamiento tan sólo se observaba una diferencia significativa entre los grupos en cuanto a las limitaciones funcionales, pero no así con respecto a la intensidad del dolor ni a la fuerza máxima, que en ambos grupos había seguido mejorando. En pacientes con epicondilitis lateral crónica del codo, la acupuntura aplicada a los puntos clásicos acupunturales seleccionados según las reglas de la medicina tradicional china logró el éxito terapéutico de forma significativamente más rápida e intensa que la acupuntura de control regional no específica. To determine if point location is an important determinant in the effectiveness of acupuncture treatment. The clinical effectiveness of real and sham acupuncture treatment was evaluated in chronic lateral epicondylitis, an example of a musculoskeletal pain. The primary outcome parameters were pain intensity, its duration, maximal strength and disability. 54 patients with chronic lateral epicondylitis were randomly divided into 2 groups to be treated either by real acupuncture or by sham acupuncture (non-acupoints) in the same segment. Depth of insertion and method of needle manipulation did not differ between both groups. Ten treatments were reducigiven (2 treatments/week). Using the target parameters, patients were examined 1 week before the start of treatment, 2 weeks and 2 months after the end of treatment. Treatment was carried out ‘blind’ to both patient and investigator. 2 weeks after the end of treatment in the real acupuncture group pain intensity was significantly reduced (8.03 ± 1,23 versus 12.28 ± 1.07; p = 0.005), the maximal strength was significantly increased (128.20 ± 11.14 N versus 92.76 ± 8.99 N; p = 0.012) and the disability was significantly reduced (14.38 ± 2.50 versus 25.19 ± 3.52; p = 0.009). 2 months after the end of treatment the disability questionnaire showed still significant lower values in the real acupuncture group. Differences in pain intensity and maximal strength between the groups were no longer significant and had improved in both groups. In the treatment of chronic lateral epicondylitis the selection of classical acupoints results in a significantly better outcome than invasive sham acupuncture at early follow-up. This additional effect could be interpreted as a particular effect of real acupuncture.

Einleitung: Der klinische Alltag zeigt, dass die Akupunkturbehandlung muskuloskeletaler Schmerzsyndrome oft zu guten Behandlungsergebnissen führt. Unklar ist, ob dieser Effekt nur durch Akupunktur an spezifischen Akupunkturpunkten erreicht wird oder auch durch eine ungezielte, aber segmentbezogene Akupunkturbehandlung erzielt werden könnte. Diese Fragestellung wurde am Beispiel der chronischen Epicondylopathia lateralis humeri überprüft. Zielparameter waren Schmerzintensität (Ruheschmerz, Bewegungsschmerz, Schmerz bei Belastung, Schmerzintensität zur Zeit der Befragung, Schmerzdauer, Häufigkeit, 0–30), isometrische Maximalkraft der Unterarmextensoren und Funktionseinschränkungen (deutsche Version des Fragebogens “Disability of Arm, Shoulder and Hand”, DASH, 0–100).

Objective: The clinical long-term effectiveness of real and sham acupuncture treatment on differentiated pain measurement was evaluated in chronic lateral epicondylitis, an example of a tendomyotic disorder. Methods: Randomised, examiner- and patient-blinded controlled clinical study. Outcome measurement: pain at rest, pain on movement, pain on exertion, frequency and duration of pain. Real acupuncture (n = 23) was tested versus invasive sham acupuncture (n = 22). Ten treatments were given (2 treatments/week). Patients were examined at baseline (E1) as well as 2 weeks (E2), 2 months (E3) and 1 year (E4) after the end of treatment. In the treatment with real acupuncture, acupuncture points were selected and mechanically stimulated while in the sham group non-acupuncture points were selected. Results: There was no significant difference between the groups at baseline for any outcome parameter. Two weeks, 2 months and 1 year after the end of treatment there were significant reductions in all pain variables compared to baseline. At the first follow-up, significant group differences were registered for pain on motion and pain on exertion in favour to the real acupuncture group. These differences in pain intensity between the groups were no longer significant at the 2 months and 12 months follow-ups. Conclusion: The results suggest that, in the treatment of chronic epicondylitis, the selection of so-called real acupuncture points gives better results than invasive sham acupuncture at early follow-up. This additional effect can be interpreted as a specific effect of real acupuncture.

OBJECTIVE:To evaluate the clinical efficacy of acupuncture in the treatment of chronic lateral epicondylitis.METHODS:In a randomized, investigator- and patient-blinded, controlled clinical study, 23 patients were treated with real acupuncture and 22 patients received sham acupuncture. Patients each received 10 treatments, with two treatments per week. The primary outcome variables were maximal strength, pain intensity (verbal rating scale) and disability scale (Disabilities of the Arm, Shoulder and Hand questionnaire). Patients were examined at baseline (1 week before the start of treatment) and at follow-up 2 weeks and 2 months after the end of treatment.RESULTS:There was no significant difference between the groups at baseline for any outcome parameter. Two weeks and 2 months after the end of treatment, there were significant reductions in pain intensity and improvements in the function of the arm and in maximal strength in both treatment groups. At the 2-week follow-up these differences were significantly greater for all outcome parameters in the group treated with real acupuncture. At 2 months the function of the arm was still better in this group than in the sham acupuncture group; however, the differences in pain intensity and maximal strength between the groups were no longer significant.CONCLUSION:In the treatment of chronic epicondylopathia lateralis humeri, acupuncture in which real acupuncture points were selected and stimulated was superior to non-specific acupuncture with respect to reduction in pain and improvement in the functioning of the arm. These changes are particularly marked at early follow-up.