Comparing analgesic effect of manual vs laser acupuncture for lateral epicondylalgia

A team of researchers from China Medical University and Da-Chien General Hospital in Taiwan (R.O.C.) recently compared the analgesic effect of laser acupuncture and manual acupuncture for the treatment of lateral epicondylalgia. Manual acupuncture is effective in short-term pain relief for the treatment of lateral epicondylalgia.

The acupuncture increases endorphin secretion to relieve pain and affects the pathway of the Aδ nerve fiber to inhibit painful sensation and relieves pain in certain body regions. The acupuncture causes a De Qi sensation and a sour and warm feeling at the acupuncture point. It is critical in pain relief because it activates the descending pain inhibitory system in the central nervous system.

Low-level laser therapy for laser acupuncture has been recently used for treatment of orthopedic diseases. Compared with manual acupuncture, laser therapy applied to the acupuncture point has more advantages because it is painless, aseptic, safe, dosage adjustable, and user friendly. The pain relief achieved using laser acupuncture is related to the metabolism of adenosine triphosphate because it encourages the myofascial trigger point to absorb energy and thereby causes local hypoxia to increase blood circulation, which subsequently decreases the pain caused by lateral epicondylalgia.

The team conducted a systematic review and meta-analysis to compare the analgesic effect of laser acupuncture and manual acupuncture for treating lateral epicondylalgia. We investigated studies in the Medline, PubMed, and CINAHL databases, published from January 1980 to December 2013.

Based on these statistics, the research team calculated the experimental event rate (EER), control event rate (CER), absolute risk reduction (ARR), and relative risk reduction (RRR) of the studies and analyzed the number needed to treat (NNT). The total effect was calculated by a total random effect model to assume the analgesic effect of laser acupuncture and manual acupuncture. The results indicated that manual acupuncture exhibited a substantial difference in treatment effect.

Lateral epicondylitis is the most common overuse syndrome in the elbow. Lateral epicondylitis or tennis elbow is an injury involving the extensor muscles of the forearm. These muscles originate on the lateral epicondylar region of the distal of the humerus.

The most common type of lateral elbow pain is lateral epiconylitis. In occupations requiring repetitive upper extremity activities and particularly those involving computer use, heavy lifting, forceful forearm pronation and supination, and repetitive vibration, lateral epicondylitis is repeatedly seen. The clinical examination of lateral epicondylitis is often clear. This is shown with local tenderness over the common forearm extensor tendon insertion at the lateral epicondyle. This can be extended to the extensor mass, with less annular ligament. Pain can be reproduced with resisted wrist and middle finger extension and with gripping activities. It is possible that symptoms are generated by passive wrist flexion with elbow extension. It is often seen that the flexibility and the strength in the wrist extensor and posterior shoulder muscles are deficient. However, in the workplace where repetitive elbow and wrist motion is involved, lateral epicondylitis occurs. On the lateral epicondyle it’s about 7 times more common than on the medial epicondyle.