But there have been no research reports about acupuncture intervention for relieving postthyroidectomy pain till now. It has been well documented from clinical practice of acupuncture analgesia and anesthesia that Futu (LI18) and Hegu (LI4)-Neiguan (PC6) are effective acupoints for thyroid surgery. It has been demonstrated that the analgesic effect of acupuncture is related to its functions in upregulating plasma beta-endorphin level in patients undergoing colonoscopy, breast radical carcinoma operation, and in activating peripheral opioid pathway in a mouse model of postoperative pain. Acupuncture, a component of traditional Chinese medicine, has been used to treat pain for millennia, and accumulating evidence indicates the efficacy of acupuncture for postoperative analgesia. Therefore, a multimodal approach combining various analgesics with a nonpharmacological strategy is necessary for providing adequate postoperative pain control. However, these drugs may worsen anesthetics-induced nausea, vomiting, and other side effects and the analgesic effect of these drugs is not always effective. In the treatment of this type of postoperative pain, oral administration of opioids (about 90% of the patients) and nonopioid adjuncts is the optimized choice currently. Postoperative pain in patients undergoing thyroidectomy generally lasts for hours or days in spite of being moderate in severity and different in duration for the types of diseases.
This study highlights the targets of EA intervention for reducing post-thyroid-surgery pain for the first time. These findings showed that LI18 and LI4-PC6 EA stimulation-induced downregulation of SP, CGRP, NK-1R, COX-1, and PGE2 levels in the dorsal cervicospinal cord may contribute to their effects in relieving neck-incision pain. EA stimulation of LI18 and LI4-PC6 markedly inhibited neck-incision induced upregulation of SP and CGRP immunoactivity, NK-1 R and COX-1 mRNA and protein expression levels, as well as the increase of PGE2 content in the dorsal cervicospinal cord ( P < 0.05).
Outcomes indicated that EA of EA-LI18 and LI4-PC6 (not ST36-GB34) significantly suppressed neck-incision induced decrease of thermal pain threshold ( P < 0.05). Cervicospinal SP and CGRP immunoactivity was detected by immunofluorescence technique, NK-1R and COX-1 protein and mRNA expression levels were determined using Western blot and real-time PCR, respectively, and PGE2 content was measured using ELISA.
EA intervention was applied to bilateral Futu (LI18), Hegu (LI4)-Neiguan (PC6), and Zusanli (ST36)-Yanglingquan (GB34) for 30 min. The present study was aimed to determine if cervicospinal substance P (SP) and its neurokinin-1 receptor (NK-1R), calcitonin gene-related peptide (CGRP), cyclooxygenase-1 (COX-1), and prostaglandin E2 (PGE2) were involved in electroacupuncture (EA) analgesia in neck-incision pain rats.
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