Medical Acupuncture for Sinusitis pain relief April 2015

I’ve written on this topic before and given more recent evidence in support of a mechanisms based approach, I thought it time to revisit. Furthermore, as a sinus pain and congestion sufferer the role of Acupuncture in providing relief is definitely of interest to me!

First a quick review of the condition:

Acute sinusitis is defined as inflammation with swelling and engorgement of the nasal cavity and sinuses characterised by the existence, for 12 weeks or less, of two or more of the following symptoms (Fokkens, 2005).

  • Blockage/congestion and discharge (anterior or posterior nasal drip which may result in a cough)
  • Facial pain or pressure
  • Reduced or loss of smell

Other associated symptoms may include toothache (involving the upper teeth), tenderness, swelling, malaise and fever (Ah-See 2007). Clinically neck pain and stiffness and headache may also occur.

Sinusitis is considered to be chronic if it lasts for more than 12 weeks, and is associated with similar symptoms.

Potential complications include spreading of the infection around the eye, which possibly leads to blindness, infection of the frontal bone, and meningitis (Ah-See 2007). Symptoms and signs of such potentially serious complications include swelling of the eyes or lids, eye redness, displacement of the eye, double vision, reduced vision, severe frontal headache, and signs of meningitis (Scadding 2008).

Chronic sinusitis is thankfully uncommon but may develop following acute sinusitis and due to poor drainage of the affected sinus, inflammatory changes to the lining of the sinus that result from infection, and a flare-up of infection from time to time as a result of these changes. Sometimes other factors may cause, or contribute, to the development of chronic sinusitis. For example, a persisting allergy that causes inflammation in a sinus, and swelling or blockage of the drainage channel creating an environment where secondary infection may occur.

Most people with acute sinusitis will recover with or without treatment within 10 days of seeing a GP (Williamson, 2007). About 92% of patients will be are prescribed an antibiotic, even though this seems to make little difference to outcome (Williamson, 2007). This is probably due to the fact that in most cases sinusitis is due to a viral infection, however secondary bacterial infection may occur (Fokkens 2005). Allergies may predispose to infection for example during or following a bout of allergic rhinitis. Other potential predisposing factors include other upper respiratory infections, smoking, diabetes mellitus, dental infections, and mechanical abnormalities such as deviation of the nasal septum (Ah-See 2007).

Symptomatic treatment of sinusitis includes paracetamol or ibuprofen sometimes combined with codeine for pain relief. Steam inhalation and saline nasal solutions can also be very effective as I have found.

With regards antibiotics, they are generally appropriate only for patients who are systemically very unwell, and have symptoms and signs of, or are at high risk of, serious complications. However you should always consult your GP for a medical opinion.

Some studies have shown Medical Acupuncture to be useful in providing symptomatic relief and improving nasal airflow (Sertel S et al, 2009) however further research is needed.

An evidence based mechanisms approach to the use of Medical Acupuncture is described below:

Local effects

For example when needling the sinus region eg. LI20, Bi Tong, Yintang

  • Analgesic effects mediated by local ATP release
  • Vasodilatory effects - increase diameter and blood flow velocity of peripheral arterioles, enhancing local microcirculation (Komori et al, 2009) possibly resulting in a flushing effect and removal of swelling/ inflammatory exudate from sinus region
  • Anti-inflammatory effects mediated by low level CGRP release (Zijlstra FJ et al, 2003)

Segmental effects

For example when needling the facial musculature as well as for example LI4 (C8,T1 myotomal/SNS supply to head and neck overlap).

  • Analgesic effects (Pomeranz B, 1987)
  • Segmental and extra segmental increase then decrease in SNS tone (Haker et al, 2000, Andersson & Lundeberg, 1995) possibly resulting in an initial vasodilation to head and neck region promoting flushing effects and removal of swelling/ inflammatory exudate from sinus region

Extra-segmental effects

For example when needling outside the facial segments eg. LI11

  • Activation of descending pain inhibitory system promoting analgesia (Pomeranz B, 1987)
  • Activation of the opioid analgesic system (Han JS, 2004).
  • Anti-inflammatory effects mediated by efferent vagus nerve activation and inflammatory macrophage deactivation (Kavoussi B, Ross BE, 2007).
  • Segmental and extra segmental increase then decrease in SNS tone (Haker et al, 2000, Andersson & Lundeberg, 1995) possibly resulting in an initial vasodilation to head and neck region promoting flushing effects and removal of swelling/ inflammatory exudate from sinus region

Central effects

For example when needling major classical points e.g LI4, ST36

  • Acupuncture has been found to significantly reduce anxiety-like behaviour, and increase brain levels of neuropeptide Y, the brain levels of which appear to correlate with reported anxiety (Lee et al, 2009)
  • Research has shown acupuncture to reduce common cold symptoms and that acupuncture stimulation enhances natural killer cell activities and modulates the number and ratio of immune cell types (Kawakita K et al, 2008).

By Simon.

References

  • Acupuncture and endorphins.Neurosci Lett 2004; 361:258-61.
  • Andersson S, Lundeberg T. Acupuncture - from empiricism to science: Functional background to acupuncture effects in pain and disease pain and disease. Medical hypotheses 1995;45.3: 271-281.
  • Ah-See KW, Evans AS. Sinusitis and its management. BMJ 2007; 334:358-61.
  • Ashworth MA et al. Variations in antibiotic prescribing and consultation rates for acute respiratory infection in UK general practices 1995-2000. Br J Gen Pract 2005;55:603-8.
  • Fokkens W et al. EAACI position paper on rhinosinusitis and nasal polyps executive summary. Allergy 2005;60:583-601.
  • Haker E, et al. Effect of sensory stimulation (acupuncture) on sympathetic and parasympathetic activities in healthy subjects. Journal auton nervous syst 2000;79.1:52-59.
  • Kawakita K et al. Do Japanese style acupuncture and moxibustion reduce symptoms of the common cold? eCAM2008;5:481-9
  • Kavoussi B, Ross BE. The neuroimmune basis of anti-inflammatory acupuncture.Integr Cancer Ther 2007;6:251-7.
  • Komori M et al. Microcirculatory responses to acupuncture stimulation and phototherapy. Anesth Analg 2009;108:635-40.
  • Lee B et al. Effects of acupuncture on chronic corticosterone-induced depression-like behavior and expression of neuropeptide Y in the rats.Neuroscience Letters 2009;453:151-6.
  • Pomeranz B. Scientific basis of acupuncture. In: Stux G, Pomeranz B, eds. Acupuncture Textbook and Atlas. Heidelberg: Springer-Verlag; 1987:1-18.
  • Sertel S et al. Acupuncture for nasal congestion: A prospective, randomized, double-blind, placebo-controlled clinical pilot study. American Journal of Rhinology and Allergy 2009;23: e23-e28.
  • Scadding GK et al. BSACI guidelines for the management of rhinosinusitis and nasal polyposis. Clin Exp Allergy 2008;38:260-75.
  • Williamson IG et al. Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: a randomized controlled trial. JAMA 2007;298:2487-96.
  • Zijlstra FJ et al. Anti-inflammatory actions of acupuncture. Mediators Inflamm 2003;12: 59-69.
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