Heilongjiang University of Traditional Chinese Medicine researchers find true acupuncture more effective than sham acupuncture for the relief of claustrophobia (fear in enclosed spaces). During an MRI, claustrophobia may cause severe nervousness or panic attacks and result in termination of the procedure. Usual care approaches to avoid claustrophobia include psychological methods and sedatives. [1] This study examines an integrative approach to care by using acupuncture to address this concern. The results indicate that acupuncture prior to an MRI procedure mitigates claustrophobia.

The acupoint selection for true acupuncture was based on Traditional Chinese Medicine (TCM) principles. The researchers note that claustrophobia is categorized in the Bei Die (abject fear), Jing Ji (fright-palpitations), and Kong Zheng (fear) class of disorders. The main zang-fu organs related to claustrophobia include the liver, kidneys, and heart. In the Su Wen (Plain Questions), it is written that “the kidneys govern fear” and “liver qi deficiency leads to susceptibility to fear.” The treatment principle is to soothe the liver qi, tonify the kidney qi, and stabilize the spirit and mind. The true acupuncture group achieved a 92.5% total effective rate; the two sham acupuncture groups achieved a total effective rate of 25.0% and 17.5% respectively. [2]

 

Design
Heilongjiang University researchers (Li et al.) used the following study design. A total of 160 subjects from the First Affiliated Hospital of Heilongjiang University of TCM participated in the study. All patients had claustrophobia during an MRI. They were divided into four groups of 40 subjects each. The first group (true acupuncture) was given true acupuncture at disease-specific acupoints. The second group (sham acupuncture A) was given sham acupuncture at non-acupoints. The third group (sham acupuncture B) was given sham acupuncture at non-disease-specific acupoints. For the sham acupuncture points in group B, the researchers comment that there are no studies or historical texts indicating these points are effective for the treatment of claustrophobia. A fourth group did not receive intervention.

The statistical breakdown for each group was as follows. The mean age of the true acupuncture group was 39 ±7 years. The average course of disease in this group was 8 ±5 years. The mean age of the sham acupuncture A group was 37 ±8 years. The average course of disease in this group was 9 ±3 years. The mean age of the sham acupuncture B group was 38 ±9 years. The average course of disease in this group was 10 ±6 years. The mean age of the blank control group was 39 ±8 years. The average course of disease in this group was 8 ±5 years. There were no significant statistical differences in terms of age, gender, and course of disease relevant to patient outcome measures prior to treatments.

 

Acupuncture
For patients receiving acupuncture, identical acupuncture manipulation techniques (rotating and twisting) were applied to all patients every 10 minutes during a 30-minute needle retention time. Only one acupuncture session was applied. The acupoints selected for the true acupuncture group were the following:

  • KI6 (Zhaohai)
  • LV3 (Taichong)
  • HT4 (Lingdao)
  • PC6 (Neiguan)
  • HT7 (Shenmen)
  • CV17 (Danzhong)
  • GV20 (Baihui)
  • GB20 (Fengchi)

The researchers provided a historical context for the selection of acupuncture points administered during the investigation. According to the Zhen Jiu Jia Yi Jing (Systematized Canon of Acupuncture and Moxibustion), Zhaohai is indicated for “susceptibility to fright and unhappiness,” Taichong is also indicated for “susceptibility to fright,” Lingdao is indicated for “heart pain, sadness, and fear.” The rest of the points were selected to stabilize the heart and calm the spirit.

For the sham acupuncture A group, body points selected were neither meridian acupoints nor special acupoints. They were located 0.5 cun lateral to the above true acupuncture point locations. For the above two groups, each point was pierced with a 0.30 mm × 40 mm needle with patients in a supine position. For Zhaohai, Lingdao, Shenmen, Neiguan, and Taichong, the needles were inserted perpendicularly to a depth of 15 mm. For Danzhong, the needle was inserted obliquely-downward to a depth of 15 mm. For Baihui, the needle was inserted obliquely-posteriorly to a depth of 15 mm. For Fengchi, the needle was inserted obliquely toward the nose tip for a depth of 15 mm. The acupoints selected for the sham acupuncture B group were the following:

  • SP3 (Taibai)
  • SP5 (Shangqiu)
  • LU7 (Lieque)
  • LU9 (Taiyuan)
  • LU10 (Yuji)
  • CV20 (Huagai)
  • SI16 (Tianchuang)

For this group, each point was pierced with a 0.30 mm × 40 mm needle, with patients in a supine position. For Shangqiu, Taibai, Lieque, Yuji, Taiyuan, and Tianchuang, needles were inserted perpendicularly to a depth of 15 mm. For Huagai, the needle was inserted obliquely-downward to a depth of 15 mm.

 

Evaluations
Patients were evaluated before and after the treatment. Their anxiety and other emotions were assessed based on the State Anxiety Inventory (SAI). The total treatment effective rate for each group was derived as the percentage of patients who achieved at least an effective treatment tier of improvement. The treatment efficacy for each patient was evaluated and categorized into 1 of 3 tiers:

  • Significantly effective: Complete or significant absence of fear and relevant symptoms (i.e., chest pain, difficult breathing). A patient can remain calm during an MRI examination.
  • Effective: Fear and relevant symptoms showed improvement. A patient can complete an MRI examination.
  • Not effective: Fear and relevant symptoms showed no visible improvement. A patient cannot complete an MRI examination.

After treatment, the SAI score was reduced in the true acupuncture, sham acupuncture A, and sham acupuncture B groups after treatment. The differences of SAI scores before and after treatment were higher than that in the blank control group. The SAI score in the true acupuncture group was lower than in the sham acupuncture A and B groups ( P<0.05). The difference of SAI scores before and after treatment was higher than that in the sham acupuncture A and B groups (P<0.05). The difference of SAI scores in sham acupuncture A group was higher than in sham acupuncture B group (P<0.05).

The total effective rate was 92.5% (37/40) in the true acupuncture group with the following breakdown of improvement tiers: 21 significant improvements, 16 improvements, 3 no improvements. This was significantly superior to 25.0% (10/40) in the sham acupuncture A group, 17.5% (7/40) in the sham acupuncture B group, and 5.0% (2/40) in the blank control group.

 

Summary
The results indicate that true acupuncture is more effective than sham acupuncture. The study demonstrates that acupuncture is effective for the treatment of claustrophobia. Important ​features of TCM protocols are that they produce an immediate result with high total effective rates and no significant adverse effects. The results show than an acupuncture treatment prior to a closed MRI procedure mitigates claustrophobia.

 

References
[1] Wang WH, Ren XJ. Treatment for patients with claustrophobia undergoing an MRI[J/OL]. Chinese Journal of Woman and Child Health Research, 2017(S2): 285. [2018-01-10].
[2] Li ZH, Zou W, Yu XP. Effects of acupoint specificity on claustrophobia [J]. Chinese Acupuncture and Moxibustion, ,2018,38(09):948-952.

 

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