QST was performed before and after EA to evaluate pain and sensory threshold change by acupuncture under different coping strategies (Figure
2A). Eight parameters were measured, in the following order: vibration detection threshold (VDT), pressure pain threshold (PPT), mechanical pain threshold (MPT), mechanical detection threshold (MDT), warm detection threshold (WDT), cold detection threshold (CDT), heat pain threshold (HPT), and cold pain threshold (CPT) [
21]. Each QST parameter was assessed by the same individual over a 30-minute testing session. MPT was assessed by an average of 5 trials, MDT by an average of 10 trials, while other thresholds were assessed by an average of 3 trials. Stimulus location for all thresholds except for VDT (lateral condyle of tibia) was on the same site midway on the anterior left lower leg (Figure
2C). Trials were separated by 30 seconds, ensuring that subjects did not feel any lingering sensations from prior trials. Multiple QST modalities were used in attempt to differentiate effects mediated by different neural pathways (e.g. Aβ, Aδ, and/or C-fibers) [
21].VDT was assessed using a 64-Hz tuning fork (Rydel Seiffer tuning fork, Germany). The tuning fork was placed upright over a bony prominence at the lateral condyle of the tibia and was left in place until the subject reported loss of sensation. The minimum magnitude of vibration (0–8 scale visible on the fork, 0: strong, 8: none) reported as being felt by the subject was recorded as a threshold for each trial. A pressure algometer (FDX 50, Wagner Instruments, USA) was used to evaluate the PPT at the QST measurement site (Figure
2C). The pressure was applied at approximately constant velocity of 1 kgf/sec, until the subject reported discernible pain onset. For each trial, the minimum magnitude causing pain was recorded as PPT. The MPT was measured similarly for each trial using the same algometry device, but with a fine, blunt tip to elicit a pinprick pain. The MDT was acquired by averaging over ten trials (five with ascending and another five with descending order) with pressures ranging from 0.02 to 60 g delivered via von Frey monofilaments (Touch-Test Sensory Evaluator Kit, North Coast Medical Inc., USA). The thermal thresholds were measured using a thermal stimulation device (PATHWAY, Medoc, Israel). A thermode (3 cm × 3 cm) was placed on the skin surface of the QST measurement site (Figure
2C). The temperature was then increased or decreased from 32°C at a rate of 1°C per second. For detection thresholds, subjects were asked to press a button when they noticed the temperature of the thermode changing form baseline to warmth or cold (WDT, CDT). For pain thresholds, subjects were asked to press a button once heat or cold sensation became painful (HPT, CPT). The temperature was recorded immediately after button press, and was used in the multi-trial average as the subject’s threshold.
Changes in pain and sensory detection thresholds (ΔVDT, ΔPPT, ΔMPT, ΔMDT, ΔWDT, ΔCDT, ΔCPT, and ΔHPT) were calculated as the post – pre EA difference score (paired t-test). In order to more easily interpret correlations, the ΔCPT and ΔCDT scores were inverted.
Because of device unavailability, not all thresholds could be acquired from all subjects (data collected for AC group: n = 15 for CDT, WDT, HPT, and CPT measurement, and n = 3 for MDT and MPT measurement; PC group: n = 15 for CDT, WDT, HPT, and CPT measurement, and n = 12 for MDT and MPT measurement; VDT and PPT were collected from all the subjects). Due to the low number of AC subjects contributing MPT and MDT data, these measures were not used for further analyses.