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Complementary and Alternative Medicine
November 25, 2024
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Acupuncture as a Viable Treatment for Visceral Pain

Sulaiman Khan, Riaz Hussain Pasha, Iqra Ali, Awais ur Rehman Sial, Ayesha Humayun, Adnan Hassan Tahir & Muhammad Arif Zafar

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SUMMARY

Visceral pain, a type of pain originating from the abdominal, thoracic, pelvic, and abdominal organs, is markedly different from somatic or neuropathic pain as it is diffuse and poorly localized and leads to an impact on the patient’s quality of life. Acupuncture, a Chinese healing practice, has gained enormous popularity among clinicians for the treatment of visceral pain in recent years. This chapter aims to elaborate on the efficacy and potential of acupuncture as a treatment for the alleviation of visceral pain. The chapter begins with an overview of visceral pain, its impact on the quality of life, and an overview of acupuncture. The etiology, characteristics, predisposing factors, and indications for visceral pain are discussed. The Peripheral and central sensitization include the sensitization of visceral afferent fibers and, the release of inflammatory mediators and neurotransmitters. We also discussed the pharmacological approach for the treatment of visceral pain, its side effects, and acupuncture as a viable treatment for visceral pain. In conclusion, the results of earlier research on the neurological and chemical alterations that occur along the brain-gut axis in people and animals to shed light on the fundamental mechanisms influencing how acupuncture treats visceral pain were shown. The findings presented in this chapter showed that acupuncture treatments significantly reduced visceral pain. This chapter acknowledged further research on the mechanism behind acupuncture analgesia on visceral pain.

INTRODUCTION

Visceral pain is a type of pain arising from the organs of the chest, pelvic or abdominal area due to inflammation, tumors or intestinal dilation (Luo et al., 2023). Visceral pain contributes significantly to morbidity and quality of life deterioration (Wie et al., 2022). Compared to somatic pain, visceral pain has various characteristics for example visceral pain is diffuse, rarely associated with actual injuries, and is not provoked by all of the viscera (Bielefeldt & Gebhart 2022). Curiosity in the factors and mechanisms that are involved in the etiology of visceral pain is expanding. Etiologies of visceral pain include activated visceral nociceptors mechanically or chemically through a variety of underlying diseases including inflammation, ischemia, intestinal distension and cancer (Wie et al., 2022). hypersensitive visceral nociceptors (visceral hypersensitivity), impaired gut-brain axis, genetic and environmental factors, infections, and psychological distress are also contributing factors (Cervero, 2014). Furthermore, a significant advancement in our understanding of human central and peripheral mechanisms and the intestinal environment such as microbiota, has led us to hypothesize that the brain-gut axis, which regulates neuronal and chemical transmission between the gastrointestinal tract and the brain, plays a critical role in visceral nociception. Abdominal pain in inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), which are organic and functional forms of visceral pain, is caused by one of the most contributing factors visceral hypersensitivity (VH) (Tahir et al., 2021). It can be defined as when a person is exposed to colorectal distension (CRD), he may perceive hypersensitive visceral pain. Patients who have IBS or IBD have a predictable development of VH. The medications used for the V

HABITAT

Fenugreek leaves originate from Eastern Europe and certain regions of Asia, including countries such as Turkey, Egypt, and India. While the seeds and leaves were traditionally used in these areas, fenugreek cultivation has expanded globally. It is widely

IMPACT OF GESTATIONAL MATERNAL UNDERNUTRITION ON FETAL DEVELOPMENT

“It is on the condition of the health of the mother that the condition of the health of the child depends”, Hippocrates stated. This is one of the very early reported references to the concept that placental life has an effect on adult life. But the full concept came into being as we know it in the 1930s, during this era substandard living conditions in infancy were linked to premature death, later. Further studies were carried out which linked these substandard living conditions in early life to several cardiac disorders later in life when the living conditions were better this gave a hint that development in early life and the environment was rather important for the well-being of the individual, in 1977 (Hanson, 2015).
Approximately one-half of the world’s total population is affected by maternal and child undernutrition (Ahmed et al., 2012). Maternal and child undernutrition causes 3·5 million deaths annually, 11% of worldwide disability-adjusted lifeyears (DALYs), and more than one-third of the disease burden in children (less than 5 years of age). Optimum and balanced maternal nutrition is indispensable for proper fetal development and growth (Barker & Clark 1997). Nutritional factors and proteins present in milk promote fetal growth in pregnant women (Borazjani et al., 2013). Ignorance, poverty, food insecurity, infectious diseases, lack of proper feeding practices for infants and young children, and poor sanitation and hygiene lead to the prevailing high levels of child and maternal undernutrition in developing nations. Maternal undernutrition is highly prevalent in the resource-poor countries of southeast Asia, sub-Saharan Africa, and south-central Asia. Its prevalence in South Asia ranges from 10 to 40% (Ahmed et al., 2012; Jouanne et al., 2021).
Pakistan being a developing country, about 12.5% population (28 million) faced undernourishment, in 2021 (FAO, 2021). In Pakistan, both lactating and pregnant women suffer from a higher prevalence of malnutrition (16.1%) than their non-pregnant peers (12.5%). It is understood that undernutrition reduces a nation’s economic progress by at least 8% resulting in poorer cognition, direct productivity losses, and reduced schooling. The enormity of children and maternal undernutrition in Pakistan is so much so that about one crore children in Pakistan face stunting, largely due to maternal undernutrition (UNICEF, 2022). To cope with this grave situation, in 2014, the World Bank committed 47.95 million US dollars to improve the nutritional status of lactating and pregnant women. A similar situation is prevalent for women and children in many developing countries (World Bank, 2014).

Maternal undernutrition has been proven to have a profound effect on fetal growth, with body weight and many key organs. It has been reported previously that during the first two weeks of pregnancy, the provision of a 5% protein diet only (undernutrition) led to a reduction in brain weight, size, and cortical thickness of the brain (Gressens et al., 1997). A severe gestational maternal protein restriction in rats caused a reduced number of glomeruli and hypertension in both male and female newborns, this hypertension is salt-sensitive and worsens with age, but is approximately equivalent in males and females (Woods et al., 2004)

Chronic energy deficit or maternal undernutrition means
having a body mass index (BMI) below 18.5. If the females are
under-nourished females at the time of conception, then during
pregnancy (when there are additional demands due to the
growing fetus), they are unlikely to improve their nutritional
status. They are more likely to fail to gain sufficient weight
during pregnancy and are at a higher risk of mortality than wellnourished and healthy women (Smith et al., 2003).

IUGR predisposes developing fetuses to reduced organ and
body weights. Most information about the long-term and short term effects of IUGR has come from animal models. In recent
years, many animal models of placental insufficiency and/or
poor maternal nutrition have been developed to investigate the
causes and effects of IUGR. Both maternal dietary
manipulations and surgical interventions have been employed
for these studies. A number of animal species have been studied
for IUGR effects, including rodents, rabbits sheep, and primates
(Louey et al., 2000; Mitchell et al., 2004; Jonker et al., 2018).

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