Layout 1 Thematic Section: Advances in Musculoskeletal and Neuromuscular Rehabilitation | Maccarone & Masiero Eur J Transl Myol 34 (3) 12777, 2024 doi: 10.4081/ejtm.2024.12777 The article summarizes the results of our own scientific and practical research in the field of biopuncture – local stimulation of acupuncture points with small doses of drugs or other agents.1,2 In 2002, for the first time in the country, the textbook “Pharmacopuncture” was presented, which was republished several times until 2015.3 A series of studies that reveal the mechanisms, efficacy and therapeutic reliability of the method are devoted to this topic. The object of the work was dorsopathies at the lumbosacral level, which are characterized by the widest coverage of the population, a protracted course and the severity of consequences, including disability of patients.2- 4 The choice of this pathology was also associated with the stages of the formation of reflexology, the methods of which were largely honed on the “model” of neurological pain syndromes.1 Methodically, in the case of the use of medications, ma- nipulations consist of subcutaneous and/or intradermal in- jection of a drug substance in the amount of 0.2-0.3 ml for each locus.3,4 The mechanisms of action of the method in- clude the prolongation of the reflex response due to changes in the volume characteristics of tissues in the area of points and the formation of multiple depots of stimuli. However, the question of the specificity of the action of drugs and, especially, the possible interaction with acupunc- ture points remains unclear. Thus, the comparability of the Abstract The article summarizes the results of our own scientific and practical research on biopuncture (or pharmacopuncture) – local stimulation of acupuncture points with small doses of drugs or other agents. The “object” of the work was dorsopathies at the lumbosacral level, the choice of which was explained by the widest coverage of the population, the protracted course and the severity of the consequences. In the course of the research, the addition and even potentiation of the reflex and drug links of the method under consideration was noted. In particular, favorable changes in the status of patients observed against the background of biopuncture by complex agents were accompanied by a significant improvement in the results of psychological and electrophysiological examination. In a series of studies on biopuncture with Alflutop, a significant superiority of this approach over the compared methods was manifested, in addition to clinical effects, in structurally-modifying changes in the intervertebral discs. Using the same drug, an original scheme of therapeutic action was proposed, combining the techniques of drug blockade and pharmacopuncture. Special attention should be paid to the fact that the effectiveness of biopuncture is enhanced due to the combined use of modern hardware techniques. In a series of separate studies, the efficacy of biopuncture with essential oils in dorsopathies was confirmed, largely explained by the cumulative effects. Key Words: dorsopathies, biopuncture, local drug stimulation, essential oils stimulation. Eur J Transl Myol 34 (3) 12777, 2024 doi: 10.4081/ejtm.2024.12777 The biopuncture in dorsopathy Lev G. Agasarov,1,2 Andrey A. Maryanovskiy,3 Oxana Yu. Kirgizova,4 Tatjana E. Belousova,5 Marina V. Bykova,6 Lilja R. Voskanyan,7 Dmitriy V. Fedorov,4 Andrey V. Nefedov,8 Kirill V. Terentev,9 Irina A. Grishechkina2 1Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of Russia, Moscow, Russia; 2National medical research center for rehabilitation and balneology, Moscow, Russia; 3Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia; 4Irkutsk State Medical Academy of Continuing Education of the Ministry of Health of Russia, Irkutsk, Russia; 5Systemic Treatment Clinic, Nizhniy Novgorod, Russia; 6Institution OBP of the Administration of the President of the Russian Federation, Moscow, Russia; 7«ISIDA» LLC, Barnaul, Russia; 8Peoples’ Friendship University of Russia named after Patrice Lumumba, Moscow, Russia; 9National Medical and Surgical Center named after N.I. Pirogov of the Ministry of Health of the Russian Federation, Russia. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License (CC BY-NC 4.0) which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. - 58 - Non -co mmerc ial us e o nly The biopuncture in dorsopathy Eur J Transl Myol 34 (3) 12777, 2024 doi: 10.4081/ejtm.2024.12777 results in response to the injection of the antioxidant Ac- tovegin or saline solution in carpal neuropathies of the hands still testified in favor of the prevalence of the reflex over the actual drug effect.5 On the other hand, the use of pharmacopuncture drugs of various classes in dorsopathies is highly effective, superior to the methods compared, ac- companied by the summation of the main therapeutic links.6-9 Results Initial research in this direction was carried out with the help of complex homeopathic preparations of the Heel (Germany). Over the course of the first study,10 the effi- cacy of the drug Discus compositum was evaluated, the choice of which was determined by the composition that even determines the pathogenetic effect. A total of 90 pa- tients with exacerbation of lumbosacral dorsopathy were divided into three randomized groups that received basic therapy, with exposure limited to it in group 1. Along with this, the other two groups used the desired drug: in group 2 intramuscularly, in group 3 – by pharmacopuncture. The analysis performed at the end of therapy confirmed the significant advantage of pharmacopuncture, which is also manifested in the earlier terms of achieving an analgesic effect. In this case, the favorable changes in the neurolog- ical status of patients were accompanied by a significant improvement in the results of psychological testing, ther- mograms, and somatosensory evoked potentials. Generally comparable results were obtained during phar- macopuncture with Placenta compositum, which differs in vascular influence.6 90 patients with lumbar dorsopathy, with the leading neurovascular component, were randomly divided into three groups in which standard treatment was carried out. In addition, the drug was used in the first two groups: in the 1st group by pharmacopuncture, in the 2nd group – intramuscularly. In group 3, pharmacopuncture was performed with saline, i.e., in a placebo format. As a result, a reliable advantage of true pharmacopuncture was con- firmed, with the use of the drug, verified by vascular anal- ysis (rheovase and Doppler sonography). During the following study,7 in order to correct lumbar vertebral manifestations, the drug Cell T, indicated for pathology of the musculoskeletal system, was used. The 120 patients with dorsopathy at the lumbosacral level were divided into three groups in which conventional treatment was background. In addition, the selected drug was used: in the 1st group by pharmacopuncture, in the 2nd group by electrophoresis. In the 3rd control group, Cell T was administered intramuscularly. As a result, only in the first two groups there was a regression of clinical manifesta- tions, but with intergroup differences. Thus, in the course of pharmacopuncture, the reduction of radicular symp- toms was more significant, and electrophoresis was more significant in the reduction of myodystonic disorders, which was confirmed by the data of objective analysis, in- cluding electromyography. The same drug was used in a follow-up study.8 Patients with lumbosacral dorsopathy were divided into four ran- domized groups, in which various techniques for admin- istering certain agents were used along with standard treat- ment. In the first two groups, intramuscular injections of Cell T or saline (as a placebo) were selectively performed. In the other two groups, these substances were injected into the points of reflexology, and saline injections were considered as a complicated version of the placebo. As a result, it was shown that only pharmacopuncture Cel T provided potentiation of reflex and drug effects, ultimately determining the effectiveness and reliability of the tech- nology. On the contrary, with similar use of saline, the in- stability of previously achieved satisfactory indicators was noted. The revealed differences in clinical characteristics were verified by the results of psychological and electro- physiological analysis, including the method of somato- sensory evoked potentials. Work was also carried out on the use of pharmacopuncture with Traumeel S and extracorporeal Shock Wave Therapy (SWT) in lumbosacral dorsopathy.11 The observed 90 pa- tients with dorsopathy were randomly divided into three treatment groups, in which medication and orthopedic care was prescribed as the baseline. At the same time, SWT was performed in the 1st group, pharmacopuncture with Traumeel S was performed in the 2nd group, and a complex of these methods was used in the 3rd and main groups. As a result, it has been proven that a combination of therapeutic approaches provides more significant re- sults in comparison with their separate use. At the same time, the positive effect of pharmacopuncture in leveling the undesirable primary effects of the acoustic shock wave has also been demonstrated. Along with the above, work was carried out to assess the effectiveness and reliability of pharmacopuncture per- formed by the drug Alflutop (Biotechnos, Romania) as a representative of classical medicines. In the first study, 110 patients with lumbosacral dorsopa- thy, with a leading vascular component, were assigned to three randomized groups.4 In addition to the basic therapy, in the first two groups, the drug was administered intra- muscularly: in the 1st group alone, in the 2nd group in combination with classical acupuncture, i.e., in the form of a labor-intensive complex. In group 3, the basic treat- ment was supplemented with pharmacopuncture with this drug. And here a significant therapeutic advantage of both the complex and pharmacopuncture over the intramuscu- lar use of the drug was established, which was confirmed by the results of an objective analysis. In furtherance of the data obtained, the efficacy of com- bining the pharmacopuncture Alflutop with zonal low- frequency Electromagnetic Stimulation (ES) was analyzed.9 Patients with exacerbation of lumbosacral dor- sopathy were divided into four randomized groups, in which standard treatment was carried out, and in group 4 (control) it was the main one. Along with it, ES was used in the 1st group, Alflutop pharmacopuncture in the 2nd group, and a combination of these methods in the 3rd group. In the course of the study, it was demonstrated that the proposed complex provided a clear improvement in clinical and instrumental characteristics, significantly su- perior to the indicators of the compared groups. In this re- gard, the positive structural-modifying effect on vertebral - 59 - Non -co mmerc ial us e o nly The biopuncture in dorsopathy Eur J Transl Myol 34 (3) 12777, 2024 doi: 10.4081/ejtm.2024.12777 tissues, namely the intervertebral discs, was fundamen- tally significant. We have also proposed an original treatment scheme that combines the techniques of drug blockade and pharmaco- puncture with Alflutop.12 90 patients with exacerbation of dorsopathy at the lumbosacral level were randomly as- signed to three groups, with conventional treatment as the baseline. The effect in group 1 was limited to it, and in the other two, local drug stimulation was additionally carried out. In particular, 12-14 points were selected along the middle and lateral lines of the back (forming a kind of “lattice” from the traces of injections) and 6-8 acupuncture points of the lower extremities. At the same time, lido- caine was injected intradermally in the “lattice” area at a dosage of 0.1 ml per locus, while various agents were in- jected subcutaneously into the projection of the points of the lower legs and feet: in group 2 – Alflutop, in group 3 – saline, as a placebo. The reverse dynamics of the indicators indicated the ad- vantage of both options of local stimulation, confirmed by the improvement of the patient’s condition within 60% of the cases - against 46.6% of cases in response to the gen- erally accepted exposure. However, in the result groups themselves, with comparable rates of pain reduction, their level by the end of therapy was significantly lower in the case of pharmacopuncture with the drug. The noted dif- ference can be explained by the points of application of the medications used. In particular, segmental blockade with the anesthetic Lidocaine determines the achievement of a rapid analgesic effect, while pharmacopuncture with Alflutop provides maximum final effectiveness. In the light of the information presented, the dermal use of essential oils seems to be an offshoot of biopuncture. Local medicinal and aromatic stimulation are indeed united by the performance of the latter by agents that are close to drugs in a number of properties. The differences relate to the area and depth of impact, which determine the volume and accuracy of information delivery. In a comparative aspect, based on the positions of low-energy exposure, the point variant can presumably be therapeuti- cally more effective. This approach was tested in a study.13 Patients under observation with prolonged exacerbation of lumbosacral dorsopathy were divided into three groups, in which conventional treatment was carried out. In ad- dition, the first two groups used a 1% mixture of essential oils recommended for dorsopathies14 in the form of a com- bination of derivatives of St. John’s wort, lavender, cayu- put, and marjoram. The composition in the 1st comparison group was used by massage manipulations, in the 2nd, main group – by biopuncture. In the 3rd control group, camphor, indifferent oil, which had no therapeutic effect, was used as a placebo. The treatment in all groups con- sisted of 10 alternating manipulations every other day. As a result, the effectiveness of both forms of using essen- tial oils was confirmed, with an improvement in the con- dition in 59% and 63.3% of cases - against 48% in the control group. However, the rates of sustained analgesia achieved after an average of 6 procedures in group 1 and group 5.2 in group 2 differed in the study groups. In a sim- ilar ratio, the intensity of pain decreased by 53% and 60%, respectively. After six months, recurrences of dorsopathy in the control group were noted in a third of patients, while in the case of the use of essential oils, they were traced in smaller quantities. However, there are differences in the severity of the resulting algias: in the 2nd group they in- creased insignificantly, while in the others to a greater ex- tent, and in the control group they increased significantly. In addition, vascular examination data showed greater sta- bility of results in the case of biopuncture with essential oils. The differences thus identified may be due to the cu- mulative effect.15-17 Conclusions The efficacy and therapeutic reliability of biopuncture per- formed for lumbosacral dorsopathies with drugs of var- ious registries – complex homeopathic and classical medicines, as well as essential oils – has been confirmed. Particular attention should be paid to the fact that the ef- fectiveness of biopuncture is enhanced due to the parallel use of hardware techniques, opening up another scientific and practical direction. At the same time, the differences in the effects achieved in a number of works, associated with the peculiarities of the techniques used, open up the possibility of individual- izing their purpose. List of acronyms SWT: Shock Wave Therapy. ES: Electromagnetic Stimulation. Contributions of Authors LGA, OYK, TEB, AVN, AAM, MVB, LRV – devel- opment of the study design, data design, writing, review of publications on the topic of the article, data interpreta- tion, statistical processing of data, data interpretation, su- pervision of the article; LGA, IAG, AVN, AAM, MVB, LRV - drafting the paper, revision of the article; LGA, AAM, MVB, LRV, DVF – development of the study de- sign, data design, writing, review of publications on the topic of the article, data interpretation, supervision of the article, LGA, EPI – supervision of the article. Acknowledgments None. Funding None. Conflict of Interest The authors declare they have no conflicts of interest. Ethics approval The Ethics Committee of the National Medical Research - 60 - Non -co mmerc ial us e o nly The biopuncture in dorsopathy Eur J Transl Myol 34 (3) 12777, 2024 doi: 10.4081/ejtm.2024.12777 Center for Rehabilitation and Balneology of the Ministry of Health of Russia approved this study. All research is carried out in accordance with the 1964 Declaration of Helsinki, revised in 2013, on human and animal rights. Informed consent: Signed by all patients participating in the study. Written informed consent was also obtained from a legally authorized representative(s) to publish an- onymized information about the patient in this article. Corresponding Author Kirill V. Terentev, Postgraduate Student of department of Neurology, Federal State Budgetary Institution “National Medical and Surgical Center named after N.I. Pirogov” of the Ministry of Health of the Russian Federation. ORCID ID: 0000-0003-0858-1906 E-mail: kirillterentev184@gmail.com Lev G. Agasarov ORCID ID: 0000-0001-5218-1163 E-mail: lev.agasarov@mail.ru Andrey A. Maryanovskiy ORCID ID: 0000-0002-1004-5347 E-mail: docaam@yandex.ru Oxana Yu. Kirgizova ORCID ID: 0000-0003-1124-0301 E-mail: kirgizova.ok@rambler.ru Tatjana E. Belousova ORCID ID: 0000-0003-3852-8129 E-mail: TEBelousova@yandex.ru Marina V. Bykova ORCID ID: 0009-0009-7470-870Х E-mail: marina-bikowa@mail.ru Lilja R. Voskanyan ORCID ID: 0000-0003-2829-9561 E-mail: voskanyan.lilya@mail.ru Dmitriy V. Fedorov ORCID ID: 0000-0001-6892-2886 E-mail: medmirt@mail.ru Andrey V. Nefedov ORCID ID: 0009-0007-2868-2911 E-mail: andworking2020@gmail.com Irina A. Grishechkina ORCID ID: 0000-0002-4384-2860 E-mail: GrishechkinaIA@nmicrk.ru References 1. Agasarov LG. Rukovodstvo po refleksoterapii: ucheb- noe posobie [Guidance on reflexology: textbook]. Moscow, 2001. Russian 2. Agasarov LG. Tekhnologiya vosstanovitel’nogo leche- niya pri dorsopatiyah: uchebnoe posobie [Technologies of rehabilitation treatment in dorsopathies: textbook]. Moscow, 2010. Russian 3. Agasarov LG. Tekhnologiya vosstanovitel’nogo leche- niya pri dorsopatiyah: uchebnoe posobie [Pharmaco- puncture (pharmacopuncture reflexotherapy)], 3rd ed., revised and supplemented. Arnebija, Moscow, 2015. Russian 4. Agasarov LG. Refleksoterapiya pri rasprostranyonnyh zabolevaniyah nervnoj sistemy [Reflexotherapy in com- mon diseases of the nervous system]. Arnenija, Mos- cow, 2017. Russian 5. Chuzavkova EA. Kliniko-fiziologicheskoe obosnovanie razlichnyh variantov akupunktury pri tunnel’nyh sin- dromah ruk [Clinical and physiological justification of various variants of acupuncture in carpal hand syn- dromes] [Dissertation]. Moscow, 1996. 6. Boldin AV. Farmakopunktura v vosstanovitel’noj kor- rekcii funkcional’nogo sostoyaniya pri vertebrogennyh nejrososudistyh sindromah [Pharmacopuncture in re- storative correction of the functional state in vertebro- genic neuro-vascular syndromes] [Dissertation]. Moscow, 2004. Russian 7. Zhuravlev VA., Agasarov LG., Filatov VI. Vosstanovi- tel’noe lechenie bol’nyh s poyasnichnymi dorsopati- yami [Restorative treatment of patients with lumbar dorsopathies]. “Health of the Capital” Assembly. 2009; 3: 113-115 Russian 8. Kuzmina IV. Optimizaciya reflektornyh metodov voz- dejstviya pri dorsopatiya [Optimization of Reflex Methods of Impact in Dorsopathies]. [Dissertation] Moscow, 2015. Russian 9. Makina SK. Primenenie chastotno-volnovoj terapii v komplekse reabilitacionnyh meropriyatij pri poy- asnichno-krestcovyh dorsopatiyah [Application of frequency-wave therapy in the complex of rehabilitation measures in lumboc-sacral dorsopathy]. [Dissertation]. Moscow, 2014. Russian 10. Putilina NE. Farmakopunktura kak metod optimal’nogo primeneniya kompleksnogo gomeopaticheskogo pre- parata Diskus kompazitum v vosstanovitel’noj korrekcii [Pharmacopuncture as a method of optimal application of the complex homeopathic preparation Discus com- positum in restorative correction] [Dissertation]. Mos- cow, 2001. Russian 11. Chigarev AA. Effektivnost’ kompleksnoj lokal’noj in”ekcionnoj i udarno-volnovoj terapii pri poy- asnichno-krestcovyh dorsopatiyah [Efficacy of Com- plex Local Injection and Shock Wave Therapy in Lumbosacral Dorsopathy] [Dissertation] Moscow, 2021. Russian 12. Agasarov LG., Saakyan ES. Optimizaciya lokal’noj medikamentoznoj stimulyacii pri dorsopatiyah [Opti- misation of local drug stimulation in dorsopathies]. Bul- letin of New Medical Technologies. 2021; 2: 89-92. doi: 10.24412/1609-2163-2021-2-89-92 Russian 13. Agasarov LG., Apkhanova TV., Bazarova BS. Perspek- tivy lokal’nogo primeneniya efirnyh masel pri dorsopa- tiyah [Prospects for local use of essential oils in dorsopathies]. Bulletin of New Medical Technologies - 61 - Non -co mmerc ial us e o nly mailto:kirillterentev184@gmail.com mailto:lev.agasarov@mail.ru mailto:TEBelousova@yandex.ru mailto:voskanyan.lilya@mail.ru mailto:andworking2020@gmail.com mailto:GrishechkinaIA@nmicrk.ru The biopuncture in dorsopathy Eur J Transl Myol 34 (3) 12777, 2024 doi: 10.4081/ejtm.2024.12777 (electronic edition). 2021; 2: 1-5. doi: 10.24412/2075- 4094-2021-2-1-5 Russian 14. Maryanovskiy AA., Agasarov LG. Аlgoritmy zdo- rov’ya pri dorsopatiyah [Algorithms of Health in Dor- sopathies]. Moscow, 2019. Russian 15. Agasarov LG. Lokal’naya in”ekcionnaya terapiya pri myshechno-sustavnaya bolevom sindrome [Local in- jection therapy in muscle-articular pain syndrome]. No- vosibirsk, 2020. Russian 16. Agasarov LG. Analiz effektivnosti variantov lokal’nogo ispol’zovaniya gomeopaticheskih preparata pri dorso- patiyah [Analysis of the effectiveness of variants of local use of homeopathic preparation in dorsopathy]. Russian Medical Journal. 2020; 13: 24-27 Russian 17. Agasarov LG. Lokalnaya-stimulyaciya-pri-vertebro- gennoj-patologii-metodicheskie-rekomendacii [Local stimulation in vertebrogenic pathology: guidelines]. Moscow, 2023. Russian Disclaimer All claims expressed in this article are solely those of the authors and do not necessarily represent those of their af- filiated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. Submitted: 3 July 2024. Accepted: 11 July 2024. Early access: 23 August 2024. - 62 - Non -co mmerc ial us e o nly