Complementary Therapies in Medicine (2013) 21, 155157

Available online at www.sciencedirect.com

journal homepage: www.elsevierhealth.com/journals/ctim

SHORT COMMUNICATION

Bee venom acupuncture point injection for central

post stroke pain: A preliminary single-blind
randomized controlled trial
Seung-Yeon Cho, Joo-Young Park, Woo-Sang Jung, Sang-Kwan Moon,
Jung-Mi Park, Chang-Nam Ko, Seong-Uk Park
Department of Cardiology and Neurology of Korean Medicine, College of Korean Medicine, Kyung Hee University, Seoul,
Republic of Korea
Available online 13 March 2013

KEYWORDS
CPSP;
Stroke;
Bee venom;
Apipuncture;
Post stroke

Summary
Objective: We investigated apipuncture, or acupuncture point injection with diluted bee venom,
as a promising new treatment for central post stroke pain (CPSP).
Methods: Bee venom, diluted to 0.005% in normal saline, was administered to the treatment
group, and normal saline given to control group as twice-weekly injections for three weeks.
The points were LI15, GB21, LI11, GB31, ST36 and GB39 of the affected side and the amount of
injection was 0.05 ml at each point.
Results: Eight patients in each group were included in the analysis. After three weeks there
were signicant decreases in visual analogue pain scores compared with baseline in both groups
and the treatment group improved more signicantly than the control group (p = 0.009).
Conclusion: Apipuncture signicantly improved CPSP in this pilot trial. Further studies of its
mechanisms and a larger and long-term follow-up trial will be needed to determine more
denitely the efcacy of apipuncture and to elucidate duration of improvement.
2013 Elsevier Ltd. All rights reserved.

Introduction
Central post stroke pain (CPSP), a neuropathic pain syndrome that can occur after a cerebrovascular accident, is
due to a lesion of the somatosensory pathways within the
central nervous system.1,2 The prevalence of CPSP is known
to be between 1% and 12%, and treatment methods such
as pharmacologic agents and neurostimulation therapy do

Corresponding author at: Department of Cardiology and Neurology of Korean Medicine, Kyung Hee University Hospital at Gangdong,
#149 Sangil-dong, Gangdong-gu, Seoul 134-727, Republic of Korea.
Tel.: +82 2 440 6217; fax: +82 2 440 6217.
E-mail address: happyomd@khu.ac.kr (S.-U. Park).

not work well in many patients.24 Apipuncture, the subcutaneous injection of diluted bee venom into an acupoint,
is used mainly to relieve pain produced by inammatory
diseases such as rheumatoid arthritis and osteoarthritis.4
Previous studies have shown analgesic activity in a neuropathic pain model,5,6 and there was a case report of CPSP
using apipuncture.4 In this study, we intended to investigate
the possibility of apipuncture, acupuncture point injection
with diluted bee venom, as a new promising treatment for
central post stroke pain (CPSP).

Methods
This study was performed in accordance with the ethical
standards of the Helsinki Declaration. The protocol was

0965-2299/$ see front matter 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ctim.2013.02.001

156

S.-Y. Cho et al.

approved by the Institutional Review Board of our university

hospital (KHNMC-OH-IRB 2008-018).
Twenty inpatients, who complained of CPSP with a visual
analogue scale (VAS) score of >4, were randomly divided
into two groups by block randomization (block size 4).
The subjects were blinded to group allocation. Treatment
and control group algorithms were enclosed in a series of
sequentially numbered opaque envelopes. One Korean medical doctor injected diluted bee venom to the treatment
group and normal saline to the control group twice a week
for three weeks, after informed consent was obtained. A
total of 0.05 ml of diluted bee venom or normal saline was
injected into each acupoint, LI15, GB21, LI11, GB31, ST36
and GB39 of the affected side, using short needle insulin
syringes (30 Gauge 8 mm, Becton, Dickinson and Company,
Franklin Lakes, NJ, USA). The selected acupoints, which
were some of the Seven Points of Stroke as described in
the literature,7 are frequently used to treat stroke, including post stroke pain. Freeze-dried bee venom (Yumil Farm,
Korea) was diluted with normal saline at the Kyung Hee University Hospital at Gangdong. The minimum effective dose
of 0.05 ml of bee venom diluted to 0.005% for each point
has been determined not to cause allergic reactions. Nevertheless, skin tests were performed to determine whether
each subject was allergic to bee venom. For this test,
an injection of 0.05 ml bee venom diluted to 0.005% in
normal saline was performed at LI11; production of a wheal
>5 mm, a rash >11 mm in diameter, or severe itching at the
site within 1520 min were considered signs of bee venom
allergy and the subject was excluded from the study. The
control group also received a test injection using normal
saline. The outcome measure was visual analogue scale (VAS)
score of pain severity. All patients maintained medications
and physical therapy from two weeks before the study until
the end.

Our data indicate that apipuncture signicantly improves

CPSP, but this is a small preliminary study. Therefore, we
cannot make concrete conclusions yet. In the mechanism
underlie this action, an antinociceptive effect may occur
by activation of 2 adrenergic and serotonergic components
of the descending pain inhibitory system of apipuncture
according to the results of previous studies,5,8,9 but it
remains unclear. Further studies of its mechanisms and
larger and longer-term follow-up double-blind trials are
needed to determine the efcacy of apipuncture and to
elucidate its duration of effect.

Results

Conict of interest statement

Ten patients were allocated to the treatment group and

10 to the control group. Two patients dropped out of the
treatment group, one due to itching and another was discharged from the hospital before follow-up assessment. In
the control group, two patients left the hospital before
follow-up assessment. Therefore, data from eight patients
in each group who completed the follow-up assessment were
included in the primary analysis.
There were no signicant differences in age, sex, duration of CPSP and visual analogue scale (VAS) scores between
the two groups at baseline. After three weeks there were
signicant decreases in VAS scores compared with baseline in both groups. Median VAS score decreased by 36.50
points in the treatment group, and by 11.50 points in
the control group (treatment group: baseline vs. after
three weeks: median 72.00, IQR[57.2580.25] vs. 35.50,
IQR[9.5046.50], p = 0.007, control group: baseline vs. after
three weeks: median 64.50, IQR[44.7582.25] vs. 53.00,
IQR[34.7582.25], p = 0.013, by Wilcoxon signed rank test).
In between-group analysis, the treatment group improved
signicantly more than the control group (p = 0.009 by
MannWhitney U test). There were no serious adverse
events (Fig. 1).

No author has any conict of interest in this work.

Figure 1 Box plots of central post stroke pain VAS scores.

There were signicant changes compared with baseline by
Wilcoxon signed ranks tests in both groups (bee venom group
p = 0.007, normal saline group p = 0.013). But, there was a significant difference between the bee venom and the normal saline
acupoint injection groups by MannWhitney U test (p = 0.009).
VAS, visual analogue scale.

Discussion

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2013 Elsevier