Article PDF first page preview

Article PDF first page preview

Background: Neck reflex points or Adler-Langer points are commonly used in neural therapy to detect so-called interference fields. Chronic irritations or inflammations in the sinuses, teeth, tonsils, or ears are supposed to induce tension and tenderness of the soft tissues and short muscles in the upper cervical spine. The individual treatment strategy is based on the results of diagnostic Adler-Langer point palpation. This study investigated the inter- and intra-rater reliability and explored treatment effects. Methods: We performed a randomized controlled trial with 104 inpatients (80.8% female, 51.8 ± 12.74 years) of a German department for internal and integrative medicine. Patients were randomized to individual neural therapy according to the pathological findings (n = 48) or no treatment (n = 56). In each patient, three experienced raters (20–45 years of experience in neural therapy) and two novice raters (medical students) rated Adler-Langer points rigidity on a standardized rating scale (“strong,” “weak,” “none”). The patients independently evaluated the tenderness on palpation of the eight points using the same scale. Pressure pain thresholds were assessed at the eight Adler-Langer points. All patients were retested after 30 min. The five raters were blinded to treatment allocation and assessments of the other raters. Video recordings were obtained to assess the consistency of the areas tested by the different raters. Results: Agreement between patients and raters (Cohen’s kappa = 0.161–0.400) and inter-rater reliability were low (Fleiss kappa = 0.132–0.150). Moreover, the individual agreement (pre-post comparisons in untreated patients) was similarly low even in experienced raters (Cohen’s kappa = 0.099–0.173). Video documentation suggests that raters do not place their fingers in the correct segments (percentage of correct position: 42.0–60.6%). Pressure pain thresholds at five of the eight Adler-Langer points showed significant changes after treatment compared to none in the control group. Conclusion: Under this artificial experimental setting, this method of Adler-Langer point palpation has not proven to be a reliable diagnostic tool. But it could be shown that, as claimed by the method, the tenderness in five of eight Adler-Langer points decreased after neural therapy.

1.
Weinschenk
S
,
Gollner
R
,
Hollmann
MW
,
Hotz
L
,
Picardi
S
,
Hubbert
K
, et al
.
Inter-rater reliability of neck reflex points in women with chronic neck pain
.
Forsch Komplementmed
.
2016
;
23
(
4
):
223
9
.
2.
Engel
R
,
Barop
H
,
Giebel
J
,
Ludin
SM
,
Fischer
L
.
The influence of modern neurophysiology on the previous definitions of “segment” and “interference field” in neural therapy
.
Complement Med Res
.
2022
;
29
(
3
):
257
67
.
3.
Saha
FJ
,
Wander
R
.
Das Störfeld als neuromodulativer Trigger auf allen Ebenen
.
Dt Zeitschr f Akup
.
2014
;
57
(
2
):
6
9
.
4.
Adler
E
.
Neurale Geschehen der Stomatologie für die Allgemeinmedizin
.
Physikal Med Rehab
.
1968
;
2
(
12
):
331
3
.
5.
Adler
E
.
Störfeld und Herd im Trigeminusbereich
. In:
Ihre Bedeutung für die ärztliche und zahnärztliche Praxis
.
Heidelberg
:
Verl. für Medizin Fischer
;
1990
.
6.
Langer
H
.
Stoerfeldsuche mittels adler-langerscher druckpunkte
.
Dt Zeitschr f Akup
.
1989
;
32
:
31
3
.
7.
Weinschenk
S
,
Hollmann
MW
,
Gollner
R
,
Picardi
S
,
Strowitzki
T
,
Diehl
L
, et al
.
Injections of local anesthetics into the pharyngeal region reduce trapezius muscle tenderness
.
Forsch Komplementmed
.
2016
;
23
(
2
):
111
6
.
8.
Uehleke
B
,
Ludtke
R
,
Albrecht
U
,
Stange
R
.
Assoziationen zwischen chronischer Tonsillenreizung, Verquellungen von Bindegewebszonen und einer Brachialgia paraesthetica nocturna
.
Complement Med Res
.
2006
;
13
(
4
):
220
6
.
9.
Weinschenk
S
.
Neural therapy: a review of the therapeutic use of local anesthetics
.
Acupuncture Relat Therapies
.
2012
;
1
(
1
):
5
9
.
10.
Fischer
LBH
,
Maxion-Bergemann
S
.
Neural therapy health technology assessment as per Huneke (HTA) within the context of a program for the evaluation of complementary medicine (PECM) by the Swiss Federal Office of Public Health
.
2005
.
11.
Egli
S
,
Pfister
M
,
Ludin
SM
,
Puente de la Vega
K
,
Busato
A
,
Fischer
L
.
Long-term results of therapeutic local anesthesia (neural therapy) in 280 referred refractory chronic pain patients
.
BMC Complement Altern Med
.
2015
;
15
:
200
.
12.
Haller
H
,
Saha
FJ
,
Ebner
B
,
Kowoll
A
,
Anheyer
D
,
Dobos
G
, et al
.
Emotional release and physical symptom improvement: a qualitative analysis of self-reported outcomes and mechanisms in patients treated with neural therapy
.
BMC Complement Altern Med
.
2018
;
18
(
1
):
311
.
13.
Saha
FJ
,
Brummer
G
,
Lauche
R
,
Ostermann
T
,
Choi
KE
,
Rampp
T
, et al
.
Gua Sha therapy for chronic low back pain: a randomized controlled trial
.
Complement Ther Clin Pract
.
2019
;
34
:
64
9
.
14.
Saha
FJ
,
Schumann
S
,
Cramer
H
,
Hohmann
C
,
Choi
KE
,
Rolke
R
, et al
.
The effects of cupping massage in patients with chronic neck pain: a randomised controlled trial
.
Complement Med Res
.
2017
;
24
(
1
):
26
32
.
15.
Landis
JR
,
Koch
GG
.
The measurement of observer agreement for categorical data
.
Biometrics
.
1977
;
33
(
1
):
159
74
.
16.
McPartland
JM
,
Goodridge
JP
.
Counterstrain and traditional osteopathic examination of the cervical spine compared
.
J Bodyw Mov Ther
.
1997
;
1
(
3
):
173
8
.
17.
Popplewell
M
,
Reizes
J
,
Zaslawski
C
.
Appropriate statistics for determining chance-removed interpractitioner agreement
.
J Altern Complement Med
.
2019
;
25
(
11
):
1115
20
.
You do not currently have access to this content.