This study details a rat fixation method suitable for photographing acupuncture and infrared thermography. Furthermore, it demonstrates that electroacupuncture at sensitized acupoints inhibits local inflammatory pain.
Method Article
* These authors contributed equally
This study details a rat fixation method suitable for photographing acupuncture and infrared thermography. Furthermore, it demonstrates that electroacupuncture at sensitized acupoints inhibits local inflammatory pain.
Knee osteoarthritis (KOA), a leading cause of musculoskeletal pain and functional disability worldwide, remains challenging to manage due to the limited efficacy of current pharmacological and surgical interventions in achieving sustained pain relief. Although acupuncture has demonstrated clinical promise in alleviating KOA-related pain, its underlying mechanisms require further elucidation. Application of acupuncture to sensitized acupoints can markedly enhance the effectiveness of therapy. This protocol establishes a rat model of KOA through intra-articular injection of sodium monoiodoacetate (MIA) and systematically describes an acupuncture protocol targeting sensitized acupoints, including restraint methods, acupoint localization, and acupuncture parameters. Therapeutic efficacy was comprehensively evaluated through pain behavioral assessments, infrared thermographic analysis of the knee joint, inflammatory cytokine detection in serum, and histopathological examination of cartilage tissue. Results indicate that acupuncture at sensitized acupoints significantly alleviates pain phenotypes in MIA-induced model rats by inhibiting the release of pro-inflammatory mediators, blocking nociceptive signal transmission, improving blood microcirculation, regulating local joint temperature, and delaying joint degeneration.
Knee osteoarthritis (KOA), a prevalent degenerative joint disorder, is characterized by chronic inflammation and whole-joint pathology, including cartilage erosion, subchondral bone remodeling, osteophyte development, and synovial inflammation1,2. Clinically, patients typically present with pain, muscle weakness, joint instability, transient morning stiffness, and progressive functional limitations. KOA imposes a substantial global disease burden, affecting approximately 365 million individuals with functional disability, with epidemiological models predicting a 74.9% escalation in case numbers from 2020 baselines by mid-century 20503. Notably, while pain serves as the primary treatment motivator4, it simultaneously exacerbates functional disability, profoundly compromising multiple quality-of-life domains through impaired mobility and reduced daily activity capacity. Consequently, therapeutic strategies aim to alleviate pain, restore function, and delay disease progression5. Current first-line pharmacotherapy includes analgesics, non-steroidal anti-inflammatory drugs, chondroitin and glucosamine sulfate, and intra-articular corticosteroids to reduce pain and inflammation6. However, prolonged use of these agents is constrained by significant iatrogenic risks, particularly gastrointestinal complications and cardiovascular adverse events7, thereby underscoring the critical need for safer, more sustainable therapeutic alternatives.
Acupuncture and electroacupuncture have been extensively utilized in osteoarthritis management, demonstrating efficacy in alleviating knee pain and improving joint functionality8,9, with the World Health Organization (WHO) recognizing arthritis as a priority condition for acupuncture therapy. As both stimulation targets and effectors, acupoints remain central to acupuncture research, where their morphological appearance, spatial dimensions, and functional responsiveness undergo dynamic changes during disease states, a phenomenon termed "acupoint sensitization"10,11. Critically, this sensitization process modulates the receptive field area and therapeutic responsiveness of acupoints, thereby determining treatment efficacy. Previous preclinical studies12,13demonstrated sensitization at Yanglingquan (GB34, located in the depression anterior and inferior to the head of the fibula, near the lateral side of the hindlimb) and Zusanli (ST36, located on the anterior side of the leg, the lateral border of the patellar ligament is depressed to the anterior midpoint, 3/16 of the ankle joint) in KOA animal models. Laser speckle imaging revealed elevated local blood perfusion at these acupoints, while photoacoustic imaging paradoxically showed no significant structural alterations in microcirculation, suggesting that microcirculatory changes during acupoint sensitization in KOA are primarily functional rather than structural. Investigations into underlying mechanisms require the use of rat models; however, poor procedural compliance in animals results in considerable time investment. To address these constraints, a rat immobilization apparatus was developed, specifically designed to facilitate access to lower limb acupoints and enhance the efficiency of electroacupuncture procedures.
Infrared thermography, as a functional imaging modality, utilizes non-contact infrared sensors to detect thermal radiation from predefined regions of interest, with computer-processed data generating pseudocolor thermograms for quantitative analysis14,15. This technique enables non-invasive monitoring of cutaneous hemodynamic changes by measuring temperature variations associated with blood flow fluctuations in cutaneous, vascular, and muscular tissues16, thereby facilitating visual assessment of functional microcirculatory alterations at acupoints. In this study, pain sensitization at GB34 and ST36 acupoints was first validated using an electronic algometer, followed by the combined application of safranin O fast green staining, IL-1β and TNF-α analysis, infrared thermographic imaging, and pain-related behavioral assessments to investigate the analgesic effects of electroacupuncture stimulation at GB34 and ST36 acupoints in monosodium iodoacetate-induced (MIA) knee osteoarthritic rats.
All experimental protocols were approved and rigorously supervised by the Animal Ethics Committee of Beijing University of Chinese Medicine (ID: bucm-2024091102-3197), and all procedures strictly adhered to the National Institutes of Health (NIH) Guide for the Care and Use of Laboratory Animals. Thirty male Sprague-Dawley rats (weight range: 210-250 g) were used in this study. The reagents and equipment used are listed in the Table of Materials.
1. Experimental animals and groups
2. Establishment of a monoiodoacetate-induced KOA model
3. Procedure for fixing rats
4. Electroacupuncture treatment
5. Mechanical Withdrawal Threshold (MWT) test
6. Paw Withdrawal Latency (PWL) test
7. Infrared thermal imaging
NOTE: Depilate the hind limbs the day before thermography to eliminate the influence of hair on temperature measurement.
8. Enzyme-Linked Immunosorbent Assay (ELISA)
9. Safranin fast green staining
NOTE: Following abdominal aortic blood collection, excise the right stifle joint using surgical scissors, preserving 1 mm osteoarticular segments of both the proximal femur and distal tibia. Carefully debride periarticular soft tissues.
10. Statistical analysis
No animals died during the entire experiment. Results of the operation procedure duration and needle detachment count for each rat in both the NF and EA groups indicated that the EA group, following restriction with nylon cable ties, experienced reduced operation time and fewer needle detachments (P < 0.001; Figure 1H,I). Analysis of acupoint pain thresholds revealed no statistically significant differences in mechanical pain sensitivity between GB34, ST36, and non-acupoint regions prior to modeling (P > 0.05). Fourteen days after MIA injection, pain sensitivity increased at all three sites, with GB34 and ST36 exhibiting significantly higher sensitivity compared to non-acupoint regions (P < 0.05 or P < 0.01; Figure 1J). Results of mechanical withdrawal threshold (MWT) and paw withdrawal latency (PWL) assessments showed that baseline thresholds were consistent across groups. Two weeks after injection of normal saline or MIA, no significant differences were observed between the Sham and Con groups (P > 0.05). After two weeks of treatment, the EA group exhibited a significantly improved pain threshold compared with the MIA group (P < 0.001; Figure 2).
Infrared thermal imaging revealed that in the Con group, the average skin temperature of the lateral and ventral surfaces of the knee joint decreased significantly after anesthesia compared to pre-anesthesia levels (P < 0.01 or P < 0.001; Figure 3). Compared with the Con group, no significant difference in knee skin temperature was observed in the Sham group (P > 0.05). However, the MIA group showed significantly higher average skin temperature in both regions compared to the Sham group (P < 0.001 or P < 0.01). The EA group demonstrated significantly lower average skin temperature than the MIA group (P < 0.05; Figure 4).
Histological analysis with safranin O fast green staining showed severe bone destruction in the knee joint cartilage of the MIA group, characterized by paler cartilage staining and a reduced number of cartilage cells. In contrast, the EA group exhibited alleviated cartilage damage, with slightly lighter cartilage color and improved morphology and quantity of cartilage cells (Figure 5).
ELISA results showed no significant differences in serum levels of inflammatory cytokines IL-1β and TNF-α between the Con and Sham groups (P > 0.05). Compared with the Sham group, the MIA group exhibited significantly elevated serum levels of TNF-α and IL-1β (P < 0.001). EA intervention significantly reduced these cytokine levels compared with the MIA group (P < 0.001; Figure 6).

Figure 1: Electroacupuncture intervention method. (A) Physical image of a rat's restraint device. (B) Diagram showing placement of nylon strapping. (C) Actual length of the nylon cable fixed in place. (D) Surface anatomical locations of GB34 and ST36 acupoints in rats. GB34 (Yanglingquan) is located in the depression anterior and inferior to the head of the fibula, near the lateral side of the hindlimb. ST36 (Zusanli) is situated on the anterior side of the leg, along the lateral border of the patellar ligament, approximately 3/16 of the distance from the knee to the ankle joint. The non-acupoint site is located 4 mm lateral to ST36. (E) Diagram of rat restraint. (F) Restraint diagram showing the upper nylon cable positioned away from the cervical region. (G) Diagram illustrating the electroacupuncture stimulation procedure. (H) Statistical comparison of operation time between the two fixation methods (***P < 0.001). (I) Frequency of acupuncture needle detachment in the two groups (n = 6 per group, ***P < 0.001). (J) Comparison of mechanical pain thresholds between acupoints and non-acupoints in the EA group (n = 6 per group, *P < 0.05, **P < 0.01). Please click here to view a larger version of this figure.

Figure 2: Comparison of mechanical and thermal pain thresholds among four experimental groups of rats (n = 6 per group). (A) Statistical results of mechanical withdrawal threshold (MWT). (B) Statistical results of paw withdrawal latency (PWL). Compared to the sham group, ♦♦♦P < 0.001; compared to the MIA group, ***P < 0.001. Please click here to view a larger version of this figure.

Figure 3: Comparison of stifle joint temperatures in awake and anesthetized states (n = 6 per group). (A) Representative infrared thermal images of the control group under awake and anesthetized conditions. (B) Mean skin temperatures at lateral and ventral stifle joint regions before and after anesthesia (**P < 0.01, ***P < 0.001). Please click here to view a larger version of this figure.

Figure 4: Comparison of stifle joint temperature among four experimental groups (n = 6 per group). (A) Representative infrared thermal images from each group. (B,C) Mean skin temperature at lateral and ventral stifle joint regions across groups. Compared to the sham group, ♦♦P < 0.01, ♦♦♦P < 0.001; compared to the MIA group, *P < 0.05. Please click here to view a larger version of this figure.

Figure 5: Comparative analysis of histopathological features in rat knee joints among four experimental groups (Safranin O-Fast Green staining, n = 3 per group). In the MIA group, a marked reduction in articular cartilage is observed (green arrow), along with pronounced cartilage damage (red arrow). Scale bar: 100 µm. Please click here to view a larger version of this figure.

Figure 6: Comparison of serum IL-1β and TNF-α expression among four experimental groups (n = 6 per group). (A) Serum IL-1β expression levels. (B) Serum TNF-α expression levels. Compared to the sham group, ♦♦♦P < 0.001; compared to the MIA group, ***P < 0.001. Please click here to view a larger version of this figure.
MIA, a metabolic inhibitor, selectively disrupts cellular aerobic glycolysis, thereby inducing chondrocyte apoptosis17,18,19. Intra-articular MIA administration results in chondrocyte depletion and subsequent articular cartilage degeneration, characterized by morphological irregularities and histopathological alterations that closely resemble human OA pathology20. Thus, it is widely utilized in research on OA pain mechanisms21. Iodoacetic acid (IAA) injection is also commonly used; however, it is not easily soluble in water, and the resulting solution typically becomes acidic. This acidity can exert an additional stimulating effect on joint tissues. Currently, the sodium salt form of IAA, known as MIA, is commonly used22. Consequently, the MIA-induced knee arthritis model was adopted in this study to conduct a visual investigation of the mechanism underlying acupuncture sensitization at specific acupoints. Safranin O-fast green staining has been widely used to demonstrate pathological changes in joint diseases. Therefore, this staining method was employed to verify successful induction of the KOA model23,24.
Both peripheral and central sensitization mechanisms critically mediate pain processing in KOA25,26. Joint injury induces sustained exposure of nociceptors to inflammatory mediators within the articular microenvironment, promoting receptor upregulation and neuronal hyperexcitability27. This persistent peripheral input drives central sensitization via enhanced synaptic transmission in spinal dorsal horn neurons, leading to chronic pain characterized by hypersensitivity28. Acupoint sensitization is defined as a dynamic biological process wherein specific body surface acupoints (or periacupoint regions) transition from a "resting" to an "activated" state under pathological conditions29. This transition is characterized by significant alterations in sensory processing, including lowered detection thresholds, heightened nociceptive hypersensitivity (allodynia/hyperalgesia), and measurable changes in local tissue physicochemical properties30. Notably, periarticular acupoints in KOA exhibit localized accumulation of algogenic substances, correlating with mechanical hyperalgesia and aberrant nociception. Clinical evidence supports targeting these sensitized acupoints31,32, which may act as homeostatic trigger points, to enhance therapeutic efficacy. Previous experimental investigations in KOA models revealed pathological mast cell infiltration and active degranulation at GB34 and ST36 acupoints, accompanied by substantial release of pronociceptive mediators, including serotonin (5-HT) and substance P (SP)11,30,33. The present study demonstrated that acupuncture at sensitized acupoints significantly elevated mechanical and thermal pain thresholds, confirming potent analgesic efficacy. Histopathological analysis further revealed ameliorated cartilage lesions, characterized by preserved chondrocyte architecture and reduced matrix degradation, indicating structural preservation alongside pain relief.
In this study, a rat restraint protocol was introduced for acupuncture intervention and infrared thermographic imaging. The use of dark visual blockage effectively reduced anxiety in rats caused by environmental stimuli. The flexible fiber composition of the restraint device allowed easy adaptation to the animal's skin, and its high breathability significantly lowered the risk of suffocation during treatment. The black cloth sleeve outperformed cable-tie fixation alone in minimizing stress responses in rats, supporting its selection. Integration of platform fixation with cable ties prevented the dislodging of acupuncture needles, thereby ensuring treatment efficacy. The protocol's advantages, derived from its simple materials and ease of operation, facilitate large-scale acupuncture procedures and reduce experimenter workload.
Importantly, thermographic measurements obtained from unanesthetized rats eliminated interference from anesthetic metabolism and temperature fluctuations, providing a refined method for infrared thermographic imaging in conscious animals. Infrared thermal imaging studies conducted in conscious and restrained laboratory mice yielded results consistent with those of Bjorn Redfors et al.34, who reported that vasodilation and core temperature changes induced by isoflurane anesthesia led to reduced peripheral tissue temperatures in rodent models. These findings support the present approach in minimizing anesthesia-related artifacts, allowing more accurate quantification of physiological temperature changes associated with knee joint disorders and offering valuable guidance for future research.
However, the restraint device has certain limitations. Its design obstructs access to acupoints in other body regions, thus limiting its use to the rat's lower extremities. Additionally, the device does not completely eliminate physical or psychological stress in the animals. As stress-related biomarkers were not measured in this study, the safety and stability of the restraint device could not be fully established. Future experiments will include systematic evaluation of stress-related biomarkers such as cortisol, along with behavioral assessments including the elevated plus maze and open field tests. This integrated approach will enable more comprehensive and objective assessment of the device's safety and stability, providing a stronger scientific foundation for its application.
In KOA, IL-1β and TNF-α promote disease progression and are closely associated with joint pain35,36,37. Inflammation in the affected region alters local temperature, which can be visually recorded via infrared thermography to capture temperature fluctuations indicative of the nature, severity, and extent of pain31. Findings from this study indicated increased skin temperature on both the underside and lateral aspects of the right knee joint in MIA rats, accompanied by heightened peripheral pain sensitivity. Levels of inflammatory factors were elevated compared to those in the control surgery group. It is important to note that earlier studies reported increased local blood flow at these acupoints, while the microcirculatory structure remained largely unchanged. Experimental findings in this study further support the view that changes in vascular microcirculation observed during the sensitization phase in KOA model animals are primarily functional12,13.
Moreover, infrared thermography enables dynamic monitoring of KOA progression, reducing the need for invasive assessments and potentially detecting subclinical joint changes earlier than radiographic imaging, thereby providing visual evidence for evaluating acupuncture efficacy38. Clinical studies have shown that joint temperature changes correlate with pain characteristics, which may contribute to advancing research in traditional Chinese medicine (TCM) syndrome differentiation and treatment20,39. However, application of this technique faces limitations, including strict environmental controls (humidity, temperature, airflow), specific measurement distance requirements, and technical challenges in mapping three-dimensional thermal variations on non-planar acupoint surfaces. Despite these constraints, the capability of infrared thermography to visualize inflammation in real time warrants continued exploration in musculoskeletal research.
In summary, this study protocol provides detailed procedures for combining acupuncture and infrared thermography. Findings indicate that acupuncture applied to sensitized acupoints can suppress the generation of inflammatory pain in local joints and the nervous system, slow the transition from acute to chronic pain, and achieve effective pain relief. This study offers a scientific and feasible research framework for investigating the mechanism of acupuncture in the treatment of knee joint diseases.
All authors have declared no potential conflicts of interest.
This research was supported by the National Key R&D Program of China (grant 2023YFC3502700) and the Fundamental Research Funds for the Central Universities (2025-JYB-XJSJJ014)
| Name | Company | Catalog Number | Comments |
|---|---|---|---|
| 0-10ul Adjustable-Volume Pipettor | Servicebio | IC012395160823 | |
| 0-200ul Adjustable-Volume Pipettor | Servicebio | IC021029160323 | |
| 1.5 ml eppendorf tubes | Servicebio | EP-150-M | |
| 10ul micropipette tip | Servicebio | TP-10 | |
| 1ml syringe | Shanghai Zhiyu Medical Equipment Co., LTD | ZSQ-1 | |
| 200ul micropipette tip | Servicebio | TP-200 | |
| 22-gauge needle | Kruuse | 112416c | |
| 2ml eppendorf tubes | Servicebio | EP-150-M | |
| 5ml red blood tube | Shanghai Xinle Biotechnology Co. LTD | CXG-5R | |
| 75% alcohol | Shandong Anjie Gaoke Disinfection Technology Co. LTD | 75-500ml | |
| Adherent slide | CITOTEST | 188105 | |
| Automatic Plate Washer | Rayto | RT-3100C | |
| Blood collection needle | Jiangxi Ruibang Industrial Group Co. LTD | CXZ-07 | |
| Bone tissue safranin and solid green staining solution | Shanghai Yuan Ye Biotechnology Co., Ltd. | R32730 | |
| Cover glass | Citotest Labware Manufacturing Co.,Ltd | 10212432C | |
| Dehydrator | DIAPATH | Donatello | |
| Electronic balance | Mettler-Toledo | ME203E/02 | |
| Electrothermal blast drying oven | Labotery | GEL-70 | |
| Embedding machine | Wuhan Junjie Electronics Co., Ltd | JB-P5 | |
| Environmental Friendly Dewaxing Transparent Liquid | Servicebio | G1128-1L | |
| Enzyme label detector | BioTeK | Epoch | |
| Ethanol | SCRC | 100092683 | |
| Ethylenediamine tetraacetic acid | Macklin | 60-00-4 | |
| Fat-free cotton ball | Caoxian Hualu Sanitary Material Co. LTD | TZMQ-500 | |
| High speed refrigerated centrifuge | Dragon | D3024R | |
| High Speed Tissue Grinder | Servicebio | KZ-III-F | |
| Hot Plate Analgesiometer | Kew basis | KW-CT-1 | |
| Imaging system | Nikon | NIKON DS-U3 | |
| Infrared thermal imager | Testo AG | Testo 865 | |
| Iodophor | Shandong Anjie Gaoke Disinfection Technology Co. LTD | DF-500 | |
| IR Soft | Testo AG | ||
| Isoflurane | RWD life science | R510-22-10 | |
| Latex gloves | Beijing Ruijing Latex Products Co. LTD | RJJC-S | |
| Mechanical Paw Poking Test Device | Kew basis | KW-RB | |
| MIA | Sigma | 206-165-7 | |
| Neutral gum | SCRC | 10004160 | |
| Normal butanol | SCRC | 100052190 | |
| Normal saline solution | SHIMEN | SLYS-500ml | |
| Paraffin liquid | Macklin | 8012-95-1 | |
| Paraformaldehyde Fixative (Neutral) | Servicebio | G1101 | |
| Pathology slicer | Shanghai Leica Instrument Co., Ltd | RM2016 | |
| Rat IL-1 beta ELISA Kit GER0002-96t | Servicebio | AC30253754 | |
| Rat TNF-alpha ELISA Kit GER0004-96t | Servicebio | AC40253711 | |
| SD rats | Beijing Sibefei Biotechnology Co., Ltd | SCXK (jing) 2024-0001 | |
| Small Animal Anesthesia Machine | YuYAN | ABM | |
| Surgical mask | winner | WJKZ-1 | |
| Tissue spreader | Zhejiang Kehua Instrument Co., Ltd | KD-P | |
| Ultrapure Water Polishing System | Aiken water El | AK-RO-C2 | |
| Upright optical microscope | Nikon | NIKON ECLIPSE E100 | |
| Urethane | Macklin | 2621-79-6 | |
| Vortex Mixer | Servicebio | MV-100 | |
| Xylene | SCRC | 10023418 |
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