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Pain Studies
Transcutaneous cranial electrical stimulation with Limoge's currents (TCES) consists of high frequency, low intensity currents which decreased anesthetic requirements during elective surgery. This action is likely to be mediated by the release of central endogenous opioids. In a DB PC study of39 ASA physical status I and II patients undergoing elective abdominal surgery, just before induction of anesthesia, patients were connected to the electrical stimulator and randomly allocated to be either stimulated or control during surgery. Postoperatively, patients were given a patient-controlled analgesia (PCA) device delivering buprenorphine for the first four postoperative hours. Buprenorphine usage was significantly reduced in the TCES group versus the control group (2.36 vs 3.43 mcg/kg/hr; P = 0.002). Intraoperative isoflurane anesthetic requirements, as well as hourly postoperative scores for pain and sedation, were the same for the two groups. Transcutaneous cranial electrical stimulation (Limoge's currents) decreases early buprenorphine analgesic requirements after abdominal surgery. Mignon A, et al. Hospital Bichat, Paris, France. Anesth Analg 1996 Oct;83(4):771-5.
The effectiveness of electronic dental anesthesia in children.
teDuits E, Goepferd S, Donly K, Pinkham J, Jakobsen J.
University of Iowa College of Dentistry, Iowa City.
This study compared the effectiveness of traditional local anesthesia with a Transcutaneous Electrical Nerve Stimulation unit that controls pain via electronic dental anesthesia for restorative dental procedures in 6- to 12-year-old children. The sample included 27 children who had two antimere teeth that required restorations of similar size (preventive resin restorations). In each case, the cavity preparation extended into dentin. One of the teeth was treated with conventional local anesthesia and the other with EDA. Selecting which tooth and which method to complete first was done randomly. Both restorations were done at the same appointment. Throughout the procedure, the child was asked to assess the level of discomfort using the Eland Color Scale, which allowed the children to draw on their past painful experiences to judge the level of pain they perceived. The patients demonstrated no overall significant difference in pain perception between the two modalities of treatment, regarding dentin sensitivity and rubber dam clamp replacement. When asked which method they preferred after the study, 78% of the patients chose EDA over local anesthesia. Pediatr Dent 1993 May-Jun;15(3):191-6.
Combined electroanesthesia: a nontraditional method of anesthesia in pediatric neurosurgery]
[Article in Russian]
Mal'kovskaia EV, Gudumak EM, Salalykin VI, Iova AS, Aksentiuk VI, Petraki VL, Shiriaeva NV.
A combination of electrical anesthesia with calypsol and nitrous oxide has been developed and used in neurosurgical operations performed to 142 children aged 8 days to 15 years, who were divided into two groups. Group 1 included 89 children administered electrical anesthesia in combination with calypsol and nitrous oxide, Group 2 consisted of 53 children, to whom only routine calypsol and nitrous oxide anesthesia was administered. The Lennar apparatus was used to administer electrical anesthesia. The adequacy of anesthesia was estimated on the basis of the clinical data and laboratory findings. The results have shown that a combination of electrical analgesia with calypsol and nitrous oxide provided sufficient protection of a child from surgical stress, was not associated with significant changes of the hypothalamo-hypophyseo-adrenal and thyroid functions and permitted a significant reduction (by 80.8%) of the drug load. Anestheziol Reanimatol 1993 May-Jun;(3):21-3.
Analgesic effect of transcutaneous cranial electrostimulation in patients treated by Nd:YAG laser for cancer of the rectum. A double-blind randomized trial]
[Article in French]
Naveau S, Barritault L, Zourabichvili O, Champagne C, Prieur G, Limoge A, Poynard T, Chaput JC.
Service d'Hepato-Gastroenterologie, Hopital Antoine-Beclere, Clamart.
The aim of this double blind cross-over randomized trial was to assess if transcutaneous cranial electrical stimulation by Limoge current could decrease the dose of fentanyl required in patients with rectal cancer treated by Nd:YAG laser. Fifty patients, 29 women, 21 men, 78 +/- 10 years old (range: 53-96 years), were treated by 2 laser sessions with an interval of 48 hours between each session. Active and sham electrostimulation were given in random order for the 2 laser sessions. The major end point was the quantity of fentanyl injected when the score of pain was greater than or equal to 5 according to a visual analgesic scale. Age, sex, body weight, tumor location and length, tumor circumferential extent and luminal patency, duration of laser session, amount of energy delivered per session (watt-seconds), and number of patients with deep sedation did not differ between the 2 groups. There was no interaction between the order of treatments and the treatments. The mean quantity of fentanyl was 29 micrograms and 42 micrograms when sham electrostimulation was given. There was a decrease of 31 percent in the quantity of fentanyl with active electrostimulation (P less than 0.05). Results were not affected either by the treatment order nor by tumor location. There were no side effects in either group. Gastroenterol Clin Biol 1992;16(1):8-11.
Efficiency of transcranial electrostimulation on anxiety and insomnia symptoms during a washout period in depressed patients. A double-blind study.
Philip P, Demotes-Mainard J, Bourgeois M, Vincent JD.
UICA, Centre Hospitalier Specialise Charles Perrens, Bourdeaux, France.
In order to test the efficacy of cerebral electrostimulation (electrosleep) as an alternative to drug therapy for the treatment of anxiety and insomnia, we conducted a double-blind study in a sample of 21 depressed inpatients submitted to a 5-day period of drug washout on admission to the psychiatric department. During this withdrawal period, anxiety and insomnia were exacerbated in the placebo group, whereas anxiety decreased and sleep duration improved in the active treatment group, with a divergent evolution during the 5-day washout period. The depressive criteria did not respond differentially to treatment, however. Thus, the effects of this drug washout period are markedly attenuated by cerebral electrostimulation, which is of possible interest in the management of psychotropic drug withdrawal. Biol Psychiatry 1991 Mar 1;29(5):451-6.
Non-medicamentous treatment of labor pain by electrostimulation]
[Article in German]
Kubista E.
Methods of electric stimulation have been tested for their effect on labour pain during delivery. Beside the central (cerebral) electric stimulation electro-acupuncture and transcutaneous electric stimulation have been used. Because of the only moderate results and the difficulties in clinical handling electro-acupuncture is not very usefull for pain reduction during child birth. Central stimulation and transcutaneous stimulation brought relief of pain in about 60% of the 209 patients treated with these methods in addition to a significant reduction of the labour period. No side effects on mother or child were observed. Zentralbl Gynakol 1985;107(9):532-8
Transcutaneous cerebral electric stimulation by Limoge current during labor]
[Article in French]
Champagne C, Papiernik E, Thierry JP, Noviant Y.
In order to test the analgesic efficacy of Anesthelec (transcutaneous cranial electrical stimulation with Limoge currents) during labour and delivery, a double blind study was performed in 20 cases for whom analgesia was necessary. In 10 cases Anesthelec was used with the Limoge currents on and in 10 cases as a sham. Labour and delivery were carried out by a medical team different from that which set up the Anesthelec. The results showed that this method, with or without nitrous oxide inhalation, decreased by 80% the number of epidural and general anaesthesias that would otherwise have been unavoidable. To define the effects of this new method, maternal and foetal parameters of 50 deliveries carried out under Anesthelec were compared with 50 deliveries carried out under epidural analgesia. Anesthelec was used only if analgesia was required. This study was a retrospective comparison between two similar non paired series. Despite the fact that analgesia obtained with Anesthelec was less powerful than with epidural analgesia, this method showed many advantages: total safety for the child and the mother, easy utilization, shorter labour time, decreased number of instrumental extractions and potentially reduced costs. Good acceptance and satisfaction for the mother should allow a rapid evolution of this new method. Ann Fr Anesth Reanmin 1984;3(6):405-13.
Transcutaneous cranial electrical stimulation decreases narcotic requirements during neurolept anesthesia and operation in man.
Stanley TH, Cazalaa JA, Atinault A, Coeytaux R, Limoge A, Louville Y.
The influence of transcutaneous cranial electrical stimulation (TCES) on fentanyl requirements was evaluated in 50 patients undergoing urologic operations with pure neuroleptanesthesia (droperidol, diazepam, fentanyl, and air oxygen) with (group I) or without (group II) simultaneous TCES. All patients had silver electrodes (three) applied between the eyebrows and behind each mastoid process and attached to a 167-kHz current generator. Current was delivered only to group I. The wave form was a complex nonsinusoidal, nonsquare wave pattern which was applied intermittently in a 3-msec-on 10-msec-off sequence. All patients had anesthesia induced with droperidol (0.20 mg/kg IV), diazepam (0.2 mg/kg IV), and pancuronium (0.08 mg/kg IV), and, after tracheal intubation, had anesthesia maintained with fentanyl in 100-microgram intravenous increments every 3 minutes whenever and as long as systolic arterial blood pressure and/or heart rate were greater than 20% of control (preanesthetic induction) values. Fentanyl requirements averaged 6.1 +/- 0.5 and 7.9 +/- 0.4 microgram/kg/min for a mean total dosage of 9.0 +/- 0.9 and 12.5 +/- 0.8 microgram/kg for the entire operation in groups I and II, respectively. These differences between groups were statistically significant (p less than 0.05). The data demonstrate that TCES augments the analgesic effects of fentanyl and thus reduces fentanyl requirements during urologic operations with neuroleptanesthesia. Anesth Analg 1982 Oct;61(10):863-6.
Percutaneous electrical nerve stimulation: a novel analgesic therapy for diabetic neuropathic pain.
Hamza MA, White PF, Craig WF, Ghoname ES, Ahmed HE, Proctor TJ, Noe CE, Vakharia AS, Gajraj N.
Eugene McDermott Center for Pain Management, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, 75235, USA.
OBJECTIVE: To evaluate the use of percutaneous electrical nerve stimulation (PENS) in the management of patients with painful diabetic peripheral neuropathy. RESEARCH DESIGN AND METHODS: A total of 50 adult patients with type 2 diabetes and peripheral neuropathic pain of >6 months duration involving the lower extremities were randomly assigned to receive active PENS (needles with electrical stimulation at an alternating frequency of 15 and 30 Hz) and sham (needles only) treatments for 3 weeks. Each series of treatments was administered for 30 min three times a week according to a standardized protocol. After a 1-week washout period, all patients were subsequently switched to the other modality. A 10-cm visual analog scale (VAS) was used to assess pain, physical activity, and quality of sleep before each session. The changes in VAS scores and daily requirements for oral analgesic medication were determined during each 3-week treatment period. Patients completed the MOS 36-Item Short-Form Health Survey (SF-36), the Beck Depression Inventory (BDI), and the Profile of Mood States (POMS) before and after completion of each treatment modality. At the end of the crossover study, a patient preference questionnaire was used to compare the effectiveness of the two modalities. RESULTS: Compared with the pain VAS scores before active (6.2 +/- 1.0) and sham (6.4 +/- 0.9) treatments, pain scores after treatment were reduced to 2.5 +/- 0.8 and 6.3 +/- 1.1, respectively. With active PENS treatment, the VAS activity and sleep scores were significantly improved from 5.2 +/- 1.0 and 5.8 +/- 1.3 to 7.9 +/- 1.0 and 8.3 +/- 0.7, respectively. The VAS scores for pain, activity, and sleep were unchanged from baseline values after the sham treatments. Patients' daily oral nonopioid analgesic requirements decreased by 49 and 14% after active and sham PENS treatments, respectively. The post-treatment physical and mental components of the SF-36, the BDI, and the POMS all showed a significantly greater improvement with active versus sham treatments. Active PENS treatment improved the neuropathic pain symptoms in all patients. CONCLUSIONS: PENS is a useful nonpharmacological therapeutic modality for treating diabetic neuropathic pain. In addition to decreasing extremity pain, PENS therapy improved physical activity, sense of well-being, and quality of sleep while reducing the need for oral nonopioid analgesic medication. Diabetes Care 2000 Mar;23(3):365-70.
Percutaneous electrical nerve stimulation (PENS) is a novel electroanalgesic therapy that combines the advantages of both TENS and electro acupuncture by using percutaneously placed disposable acupuncture-like needle probes to stimulate peripheral sensory nerves innervating the region of neuropathic pain. This therapy has recently been reported to be highly effective in the short-term management of a wide variety of acute and chronic pain syndromes (9–13). The needles were placed 1-3 cm into the lower legs at different locations.
Evaluation of electroacupuncture treatment of horses with signs of chronic thoracolumbar pain.
Xie H, Colahan P, Ott EA.
Department of Large Animal Clinical Science, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610-0136, USA.
OBJECTIVE: To evaluate use of electroacupuncture for treatment of horses with signs of chronic thoracolumbar pain. DESIGN: Prospective study. ANIMALS: 15 horses with signs of chronic thoracolumbar pain. PROCEDURE: Horses were randomly allocated to 1 of 3 treatment groups. Horses in group 1 received electroacupuncture stimulation (once every 3 days for 5 treatments), those in group 2 received phenylbutazone (2.2 mg/kg [1 mg/lb], PO, q 12 h, for 5 days), and those in group 3 received saline (0.9% NaCl) solution (20 mL, PO, q 12 h, for 5 days). Thoracolumbar pain scores (TPSs) were evaluated before (baseline) and after each treatment. RESULTS: Mean +/- SE TPSs in horses receiving phenylbutazone or saline solution did not change significantly during the study. After the third treatment, mean +/- SE TPS (2.1 +/- 0.6) in horses receiving electroacupuncture stimulation was significantly lower than baseline (6.0 +/- 0.6) TPS. Mean +/- SE TPSs in horses receiving electroacupuncture stimulation were significantly lower than baseline TPSs and TPSs in horses receiving phenylbutazone or saline solution after the third treatment to 14 days after the last treatment. CONCLUSIONS AND CLINICAL RELEVANCE: TPSs are useful for evaluating the efficacy of various analgesic methods used for treatment of thoracolumbar pain in horses. Electroacupuncture was effective for treatment of chronic thoracolumbar pain in horses. Results provided evidence that 3 sessions of electroacupuncture treatment can successfully alleviate signs of thoracolumbar pain in horses. The analgesic effect induced by electroacupuncture can last at least 2 weeks. Phenylbutazone administered PO did not effectively alleviate signs of thoracolumbar pain in horses in this study. J Am Vet Med Assoc 2005 Jul 15;227(2):281-6.
Transcutaneous electrical acupoint stimulation versus ondansetron in the prevention of postoperative vomiting following pediatric tonsillectomy.
Kabalak AA, Akcay M, Akcay F, Gogus N.
Department of Anesthesiology and Reanimation, Numune Education and Research Hospital, Ankara, Turkey. [email protected]
OBJECTIVES: Postoperative retching and vomiting is an important cause of morbidity that may lead to patient discomfort, distress, and complications. Stimulation of acupuncture points has been shown to be effective in the prevention as well as treatment of PONV. The current treatments of choice are the 5-hydroxytryptamine type 3-antagonists, such as ondansetron. We aimed to evaluate the efficacy and side-effects of either transcutaneous electrical acupoint stimulation (TEAS) or Ondansetron compared to a control group receiving no treatment in the prevention of postoperative retching and vomiting. SUBJECT AND DESIGN: This randomized, controlled, prospective study was carried out in a group of 90 children (in three equal randomly assigned groups), aged between 4 and 12 who underwent tonsillectomy under general anesthesia. In the first group, electrical stimulation via surface electrodes on acupoints Neiguan and Shangwan was performed (20 Hz, 5 minutes). The second group received a single dose of Ondansetron (0.15 mg . kg(-1)). No treatment was given to the control group. OUTCOME MEASURES: The frequency of retching and vomiting attacks and side-effects were noted on the day of surgery in the postanesthesia care unit and the day surgery care unit, on the day of surgery after discharge, and on the first day after surgery. A satisfaction scale was completed by each family. RESULTS: There was a significant difference between the treatment groups and the control group in the incidence of emetic episodes occurring in the day surgery care unit and on the day after discharge (p < 0.001). In the ondansetron group, side-effects were seen in more patients than in the other groups (p < 0.001). The satisfaction scores of the parents were greater in the treatment groups than in the control group (p < 0.05). CONCLUSION: Application of TEAS on sedated children is an easy, painless, reliable and effective method for the prophylaxis of postoperative retching and vomiting in pediatric tonsillectomy. J Altern Comple Med 2005 Jun;11(3):407-13.
Electroacupuncture in obese women: a randomized, controlled pilot study.
Hsu CH, Hwang KC, Chao CL, Chang HH, Chou P.
Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
OBJECTIVE: To compare the effects of electroacupuncture and sit-up exercise on reducing body weight (BW) and waist circumference (WC) among obese women. METHODS: A randomized, controlled clinical trial was conducted from July 1, 2002, to June 30, 2003, in the outpatient department of Taipei Hospital, Taiwan. The subjects were 72 obese women, with WC>90 cm and body mass index (BMI)>30 kg/m2 and who had not received any other weight control maneuver within the prior 3 months. The subjects were randomly divided into groups A, B, and C. Group A (n=22) received electroacupuncture, group B (n=20) was assigned sit-up exercises, and group C (n=21) received no intervention. All three treatments lasted for 6 weeks. The measurements of BW, BMI, and WC were performed in the beginning and after 6 weeks. The data were compared and expressed as percent reductions. RESULTS: Electroacupuncture showed significantly greater percent reductions in BW (p=0.009, 0.004), BMI (p=0.008, 0.016), and WC (p=0.013, 0.006) compared with sit-up exercises or no intervention. CONCLUSIONS: In this pilot study, electroacupuncture treatment was more effective than situp exercise or no intervention in reducing BW, BMI, and WC. J Women Health (Larchmt) 2005 Jun;14(5):434-40.
Effect of scalp acupuncture on glucose metabolism in brain of patients with depression]
[Article in Chinese]
Huang Y, Li DJ, Tang AW, Li QS, Xia DB, Xie YN, Gong W, Chen J.
Department of TCM, Nanfang Medical University, Guangzhou 510515. [email protected]
OBJECTIVE: To observe the effect of scalp acupuncture (SA) on the glucose metabolism in different regions of brain in patients with depression by positron emission computed tomography (PET). METHODS: Twelve depressive patients were treated by scalp acupuncture on middle line of vertex (MS5), middle line of forehead (MS1) and bilateral lateral line 1 of forehead (MS2), once a day for six days per week, and received PET detection on different region of brain before and after 6 weeks acupuncture treatment. Semiquantitative analysis was used to compare the average values of radioactive count gotten from various brain regions before and after treatment, which could reflect the condition of glucose metabolism at the brain region detected. RESULTS: SA could increase the glucose metabolism at bilateral frontal lobes, bilateral parietal lobes, right occipital lobe, right caudate nucleus, right cingulated gyrus and left cerebellum and decrease that at right temporal lobe and bilateral thalamus. CONCLUSION: SA on MS5, MS1 and MS2 in depressive patients could influence the glucose metabolism in various brain regions. It primarily illustrated that the mechanism of SA in treating depression is related with its regulation on cortex-limbic circuitry dysfunction and increase the glucose metabolism in various brain regions. Zhongguo Zhong Xi Yi Jie He Za Zhi 2005 Feb;25(2):119-22.
Electroacupuncture attenuates inflammation in a rat model.
Zhang RX, Lao L, Wang X, Fan A, Wang L, Ren K, Berman BM.
Center for Integrative Medicine, School of Medicine, University of Maryland, Baltimore, MD, USA.
BACKGROUND: Acupuncture has traditionally been used in China and is being increasingly applied in Western countries to treat a variety of conditions, including inflammatory disease. However, clinical trials investigating the effectiveness of the anti-inflammatory effects of acupuncture have yielded inconsistent results, and the underlying mechanisms of acupuncture-produced anti-inflammation are unclear. OBJECTIVE: To evaluate the effectiveness of electroacupuncture (EA) on inflammation in a rat model. MATERIALS AND METHODS: Four experiments were conducted on male Sprague-Dawley rats (n = 8-9 per group). Inflammation was induced by injecting complete Freund's adjuvant (CFA) subcutaneously into the plantar surface of one hind paw of the rat. Experiment 1: To determine the effect of EA (10 and 100 Hz) versus sham treatment on inflammation. Experiment 2: To investigate the involvement of the adrenal glands on the effect of EA treatment using adrenalectomized (ADX) rats. Experiment 3: To determine the effects of EA on plasma levels of corticosterone. Experiment 4: To determine the effects of EA treatment versus immobilization on such stress indicators as heart rate and blood pressure. RESULTS: At 10 Hz EA significantly reduced CFA-induced hind paw edema. The effect was partially blocked in the ADX rats. EA significantly increased plasma levels of corticosterone but produced no noticeable signs of stress. CONCLUSION: At 10 Hz but not 100 Hz, EA suppresses inflammation by activating the hypothalamus-pituitary-adrenal axis (HPA) and the nervous system. J Altern Complement Med 2005 Feb;11(1):135-42.
Low-frequency transcutaneous nerve stimulation in mild/moderate hypertension.
Kaada B, Flatheim E, Woie L.
Rogaland Central Hospital, Stavanger, Norway.
Low-frequency peripheral nerve stimulation may induce widespread cutaneous and muscular vasodilatation in animals and humans due to sympatho-inhibition. This response has in humans been shown to be associated with a lowering of the systemic vascular resistance and arterial pressure. In the present study the effectiveness of low-frequency (2 Hz) transcutaneous electrical nerve stimulation (TNS) has been examined in 46 patients, all 41-43 years of age, with a primary diagnosis of uncomplicated mild/moderate hypertension (90-115 mmHg diastolic pressure). The study was designed blind with matched controls in a TNS group and a placebo group. The blood pressure was measured objectively with an automatic monitor. In a short-term experiment TNS produced a significant lowering of systolic, mean arterial, and diastolic pressures amounting to 8 mmHg (P less than 0.01), 6 mmHg (P less than 0.01), and 4 mmHg (P less than 0.02), respectively. In a long-term study, after 2 weeks of daily stimulation, a similar depression was recorded with no stimulation on the day of examination. An eventual clinical use of the depressor effect of TNS demands further clinical research. Clin Physiol 1991 Mar;11(2):161-8.
Effects of electroacupuncture of different frequencies on cerebral blood perfusion and cerebral function in the patient of stroke]
[Article in Chinese]
Ouyang G, Jia SW, Wang F, Shi Y, Gao Z.
Peking University Shenzhen Hospital, Guangdong 518036, China.
OBJECTIVE: To explore effects of electroacupuncture of different frequencies on stroke. METHODS: Forty-seven cases of stroke were treated with electroacupuncture at the motor region of the scalp and divided into 2 Hz, 2/15 Hz and 100 Hz groups according to the used frequency. Cerebral blood perfusion and brain functions before and during electroacupuncture in the 3 groups were investigated with single photon emission computed tomography (SPECT). RESULTS: Local cerebral blood perfusion and brain cell functions could be improved by electroacupuncture of the 3 frequencies, and the actions of 2/15 Hz and 100 Hz were better. CONCLUSION: Electroacupuncture of 2/15 Hz and 100 Hz has a better therapeutic effect on stroke when the stimulating intensity is fixed. Zhongguo Zhen Jiu 2005 Nov;25(11):776-8.
Electroacupuncture on PC6 (Neiguan) attenuates ischemia/reperfusion injury in rat hearts.
Tsou MT, Huang CH, Chiu JH.
Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan.
The use of somato-visceral regulation has been proposed as a treatment for a wide range of diseases. The aim of this study was to test the hypothesis that through somato-visceral regulation, ischemia-reperfusion (I/R) injury to the myocardium can be avoided by electroacupuncture (EA) on PC6 (Neiguan). Electroacupuncture on PC6 (Neiguan) was brought about by the application of metal needles over the bilateral median nerve at a point 1.5 cm proximal to the palm crease in male Spraque-Dawley rats. The animals were randomized into two groups: (1) prevention group with preconditioning by the application of EA on PC6 (n = 13); and (2) treatment group with EA on PC6 during I/R injury (n = 10). The protection against myocardial injury was blocked by different mechanisms: (1) severing of the bilateral median nerve (n = 10), (2) bilateral vagotomy (n = 10), and (3) intravenous naloxone injection (n = 10). The hemodynamic parameters (mean artery pressure and heart rate), duration of arrhythmia, mortality rate and cardiac enzymes were evaluated in these groups. The results showed that there were significant reductions in cardiac enzymes, the duration of arrhythmia and mortality rate in rats that were either preconditioned or treated with EA on PC6, compared with those that did not undergo EA on PC6 (P < 0.05). The cardioprotective effects were blocked by different procedures (P > 0.05). We conclude that EA on bilateral PC6 (Neiguan) prevents and attenuates I/R injury to the heart, and that this approach may provide an applicable and preventative alternative for patients with ischemic heart disease. Am J Chin Med 2004;32(6):951-65.
Ketamine enhances the efficacy to and delays the development of tolerance to electroacupuncture-induced antinociception in rats.
Huang C, Long H, Shi YS, Han JS, Wan Y.
Neuroscience Research Institute, Peking University, Key Laboratory of Neuroscience, The Ministry of Education, 38 Xueyuan Road, Beijing 100083, China.
Our previous studies have shown that 100 Hz electroacupuncture (EA) produced antinociception through the release of endogenous opioids (mainly dynorphin) and the activated kappa-opioid receptors in normal rats. Acupuncture is an effective treatment in relieving pain, but it develops tolerance after repeated administration. It has been reported that N-methyl-D-aspartate (NMDA) receptor antagonists could increase the antinociceptive effects induced by morphine and delay the development of tolerance to morphine but nothing has yet been described to reduce EA tolerance. Here we test whether ketamine, a non-competitive NMDA receptor antagonist, would enhance 100 Hz EA antinociception as well as prevent or delay the development of chronic tolerance to 100 Hz EA in normal rats. The results are as follows: (1) ketamine injected intraperitoneally (i.p.) 15 min prior to EA enhanced the antinociceptive effects of 100 Hz EA at a dose of 5.0 mg/kg, but not 0.2 or 1.0 mg/kg. However, ketamine at either dose did not affect the basal nociceptive threshold (represented by tail-flick latency). (2) Ketamine at a dose of 5.0 mg/kg delayed the development of chronic tolerance to 100 Hz EA antinociception. We conclude that ketamine can enhance antinociception of 100 Hz EA and delay the tolerance to 100 Hz EA in rats. These results suggest that the development of 100 Hz EA tolerance to antinociception was mediated, at least in part, through peripheral NMDA receptors, which may be useful in improving the therapeutic effects of EA in the treatment of pain when EA tolerance occurs. Neurosci Lett 2005 Feb 28;375(2):138-42.
Electro-acupuncture versus conventional analgesia: a comparison of pain levels during oocyte aspiration and patients' experiences of well-being after surgery.
Gejervall AL, Stener-Victorin E, Moller A, Janson PO, Werner C, Bergh C.
Reproductive Medicine, Department of Obstetrics and Gynecology, Institute for the Health of Women and Children, Sahlgrenska University Hospital, Goteborg University, SE-413 45 Goteborg, Sweden. [email protected]
BACKGROUND: The primary aims were to compare the pain-relieving effect and post-operative well-being between electro-acupuncture analgesia (EA) and conventional analgesia (CA) comprising opiates. Further aims were to compare time for mobilization, and costs for time and drug consumption. METHODS: In all, 160 women undergoing IVF were randomized, according to a computer-generated list, to EA or CA. Well-being was evaluated with the State Trait Anxiety Inventory (STAI). Pain and subjective expectations and experiences were recorded on a visual analogue scale (VAS). Time and drug consumption were recorded. RESULTS: Although VAS pain ratings were significantly higher at oocyte aspiration (P < 0.0001) and after retrieval (P < 0.01) in the EA than in the CA group, they were similar 60 min after surgery. Both groups had similar STAI well-being scores. The EA group was significantly less tired and confused than the CA group after oocyte aspiration. No significant differences in time and costs for drug consumption were noted. CONCLUSION: EA cannot generally be recommended as a pain-relieving method at oocyte aspiration but might be an alternative for women desiring a non-pharmacological method. An advantage of EA is less post-operative tiredness and confusion compared with CA. Hum Reprod 2005 Mar;20(3):728-35.
Electroacupuncture combined with indomethacin enhances antihyperalgesia in inflammatory rats.
Zhang RX, Lao L, Wang X, Ren K, Berman BB.
Center for Integrative Medicine, School of Medicine, University of Maryland, Baltimore, MD 21201, USA.
Our previous study showed that electroacupuncture (EA), an adjuvant to conventional medicine, significantly attenuated hyperalgesia and inflammation. The present study is an evaluation of the potential synergism of EA and a subeffective dosage of indomethacin (INDO) in a rat model. Inflammation and hyperalgesia, manifesting as edema and decreased paw withdrawal latency (PWL) to a noxious stimulus, were induced by injecting complete Freund's adjuvant (CFA) subcutaneously into the plantar surface of one hind paw of the rat. EA treatments were given at acupoint GB30 immediately and 2 h post-CFA. INDO at 2 mg/kg was given (intraperitoneally) 40 min before the second EA. PWL and edema were measured prior to CFA and 2.5 and 5 h post-CFA. Ten and 100 Hz EA significantly inhibited CFA-induced hind paw hyperalgesia. Both low- and high-frequency EA combined with INDO enhanced antihyperalgesia compared to each component alone, and 10 Hz but not 100 Hz EA significantly reduced CFA-induced hind paw edema. A combination of low-frequency EA and INDO did not show synergistic inhibitory effects on edema. The results demonstrate that EA combined with INDO synergistically inhibits hyperalgesia and suggest an improved treatment strategy for inflammatory pain. Pharmacol Biochem Behav 2004 Aug;78(4):793-7.
Inhibitory effect of electroacupuncture (EA) on the pressor response induced by exercise stress.
Li P, Ayannusi O, Reid C, Longhurst JC.
Dept. of Medicine, University of California, Irvine Medical Science I, C235, Irvine, CA 92697-4075, USA. [email protected]
We examined the effect of EA on the exercise stress-induced pressor response in healthy adult subjects of both sexes. Each subject was subjected to a bicycle exercise test using a ramp protocol once/week for three or four weeks. Subjects were asked to perform the following tests in random order: 1) a baseline exercise test without EA and 2) exercise after acupuncture at P 5-6, LI 4-L 7 and/or G 37-39 acupoints. Brachial systolic (SBP), diastolic (DBP), and mean blood pressures (MBP), heart rate (HR) and the rate-pressure product (RPP, systolic BP x HR/100) were measured every three min, while a 12 lead ECG was monitored continuously. We observed increases in MBP, SBP, HR and RPP in all 17 subjects during exercise. In 12 of the 17 subjects (71 %), EA for 30 min before exercise, either at Jianshi-Neiguan acupoints (P 5-6) or Hegu-Lique acupoints (LI 4-L 7), led to an increase in maximal workload, and reduced peak SBP, MBP and RPP responses to exercise; EA did not alter DBP or HR responses in these subjects. EA at control acupoints (Guangming-Xuanzhong acupoints, G 37-39) in five subjects did not alter the hemodynamic responses. Seven additional subjects were enrolled to study the effect of EA during a bicycle exercise test using a constant workload. The results were similar, in five of the seven subjects SBP, MBP and RPP after exercise were attenuated significantly by EA at P 5-6. We conclude that EA at specific acupoints improves exercise capacity and reduces the hemodynamic responses in approximately 70% of normal subjects. Clin Auton Res 2004 Jun;14(3):182-8.
Electroacupuncture for tension-type headache on distal acupoints only: a randomized, controlled, crossover trial.
Xue CC, Dong L, Polus B, English RA, Zheng Z, Da Costa C, Li CG, Story DF.
RMIT Chinese Medicine Research Group, RMIT University, Bundoora, Victoria, Australia.
OBJECTIVE: To investigate the efficacy of electroacupuncture, applied to distal acupoints only, for tension-type headache. BACKGROUND: Electroacupuncture is commonly used for tension-type headache, but when applied to distal acupoints only, evidence of its efficacy is lacking. DESIGN: A randomized, single-blinded, sham-controlled, crossover clinical trial. Methods.-The trial had 5 stages: baseline (2 weeks), phases I and II (each 4 weeks), washout period (2 weeks), and follow-up (3 months after phase II). Forty patients were randomly assigned to either group A or group B. Group A received real electroacupuncture during phase I, then sham electroacupuncture in phase II. Group B received the treatments in reverse order. Outcome measures were headache frequency and duration, pain intensity using a visual analog scale, mechanical pain threshold, headache disability, and sickness impact. Data were analyzed by univariate 2-way analysis of variance. RESULTS: Thirty-seven patients completed the trial. There were no significant differences between the 2 groups at baseline. At the end of phase I, group A, but not group B, demonstrated significant improvement in mean (standard error of the mean [SEM]) headache frequency (3.0 per month [0.3] versus 12.0 per month [1.7]), duration (13.3 hours [3.5] versus 32.0 hours [6.2]), pain intensity (32.8 mm [4.1] versus 47.5 mm [2.7]), pain threshold (right side, 2.9 kg/second [0.1] versus 0.9 kg/second [0.1]; left side, 2.4 kg/second [0.1] versus 1.1 kg/second [0.1]), headache disability score (6.0 [1.0] versus 16.3 [1.6]), and sickness impact score (288.7 [48.0] versus 687.1 [77.2]). For each parameter, significant differences also were demonstrated for both groups between baseline and phase II, and baseline and follow-up. There were no significant differences between the groups at the end of follow-up (P >.05). CONCLUSION: Electroacupuncture to distal points alone is effective for short-term symptomatic relief of tension-type headache. Headache 2004 Apr;44(4):333-41.
The short- and long-term benefit in chronic low back pain through adjuvant electrical versus manual auricular acupuncture.
Sator-Katzenschlager SM, Scharbert G, Kozek-Langenecker SA, Szeles JC, Finster G, Schiesser AW, Heinze G, Kress HG.
Department of Anesthesiology and Intensive Care Medicine (B), Outpatient Pain Center, University of Vienna, Vienna, Austria. [email protected]
Acupuncture is an established adjuvant analgesic modality for the treatment of chronic pain. Electrical stimulation of acupuncture points is considered to increase acupuncture analgesia. In this prospective, randomized, double-blind, controlled study we tested the hypothesis that auricular electroacupuncture (EA) relieves pain more effectively than conventional manual auricular acupuncture (CO) in chronic low back pain patients with insufficient pain relief (visual analogue scale [VAS] > or = 5) treated with standardized analgesic therapy. Disposable acupuncture needles were inserted in the auricular acupuncture points 29, 40, and 55 of the dominant side and connected to a newly developed battery-powered miniaturized stimulator worn behind the ear. Patients were randomized into group EA (n = 31) with continuous low-frequency auricular EA (1 Hz biphasic constant current of 2 mA) and group CO (n = 30) without electrical stimulation (sham-electroacupuncture). Treatment was performed once weekly for 6 wk, and in each group needles were withdrawn 48 h after insertion. During the study period and a 3-mo follow-up, patients were asked to complete the McGill questionnaire. Psychological well being, activity level, quality of sleep, and pain intensity were assessed by means of VAS; moreover, analgesic drug consumption was documented. Pain relief was significantly better in group EA during the study and the follow-up period as compared with group CO. Similarly, psychological well-being, activity, and sleep were significantly improved in group EA versus group CO, the consumption of analgesic rescue medication was less, and more patients returned to full-time employment. Neuropathic pain in particular improved in patients treated with EA. There were no adverse side effects. These results are the first to demonstrate that continuous EA stimulation of auricular acupuncture points improves the treatment of chronic low back pain in an outpatient population. IMPLICATIONS: Continuous electrical stimulation of auricular acupuncture points using the new point stimulation device P-stim significantly decreases pain intensity and improves psychological well-being, activity, and sleep in chronic low back pain patients. Anesth Analg 2004 May;98(5):1359-64.
Comparison between electro-acupuncture and hydrotherapy, both in combination with patient education and patient education alone, on the symptomatic treatment of osteoarthritis of the hip.
Stener-Victorin E, Kruse-Smidje C, Jung K.
Department of Physiology and Pharmacology, Goteborg University, Goteborg, Sweden. [email protected]
OBJECTIVES: The aim of the study was to evaluate the therapeutic effect of electro-acupuncture (EA) and hydrotherapy, both in combination with patient education or with patient education alone, in the treatment of osteoarthritis in the hip. METHODS: Forty-five patients, aged 42-86 years, with radiographic changes consistent with osteoarthritis in the hip, pain related to motion, pain on load, and ache were chosen. They were randomly allocated to EA, hydrotherapy, both in combination with patient education, or patient education alone. Outcome measures were the disability rating index (DRI), global self-rating index (GSI), and visual analogue scale (VAS). Assessments were done before the intervention and immediately after the last treatment and 1, 3, and 6 months after the last treatment. RESULTS: Pain related to motion and pain on load was reduced up to 3 months after last the treatment in the hydrotherapy group and up to 6 months in the EA group. Ache during the day was significantly improved in both the EA and hydrotherapy group up to 3 months after the last treatment. Ache during the night was reduced in the hydrotherapy group up to 3 months after the last treatment and in the EA group up to 6 months after. Disability in functional activities was improved in EA and hydrotherapy groups up to 6 months after the last treatment. Quality of life was also improved in EA and hydrotherapy groups up to 3 months after the last treatment. There were no changes in the education group alone. DISCUSSION: In conclusion, EA and hydrotherapy, both in combination with patient education, induce long-lasting effects, shown by reduced pain and ache and by increased functional activity and quality of life, as demonstrated by differences in the pre- and post-treatment assessments. Clin J Pain 2004 May-Jun;20(3):179-85.
The effect of acupuncture on the symptoms of knee osteoarthritis--an open randomised controlled study.
Tukmachi E, Jubb R, Dempsey E, Jones P.
Selly Oak Hospital, Birmingham, UK.
BACKGROUND: Using an open randomised controlled study, we examined the effectiveness of manual and electroacupuncture on symptom relief for patients with osteoarthritis of the knee. METHODS: Patients with symptomatic osteoarthritis of the knee were randomised to one of three treatment groups. Group A had acupuncture alone, group B had acupuncture but continued on their symptomatic medication, and group C used their symptomatic medication for the first five weeks and then had a course of acupuncture added. Patients receiving acupuncture were treated twice weekly over five weeks. Needles were inserted (with manual and electrical stimulation) in acupuncture points for pain and stiffness, selected according to traditional acupuncture theory for treating Bi syndrome. Patients were assessed by a blinded observer before treatment, after five weeks' treatment and at one month follow up, using a visual analogue pain scale (VAS) and the Western Ontario McMaster (WOMAC) questionnaire for osteoarthritis of the knee. RESULTS: The 30 patients in our study were well matched for age, body mass index, disease duration, baseline VAS pain score and baseline WOMAC scores. Repeated measure analyses gave a highly significant improvement in pain (VAS) after the courses of acupuncture in groups A (P = 0.012) and B (P=0.001); there was no change in group C until after the course of acupuncture, when the improvement was significant (P = 0.001). Similarly significant changes were seen with the WOMAC pain and stiffness scores. These benefits were maintained during the one month after the course of acupuncture. Patients' rating of global assessment was higher than that of the acupuncturist. CONCLUSION: We conclude that manual and electroacupuncture causes a significant improvement in the symptoms of osteoarthritis of the knee, either on its own or as an adjunct therapy, with no loss of benefit after one month. Acupunct Med 2004 Mar;22(1):14-22.
Analgesic effect of auricular acupuncture for cancer pain: a randomized, blinded, controlled trial.
Alimi D, Rubino C, Pichard-Leandri E, Fermand-Brule S, Dubreuil-Lemaire ML, Hill C.
Pain Management Unit, INSERM, U521, Villejuif, France.
PURPOSE: During the last 30 years, auricular acupuncture has been used as complementary treatment of cancer pain when analgesic drugs do not suffice. The purpose of this study is to examine the efficacy of auricular acupuncture in decreasing pain intensity in cancer patients. PATIENTS AND METHODS: Ninety patients were randomly divided in three groups; one group received two courses of auricular acupuncture at points where an electrodermal signal had been detected, and two placebo groups received auricular acupuncture at points with no electrodermal signal (placebo points) and one with auricular seeds fixed at placebo points. Patients had to be in pain, attaining a visual analog score (VAS) of 30 mm or more after having received analgesic treatment adapted to both intensity and type of pain, for at least 1 month of therapy. Treatment efficacy was based on the absolute decrease in pain intensity measured 2 months after randomization using the VAS. RESULTS: The main outcome was pain assessed at 2 months, with the assessment at 1 month carried over to 2 months for the eight patients who interrupted treatment after 1 month. For three patients, no data were available because they withdrew from the study during the first month. Pain intensity decreased by 36% at 2 months from baseline in the group receiving acupuncture; there was little change for patients receiving placebo (2%). The difference between groups was statistically significant (P <.0001). CONCLUSION: The observed reduction in pain intensity measured on the VAS represents a clear benefit from auricular acupuncture for these cancer patients who are in pain, despite stable analgesic treatment. J Clin Oncol 2003 Nov 15;21(22):4120-6.
Electrical stimulation of auricular acupuncture points is more effective than conventional manual auricular acupuncture in chronic cervical pain: a pilot study.
Sator-Katzenschlager SM, Szeles JC, Scharbert G, Michalek-Sauberer A, Kober A, Heinze G, Kozek-Langenecker SA.
Department of Anesthesiology and Intensive Care B,University of Vienna, Vienna, Austria. [email protected]
In this prospective, randomized, double-blinded, controlled study, we tested the hypothesis that auricular electroacupuncture relieves pain more effectively than conventional manual auricular acupuncture. We studied 21 chronic cervical pain patients without radicular symptoms with insufficient pain relief (visual analogue scale >5) treated with standardized analgesic therapy. All patients received disposable acupuncture needles on the dominant side on the following acupuncture points: cervical spine, shen men, and cushion. In 10 patients, needles were continuously stimulated (2-mA constant current, 1 Hz monophasic) by using the electrical point stimulation device P-STIM. In 11 control patients, no electrical stimulation was administered. All needles were withdrawn 48 h after insertion. Acupuncture was performed once a week for 6 wk. Patients had to complete a questionnaire assessing pain intensity, psychological well-being, activity, sleep, and demand for rescue medication (lornoxicam and tramadol). The reduction in pain scores was significant in the electrical acupuncture group. Similarly, psychological well-being, activity, and sleep were significantly improved in patients receiving electrical acupuncture, and consumption of rescue medication was significantly less. These results demonstrate that continuous electrical stimulation of auricular acupuncture points by using the new point stimulation device P-STIM improves the treatment of chronic cervical pain in an outpatient population. IMPLICATIONS: Continuous electrical stimulation of auricular acupuncture points by using the new point stimulation device P-STIM significantly decreases pain intensity and significantly improves psychological well-being, activity, and sleep in chronic cervical pain patients. Anesth Analg 2003 Nov;97(5):1469-73.
The use of electro-acupuncture in conjunction with exercise for the treatment of chronic low-back pain.
Yeung CK, Leung MC, Chow DH.
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
OBJECTIVES: To determine the effect of a series of electro-acupuncture (EA) treatment in conjunction with exercise on the pain, disability, and functional improvement scores of patients with chronic low-back pain (LBP). DESIGN: A blinded prospective randomized controlled study. Subjects and interventions: A total of 52 patients were randomly allocated to an exercise group (n = 26) or an exercise plus EA group (n = 26) and treated for 12 sessions. OUTCOME MEASURES: Numerical Rating Scale (NRS), Aberdeen LBP scale, lumbar spinal active range of movement (AROM), and the isokinetic strength were assessed by a blinded observer. Repeated measures analysis of variance (R-ANOVA) with factors of group and time was used to compare the outcomes between the two groups at baseline (before treatment), immediately after treatment, 1-month follow-up, and 3-month follow-up. The level of significance was set at p = 0.05. RESULTS: Significantly better scores in the NRS and Aberdeen LBP scale were found in the exercise plus EA group immediately after treatment and at 1-month follow-up. Higher scores were also seen at 3-month follow-up. No significant differences were observed in spinal AROM and isokinetic trunk concentric strength between the two groups at any stage of follow-up. CONCLUSIONS: This study provides additional data on the potential role of EA in the treatment of LBP, and indicates that the combination of EA and back exercise might be an effective option in the treatment of pain and disability associated with chronic LBP. J Altern Complement Med 2003 Aug;9(4):479-90.
Electroacupuncture, which is not the same as acupuncture, was reported to help obesity in 3 poorly designed Turkish (4.5% vs. 3.1% loss with diet restriction), Chinese, and Uigur studies. Chinese traditional medicine research is highly unreliable even when it appears well designed. Claims of 100% or near 100% cure rates for all sorts of disorders are common in Chinese publications (e.g. Zhonggue Zhen Jiu 2005 Oct;25(10):713-4). Claims have been made for benefit in gout and chronic fatigue syndrome is poorly designed studies. Traditional acupuncture rarely does any better than sham controls in numerous well-designed studies when controlled by practitioners who are not promoters of acupuncture. Electroacupuncture definitely looks better.
Animal Studies
A specific form of Transcranial Electrostimulation Treatment (TCET) has been shown to induce analgesia, alleviate symptoms of opiate withdrawal and alter nociceptive responses in neurons in the midbrain and hypothalamus of rats. TCET consists of a 10Hz, charge balanced, 10 mu A current passed for 30 minutes between electrodes placed in the ears. Both serotonin (5HT) and endogenous opioids have been strongly implicated in TCET responses. This study directly measured brain levels of several neurotransmitters and their metabolites in anesthetized rats stimulated with either 10 mu A TCET or 0 mu A (Sham). Neurotransmitters measured in selected homogenized brain areas by high performance liquid chromatography were 5HT and its metabolite, 5-hydroxyindolacetic acid (5HIAA); norepinephrine (NE) and its metabolite, 3-methoxy-4-hydroxyphenethyleneglycol (MHPG); and dopamine (DA). Levels of NE and DA were significantly higher in the hypothalamic region of TCET rats than of control rats. The midbrains of TCET rats contained significantly elevated levels of DA, MHPG, 5HT and 5HIAA. In the hindbrain no significant differences were observed. Thus, TCET appears to cause an increase in the synthesis or release of 5HT, DA and NE in the midbrain and DA and 5HT in the hypothalamus. In a separate experiment, beta-endorphin-like immunoreactivity was measured in blood plasma taken from rats at intervals before, during and after a 30 minute TCET treatment, but no demonstrable TCET effect was observed. The lack of change in serum endorphin levels suggests that TCET-induced opioid activity may be confined to the central nervous system, a reasonable theory because the current passes only through the head. Transcranial electrostimulation effects on rat opioid and neurotransmitter levels. Warner RL, et al. University of Texas, Houston Dental Branch. Life Sci 1994;54(7):481-90.
Thomas E. Radecki, M.D., J.D.
modern-psychiatry.com
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