Effect of Transcutaneous Electrical Nerve Stimulation on the Pain Intensity During Insertion of Needle in Patients Undergoing Spinal Anesthesia: A Randomized Controlled Study.

BACKGROUND AND OBJECTIVES: Needle insertion pain during spinal anesthesia is an unpleasant experience for patients. This study aimed to investigate the effects of Transcutaneous Electrical Nerve Stimulation (TENS) on the pain intensity during the insertion of spinal needles in patients undergoing spinal anesthesia. MATERIALS AND METHODS: In a double-blind clinical trial, 60 candidates for elective Trans Ureteral Lithotripsy surgery under spinal anesthesia were randomly divided into intervention and control groups. The electrodes of the TENS device were placed in the space between L3-L4 and L5-S1 vertebrae. The intensity of pain during insertion of the spinal needle by Visual Analog Scale and the frequency of attempts were recorded. RESULTS: The mean age of the study samples was 34.26 ± 5.07 and 32.8 ± 5.28 in the control and intervention group, respectively. The pain intensity during insertion of spinal needles was less significant in the intervention group compared to the control group (p = 0.001). The number of attempts to insert the spinal needle between the two groups was not statistically significant (p = 0.51). The duration of spinal anesthesia implementation procedure by physician in the intervention group was significantly shorter than that of the control group (p = 0.001). CONCLUSION: The use of TENS effectively reduced the pain of spinal needle insertion. Considering these beneficial effects, it is suggested that this procedure be used to relive pain in patients with spinal anesthesia.

Effect of fascia dry needling on non-specific thoracic pain - A proposed dry needling grading system.

This case report describes a 42-year-old female who presented with complaints of diffuse pain in her thoracic paraspinal region from T2 to T7. Physical examination revealed tenderness, increased turgor and restriction of her superficial fascia. A potential first time description of successful management utilizing fascia dry needling is described in this report with improvements noted in pain, range of motion, and functional activities. The patient was discharged from physiotherapy after four treatment sessions, and a follow-up after 3 months revealed that she was pain free and fully functional. A grading system (Sudarshan and Murugavel Dry Needling Grading Scale©) is proposed describing the various grades of dry needling to guide clinical reasoning and decision-making.

[Research on Acupuncture Anesthesia-analgesia].

In the present paper, the author retrospects the historical developmental stages of acupuncture anesthesia-analgesia from 1) preliminary exploration:the creative application of acupuncture therapy to surgery with lower dosage or without anesthetics began in Shanghai and Xi'an in 1958; 2) clinical popularization:the acupuncture anesthesia-analgesia became popularized from 1965, peaked in 1970s' and declined from 1980s'; 3) mechanism study:from 1970 to 2000, a large quantity of research papers were published to confirm the validity of acupuncture analgesia (AA), and in 1997, NIH Consensus Conference for acupuncture was held, promoting the related research in the world; 4) focused research:from 2007 to now, the acupuncture anesthesia-analgesia was listed as one of the key research program in China; 5) theoretical summary:in view of the uncertainty of the scientific basis of the meridian system of traditional Chinese medicine, the nerve fibers distributed under the acupoint are now considered to be the indispensable components for AA, and the knowledge of modern neuroscience is competent to explain the underlying mechanism of AA; 6) returning to reality:AA has been accepted by the international scientific community, and the "acupuncture-assisted anesthesia", or "compound acupuncture and anesthetics anesthesia" has been used as the first choice for some types of surgical operation. The research on acupuncture anesthesia-analgesia greatly facilitates clinical application of acupuncture therapy in the world, and also promotes the development of acupuncture therapy itself and neuroscience. However, the transformation between theory and practice and their mutual interaction are endless endeavor. Thus, a careful review of the half-century-long practice of acupuncture anesthesia-analgesia is painstakingly necessary in order to clarifying the mechanisms, to raise the efficacy of clinical practice and to correct the possible errors referred to this concept.

[Parametric optimization of electroacupuncture against bone-cancer pain in rats and its intervention on mRNA expression of opioid receptor and precursor].

OBJECTIVE: To observe the intervention of electroacupuncture (EA) with different current frequencies and treatment frequencies on pain thresholt in rats with bone-cancer pain, so as to optimize treatment parameters of EA against bone cancer pain; and by measuring gene expression of opioid receptor and precursor in different tissues to preliminarily explore the possible mechanism of EA against bone cancer pain. METHODS: Ninety healthy female SD rats were randomly divided into a control group, a model group, EA groups (6 subgroups according to different frequencies) and a sham EA group, ten rats in each one. Rats in the control group were injected with 10 µL of amicrobic phosphate buffer solution (PBS) into tibial cavity; rats in the remaining groups were injected with Walker 256 cancer cells to establish model of bone-cancer pain. No treatment was given to rats in the control group and model group; rats in the EA groups were treated with EA at bilateral "Housanli" (ST 36) and "Genduan" with 3 different current frequencies (2 Hz, 100 Hz and 2 Hz/100 Hz), once a day and once every other day, 30 min per treatment (1mA for 15 min, 2 mA for 15 min); rats in the sham EA group were treated with identical acupoints as the EA group, but the acupoints were needled subcutaneously and EA was connected with power off. All the treatment was given for 14 days. Dynamic plantar aesthesiometer was applied to measure the paw withdrawal thresholds (PWTs) of the affected side before the model establishment, 6d, 8d, 10d, 12d, 14d, 16d, 18d, and 20d after model establishment. The mRNA expressions of µ-opioid receptor (MOR), κ-opioid receptor (KOR), δ-opioid receptor (DOR), proopiomelanocortin (POMC) and prodynorphin (PDYN) in dorsal root ganglion (DRG) and lumbar spinal cord dorsal horn (SCDH) of L4-L6 of the affected side were detected by PCR method. RESULTS: There were no differences in PWTs among all groups before model establishment (P>0. 05). Each time point after model establishment, PWTs in model group were obviously lower than those in the control group (all P<0. 01). Compared with the model group, PWTs in each EA subgroup were all increased (all P<0.05), but the differences at different time points were not significant among EA subgroups (P>0.05). The mRNA expressions of MOR, KOR, POMC, and PDYN in L4-L6 DRG in the 2 Hz/100 Hz II group were significantly higher than those in model group (P<0. 05, P<0. 01), while the mRNA expressions of MOR, KOR, DOR, POMC and PDYN in SCDH were not different compared with the model group (P>0. 05). CONCLUSION: EA treatment has obvious analgesic effect on bone-cancer pain, however, its effect is not related with current frequency and treating frequency. EA against bone-cancer pain may be related with increasing the mRNA expression of some peripheral opioid receptors and precursor.

[Efficacy on analgesia with electric stimulation of long-term retaining needle after laparoscopic cholecystectomy].

OBJECTIVE: To observe the clinical effect of electric stimulation of long-term retaining needle on analgesia after laparoscopic cholecystectomy (LC) and the impacts on the post-surgical flatus time. METHODS: Under static absorptive composite general anesthesia, 90 cases of LC were randomized into three groups, 30 cases in each one. In the control group, the analgesia was not applied after LC. In the analgesia-pumper group, the patient controlled intravenous analgesia (PCIA) was used. In the needle-retaining group, the electric acupuncture stimulator was used. The needles were inserted transversely at Riyue (GB 24), Qichong (ST 30) and Yanglingquan (GB 34) and fixed with sterile sticker. Separately, in 8 h and 24 h after surgery, the electric acupuncture stimulation with disperse-dense wave, 2 Hz/100 Hz frequency was applied continuously for 30 min. Visual analogue scale (VAS), adverse reactions such as vomiting and nausea and the postoperative flatus time in 2, 4, 8, 12, 24 and 36 h after surgery were observed and recorded in the three groups. RESULTS: In 2, 4, 8, 12 and 24 h after surgery, VAS scores in the needle-retaining group and the analgesia-pumper group were all lower than those in the control group (P < 0.05, P < 0.01). The analgesia effect at the above time points in the needle-retaining group was better than that in the analgesia-pumper group (all P < 0.05). There was not adverse reaction in the needle-retaining group. But there were 3 cases of somnolence, 6 cases of nausea and 3 cases of vomiting in the analgesia-pumper group, and 2 cases of nausea and 1 case of vomiting in the control group. The flatus time was quite earlier in the needle-retaining group as compared with the other two groups [(14.77 +/- 4.99) h vs (18.50 +/- 4.22) h, P < 0.01; (14.77 +/- 4.99) h vs (18.17 +/- 4.69) h, P < 0.05]. CONCLUSION: The electric stimulation of long-term retaining needle is safe and effective in analgesia after LC. It avoids the adverse reactions of analgesics and promotes postoperative flatus.

Laser acupuncture does not improve menopausal symptoms.

OBJECTIVE: Acupuncture is commonly used to treat menopausal symptoms and other gynecological conditions. Laser acupuncture, more accurately named "laser acupoint stimulation," has the advantages of being noninvasive, reproducible, and convenient. A few studies of conventional acupuncture have suggested a beneficial effect in treating menopausal symptoms. This study sought to investigate the effectiveness of laser acupoint stimulation in relieving symptoms associated with menopause. METHODS: A double-blind, randomized, placebo-controlled study was conducted in 40 women experiencing active symptoms of menopause. Outcome variables were numbers of diurnal and nocturnal flushes and symptom score, determined using a previously validated scale. A laser acupoint stimulation device was altered to produce identical flashing lights whether or not the laser was operating to allow for a placebo ("laser off") control. Participants received either active or placebo treatment on a fortnightly basis for 12 weeks. The acupoint selection in both groups was individualized to each participant, selected from a set of 10 acupoints. RESULTS: There were no significant differences between the active and placebo treatment groups in numbers of diurnal or nocturnal flushes or in nonflushing symptom scores. CONCLUSIONS: Laser acupoint stimulation chosen from a fixed set of acupoints is no more efficacious than manual stimulation with an inert laser probe in altering menopausal symptoms.

Warm needle acupuncture at Pungsi (GB31) has an enhanced analgesic effect on formalin-induced pain in rats.

Warm needle acupuncture (WNA) therapy combines the effects of acupuncture and heat produced by moxibustion. This therapy has been widely used in Korean traditional medicine to treat a number of health problems. We evaluated the analgesic effect of WNA treatment on formalin-induced pain behavior and c-Fos expression in the spinal cord of rats. Acupuncture and heat stimulation by moxibustion were performed at the Pungsi (GB31) acupoint. Needle insertion without heat stimulation (ACU) and heat stimulation without needle insertion (SWNA) were used as negative controls. WNA therapy was executed by burning 1.5 g of cylinder-shaped moxa on top of the needle that was inserted at the acupoint. We measured temperatures of two different locations on the needle using an automatic temperature-acquisition system. Needle temperatures were overwhelmingly dependent on the distance from moxa while burning and showed a maximum of 44.9 degrees C at the location 7 mm apart from the ground after ignition. WNA treatment was more effective than ACU or SWNA in alleviating pain during the late phase in the rat formalin test. WNA, ACU, and SWNA significantly reduced c-Fos expression in the superficial dorsal horn by 23.5, 28.3 and 19.4%, respectively.

Acupuncture analgesia: II. Clinical considerations.

BACKGROUND: Acupuncture and related percutaneous neuromodulation therapies can be used to treat patients with both acute and chronic pain. In this review, we critically examined peer-reviewed clinical studies evaluating the analgesic properties of acupuncture modalities. METHODS: Using Ovid and published medical databases, we examined prospective, randomized, sham-controlled clinical investigations involving the use of acupuncture and related forms of acustimulation for the management of pain. Case reports, case series, and cohort studies were not included in this analysis. RESULTS: Peer-reviewed literature suggests that acupuncture and other forms of acustimulation are effective in the short-term management of low back pain, neck pain, and osteoarthritis involving the knee. However, the literature also suggests that short-term treatment with acupuncture does not result in long-term benefits. Data regarding the efficacy of acupuncture for dental pain, colonoscopy pain, and intraoperative analgesia are inconclusive. Studies describing the use of acupuncture during labor suggest that it may be useful during the early stages, but not throughout the entire course of labor. Finally, the effects of acupuncture on postoperative pain are inconclusive and are dependent on the timing of the intervention and the patient's level of consciousness. CONCLUSIONS: Current data regarding the clinical efficacy of acupuncture and related techniques suggest that the benefits are short-lasting. There remains a need for well designed, sham-controlled clinical trials to evaluate the effect of these modalities on clinically relevant outcome measures such as resumption of daily normal activities when used in the management of acute and chronic pain syndromes.

Clinical applications of acupuncture in anesthesia practice.

The most widely successful use of acupuncture in Western medicine has been in the treatment of chronic and intractable pain syndromes. Thus, it is especially important for the nurse anesthetist who is the practice of chronic pain management to be familiar with this treatment choice. This article provides the nurse anesthetist with basic information about the practice of acupuncture, the patient who may ask for acupuncture, application of segmental acupuncture techniques, and legislative and licensure issues.

Pain treatment by means of acupuncture.

Acupuncture has played an important part in pain research. Bischko was the first in the Western hemisphere to undertake surgery using acupuncture analgesia. This tonsillectomy was performed in 1972. Decisive research work has been carried out at the Ludwig Boltzmann Acupuncture Institute in Vienna. We now have far more knowledge about the importance of the basic system. Furthermore, we know that the theories on chaos research, and, especially the fractals play an important role. Various ways of treating pain by means of acupuncture will be discussed: e.g. body acupuncture (with or without supportive transcutaneous electrical nerve stimulation); treatment via the so-called somatotopies (ear, oral mucous membrane, scalp acupuncture according to Yamamoto etc.). The Ludwig Boltzmann Acupuncture Institute, in close collaboration with the II. Dept. of Internal Medicine at the Kaiserin-Elisabeth Hospital, Vienna, has been able to demonstrate on inpatients with a variety of conditions, that acupuncture could significantly reduce the quantity of analgesics required.

Lack of influence of acupuncture and transcutaneous stimulation on the immunoglobulin levels and leucocyte counts following upper-abdominal surgery.

The changes in immunoglobulins (IgA, IgG and IgM) and total and differential leucocyte counts in the peripheral blood during, and for 6 days after, surgery were evaluated in 29 male patients submitted to standardized upper-abdominal surgery performed under two different anaesthetic techniques. Group 1 received stimulation of ear and paravertebral points, supplemented by small doses of fentanyl (mean 1.2 micrograms kg-1, range 0.0-5.7) and Group 2 received moderate-dose fentanyl (mean 22.9 micrograms kg-1, range: 17.5-29.8). All were induced with thiopentone 5 mg kg-1, intubated after vecuronium 0.1 mg kg-1 and ventilated with 67% nitrous oxide in oxygen. Inhalation anaesthesia was not used. Surgery was followed by a fall in immunoglobulins, lymphocyte and eosinophil counts and a rise in leucocyte and neutrophil counts in both groups (P less than 0.01). No recovery was observed until the last assessment on Day 6 after surgery in IgA, IgG, leucocyte, neutrophil and lymphocyte counts in both groups, whereas IgM and eosinophil counts recovered by Day 4. Monocyte and basophil counts were unchanged in either group. Acupuncture and transcutaneous stimulation analgesia performed for major abdominal surgery did not influence the body's immune system either during or after surgery as measured by the concentrations of immunoglobulin and total and differential WBC counts.