Effect of Electroacupuncture vs Sham Treatment on Change in Pain Severity Among Adults With Chronic Low Back Pain: A Randomized Clinical Trial.

Importance: Chronic low back pain has high societal and personal impact but remains challenging to treat. Electroacupuncture has demonstrated superior analgesia compared with placebo in animal studies but has not been extensively studied in human chronic pain conditions. Objective: To evaluate the treatment effect of real electroacupuncture vs placebo in pain and disability among adults with chronic low back pain and to explore psychophysical, affective, and demographic factors associated with response to electroacupuncture vs placebo in treating chronic low back pain. Design, Setting, and Participants: This double-blind randomized clinical trial was conducted between August 2, 2016, and December 18, 2018, at a single center in Stanford, California. Primary outcomes were collected at approximately 2 weeks before and after intervention. Participants included English-speaking adults with at least 6 months of chronic low back pain, pain intensity of at least 4 on a scale of 0 to 10, and no radiculopathy. Data analyses for this intent-to-treat study were conducted from June 2019 to June 2020. Interventions: Twelve sessions of real or placebo (sham) electroacupuncture administered twice a week over 6 weeks. Main Outcomes and Measures: The main outcome was change in pain severity from baseline to 2 weeks after completion of treatment, measured by the National Institutes of Health PROMIS pain intensity scale. A secondary outcome was change in the Roland Morris Disability Questionnaire (RMDQ). Baseline factors potentially associated with these outcomes included psychophysical testing (ie, thermal temporal summation, conditioned pain modulation, pressure pain threshold), participant's self-report (ie, widespread pain, coping strategies, expectations, self-efficacy, and pain catastrophizing), and demographic characteristics (eg, age, sex, and race). Results: A total of 121 adults were recruited to the study, among whom 59 participants (mean [SD] age, 46.8 [11.9] years; 36 [61.0%] women) were randomized to real electroacupuncture and 62 participants (mean [SD] age, 45.6 [12.8] years; 33 [53.2%] women) were randomized to sham electroacupuncture. At baseline, the mean (SD) PROMIS T-score was 50.49 (3.36) in the real electroacupuncture group and 51.71 (4.70) in the sham acupuncture group, and the mean (SD) RMDQ score was 10.16 (4.76) in the real electroacupuncture group and 10.03 (5.45) in the sham acupuncture group. After adjusting for baseline pain scores, there was no statistically significant difference between groups in change in T-scores 2 weeks after completion of treatment (real electroacupuncture: -4.33; 95% CI, -6.36 to -2.30; sham acupuncture: -2.90; 95% CI, -4.85 to -0.95; difference: -2.09; 95% CI, -4.27 to 0.09; P = .06). After adjusting for baseline RMDQ, there was a significantly greater reduction in RMDQ in the real electroacupuncture group (-2.77; 95% CI, -4.11 to -1.43) compared with the sham electroacupuncture group (-0.67; 95% CI, -1.88 to 0.55; difference: -2.11; 95% CI, -3.75 to -0.47; P = .01). Within the real electroacupuncture group, effective coping at baseline was associated with greater RMDQ reduction (r = -0.32; 95% CI, -0.54 to -0.05; P = .02), and White race was associated with worse outcomes in PROMIS score (ß = 3.791; 95% CI, 0.616 to 6.965; P = .02) and RMDQ (ß = 2.878; 95% CI, 0.506 to 5.250; P = .02). Conclusions and Relevance: This randomized clinical trial found no statistically significant difference in change in PROMIS pain score in real electroacupuncture vs sham electroacupuncture. There was a statistically significant treatment effect for the secondary outcome of RMDQ compared with sham electroacupuncture. Effective coping skills and non-White race were associated with response to electroacupuncture. Trial Registration: ClinicalTrials.gov Identifier: NCT02890810.

Electroacupuncture for lumbar disc herniation: A protocol for systematic review and meta-analysis.

BACKGROUND: This systematic review aims to evaluate the effectiveness of electroacupuncture in treatment of lumbar disc herniation (LDH). METHODS: Electronic databases of all electroacupuncture for LDH will be searched at PubMed, Cochrane Library, Springer, EMBASE, China National Knowledge Infrastructure (CNKI), Wan-Fang, and Chinese Biological Medical disc, (CBM) from inception to February 29, 2020, with language restricted in Chinese and English. The primary outcome is Japanese Orthopedic Association Scores, a quantification scale for a comprehensive assessment according to patients' subjects feeling and objective function. Secondary outcomes included visual analogue scale (VAS), Oswestry dysfunction index (ODI), Pittsburgh sleep quality index (PSQI), Self-rating anxiety scale (SAS), self-depression rating scale (SDS), follow-up relapse rate. The systematic review and searches for randomized controlled trials of this therapy for LDH. The Cochrane RevMan V5.3 bias assessment tool is implemented to assess bias risk, data integration risk, meta-analysis risk, and subgroup analysis risk (if conditions are met). Mean difference (MD), standard mean deviation (SMD) and binary data will be used to represent continuous results. RESULTS: This study will provide a comprehensive review and evaluation of the available evidence for the treatment of LDH with this therapy. CONCLUSION: This study will provide new evidence to evaluate the effectiveness and side effects of electroacupuncture for LDH. Due to the data is not personalized, no formal ethical approval is required.

Electroacupuncture for post-thoracotomy pain: Protocol for a systematic review and meta-analysis.

BACKGROUND: Thoracotomy is a common surgical procedure used in cases such as trauma and cancer resection. It is an invasive procedure in which incisions are made in the chest wall to gain access to the chest. Therefore, it often produces intense postoperative pain. Electroacupuncture has been known for its analgesic effects in various conditions, including cases of postoperative pain. This protocol design is for a systematic review and meta-analysis to gather evidence and investigate the analgesic effects of electroacupuncture in pain after thoracotomy. METHODS: The studies for the systematic review will be searched with keywords on the following 10 databases: PubMed, Cochrane Library (CENTRAL), EMBASE, MEDLINE, Google Scholar, CNKI, KoreaMed, KMBASE, KISS, and OASIS. The search will be done without language restrictions. Only the randomized controlled trials that meet the eligibility criteria will be finally included in the study. The quality of the study will be assessed using the Cochrane Collaborations' risk-of-bias tool, and Cochrane's software RevMan 5.3 will be used for meta-analysis. RESULTS: The designed study will provide a systematic review and meta-analysis of the searched and randomized controlled trials that meet the eligibility criteria. Meta-analysis will be performed with pain scores as the main outcome measure, and they may also be performed with additional outcomes. The qualitative and quantitative data synthesis is expected to provide high quality evidence to judge the pain management effect of electroacupuncture for patients who underwent thoracotomy. CONCLUSION: The conclusion of this systematic review and meta-analysis will provide evidence to judge whether electroacupuncture is an effective analgesic treatment option for patients suffering with post-thoracotomy pain. PROSPERO REGISTRATION NUMBER: CRD42019142157.

Randomized controlled trial for the efficacy of electroacupuncture in the treatment of urge urinary incontinence: A clinical study protocol.

BACKGROUND: Despite that the urge urinary incontinence (UUI) is a nonfatal disease, it can lead to anxiety, embarrassment and depression to the patient. UUI is a common public health problem that can significantly affect the quality of life of the patient. Several conservative treatments have been recommended for the treatment of UUI; however, their efficiency remains unclear, leaving the disease without a real effective treatment. The clinical application of acupuncture to treat UUI is currently considered an effective approach despite the limited evidence that support its efficiency. The aim of this study is to assess the efficacy and safety of electroacupuncture therapy in the treatment of UUI. METHODS AND ANALYSIS: A randomized, parallel, controlled study will be performed. Patients with UUI treated with electroacupuncture group (EA) will compare with the sham-treated sham EA (SA) patients. A total of 100 participants with UUI will be randomly allocated to either the EA or the SA group with a 1:1 ratio. The treatment of UUI patients will performed 3 times per week, for 8 weeks in 30-minute sessions. At the end of the treatment the patients will be followed-up until week 32. The primary outcomes include scores of incontinence questionnaire-short form, the average 24-hour urgency incontinence episodes, and the average 24-hour urge episodes responses from baseline until the 4th, 8th , 24th, and 32nd week. The secondary outcomes included the average 24-hour urine volume and the average 24-hour micturition frequency responses from baseline until the 8th and 32nd week, as well as the change in incontinence quality of life scores from baseline at the 8th and 32nd week. In addition, the degree of satisfaction of the participants undergoing acupuncture treatment will be measured at the 4th and 8th week. The participants' clinical acupuncture expectations were evaluated at baseline, and the questionnaire for urinary incontinence diagnosis was used to identify stress incontinence, mixed urinary incontinence, and urge incontinence at baseline. DISCUSSION: This is a randomized, controlled, observer-blinded trial of electroacupuncture treatment for UUI. The results of this trial will provide more evidence on whether electroacupuncture is efficacious for treating UUI.

[Anaesthetic effect of acupuncture during an inguinal hernia repair ­ a self-experiment]. / Akupunkturanästhesie bei Leistenbruchoperation - ein Selbstversuch.

There are references in the media and in the literature to the use of acupuncture as an anaesthetic in surgical operations. The author, an experienced acupuncturist, tested the anaesthetic effect of acupuncture during an inguinal hernia repair in a self-experiment. Acupuncture combined with electrostimulation was administered for the 6-cm skin cut and preparation to 15 mm in depth. However, acupuncture alone provided an inadequate anaesthetic effect for the entire operation and an additional local anaesthetic had to be administered.

[Study on the project of quantification of electroacupuncture stimulation quantity].

In order to study on the definition domain and their correlated influencing factors about the acupuncture and moxibustion stimulation quantity, electroacupuncture (EA) stimulation quality and intensity, and to probe into the project of quantification of EA stimulation quantity. The authors reviewed the standardization work of EA, summed up the current state of the application of EA and the problems in quantification of the stimulation quantity in clinically control studies, expounded the different opinions and misunderstanding in acupuncture and moxibustion stimulation quantity and analyzed the definition domain and associated factors about acupuncture and moxibustion stimulation quantity and EA stimulation quantity and intensity. After the technical analysis, the calculation methods and formulas of pulse energy, quantity and intensity of EA stimulation were derived. On this basis, several schemes for the quantification of EA stimulation quantity with a certain feasibility and strong maneuverability are proposed.

Investigating the safety of electroacupuncture with a Picoscope.

Our wish to know more about the paths taken by electrical currents in electroacupuncture (EA) with special reference to the heart, particularly in patients with an implanted pacemaker, prompted us to undertake this study. Using ourselves as subjects, we have developed a safe oscillographic method to detect, visualise and record the EA currents that avoids the use of equipment requiring mains electricity. After two trials with unsatisfactory equipment, we found that the newly developed model 3425 PicoScopeTM (Pico Technology Ltd), with a four channel differential amplifier input connected to a laptop PC operating in battery mode, satisfied our criteria. With this recording system, we carried out two sets of experiments in which EA was provided by a Cefar acus4TM stimulator. The results confirm that the placement of a pair of acupuncture needles for EA can be used to predict the paths taken by the stimulating currents, and thus their areas of likely influence. When the needles are placed in closely adjacent acupuncture points in a limb, there is little or no detectable spread of the currents along the limb or into the chest. By contrast, when the needles are placed far apart, the electrical currents spread widely. Thus, when each of a pair of needles is placed in a point on opposite arms, the electrical currents recorded in the area of the pectoral muscles is of an order that might trigger an abnormal cardiac rhythm in a susceptible heart or activate a cardiac pacemaker incorporating an intracardiac defibrillator (ICD). Our results confirm the guidelines for EA safe practice recommended by the British Medical Acupuncture Society (BMAS) to avoid adverse events, ie EA should not be applied such that the current is likely to traverse the heart. We can now be confident that electric fields generated by pairs of needles below the knee or elbow do not create detectable currents in the chest. It is likely that similar results would be obtained with the use of transcutaneous electrical nerve stimulation (TENS) but this remains to be established by additional experiments.

Evaluating the efficacy of acupuncture in defined aspects of stroke recovery: a randomised, placebo controlled single blind study.

OBJECTIVE: To investigate the efficacy of acupuncture on stroke recovery compared to an inert placebo. DESIGN: Placebo-controlled, randomised, clinical trial. SETTING: Post-stroke rehabilitation wards in five NHS hospitals in the UK. SUBJECTS: Patients between 4 and 10 days after their first stroke. INTERVENTIONS AND OUTCOME MEASURES: The patients received 12 acupuncture or placebo treatments over four weeks. Acupuncture with electrical stimulation was compared with mock TENS, and assessments continued for 12 months after entry. Primary outcome was the Barthel Index (BI). Secondary outcomes were muscle power, Motricity Index (MI), mood, Nottingham Health Profile (NHP) and treatment credibility. RESULTS: 92 patients completed data sets. Data were analysed using both t tests and a structural equation based on longitudinal analysis of both BI and MI, using generalised estimating equations with an exchangeable correlation structure. While both acupuncture and placebo (mock TENS) appeared to have had an equal effect on stroke recovery, there is no significant difference between the two interventions at 12 (p = 0.737, 95 % CI -2.00 to 2.81) and 52 weeks (p = 0.371, 95 % CI -3.48 to 1.32). An apparently accelerated improvement in the MI scores in the acupuncture group at 3 weeks (p = 0.009, 95 % CI 1.55 to 10.77) is interesting. CONCLUSIONS: Acupuncture did not demonstrate specific efficacy over placebo and both groups did as well as normally expected with this condition.

Low-frequency electroacupuncture suppresses zymosan-induced peripheral inflammation via activation of sympathetic post-ganglionic neurons.

Electroacupuncture (EA) is used to treat a variety of inflammatory diseases; however, the neurophysiological mechanisms underlying EA's anti-inflammatory effect remain unclear. Accumulating evidence suggests that the sympathetic nervous system regulates immunologic and inflammatory responses and thus we hypothesized that this system could be involved in EA's anti-inflammatory effect (EA-AI). The goal of the present study was to evaluate whether the sympathetic nervous system plays a critical role in EA-AI using a mouse air pouch inflammation model. We found that bilateral low-frequency (1 Hz) EA applied to the Zusanli acupoint significantly suppressed the number of zymosan-induced leukocytes migrating into the air pouch. Furthermore, double-labeling immunohistochemical experiments showed that EA stimulation increased Fos expression in choline acetyltransferase (ChAT)-positive sympathetic pre-ganglionic neurons in the intermediolateral region of thoracic spinal cord segments. Chemical sympathetic denervation by intraperitoneal injection of 6-hydroxydopamine (which spares sympathetic adrenal medullary innervation) significantly inhibited EA-AI. In contrast, adrenalectomy did not alter EA-AI. Finally, systemic propranolol administration significantly inhibited EA's anti-inflammatory effect, suggesting that beta-adrenoceptors are involved. Collectively, these results suggest that EA produces an anti-inflammatory effect in this mouse air pouch model by activating the sympathetic nervous system leading to the release of catecholamines from post-ganglionic nerve terminals, which act on beta-adrenoceptors on immune cells to inhibit their migration.

Effects of abdominal electroacupuncture on parameters related to obesity in obese women: a pilot study.

The aim of this study was to elucidate the effects of electroacupuncture at abdominal meridian points on various obesity-related parameters: body weight (BW), body fat (BF) percentage, body mass index (BMI), percent ideal body weight (PIBW), and waist (WC) and hip (HC) circumferences. All of these parameters changed significantly compared to pretreatment in this pilot uncontrolled study involving 31 women with obesity. The percent reductions were 5.3% in BW, 1.3% in BF, 4.7% in BMI, 6.0% in PIBW, 4.6% in WC, 6.2% in HC, and 2.1% in the WC/HC ratio. The most affected variable was WC (effect size=0.58). Since this was a pilot study with several limitations, such as a small sample size and absence of a control treatment and appropriate follow-up, further studies that include a randomized design, larger sample sizes, and more detailed data about the subjects are needed to convincingly show the effects of electroacupuncture at abdominal meridian points on overweight and obese patients.

The effectiveness of acupuncture for depression--a systematic review of randomised controlled trials.

OBJECTIVE: To summarise the existing evidence on acupuncture as a therapy for depression. METHODS: RCTs were included, in which either manual acupuncture or electroacupuncture was compared with any control procedure in subjects with depression. Data were extracted independently by two authors. The methodological quality was assessed. Pre and post means and SDs for depression specific measures were extracted, when available, for meta-analysis. RESULTS: Seven randomised comparative trials involving 509 patients were included. The evidence is inconsistent on whether manual acupuncture is superior to sham, and suggests that acupuncture was not superior to waiting list. Evidence suggests that the effect of electroacupuncture may not be significantly different from antidepressant medication, weighted mean difference -0.43(95% CI -5.61 to 4.76). There is inconclusive evidence on whether acupuncture has an additive effect when given as an adjunct to antidepressant drugs. CONCLUSION: The evidence from controlled trials is insufficient to conclude whether acupuncture is an effective treatment for depression, but justifies further trials of electroacupuncture.

Acupuncture and endorphins.

Acupuncture and electroacupuncture (EA) as complementary and alternative medicine have been accepted worldwide mainly for the treatment of acute and chronic pain. Studies on the mechanisms of action have revealed that endogenous opioid peptides in the central nervous system play an essential role in mediating the analgesic effect of EA. Further studies have shown that different kinds of neuropeptides are released by EA with different frequencies. For example, EA of 2 Hz accelerates the release of enkephalin, beta-endorphin and endomorphin, while that of 100 Hz selectively increases the release of dynorphin. A combination of the two frequencies produces a simultaneous release of all four opioid peptides, resulting in a maximal therapeutic effect. This finding has been verified in clinical studies in patients with various kinds of chronic pain including low back pain and diabetic neuropathic pain.

Pain relief during oocyte retrieval with a new short duration electro-acupuncture technique--an alternative to conventional analgesic methods.

BACKGROUND: Acupuncture previously has proved its pain-relieving effect for ovum pick-up (OPU). The analgesic effect of electro-acupuncture (EA) was evaluated when EA was applied for only a few minutes prior to OPU in an attempt to make EA more attractive for clinical use. METHODS: Two hundred patients undergoing OPU were randomized prospectively using sealed, unlabelled envelopes, to receive pain relief with either EA in combination with a paracervical block (PCB) (n = 100) or conventional medical analgesia (CMA) in combination with a PCB (n = 100). A visual analogue scale (VAS) was used to evaluate pain and anxiety before, during and after OPU. The primary outcome measure was pain relief; secondary end-points were costs, time to discharge and clinical outcome parameters. RESULTS: There were no differences in any VAS ratings before the procedure. Directly after OPU, the EA group reported significantly higher mean and maximum pain, and 'pain now' than the CMA group. At 30 min after OPU and thereafter, no significant differences were found between the groups regarding abdominal pain. Time to discharge and costs were significantly lower in the EA group compared with the CMA group. No differences in clinical outcome parameters were seen. CONCLUSION: A significant difference was found between the EA and the CMA groups regarding pain during the OPU, probably due to the fact that the CMA group was pre-medicated as part of the study design. Despite a per-operative difference in pain rating, EA, given a few minutes prior to OPU, is a good alternative to CMA. The procedure is well tolerated by the patients, with a shorter hospitalization time and lower costs.

Electrostimulators for acupuncture: safety issues.

Three representative electrostimulators were evaluated to determine whether they meet the manufacturers' labeled nominal output parameters and how the measured parameters compare with a safety standard written for implanted peripheral nerve stimulators. The pulsed outputs (pulse width, frequency, and voltage) of three devices were measured with an oscilloscope across a 500-ohm resistance, meant to simulate subdermal tissue stimulated during electroacupuncture. For each device, at least two measured parameters were not within 25% of the manufacturer's claimed values. The measured values were compared with the American National Standard ANSI/AAMI NS15 safety standard for implantable peripheral nerve stimulators. Although for two stimulators the pulse voltage at maximum intensity was above that specified by the standard, short-term clinical use may still be safe because the standard was written for long-term stimulation. Similarly, the net unbalanced DC current, which could lead to tissue damage, electrolysis, and electrolytic degradation of the acupuncture needle, was within the limits of the standard at 30 pulses per second, but not at higher frequencies. The primary conclusions are (1) that the outputs of electrostimulators must be calibrated and (2) that practitioners must be adequately trained to use these electrostimulators safely.

Expression of c-fos protein in serotonergic neurons of rat brainstem following electro-acupuncture.

The c-fos proto-oncogene encodes a nuclear phosphoprotein, Fos which has been proposed to be a "third messenger" coupling short term extracellular signals to long term alteration in cell function. Using double labeling immunocytochemistry, the present work demonstrated the co-localization of Fos protein and serotonin in the nucleus raphe dorsalis, nucleus raphe centralis superior and rostral ventromedial medulla. The results pose an interesting problem, the possible relation of Fos protein to the biosynthesis of serotonin, awaiting further investigation.

Effects of the electrical stimulation of myofascial trigger points with tension headache.

The effects of electrical stimulation by simple pocket size stimulator were evaluated on myofascial trigger points by pain threshold (PTH) algometry. The study consisted 14 patients with 76 treated trigger points in randomly selected double blind cross-over study protocol. The effects of 30 seconds stimulation increased the PTH values 0.58 kg/cm2 in study group, but only 0.13kg/cm2 in controls (p < 0.01). These results suggested that the stimulation had positive effects on myofascial trigger points, but these effects were seen only on the treated points.

An introduction to sequential electric acupuncture (SEA) in the treatment of stress related physical and mental disorders.

A method of sequential electrical stimulation to certain acupuncture loci was found to be effective in the treatment of stress related physical and mental disorders. Recent research found that cerebral serotonin has anti-depressant and analgesic effects. It was reported that cerebral serotonin can be released by the stimulation of certain acupuncture loci. Omura reported that the stimulation of ST36 and GB20 increased intracephalic blood flow. Increasing intracephalic blood flow may indirectly increase the quantity of serotonin released. The release of serotonin can be enhanced further by sequential stimulation of these acupuncture loci. A marked degree of mental relaxation by SEA was shown in this study of 85 clinical cases of chronic physical disorders, e.g. intractable pain, headache, with most disorders complicated by reactive depression. Some of the cases were psycho-somatic disorders. The percentage of improvement from slight to remarkable between mental disorders (78.8%) and physical disorders (77.1%) is about equal. The method of treatment and schematic of the SEA device are discussed and shown.