ArticlePDF Available

Single-Blinded, Randomised Preliminary Study Evaluating the Effects of 2 hz Electroacupuncture for Postoperative Pain in Patients with Total Knee Arthroplasty

April 2015
Acupuncture in Medicine 33(4)

April 2015
33(4)

DOI:10.1136/acupmed-2014-010722

Source
PubMed

License
CC BY-NC 4.0

Authors:

chung-yuh Tzeng

Taichung Veterans General Hospital

Shih-Liang Chang

Da-Yeh University

Show all 8 authorsHide

To explore the point-specific clinical effect of 2 Hz electroacupuncture (EA) in treating postoperative pain in patients undergoing total knee arthroplasty (TKA), METHODS: In a randomised, partially single-blinded preliminary study, 47patients with TKA were randomly divided into three groups: control group (CG, n=17) using only patient-controlled analgesia (PCA); EA group (EAG, n=16) with 2 Hz EA applied at ST36 (Zusanli) and GB34 (Yanglingquan) contralateral to the operated leg for 30 min on the first two postoperative days, also receiving PCA; and non-point group (NPG, n=14), with EA identical to the EAG except given 1 cm lateral to both ST36 and GB34. The Mann-Whitney test was used to show the difference between two groups and the Kruskal-Wallis test to show the difference between the three groups. The time until patients first required PCA in the CG was 34.1±22.0 min, which was significantly shorter than the 92.0±82.7 min in the EAG (p<0.001) and 90.7±94.8 min in the NPG (p<0.001); there was no difference between the EAG and NPG groups (p>0.05). The total dosage of PCA solution given was 4.6±0.9 mL/kg body weight in the CG, 4.2±1.0 mL/kg in the EAG and 4.5±1.0 mL/kg in the NPG; there were no significant differences (p>0.05) among the three groups. In this small preliminary study, EA retarded the first demand for PCA in comparison with no EA. No effect was seen on the total dosage of PCA required and no point-specific effect was seen. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Flowchart.

…

and basic data of the 47 patients undergoing total knee arthroplasty

…

Figures - uploaded by Shih-Liang Chang

Content may be subject to copyright.

Content uploaded by Shih-Liang Chang

Content may be subject to copyright.

Single-blinded, randomised

preliminary study evaluating the

effects of 2 Hz electroacupuncture

for postoperative pain in patients

with total knee arthroplasty

Chung-Yuh Tzeng,

1,2

Shih-Liang Chang,

Chih-Cheng Wu,

4,5

Chu-Ling Chang,

Wen-Gii Chen,

Kwok-Man Tong,

Kui-Chou Huang,

Ching-Liang Hsieh

6,7,8

For numbered affiliations see

end of article.

Correspondence to

Dr Ching-Liang Hsieh, Graduate

Institute of Integrated Medicine,

College of Chinese Medicine,

China Medical University,

91 Hsueh-Shih Road, Taichung

40402, Taiwan;

clhsieh@mail.cmuh.org.tw

Accepted 27 March 2015

To cite: Tzeng C-Y,

Chang S-L, Wu C-C, et al.

Acupunct Med Published

Online First: [please include

Day Month Year]

doi:10.1136/acupmed-2014-

010722

ABSTRACT

Objective To explore the point-specific clinical

effect of 2 Hz electroacupuncture (EA) in treating

postoperative pain in patients undergoing total

knee arthroplasty (TKA),

Methods In a randomised, partially single-

blinded preliminary study, 47patients with TKA

were randomly divided into three groups: control

group (CG, n=17) using only patient-controlled

analgesia (PCA); EA group (EAG, n=16) with

2 Hz EA applied at ST36 (Zusanli) and GB34

(Yanglingquan) contralateral to the operated leg

for 30 min on the first two postoperative days,

also receiving PCA; and non-point group (NPG,

n=14), with EA identical to the EAG except given

1 cm lateral to both ST36 and GB34. The Mann–

Whitney test was used to show the difference

between two groups and the Kruskal–Wallis test

to show the difference between the three

groups.

Results The time until patients first required PCA

in the CG was 34.1±22.0 min, which was

significantly shorter than the 92.0±82.7 min in

the EAG (p<0.001) and 90.7±94.8 min in the

NPG ( p<0.001); there was no difference between

the EAG and NPG groups (p>0.05). The total

dosage of PCA solution given was 4.6±0.9 mL/kg

body weight in the CG, 4.2±1.0 mL/kg in the

EAG and 4.5±1.0 mL/kg in the NPG; there were

no significant differences (p>0.05) among the

three groups.

Conclusions In this small preliminary study, EA

retarded the first demand for PCA in comparison

with no EA. No effect was seen on the total

dosage of PCA required and no point-specific

effect was seen.

INTRODUCTION

Total knee arthroplasty (TKA) is considered

an effective method for the treatment of

severe degenerative knee-joint arthritis and

has been widely used. It is a painful proced-

ure that has prompted the implementation

of a number of strategies to promote post-

operative patient comfort and early mobil-

isation. These strategies can be divided into

systemic (such as narcotics) and local proce-

dures, which involve intervention at the

level of the spinal cord, paravertebral

nerves, or the joint itself.

The goal of post-

operative analgesia is to make patients feel

as comfortable as possible with the lowest

possible morbidity from analgesic compli-

cations, such as cardiorespiratory or central

nervous system (CNS) depression.

Electroacupuncture (EA) has been used

as an alternative method to relieve both

acute and chronic pain.

Studies on the

mechanism of action have shown that

endogenous opioid peptides in the CNS

play an essential role in mediating the

analgesic effect of EA.

Most studies on

the efficacy of EA have tested it for treat-

ing chronic pain syndromes.

6–9

Several

studies have assessed the effect of EA in

the treatment of acute pain, including

postoperative situations, with varying

results.

10–14

We propose that EA may be

used to relieve postoperative pain after

knee surgery. Two Hz, but not 100 Hz EA

analgesia involves endomorphin-1 release

at the spinal level

and β-endorphin and

encephalin release in the CNS.

Original paper

Tzeng C-Y, et al.Acupunct Med 2015;0:1–5. doi:10.1136/acupmed-2014-010722 1

group.bmj.com on May 23, 2015 - Published by http://aim.bmj.com/Downloaded from

As a preliminary study, we aimed to explore the

effect on postoperative pain of 2 Hz EA applied at

ST36 (Zusanli) and GB34 (Yanglingquan) contralateral

to the operative leg. We wished to test the overall

effectiveness and the point-specific effect.

PATIENTS AND METHODS

A single-blinded, randomised, controlled preliminary

study was conducted in patients with severe degenera-

tive knee joint arthritis requiring TKA. A total of 47

patients were randomly assigned to the following

groups: control group (CG) without EA; EA group

(EAG), EA at points; non-point group (NPG), EA at

non-points. All groups received patient-controlled

analgesia (PCA), which was used to evaluate the effect.

Because we could find no previous studies of this

design, we had no basis on which to calculate the stat-

istical power or sample size and recruited as many

patients as volunteered during the study period. The

trial was approved by the institutional ethics commit-

tee of the Veterans General Hospital, Taichung,

Taiwan (IRB TCVGH number: 940118/456). Written

informed consent was obtained from all the partici-

pants before the trial.

Patients

The patients had to have severe degenerative knee

joint arthritis that required TKA and be older than

50 years. Patients were excluded if they had a history

of morphine allergies, severe cardiac arrhythmias,

seizure disorders or cardiopulmonary disorders such

as heart failure, chronic pulmonary obstructive

disease, and others. Patients who refused spinal anaes-

thesia or had a history of psychiatric disease or drug

abuse, or who had had acupuncture treatment within

1 month before the trial, were also excluded.

Randomisation and blinding

Patients were randomly allocated to the groups

according to a blank envelope containing a card indi-

cating one of three groups; the envelope was opened

immediately after closure of the operative wound.

Patients and staffs were blinded to group allocation

before the envelope was opened. Patients receiving EA

were blinded to whether the EA was given at a point

or not.

Interventions

The patients underwent a routine anaesthetic protocol

before the TKA surgery. We used spinal (subarach-

noid) anaesthesia over the L3–L4 levels with 0.5%

bupivacaine (12–14 mg) for the intraoperative anaes-

thesia. The epidural PCA solution contained 1.5 μg/

mL fentanyl and 0.1% bupivacaine (750 μg of fen-

tanyl and 100 mg of bupivacaine in 500 mL of

normal saline); a standard setup was used as the con-

ventional treatment for postoperative pain control in

each patient.

The CG received only PCA (1.5 μg/mL fentanyl and

0.1% bupivacaine). The EAG patients were treated

with 2 Hz EA with 2 mA intensity and adjusted to

produce visible twitching of the anterior tibial muscle

for 30 min using a HANS electrical stimulation device

(Healthtronic Inc, Singapore City, Singapore); two

needles were inserted at ST36 and GB34 (disposal

stainless steel acupuncture needles, 50 mm in length,

0.26 mm in diameter and insertion depth of

20–30 mm) contralateral to the operated leg. The

NPG received the same intervention as the EAG,

except that the needles were inserted and 2 Hz EA

applied to needles inserted 1 cm lateral to ST36 and

GB34. The PCA machine was set to each patient

when the operation was finished. The PCA machine

was started after the operation when the patients were

sent to the recovery room. EA stimulation was per-

formed when the PCA machine was started and

repeated (identically in every respect to the first EA

stimulation) 24 h later (figure 1).

The main outcome measures were the time of first

demand for PCA and the total dosage of PCA solu-

tiongivenin48h.Thesecondaryoutcomemeasure

was the incidence rate of vomiting over a 48 h post-

operative period. The time of first demand for PCA

was recorded automatically by the PCA machine.

The measurement of the incidence rate of vomiting

was recorded by the caregiver of the patients.

In addition, Visual Analogue Scale (VAS) scores

were recorded by a member of staff before the

PCA was set up. The data were analysed by

Biostatistics Task Force, Taichung Veterans General

Hospital, Taichung, Taiwan; they were blinded to

the groups.

Statistical analysis

All data were represented as the mean±SD and the

data were analysed using SPSS V.10.0 (Chicago,

Illinois, USA). The differences between two groups

were tested using the Mann–Whitney test and among

the three groups using a Kruskal–Wallis test. In add-

ition, a Pearson χ

test was used to compare the differ-

ences between sex (male and female) and vomiting.

Our study defined a p value <0.05 as statistically

significant.

RESULTS

Characteristics and baseline data

A total of 47 patients (36 female, 11 male; aged 59–

84 years) with severe degenerative knee joint arthritis

who had received TKA completed the study; the study

period was from May 2005 to May 2006. No patients

dropped out of the study. The CG consisted of 17

patients, the EAG 16 patients and the NPG 14

patients. There were no significant differences

between groups in mean age, height, weight, sex and

VAS pain score (table 1).

Original paper

2Tzeng C-Y, et al.Acupunct Med 2015;0:1–5. doi:10.1136/acupmed-2014-010722

group.bmj.com on May 23, 2015 - Published by http://aim.bmj.com/Downloaded from

Effect of 2 Hz EA on postoperative pain after TKA

The time for first demand of PCA in the CG was 34.1

±22.0 min, which was significantly shorter than the

92.0±82.7 min in the EAG ( p<0.001) and the 90.7

±94.8 min in the NPG ( p<0.001). There was no sig-

nificant difference between time to first use of PCA in

the EAG and NPG ( p>0.05) (table 2).

The dose of PCA solution was calculated according

to the body weight and is reported in table 2. There

was no significant difference (p>0.05) among the

groups.

The incidence of vomiting was 10/17 patients in the

CG, 8/16 patients in the EAG and 6/14 patients in the

NPG over a 48 h period after TKA. Again, there was

no statistically significant difference among the three

groups (p>0.05) (table 2).

DISCUSSION

Our results indicate that 2 Hz EA applied at ST36 and

GB34 and at locations 1 cm lateral to these points,

contralateral to the operated leg, may prolong the

time until the patients first demand PCA after TKA

for knee joint arthritis, compared with no EA.

However, in this study we found that 2 Hz EA did not

lead to a significant reduction in the dose of PCA or

the incidence of vomiting.

Since there were no significant differences in patient

characteristics that might explain this difference in

outcome, these findings suggest that 2 Hz EA may

Figure 1 Flowchart.

Table 1 Characteristics and basic data of the 47 patients

undergoing total knee arthroplasty

Characteristics CG (n=17)

EAG

(n=16)

NPG

(n=14)

Value

Sex

Female 14 12 10 0.328*

Male 3 4 4

Age 70.1±6.9 69.6±5.6 71.4±7.3 0.738†

Height (cm) 154.1±7.0 156.0±6.8 157.2±8.3 0.517†

Weight (kg) 65.0±11.4 69.3±9.1 68.0±8.2 0.252†

Pain VAS 3.8±1.1 4.0±0.7 3.9±0.8 0.645†

Results are shown as mean±SD.

*Pearson χ

test; †Kruskal-Wallis test.

CG, conventional treatment group with only patient-controlled analgesia

(PCA); EAG, point group, 2 Hz EA group; NPG, non-point group; both

groups receiving EA also received PCA; VAS, Visual Analogue Scale.

Original paper

Tzeng C-Y, et al.Acupunct Med 2015;0:1–5. doi:10.1136/acupmed-2014-010722 3

group.bmj.com on May 23, 2015 - Published by http://aim.bmj.com/Downloaded from

produce a transient relief or delay the onset of post-

operative pain in patients who have undergone TKA,

though the effect cannot be distinguished from the

placebo response.

TKA is a painful procedure requiring vigorous anal-

gesic management, usually a systemic narcotic agent.

However, an analgesic regimen given before the onset

of pain may prevent sensitisation of the nervous

system, reducing the patient’s pain response.

(2 Hz) induces the release of β-endorphin and enkeph-

alin, which activate μand δopioid receptors in the

brain and may provide pre-emptive analgesia.

has been used to treat postoperative pain, although

the evidence on its effectiveness is conflicting.

Morioka et al

and Chernyak et al

reported that

EA did not reduce the perioperative analgesic require-

ments, though most studies have reported positive

effects.

10 12 14 21 22

Our results indicate that the total

dosage of the PCA solution and the incidence rate of

vomiting over a 48 h period after the operation were

similar among the three groups. These results may be

explained by the supposition that 2 Hz EA exerts only

a transient analgesic effect, or our study was too small

to identify an effect, or the stimulation used was inad-

equate. The incidence of vomiting was closely related

to the dosage of the PCA solution, explaining the lack

of difference between groups in both respects.

23–25

Our study used contralateral treatment for obvious

practical reasons. Though apparently unconventional,

there is both a traditional Chinese medicine descrip-

tion of contralateral effects,

and a neurological

explanation from opioid peptide release.

In addition,

we have previously shown that 2 Hz EA at unilateral

ST36 and ST37 depressed the contralateral R2 com-

ponent of the blink reflex. This study also used only

two points.

Further, acupuncture at left SJ5

increased capillary red blood cell velocity of the right

nailfold microcirculation.

We found no point-specific effect of ST36 and GB34

compared with nearby non-points, although our study

had limitations (see below). It is likely that a segmental

effect of the stimulation plays a critical role: ST36 and

GB34 are located 3 and 6 cun below the knee, respect-

ively, in the region innervated by the superficial

peroneal nerve and L5. The locations of the control

points, 1 cm lateral to ST36 and GB34, are also in the

region of the superficial peroneal nerve and L5.

This

explanation is consistent with our previous results,

demonstrating that the segmental effect of the spinal

nerve plays a critical role in the effects of acupuncture

on nailfold microcirculation.

Nevertheless, it is

essential to determine the long-term analgesic proper-

ties of acupuncture that are more effective at relieving

pain during a postsurgical operation.

This study was limited by the small sample size.

Furthermore, the difference in the location of the EA

between the EAG and NPG was only 1 cm; therefore,

comparing the therapeutic effect was difficult.

Furthermore, we are not certain whether the number

of points used, or the intensity of EA stimulation,

were optimal. Future studies should include an

adequate sample size and a sham CG and consider

using four points instead of two to further examine

the effectiveness of EA on postoperative pain.

In conclusion, we found that 2 Hz EA applied for

30 min on the first two postoperative days at ST36

and GB34 and 1 cm lateral to both the ST36 and

GB34, contralateral to the operative leg prolonged the

time to the first demand for PCA compared with no

EA. We did not observe any effect on the total dosage

of PCA solution or the incidence rate of vomiting, or

any point-specific effect, but limitations to the study

prevent definite conclusions. These findings suggest

that 2 Hz EA may provide transient relief or delay the

onset of postoperative pain.

Summary points

▸We conducted a small study on the effect of electroacu-

puncture (EA) at classical points and at non-point loca-

tions on postoperative pain, compared with no EA.

▸EA delayed the demand for analgesic drugs.

▸There was no difference between the effect of EA at

points and non-points.

Author affiliations

Department of Orthopedic Surgery, Taichung

Veterans General Hospital, Taichung, Taiwan

Department of Nursing, Hung Kuang University,

Taiwan

Department of Medicinal Botanicals and Health

Care, Da-Yeh University, Chunghwa, Taiwan

Department of Anesthesia, Taichung Veterans

General Hospital, Taichung, Taiwan

Department of Financial and Computational

Mathematics, Providence University, Taichung, Taiwan

Graduate Institute of Integrated Medicine, College of

Chinese Medicine, China Medical University,

Taichung, Taiwan

Table 2 Effect of 2 Hz EA on postoperative pain and vomiting

after total knee arthroplasty

CG EAG NPG

Time to patients’initial

demand for PCA (min)

34.1±22.0 92.0±82.7* 90.7±94.9*

Dosage of PCA (mL/kg body

weight)

4.6±0.9 4.2±1.0 4.5±1.0

Incidence rate of vomiting 10/17 8/16 6/14

Results are shown as mean±SD.

*p<0.001 compared with the CG.

CG, conventional treatment group with only patient-controlled analgesia

(PCA); EAG, point group, 2 Hz EA group; NPG, non-point group; both

groups receiving EA also received PCA.

Original paper

4Tzeng C-Y, et al.Acupunct Med 2015;0:1–5. doi:10.1136/acupmed-2014-010722

group.bmj.com on May 23, 2015 - Published by http://aim.bmj.com/Downloaded from

Department of Chinese Medicine, China Medical

University Hospital, Taichung, Taiwan

Research Center for Chinese Medicine and

Acupuncture, China Medical University, Taichung,

Taiwan

Twitter Follow Ching-Liang Hsieh at @CLH

Acknowledgements We thank the Biostatistics Task Force of

Veterans General Hospital, Taichung, for the statistics work

performed for this study.

Funding This study was supported by China Medical University

under the Aim for Top University Plan of the Ministry of

Education, Taiwan and by the Taiwan Ministry of Health and

Welfare Clinical Trial and Research Center of Excellence

(MOHW104-TDU-B-212-113002).

Contributors C-YT performed the experiment and wrote the

paper; S-LC participated in the discussion and design; C-CW

performed anaesthesia and helped with the experiment; C-LC

and W-GC participated in the discussion; K-MT and K-CH

helped with the experiment; C-LH participated in the

discussion and design and revised the document.

Competing interests None declared.

Ethics approval The institutional ethics committee of Veterans

General Hospital, Taichung, Taiwan.

Provenance and peer review Not commissioned; externally

peer reviewed.

Open Access This is an Open Access article distributed in

accordance with the Creative Commons Attribution Non

Commercial (CC BY-NC 4.0) license, which permits others to

distribute, remix, adapt, build upon this work non-

commercially, and license their derivative works on different

terms, provided the original work is properly cited and the use

is non-commercial. See: http://creativecommons.org/licenses/by-

nc/4.0/

REFERENCES

1 Ginsberg B. Pain management in knee surgery. Orthop Nurs

2001;20:37–44.

2 Hedenstierna G, Löfström J. Effect of anaesthesia on

respiratory function after major lower extremity surgery.

A comparison between bupivacaine spinal analgesia with

low-dose morphine and general anaesthesia. Acta Anaesthesiol

Scand 1985;29:55–60.

3 Ulett GA, Han S, Han JS. Electroacupuncture: mechanisms and

clinical application. Biol Psychiatry 1998;44:129–38.

4 Han JS. Acupuncture and endorphins. Neurosci Lett

2004;361:258–61.

5 Wang HH, Chang YH, Liu DM, et al. A clinical study on

physiological response in electroacupuncture analgesia and

meperidine analgesia for colonoscopy. Am J Chin Med

1997;25:13–20.

6 Lee PK, Modell JH, Andersen TW, et al. Incidence of

prolonged pain relief following acupuncture. Anesth Analg

1976;55:229–31.

7 Ng MM, Leung MC, Poon DM. The effects of

electro-acupuncture and transcutaneous electrical nerve

stimulation on patients with painful osteoarthritic knees:

a randomized controlled trial with follow up evaluation.

J Altern Complement Med 2003;9:641–9.

8 Tsui P, Leung MC. Comparison of the effectiveness between

manual acupuncture and electro-acupuncture on patients with

tennis elbow. Acupunct Electrother Res 2002;27:107–17.

9 Yeung CKN, Leung MCP, Chow DHK. The use of

electro-acupuncture in conjunction with exercise for the

treatment of chronic low-back pain. J Altern Complement Med

2003;9:479–90.

10 Ntritsou V, Mavrommatis C, Kostoglou C, et al. Effect of

perioperative electroacupuncture as an adjunctive therapy on

postoperative analgesia with tramadol and ketamine in

prostatectomy: a randomised sham-controlled single-blind trial.

Acupnct Med 2014:32:215–22.

11 Mayor D. An exploratory review of the electroacupuncture

literature: clinical applications and endorphine mechanisms.

Acupunt Med 2013:31:409–15.

12 Christensen PA, Noreng M, Andersen PE, et al.

Electroacupuncture and postoperative pain. Br J Anaesth

1989;62:258–62.

13 Gejervall AL, Stener-Victorin E, Möller A, et al. Electro-

acupuncture versus conventional analgesia: a comparison of

pain levels during oocyte aspiration and patients’experiences

of well-being after surgery. Hum Reprod 2005;20:728–35.

14 Sim CK, Xu PC, Pua HL, et al. Effects of electroacupuncture

on intraoperative and postoperative analgesic requirement.

Acupunct Med 2002;20:56–65.

15 Han Z, Jiang YH, Wan Y, et al. Endomorphin-1 mediates 2 Hz

but not 100 Hz electroacupuncture analgesia in the rat.

Neurosci Lett 1999;274:76–8.

16 Han JS. Acupuncture: neuropeptide release produced by

electrical stimulation of different frequencies. Trends Neurosci

2003;26:17–22.

17 Narchi P, Barakat H. Regional analgesia after total knee

replacement. Anesth Analg 2000;91:247.

18 Gottschalk A, Smith D. New concepts in acute pain therapy:

preemptive analgesia. Am Fam Physician 2001;63:1979–84.

19 Morioka N, Akça O, Doufas AG, et al. Electro-acupuncture at

the Zusanli, Yanglingquan and Kunlun points does not reduce

anesthetic requirement. Anesth Analg 2002;95:98–02.

20 Chernyak G, Sengupta P, Lenhardt R, et al. The timing of

acupuncture stimulation does not influence anesthetic

requirement. Anesth Analg 2005;100:387–92.

21 Lin JG, Lo MW, Wen YR, et al. The effect of high and low

frequency electroacupuncture in pain after lower abdominal

surgery. Pain 2002;99:509–14.

22 Martelete M, Fiori AM. Comparative study of the analgesic

effect of transcutaneous nerve stimulation (TNS);

electroacupuncture (EA) and meperidine in the treatment of

postoperative pain. Acupunct Electrother Res 1985;10:183–93.

23 Schug SA, Torrie JJ. Safety assessment of postoperative pain

management by an acute pain service. Pain 1993;55:387–91.

24 Love AG, Pace NL. Respiratory-related critical events with

intravenous patient-controlled analgesia. Clin J Pain 1994;10:52–6.

25 Ballantyne JC, Carr DB, deFerranti S, et al. The comparative

effects of postoperative analgesic therapies on pulmonary

outcome: cumulative meta-analyses of randomized, controlled

trials. Anesth Analg 1998;86:598–12.

26 Original Note (Tang Dynasty) Wang B. English by Wu NL, Wu

AQ. Yellow Emperor’s Canon of Internal Medicine, China

Science & Technology Press, First Edition, Bejing, 1999:293–300.

27 Hsieh CL, Wu CH, Lin JG, et al. The physiological

mechanisms of 2 Hz electroacupuncture: a study using blink

and H reflex. Am J Chin Med 2002;30:369–78.

28 Hsieh CL, Chang YM, Tang NY, et al. Time course of changes in

nail fold microcirculation induced by acupuncture stimulation at

the Waiguan acupoints. Am J Chin Med 2006;34:777–85.

29 Saunders WB. Aids to the examination of the peripheral

nervous system. 4th edn. New York: The Guarantors of Brain,

2000:37–43.

Original paper

Tzeng C-Y, et al.Acupunct Med 2015;0:1–5. doi:10.1136/acupmed-2014-010722 5

group.bmj.com on May 23, 2015 - Published by http://aim.bmj.com/Downloaded from

patients with total knee arthroplasty

electroacupuncture for postoperative pain in

Hz evaluating the effects of 2

Single-blinded, randomised preliminary study

HsiehWen-Gii Chen, Kwok-Man Tong, Kui-Chou Huang and Ching-Liang

Chung-Yuh Tzeng, Shih-Liang Chang, Chih-Cheng Wu, Chu-Ling Chang,

published online April 24, 2015Acupunct Med

http://aim.bmj.com/content/early/2015/04/23/acupmed-2014-010722

Updated information and services can be found at:

These include:

References

#BIBL

http://aim.bmj.com/content/early/2015/04/23/acupmed-2014-010722

This article cites 27 articles, 3 of which you can access for free at:

Open Access

http://creativecommons.org/licenses/by-nc/4.0/non-commercial. See:

provided the original work is properly cited and the use is

non-commercially, and license their derivative works on different terms,

permits others to distribute, remix, adapt, build upon this work

Commons Attribution Non Commercial (CC BY-NC 4.0) license, which

This is an Open Access article distributed in accordance with the Creative

service

Email alerting box at the top right corner of the online article.

Receive free email alerts when new articles cite this article. Sign up in the

Collections

Topic Articles on similar topics can be found in the following collections

(24)Open access

Notes

http://group.bmj.com/group/rights-licensing/permissions

To request permissions go to:

http://journals.bmj.com/cgi/reprintform

To order reprints go to:

http://group.bmj.com/subscribe/

To subscribe to BMJ go to:

group.bmj.com on May 23, 2015 - Published by http://aim.bmj.com/Downloaded from

Effects of Acupuncture on Postoperative Pain After Total Knee Replacement: Systematic Literature Review and Meta-Analysis

Article

Jun 2021

Objective To identify the effectiveness of the analgesic acupuncture after total knee replacement by systematic review. Methods A search of randomized controlled trials was conducted in 5 English medical electronic databases and 5 Chinese databases. Two reviewers independently conducted in 5 English medical electronic databases and 5 Chinese databases. Two reviewers independently retrieved related studies, assessed the methodological quality, and extracted data with a standardized data retrieved related studies, assessed the methodological quality, and extracted data with a standardized data form. Meta-analyses were performed using all time-points meta-analysis. Results A total of 7 studies with 891 participants were included. The meta-analysis results indicated that acupuncture had a statistically significant influence on pain relief (SMD = -0.705, 95% CI -1.027 to -0.382, p = 0.000). The subgroup analysis results showed that acupuncture’s effects on analgesia had a statistically significant influence (SMD = -0.567, 95% CI -0.865 to -0.269, p = 0.000). The main acupuncture points that produced an analgesic effect when they were used after total knee replacement included the Xuehai, Liangqiu, Dubi, Neixiyan, Yanglingquan, and Zusanli points. Electro acupuncture frequency ranged between 2-100 Hz. Conclusions As adjunct modalities, the use of acupuncture is associated with reduced pain and use of analgesic medications in postoperative patients. In particular, ear acupuncture one day before surgery could reduce analgesia.

Electroacupuncture as an Adjuvant Approach to Rehabilitation during Postacute Phase after Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Article

Full-text available

Jul 2021
EVID-BASED COMPL ALT

Background: Increasing attention has been paid to electroacupuncture (EA) for promoting postoperative rehabilitation, but the effectiveness of EA for rehabilitation after total knee arthroplasty (TKA) remains obscure. Objective: To examine the effect of EA on rehabilitation after TKA. Methods: Database searches on PubMed, CINAHL, Embase, and China National Knowledge Infrastructure (CNKI) were carried out to obtain articles, from inception to 15 October 2020. All identified articles were screened, and data from each included study were extracted independently by two investigators. Meta-analysis was conducted to assess the effects of acupuncture on pain, range of knee motion, and postoperative vomiting after TKA. Results: In the current study, a total of ten randomized clinical trials were included according to the inclusion and exclusion criteria. Compared to basic treatment, EA combined with basic treatment showed a significantly greater pain reduction on 3, 7, and 14 days postoperatively after TKA. However, we found that EA had no significant improvement in enhancing the range of knee motion and decreasing the percentage of vomiting. Subgroup analysis suggested that a combination of EA and rehabilitation training was superior to rehabilitation training in pain relief, while EA combined with celecoxib capsules showed no significant difference in improving pain compared to celecoxib capsules alone. Conclusions: In the postacute phase after TKA, EA, as a supplementary treatment, could reduce postoperative pain, but no evidence supported the benefits of EA for improving ROM of knee and decreasing the ratio of vomiting. Additional high-quality and large-scale RCTs are warranted.

Inhibition of discharge rates of neurons via electroacupuncture at Shenshu (BL23), Huantiao (GB30) , Weizhong (BL40) and Yanglingquan (GB34) to alleviate inflammation-induced discogenic sciatica

Preprint

Full-text available

Apr 2024

Sciatica is closely related to the disease symptoms of lumbar disc herniation. Previous studies exhibited that electroacupuncture (EA) can effectively relieve chronic low back pain and sciatica. However, the mechanism underlying the analgesic effects of EA on discogenic sciatica is still largely confusing. In this study, model rats of discogenic sciatica were established to avoid causing direct compression. Male SD rats were randomly divided into sham operation group (FM), model group (M), electroacupuncture group (EA), electroacupuncture sham point group (NA) and sham operation electroacupuncture group (SEA). EA with low-frequency electronic pulse was adjusted to continuous wave (2Hz, 1mA) mode, and applied to the specified fixed acupuncture points (BL23, GB30, BL40, GB34) for 20 min on odd days for 4 weeks. After EA treatment for 4 weeks, the sensory neurons in the dorsal horn of the spinal cord in FM and SEA groups remained silent throughout the recording time, while the firing rates of neurons in M and NA groups stayed active at 20 ~ 30 sparks/10s. The EA group had a significantly lower firing rate during the EA intervention process compared to the M and NA groups. EA intervention can effectively reverse the abnormal excitability of sensory neurons in the dorsal horn of the spinal cord, improve the plantar mechanical pain threshold and inflammatory factors depending on the accurate selection of acupuncture points in discogenic sciatica rat models.

Combining various acupuncture therapies with multimodal analgesia to enhance postoperative pain management following total knee arthroplasty: a network meta-analysis of randomized controlled trials

Article

Full-text available

Mar 2024

Objective This study aims to evaluate the efficacy and safety of various acupuncture treatments in conjunction with multimodal analgesia (MA) for managing postoperative pain and improving knee function in patients undergoing total knee arthroplasty (TKA), based on the findings from clinical research indicating the potential benefits of acupuncture-related therapies in this context. Methods We searched Web of Science, PubMed, SCI-hub, Embase, Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Data, and Chinese Scientific Journal Database (VIP) to collect randomized controlled trials of acupuncture-related therapies for post-TKA pain. After independent screening and data extraction, the quality of the included literature was evaluated. The potential for bias in the studies incorporated in the analysis was assessed according to the guidelines outlined in the Cochrane Handbook 5.1. Network meta-analysis (NMA) was conducted using RevMan 5.4 and Stata 16.0 software, with primary outcome measures including visual analog scale (VAS), pain pressure threshold (PPT), hospital for special surgery knee score (HSS), and knee joint range of motion (ROM). Furthermore, the interventions were ranked based on the SUCRA value. Results We conducted an analysis of 41 qualifying studies encompassing 3,003 patients, examining the efficacy of four acupuncture therapies (acupuncture ACU, electroacupuncture EA, transcutaneous electrical acupoint stimulation TEAS, and auricular acupoint therapy AAT) in conjunction with multimodal analgesia (MA) and MA alone. The VAS results showed no significant difference in efficacy among the five interventions for VAS-3 score. However, TEAS+MA (SMD: 0.67; 95%CI: 0.01, 1.32) was more effective than MA alone for VAS-7 score. There was no significant difference in PPT score among the three interventions. ACU + MA (SMD: 6.45; 95%CI: 3.30, 9.60), EA + MA (SMD: 4.89; 95%CI: 1.46, 8.32), and TEAS+MA (SMD: 5.31; 95%CI: 0.85, 9.78) were found to be more effective than MA alone for HSS score. For ROM score, ACU + MA was more efficacious than EA + MA, TEAS+MA, and AAT + MA, MA. Regarding the incidence of postoperative adverse reactions, nausea and vomiting were more prevalent after using only MA. Additionally, the incidence of postoperative dizziness and drowsiness following ACU + MA (OR = 4.98; 95%CI: 1.01, 24.42) was observed to be higher compared to that after AAT + MA intervention. Similarly, the occurrence of dizziness and drowsiness after MA was found to be significantly higher compared to the following interventions: TEAS+MA (OR = 0.36; 95%CI: 0.18, 0.70) and AAT + MA (OR = 0.20; 95%CI: 0.08, 0.50). The SUCRA ranking indicated that ACU + MA, EA + MA, TEAS+MA, and AAT + MA displayed superior SUCRA scores for each outcome index, respectively. Conclusion For the clinical treatment of post-TKA pain, acupuncture-related therapies can be selected as a complementary and alternative therapy. EA + MA and TEAS+MA demonstrate superior efficacy in alleviating postoperative pain among TKA patients. ACU + MA is the optimal choice for promoting postoperative knee joint function recovery in TKA patients. AAT + MA is recommended for preventing postoperative adverse reactions. Systematic review registration https://www.crd.york.ac.uk/, identifier (CRD42023492859).

Clinical application of electroacupuncture in enhanced recovery after surgery

Article

Full-text available

May 2023

Enhanced recovery after surgery (ERAS) is currently the recommended surgical strategy, the main content of which is to reduce perioperative stress response and postoperative complications through perioperative multimodal analgesia and intensive surgery. Since ERAS was introduced, many rehabilitation medicine teams have been deeply involved, including physical therapy, occupational therapy, nutrition therapy and psychological counseling. However, ERAS lacks several powerful means to address perioperative prognostic issues. Therefore, how to further improve the effects of ERAS, reduce perioperative complications and protect vital organ functions has become an urgent problem. With the continuous development of traditional Chinese medicine, electroacupuncture (EA) has been widely used in various clinical applications, and its efficacy and safety have been fully proved. Recent studies have shown that the application of EA in ERAS has had an important impact on rehabilitation researches. In terms of reducing complications, the therapeutic effects of EA treatment mainly include: reducing pain and the use of analgesics; Improvement of postoperative nausea and vomiting; Postoperative immune function treatment; Relieve anxiety and depression. In addition, EA also protects the recovery of physiological functions, including cardiovascular function, cerebrovascular function and gastrointestinal function, etc. To sum up, the complementary strengths of EA and ERAS will allow them to develop and combine. This review discusses the potential value and feasibility of EA in ERAS from the aspects of improving perioperative efficacy and protecting organ functions.

Efficacy of Acupuncture Combined with Patient-Controlled Analgesia in the Treatment of Acute Pain after Back Surgery: A Meta-Analysis

Article

Full-text available

Oct 2022
Pain Res Manag

Objectives. Acupuncture is used worldwide to relieve both acute and chronic pain. Patient-controlled analgesia (PCA) is also frequently used for postoperative pain relief. However, there are few meta-analyses of the efficacy of acupuncture with PCA in reducing acute postoperative pain. This meta-analysis aimed to assess the effectiveness of acupuncture with PCA in relieving acute pain after back surgery. Methods. We searched seven databases (Cochrane Library, Web of Science, PubMed, China National Knowledge Infrastructure (CNKI), Wanfang database, Chongqing VIP (VIP), and Chinese BioMedical Literature Database (CBM)-from 1949 until now) without language restrictions for randomized controlled trials, including patients undergoing back surgery and receiving PCA alone or treated with acupuncture/sham acupuncture + PCA for pain relief. This meta-analysis assessed pain intensity, with visual analogue scale (VAS) score and postoperative opioid dosage as primary outcomes. Results. A total of 12 randomized controlled trials (n = 904) met the inclusion criteria. Compared with the control group (standard mean difference (SMD) = ‒0.42, 95% CI = ‒0.60 to ‒0.25, P

Effect of Electroacupuncture on Noise-Induced Hearing Loss in Rats

Article

Full-text available

Oct 2021
EVID-BASED COMPL ALT

Acupuncture has long been used to relieve some inner ear diseases such as deafness and tinnitus. The present study examined the effect of electroacupuncture (EA) on noise-induced hearing loss (NIHL) in animals. A NIHL rat model was established. Electroacupuncture pretreatment at 2 Hz or posttreatment at the right Zhongzhu (TE3) acupoint was applied for 1 hour. Auditory thresholds were measured using auditory brainstem responses (ABRs), and histopathology of the cochlea was examined. The results indicated that the baseline auditory threshold of ABR was not significantly different between the control (no noise), EA-only (only EA without noise), noise (noise exposure only), pre-EA (pretreating EA then noise), and post-EA (noise exposure then posttreating with EA) groups. Significant auditory threshold shifts were found in the noise, pre-EA, and post-EA groups in the immediate period after noise exposure, whereas auditory recovery was better in the pre-EA and post-EA groups than that in the noise group at the three days, one week (W1), two weeks (W2), three weeks (W3), and four weeks(W4) after noise stimulation. Histopathological examination revealed greater loss of the density of spiral ganglion neurons in the noise group than in the control group at W1 and W2. Although significant loss of spiral ganglion loss happened in pre-EA and post-EA groups, such loss was less than the loss of the noise group, especially W1. These results indicate that either pretreatment or posttreatment with EA may facilitate auditory recovery after NIHL. The detailed mechanism through which EA alleviates NIHL requires further study.

The Role of Acupuncture in Postoperative Pain Management of Patients Undergoing Knee Arthroplasty Surgery: A Systematic Review and Meta-Analysis

Article

Aug 2021

»: Acupuncture after total knee arthroplasty (TKA) may decrease the incidence of postoperative nausea and vomiting (PONV). »: Acupuncture did not decrease visual analog scale (VAS) scores in the 0 to 48-hour interval but did decrease VAS scores at >48 hours after TKA. »: The heterogeneity of the studies prevented meta-analysis of opioid use with acupuncture after TKA; a systematic review demonstrated mixed results. »: Additional studies are needed to investigate opioid reduction with acupuncture after TKA.

Electroacupuncture for post-thoracotomy pain: A systematic review and meta-analysis

Article

Full-text available

Jul 2021
PLOS ONE

Background Thoracotomy is an invasive surgical procedure that produces intense postoperative pain. Electroacupuncture has been used to induce analgesia in various situations, including after surgery. The aim of the following systematic review and meta-analysis was to evaluate the effect of electroacupuncture on post-thoracotomy pain. Methods The studies for the systematic review were searched using the following 9 databases: PubMed, Cochrane Library, EMBASE, MEDLINE Complete, Google Scholar, China National Knowledge Infrastructure (CNKI), Korean Medical Database (KMBASE), Koreanstudies Information Service System (KISS), and OASIS, without language restriction. Randomized controlled trials (RCTs) that met the inclusion criteria were selected. The quality assessment was performed using the Cochrane risk-of-bias tool, and RevMan 5.3 was used for meta-analysis. The review protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO) as CRD42019142157. Results Eleven randomized controlled trials were included in the systematic review. The meta-analysis was performed for two outcome measures: pain score 24 hours after surgery and total dose of opioid analgesics. A subgroup analysis was performed according to the control group: sham acupuncture and conventional analgesia group. Pain score 24 hours after surgery of electroacupuncture group showed a standard mean difference of -0.98 (95% CI: -1.62 to -0.35) compared to sham acupuncture. The standard mean difference was -0.94 (95% CI: -1.33 to -0.55) compared to conventional analgesia. The total dose of opioid analgesics of electroacupuncture group showed a standard mean difference values of -0.95 (95% CI: -1.42 to -0.47) compared to sham acupuncture. The standard mean difference was -1.96 (95% CI: -2.82 to -1.10) compared to conventional analgesia. Conclusion Current evidence suggests that electroacupuncture might provide useful pain relieving effect on post-thoracotomy patients. However, due to low quality and high heterogeneity of existing data, further rigorously designed studies should be performed to confirm the safety and efficacy.

Assessing outcome in postoperative pain trials: are we missing the point?A systematic review of pain-related outcome domains reported in studies early after total knee arthroplasty

Article

Jan 2021

The management of acute postoperative pain remains suboptimal. Systematic reviews and Cochrane analysis can assist with collating evidence about treatment efficacy, but the results are limited in part by heterogeneity of endpoints in clinical trials. In addition, the chosen endpoints may not be entirely clinically relevant. To investigate the endpoints assessed in perioperative pain trials, we performed a systematic literature review on outcome domains assessing effectiveness of acute pain interventions in trials after total knee arthroplasty (TKA). We followed the Cochrane recommendations for systematic reviews, searching Pubmed, Cochrane, and Embase, resulting in the screening of 1590 potentially eligible studies. After final inclusion of 295 studies, we identified 11 outcome domains and 45 subdomains/descriptors with the domain "pain"/"pain intensity" most commonly assessed (98.3%), followed by "analgesic consumption" (88.8%) and "side effects" (75.3%). In contrast, "physical function" (53.5%), "satisfaction" (28.8%) and "psychological function" (11.9%) were given much less consideration. The combinations of outcome domains were inhomogeneous throughout the studies, regardless of the type of pain management investigated. In conclusion, we found that there was high variability in outcome domains and inhomogeneous combinations, as well as inconsistent subdomain description and utilization in trials comparing for effectiveness of pain interventions after TKA. This point towards the need for harmonizing outcome domains, e.g. by consenting on a core outcome set (COS) of domains which are relevant for both stakeholders and patients. Such a COS should include at least 3 domains from 3 different health core areas like pain intensity, physical function and one psychological domain.

Effect of Perioperative Electroacupuncture as An Adjunctive Therapy on Postoperative Analgesia with Tramadol and Ketamine in Prostatectomy: A Randomised Sham-Controlled Single-Blind Trial

Article

Full-text available

Jan 2014

To study the analgesic effect of electroacupuncture (EA) as perioperative adjunctive therapy added to a systemic analgesic strategy (including tramadol and ketamine) for postoperative pain, opioid-related side effects and patient satisfaction. In a sham-controlled participant- and observer-blinded trial, 75 patients undergoing radical prostatectomy were randomly assigned to two groups: (1) EA (n=37; tramadol+ketamine+EA) and (2) control (n=38; tramadol+ketamine). EA (100 Hz frequency) was applied at LI4 bilaterally during the closure of the abdominal walls and EA (4 Hz) was applied at ST36 and LI4 bilaterally immediately after extubation. The control group had sham acupuncture without penetration or stimulation. The following outcomes were evaluated: postoperative pain using the Numerical Rating Scale (NRS) and McGill Scale (SF_MPQ), mechanical pain thresholds using algometer application close to the wound, cortisol measurements, rescue analgesia, Spielberger State Trait Anxiety Inventory (STAI Y-6 item), patient satisfaction and opioid side effects. Pain scores on the NRS and SF_MPQ were significantly lower and electronic pressure algometer measurements were significantly higher in the EA group than in the control group (p<0.001) at all assessments. In the EA group a significant decrease in rescue analgesia was observed at 45 min (p<0.001) and a significant decrease in cortisol levels was also observed (p<0.05). Patients expressed satisfaction with the analgesia, especially in the EA group (p<0.01). Significant delays in the start of bowel movements were observed in the control group at 45 min (p<0.001) and 2 h (p<0.05). Adding EA perioperatively should be considered an option as part of a multimodal analgesic strategy.

Peripheral nervous system

Chapter

Jan 2018

S.D. Dodds

Regional Analgesia After Total Knee Replacement

Article

Jul 2000
ANESTH ANALG

The Comparative Effects of Postoperative Analgesic Therapies on Pulmonary Outcome

Article

Mar 1998
ANESTH ANALG

We performed meta-analyses of randomized, control trials to assess the effects of seven analgesic therapies on postoperative pulmonary function after a variety of procedures: epidural opioid, epidural local anesthetic, epidural opioid with local anesthetic, thoracic versus lumbar epidural opioid, intercostal nerve block, wound infiltration with local anesthetic, and intrapleural local anesthetic. Measures of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), vital capacity (VC), peak expiratory flow rate (PEFR), PaO2, and incidence of atelectasis, pulmonary infection, and pulmonary complications overall were analyzed. Compared with systemic opioids, epidural opioids decreased the incidence of atelectasis (risk ratio [RR] 0.53, 95% confidence interval [CI] 0.33-0.85) and had a weak tendency to reduce the incidence of pulmonary infections (RR 0.53, 95% CI 0.18-1.53) and pulmonary complications overall (RR 0.51, 95% CI 0.20-1.33). Epidural local anesthetics increased PaO2 (difference 4.56 mm Hg, 95% CI 0.058-9.075) and decreased the incidence of pulmonary infections (RR 0.36, 95% CI 0.21-0.65) and pulmonary complications overall (RR 0.58, 95% CI 0.42-0.80) compared with systemic opioids. Intercostal nerve blockade tends to improve pulmonary outcome measures (incidence of atelectasis: RR 0.65, 95% CI 0.27-1.57, incidence of pulmonary complications overall: RR 0.47, 95% CI 0.18-1.22), but these differences did not achieve statistical significance. There were no clinically or statistically significant differences in the surrogate measures of pulmonary function (FEV1, FVC, and PEFR). These analyses support the utility of epidural analgesia for reducing postoperative pulmonary morbidity but do not support the use of surrogate measures of pulmonary outcome as predictors or determinants of pulmonary morbidity in postoperative patients. Implications: When individual trials are unable to produce significant results, it is often because of insufficient patient numbers. It may be impossible for a single institution to study enough patients. Meta-analysis is a useful tool for combining the data from multiple trials to increase the patient numbers. These meta-analyses confirm that postoperative epidural pain control can significantly decrease the incidence of pulmonary morbidity. (Anesth Analg 1998;86:598-612)

A Clinical Study on Physiological Response in Electroacupuncture Analgesia and Meperidine Analgesia for Colonoscopy

Article

Apr 2012

Fifty-nine patients underwent consecutive colonoscopic examination with premedication of electroacupuncture analgesia (EA) were compared with conventional meperidine analgesia (MA) in pain relief and changes of neurotransmitters in serum. The results showed that analgesic efficacy of both groups were the same but with less side effects in the EA group (P < 0.01) especially in regard to dizziness. Serum concentration of β-endorphin in both groups has a similar curve change at 4 different phases during colonoscopy. Serum concentration of epinephrine, norepinephrine, dopamine and cortisol showed no significant difference between these two groups. The analgesic effect of EA and MA during colonoscopic examination may be closely related to β-endorphin production in serum.

The Physiological Mechanisms of 2 Hz Electroacupuncture: A Study Using Blink and H Reflex

Article

Apr 2012

Our previous studies have shown that the cerebral cortex modulates the physiological mechanisms of acupuncture. However, the role of the brain stem and spinal cord in acupuncture remains unclear. The present study investigated the action of the brain stem and spinal cord in acupuncture. A total of eight healthy adult volunteers were studied. Electrical stimulation of the supraorbital nerve in the supraorbital foramen was used to evoke the blink reflex. Electrical stimulation of the posterior tibial nerve in the right popliteal fossa was used to evoke the H reflex. Electroacupuncture (EA) of 2 Hz was applied to the Zusanli acupoint in the right or left leg. The area of the R1 and R2 components of the blink reflex, and the greatest H/M ratio and H-M interval of the H reflex were measured before EA, during EA and at various post-EA periods. These data were analyzed quantitatively by a computerized electromyographic examination system. The results indicate that EA did not change the R1 and ipsilateral R2 components of the blink reflex. EA depressed the contralateral R2 component of the blink reflex 10 minutes and 40 minutes after the start of EA, but not after 5 minutes. EA applied to the Zusanli acupoint did not change the H/M ratio or the H-M interval of the H reflex. The results of this study indicate that 2 Hz EA of the Zusanli acupoint does not change the R1 component of the blink reflex, and the H/M ratio and the H-M interval of the H reflex, suggesting that 2 Hz EA does not change the monosynaptic reflex in the brain stem and spinal cord in humans. We also found that EA at 2-Hz depressed the contralateral but not the ipsilateral R2 component of the blink reflex, suggesting that longer pathways, perhaps including the cerebral cortex, may play a role in the physiological mechanisms responsible for the effectiveness of acupuncture.

Safety assessment of postoperative pain management by an acute pain service

Article

Dec 1993
PAIN

While there are increasing demands for improved post-operative analgesia and the implementation of Acute Pain Services (APS), the safety of such an approach remains under discussion. This paper analyses the safety outcome of 3016 consecutive post-operative patients treated under the care of a formalised Acute Pain Service. No serious complication resulting in morbidity or mortality occurred. Potentially severe complications without sequelae were discovered in 16 patients (0.53%); this incidence was similar for techniques of systemic opioid administration and continuous regional analgesia. Patient-controlled analgesia (PCA) alone had a significantly lower rate of respiratory depression than PCA with a background infusion or continuous morphine infusion. In 1069 patients receiving continuous regional analgesia (epidural, interpleural, peripheral) no trauma to nervous structures, no infection and no local anaesthetic toxicity occurred. In conclusion, an anaesthesiology-based APS can provide postoperative pain relief using a wide range of relatively invasive techniques without endangering patient safety.

An Exploratory Review of the Electroacupuncture Literature: Clinical Applications and Endorphin Mechanisms

Article

Aug 2013

David Mayor

Electroacupuncture (EA) is widely used in clinical practice and research, as well as in experimental investigations into the mechanisms of acupuncture. This study explores publication trends in clinical and experimental studies of EA (1975–2011) for pain and non-pain research; EA use for different clinical conditions (1974–2012); and the relation of EA research, including stimulation frequency, to opioid peptide mechanisms. Appropriate PubMed ‘all fields’ searches were conducted, identified studies were classified using PubMed filters and manually, and data extracted into tables. A total of 2916 clinical studies were located, of which 19% involved EA. Additionally, 3344 animal studies were located, of which 48% involved EA. The publication rate of EA studies per year has risen over time, but the percentage of studies of pain has fallen from 60% to 25%. The conditions most commonly treated with EA are musculoskeletal, neurological, obstetric and gastrointestinal, along with intraoperative and postoperative analgesia. EA studies, particularly with low frequency stimulation, are more likely to support the role of endogenous opioid mechanisms than manual acupuncture studies, and opioid release is more likely in the central nervous system than the circulation. EA is increasingly used in clinical and especially experimental research, particularly for non-pain conditions. Acupuncture does release endogenous opioids, but this probably depends on ‘dosage’, with the evidence more consistent and convincing for EA than for manual acupuncture. Different frequencies of EA appear to activate different endogenous opioid mechanisms.

Acupuncture and endorphins*1

Article

May 2004
NEUROSCI LETT

Jisheng Han

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, β-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.

Incidence of Prolonged Pain Relief Following Acupuncture

Article

Mar 1976
ANESTH ANALG

From March 1973 to Decenber 1974, 2090 electroacupuncture treatments were applied to 533 patients with chronic pain. Of 533 patients, 276 (52%) reported excellent (greater than 75%) pain relief immediately after the last treatment, and 103 (19.3%) still reported excellent pain relief on a 4-week followup questionnaire. In March 1975, the authors contacted 87 of these 103 patients. Sixty-three reported that they still had excellent pain relief 3 to 18 months after therapy, 3 patients reported that their pain still was relieved 50%, and 21 patients said their pain had returned to the same intensity as before therapy. Thus, 12% of 533 patients who received acupuncture treatment for chronic pain had a significant degree of pain relief at least 3 months after therapy.