Electroacupuncture
***Disclaimer: This blog is not meant to be used as legal or medical advice. It is written as my person perspective on how medical professionals could blend western medicine with other modalities***
Welcome to this week's episode of The Integrated Pharmacist Podcast. In episode 2, I discussed the benefits of acupuncture. Many studies have demonstrated its effects on pain. In more recent years, therapists have added mild currents of electricity to acupuncture to enhance the healing effects. Even though acupuncture has a lot of clincal evidence by itself, some patients and therapists are still hesitant to use this therapy. Because the acupuncture needles penetrate the skin, there are some complications with blood exposure, sanitation, and potentially breaking needle tips in the skin. For these people, a new form of acupuncture was created. Dr. Clyde Shealy an American neurosurgeon was credited with inventing a machine in 1974 that could extend the electrical stimulation to acupoints without needles. This machine is called a transcutaneous electrical nerve stimulation (or TENS) machine. With a TENS machine, electrodes are taped to the outside of the skin on specific acupuncture points and a mild current is sent through the skin. It is often too mild to actually sense, but some people report a mild buzzing feeling.
Electroacupuncture has been used for pain management, anesthesia, nausea due to chemotherapy, neurological disorders, acne, blood pressure, and heart disease. As a word of caution, this therapy should not be used by anyone with a history of seizures or epilepsy, heart disease or stroke, or people with pacemakers. In practicing this therapy, it is important not to have leads on the head, neck, or at the heart and currents should not cross the mid-line. Because the body uses small changes in electromagnetic fields to conduct muscular and neural actions, using electricity even at low frequencies can be disruptive. Thus we practice extra precaution around the brain and heart.
An interesting study was performed including 50 pneumonia patients in Iran who were on a ventilator as part of their treatment. Of note, we find exclusion criteria of heart conditions or previous seizures. They must be ventilated during the duration of the study and be opioid naive. Pain was measured by observation of the patient in 4 areas: facial expression, body movement, muscle tension, and compliance with the ventilator. Amount of fentanyl and midazolam usage were also measured for pain and sedation requirements. The study was a placebo-controlled, double-blind study using TENS machines attached to two specific acupuncture points. The placebo had dead batteries, so the administrator was unable to detect whether they were administering actual electroacupuncture or a sham. As long as the strength of the electricity was below the threshold of recognition, the patient would be blinded, too. It seems like the target patient is conveniently unable to convey whether they could detect therapy, because they were intubated. I feel like that may have implications of the validity of the trial, but I am undecided as to which way it affects the results. Study results indicate that pain remained consistent in the placebo arm where as the experimental arm decreased linearly over time. Statistical significance was reach between the two groups by hour 22 of the study. This study suggests that electroacupuncture at these specific points called Hegu (the fleshy part of your hand next to your thumb) and Zusanli (4 fingers down from the knee on the outside of the leg) can be effective at reducing pain and pain medication requirements. The study limits this to having continual treatment over 24 hours; however, it does show statistical significance for this modality.
This modality can often be performed by acupuncturists or an electroacupucture specialist. One
session typically costs about $70-$120 with first sessions frequently costing more than follow ups. For people dealing with pain, this may be an acceptable form of pain management to augment medication usage. Like acupuncture, this kind of therapy may be highly dependent on the quality of the therapist.
I want to thank you for listening. I hope you get as much value out of this podcast as I do. If you do, and you think a friend would, too, why not invite them to listen. If you would like to reach me for comments, concerns, questions, or suggestions, please reach out to me at integratedpharmacist@gmail.com. Thanks again. I'll see you next week on the Integrated Pharmacist Podcast.
References:
https://www.acupuncturetoday.com/abc/electroacupuncture.php
AminiSaman J, Mohammadi S, Karimpour H, et al. Transcutaneous Electrical Nerve Stimulation at the Acupuncture Points to Relieve Pain of Patients Under Mechanical Ventilation: A Randomized Controlled Study. Journal of Acupuncture and Meridian Studies, Volume 11, Issue 5, 2018, Pages 290-295, ISSN 2005-2901.
https://doi.org/10.1016/j.jams.2018.06.008.
Welcome to this week's episode of The Integrated Pharmacist Podcast. In episode 2, I discussed the benefits of acupuncture. Many studies have demonstrated its effects on pain. In more recent years, therapists have added mild currents of electricity to acupuncture to enhance the healing effects. Even though acupuncture has a lot of clincal evidence by itself, some patients and therapists are still hesitant to use this therapy. Because the acupuncture needles penetrate the skin, there are some complications with blood exposure, sanitation, and potentially breaking needle tips in the skin. For these people, a new form of acupuncture was created. Dr. Clyde Shealy an American neurosurgeon was credited with inventing a machine in 1974 that could extend the electrical stimulation to acupoints without needles. This machine is called a transcutaneous electrical nerve stimulation (or TENS) machine. With a TENS machine, electrodes are taped to the outside of the skin on specific acupuncture points and a mild current is sent through the skin. It is often too mild to actually sense, but some people report a mild buzzing feeling.
An interesting study was performed including 50 pneumonia patients in Iran who were on a ventilator as part of their treatment. Of note, we find exclusion criteria of heart conditions or previous seizures. They must be ventilated during the duration of the study and be opioid naive. Pain was measured by observation of the patient in 4 areas: facial expression, body movement, muscle tension, and compliance with the ventilator. Amount of fentanyl and midazolam usage were also measured for pain and sedation requirements. The study was a placebo-controlled, double-blind study using TENS machines attached to two specific acupuncture points. The placebo had dead batteries, so the administrator was unable to detect whether they were administering actual electroacupuncture or a sham. As long as the strength of the electricity was below the threshold of recognition, the patient would be blinded, too. It seems like the target patient is conveniently unable to convey whether they could detect therapy, because they were intubated. I feel like that may have implications of the validity of the trial, but I am undecided as to which way it affects the results. Study results indicate that pain remained consistent in the placebo arm where as the experimental arm decreased linearly over time. Statistical significance was reach between the two groups by hour 22 of the study. This study suggests that electroacupuncture at these specific points called Hegu (the fleshy part of your hand next to your thumb) and Zusanli (4 fingers down from the knee on the outside of the leg) can be effective at reducing pain and pain medication requirements. The study limits this to having continual treatment over 24 hours; however, it does show statistical significance for this modality.
This modality can often be performed by acupuncturists or an electroacupucture specialist. One
I want to thank you for listening. I hope you get as much value out of this podcast as I do. If you do, and you think a friend would, too, why not invite them to listen. If you would like to reach me for comments, concerns, questions, or suggestions, please reach out to me at integratedpharmacist@gmail.com. Thanks again. I'll see you next week on the Integrated Pharmacist Podcast.
References:
https://www.acupuncturetoday.com/abc/electroacupuncture.php
AminiSaman J, Mohammadi S, Karimpour H, et al. Transcutaneous Electrical Nerve Stimulation at the Acupuncture Points to Relieve Pain of Patients Under Mechanical Ventilation: A Randomized Controlled Study. Journal of Acupuncture and Meridian Studies, Volume 11, Issue 5, 2018, Pages 290-295, ISSN 2005-2901.
https://doi.org/10.1016/j.jams.2018.06.008.
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