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Electro Acupuncture

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Electro Acupuncture

  1. 1. The Efficacy & Safety of Electroacupuncture for Pain Management Cathryn Hu, Ph.D., O.M.D., L.Ac. Advanced Acupuncture, Inc. Los Angeles, California American Academy of Pain Management 19 th Annual Clinical Meeting Nashville, TN September 11, 2008
  2. 2. Conflict of Interest and Financial Disclosure <ul><li>The Efficacy & Safety of </li></ul><ul><li>Electro acupuncture for </li></ul><ul><li>Pain Management </li></ul><ul><li>Cathryn Hu, Ph.D., O.M.D., L.Ac . </li></ul><ul><li>President of Advanced Acupuncture, Inc. </li></ul><ul><li>NONE </li></ul>
  3. 3. Learning Objectives <ul><li>Techniques and methodology of use EA </li></ul><ul><li>Mechanisms of EA in Pain Management </li></ul><ul><li>Clinical application of EA in Pain practice </li></ul><ul><li>Analysis the Efficacy and Safety in use of EA for Pain management </li></ul>
  4. 4. Electroacupuncture (EA) Definition: Electro acupuncture is an acupuncture techniques that applies small electrical currents to needles that have been inserted at an specific acupuncture points .
  5. 5. Concepts of EA <ul><li>Each electro current connects two selected points at a time. </li></ul><ul><li>Margin of error> regular acupuncture (EA stimulates larger area) </li></ul><ul><li>A small device used to create and regulate a pulsing electric charges which is sent to the needles by attaching small clips to the needles. </li></ul><ul><li>Both intensity and frequency of the voltage could be adjusted by healing needs. </li></ul><ul><li>-Electro-Acupuncture by S. Dharmanerda, Ph.D. </li></ul><ul><li> Director, institute for Traditional Medicine, Portland, Oregon </li></ul>
  6. 6. History of EA <ul><li>1934, China- as extension of hand manipulation of acupuncture points by attach an electrode to the inserted needles to provide continued stimulation </li></ul><ul><li>Acupuncture- Promote and Balances Qi (Chi): the vital energy system. </li></ul><ul><li>Trained to determine where and how the acupuncture points to be selected to correct the weakness (deficiency) or stagnation (chronic pain conditions) </li></ul><ul><li>EA promote the Chi (vital energy) circulations more efficiently by controlled electrical stimulation. </li></ul><ul><li>When experimenting with surgical anesthesia or pain management </li></ul><ul><li>Widely used in clinical applications due to its benefits and conveniences. </li></ul><ul><li>Electro-Acupuncture by S. Dharmanerda, Ph.D. </li></ul><ul><li> Director, institute for Traditional Medicine, Portland, Oregon </li></ul>
  7. 7. Benefits of EA <ul><li>Effectiveness: </li></ul><ul><ul><li>As means of reducing chronic pain & muscle spasms and neurological disorders </li></ul></ul><ul><ul><li>Beneficial for conditions that do not responded to manual acupuncture </li></ul></ul><ul><ul><li>Assures the patients gets the adequate stimulation among the points </li></ul></ul><ul><ul><li>Produces a stronger stimulation than manual acupuncture without causing tissue damages. </li></ul></ul><ul><ul><li>Effectively used in acupuncture anesthesia by controlled frequency and intensity </li></ul></ul><ul><ul><li>Stronger Stimulation may benefit the paralysis or neuralgia cases </li></ul></ul><ul><ul><li>Easier to control the frequency of the stimulus than manual one. </li></ul></ul><ul><ul><li>The pain relieve can be doubled by continuously twirling the needles or by EA. </li></ul></ul><ul><li>Cost effective: </li></ul><ul><ul><li>Substitutes for prolonged hand maneuvering </li></ul></ul><ul><ul><li>Reduces total treatment time by providing continued stimulus. </li></ul></ul><ul><ul><li>During EA, Practitioners can attend to other patients. </li></ul></ul><ul><li>Electro-Acupuncture by S. Dharmanerda, Ph.D. </li></ul><ul><li> Director, institute for Traditional Medicine, Portland, Oregon </li></ul>
  8. 8. Timing of EA <ul><li>Duration: 10-20 minutes, or < than 30 minutes per session </li></ul><ul><li>1-3 times per week </li></ul><ul><li>When pain level decreases, the frequency of the treatment should be reduced </li></ul><ul><li>Longer or more frequency of TX may decreases the effectiveness </li></ul><ul><li>Acupuncture and electro-acupuncture to treat chronic pain , </li></ul><ul><li>Retrieved from world wide web: www. on 4/25/2008 </li></ul>
  9. 9. Techniques of EA <ul><li>Raised voltage slowly </li></ul><ul><li>Severe pain, use several pairs EA </li></ul><ul><li>High-Low intermittent stimulation produces greatest pain relief </li></ul><ul><li>Rule out contraindications before use EA </li></ul><ul><li>Avoid placing electrodes near the heart </li></ul><ul><li>The path between any two electrodes should not cross the heart are a. </li></ul><ul><li>Electro-Acupuncture by S. Dharmanerda, Ph.D. </li></ul><ul><li> Director, institute for Traditional Medicine, Portland, Oregon </li></ul>
  10. 10. Frequencies of EA <ul><li>High frequencies (>200 /min) used for scalp acupuncture </li></ul><ul><li>Low frequencies (< 50/min) used for body acupuncture </li></ul><ul><li>High/low alternated frequencies, most effect on pain relief </li></ul><ul><li>Mayor, David. Electro acupuncture . 2007, Spain: Elsevier Ltd. </li></ul>
  11. 11. Mechanisms of EA <ul><li>EA induction and recovering profiles of acupuncture analgesia involvement of hormonal factors </li></ul><ul><li>Supported by cross-perfusion experiments in which acupuncture induced analgesic effect was transferred from the donor rabbit to the recipient rabbit when the cerebrospinal fluid (CSF) was antiserum against endorphins suggests that endorphins are involved. </li></ul><ul><li>More recent research found the release of endorphins into CSF following EA </li></ul><ul><li>The low frequency (2Hz) and high frequency (100 Hz) of EA selectively induces the release of enkephalins and dynophins in both experimental animals and humans. </li></ul><ul><li>Clinical studies suggesting the effectiveness for the treatment of various types of pain, depression, anxiety, spinally induced muscle spasms, stroke, gastrointestinal disorders and drug addictions. </li></ul><ul><ul><li>Ulett GA, Han S, Han JS., Biol Psychiatry 1998 Jul 15;44 (2):129-38 </li></ul></ul>
  12. 12. Electrical properties of acupuncture points <ul><li>Acupuncture points are special conduits for electrical signals </li></ul><ul><li>The anatomical structures are characterized by lower electrical impedance compared to adjacent controls. </li></ul><ul><li>Aug. 2007, 16 articles (18 experiments) showed positive association between acupuncture points and lower electrical resistance and impedance. </li></ul><ul><li>5/9 point studies showed positive association between acupuncture points and lower electrical impedance. </li></ul><ul><li>7/9 meridian studies showed positive association between acupuncture meridians and lower electrical impedance and higher capacitance. </li></ul><ul><li>The preliminary findings are suggestive and offer future directions for research based on in-depth interpretation of the data. </li></ul><ul><li>Ahn AC , et all </li></ul><ul><li>Bioelectromagnetics , 2008 May;29(4):245-56 </li></ul>
  13. 13. Electro-acupuncture vs. Nerve Block for Treatment of Radicular Sciatic <ul><li>Applied electro-acupuncture to the spinal nerve root by inserting needles under x-ay imaging in 3 cases of radicular sciatica </li></ul><ul><li>In all 3 cases, symptoms were markedly reduced immediately after treatment. </li></ul><ul><li>Sustained effect was noticeably longer than that of spinal nerve blocks in 2 of the pervious cases. </li></ul><ul><li>Suggest the descending inhibitory control, inhibitory control at the spinal level. Inhibition of potential activity by hyper-polarization of nerve endings or changes in nerve blood flow may be involved in the mechanism of the EA. </li></ul><ul><li>Results suggest the EA to the spinal nerve root may be superior to lumbar spinal nerve block when it is applied appropriately. Acupuncture in Medicine 2005 March; 23(1):27-30 </li></ul><ul><li>Electro-acupuncture direct to spinal nerves as an alternative to selective spinal nerve block </li></ul><ul><li>in patients with radicular sciatica - a cohort study by Motohiro Inoue, Tatsuya Hojo, Tadashi Yano, Yasukazu Katsumi </li></ul>
  14. 14. The effective of EA on Osteoarthritis knees <ul><li>Study Methods: </li></ul><ul><li>Single blinded , randomized & controlled study ,24 subjects. </li></ul><ul><li>EA group vs. Tense group </li></ul><ul><li>Results: </li></ul><ul><li>Reduction of knee pain in both groups </li></ul><ul><li>EA had additional advantage of enhancing the TUGU </li></ul><ul><li>Ng MM , Leung MC , Poon DM. AlternComplement Med. 2003 Oct;9(5):641-9 </li></ul>
  15. 15. Effect of acupuncture of pain threshold a controlled study <ul><li>The effect of needling Li-4 and P-6 compare to arbitrarily chosen points was measured in 12 healthy subjects </li></ul><ul><li>In a crossover blind study pain tolerance and pain threshold were measured by electrical stimulation of the skin in the thyroid area. </li></ul><ul><li>TCM acupuncture was found to be significantly more effective in elevating pain threshold than needling arbitrarily chosen points. </li></ul><ul><li>Pain tolerance also rose more under “ real” acupuncture. </li></ul><ul><li>However, the difference is not significant </li></ul><ul><li>“ Effect of acupuncture of pain threshold and pain tolerance determined by </li></ul><ul><li>electrical stimulation of the skin” </li></ul><ul><li>Stacher G , Wancura I , Bauer P , Lahoda R , Schulze D . </li></ul><ul><li>Am3 Chin Med. ( Gard City N Y). 1975 Apr;3 (2):143-9 </li></ul>
  16. 16. P-Stim Auricular acupuncture <ul><li>Clinical studies in outpatient have investigated the chronic cervical or low back pain </li></ul><ul><li>Reduced pain and remifentanil consumption during oocyte aspiration when compared with conventional auricular acupuncture or a sham treatment. </li></ul><ul><li>Large-scale studies are required to evaluate the analgesic efficacy of auricular EA </li></ul><ul><li>“ P-Stim Auricular Electro-acupuncture stimulation device for pain relieve” By Sator-KatzenschlagerSM, Michalek-Sauberer A. </li></ul><ul><li>Expert Rev Med Devices. 2007 Jan;4(1):23-32 </li></ul>
  17. 17. Suppression of morphine withdrawal by EA in rats <ul><li>100-Hz EA or 100 Hz Tens was very effective in ameliorating the morphine withdraw syndrome in rats and humans. </li></ul><ul><li>Methods: Rats were made dependent on morphine by repeated morphine injection (5—140 mg/kg bid X 8 days) </li></ul><ul><li>Evidences: A marked increase in tall flick latency was observed: The effect of 100 Hz EA could be blocked by naloxone at 20 mg/kg, but not at 1 mg/kg. </li></ul><ul><li>Conclusion: </li></ul><ul><li>1. 100-Hz EA induced analgesia observed in morphine dependent rats is mediated by kappa-opioid receptors. </li></ul><ul><li>2. a significant decreases of the concentration of dynophin A (1-17) immunoreactivity was observed in the spinal perfusate in morphine-dependent rates that could be bought back to normal level by 100-Hz EA </li></ul><ul><li>3. 100-Hz EA was every effective in suppressing NX= precipitated morphine withdrawal syndrome. </li></ul><ul><li>4. The effect of EA could be prevented by intrathecal administration of nor-BNI (2.5 micrograms/20microliters, a kappa- opioid receptor antagonist, or dynophine A (1-13) antibodies administered 10 min prior to EA </li></ul><ul><li>5. The steady state spinal dynophin release is low in morphine-dependent rates, it can be activated by 100-Hz EA stimulation, which may be responsible for eliciting an analgesic effect and ameliorating morphine withdrawal syndrome. </li></ul><ul><li>Wu LZ , Cui CL , Tian JB, Ji D , Han JS. Brain Res. 1999 Dec 18;851(1-2):209-6 </li></ul>
  18. 18. Analgesia induced by EA of different frequencies <ul><ul><li>Methods: </li></ul></ul><ul><ul><li>Cross tolerance techniques to analyses the receptor mechanism of analgesia induced by EA of 2-Hz, 100-Hz, or 2-15 Hz. </li></ul></ul><ul><ul><li>Rats were given EA stimulation of each frequency for 30 min with 30 min. intervals successively. </li></ul></ul><ul><ul><li>TFL was taken to indicate the intensity of EA analgesia </li></ul></ul><ul><ul><li>Observations: </li></ul></ul><ul><ul><li>Rats made tolerant of repeated intrathecal injection, showed a cross-tolerance to 100-Hz and 2-15 Hz, but not to 2 Hz. </li></ul></ul><ul><ul><li>Rats made tolerant to 2-15 Hz EA showed cross-tolerance to either 2-Hz or 100-Hz EA analgesia </li></ul></ul><ul><ul><li>Rats made tolerant to either 2 Hz or 100-Hz were still reactive to 2-15 Hz-EA. </li></ul></ul><ul><ul><li>Results: </li></ul></ul><ul><ul><li>2-Hz-EA analgesia is mediated by mu- and delta-receptors </li></ul></ul><ul><ul><li>100 HZ EA analgesia is mediated by kappa-receptor </li></ul></ul><ul><ul><li>2-15Hz-EA analgesia by combined action of mu-delta- and kappa receptors in the spinal cord of the rats. </li></ul></ul><ul><ul><li>Chen X H , Han J S . Behav Brain Res. 1992 Apr 10;47(2):143-9 </li></ul></ul>
  19. 19. Characteristics of EA induced analgesia in mice <ul><li>Methods: </li></ul><ul><li>3 inbred strains/3 outbreed strains of mice. </li></ul><ul><li>2 pair of metallic needles were inserted into acu -points ST-36 and Sp-6 connected to an EA generator </li></ul><ul><li>EA parameters were set as constant current output with alteration of a positive and negative square wave, 0.6ms in pulse width for 2 Hz and 0.3 ms for 100 Hz. </li></ul><ul><li>Tauk-flick latencies evoked by radiant heat were measured before, during and after EA stimulation </li></ul><ul><li>Observations: </li></ul><ul><li>1. DBA/2 mice showed a significantly more potent analgesic effect than the other five strains in response both to both 100 and 2 Hz EA </li></ul><ul><li>2. EA analgesia increased as the intensity of stimulation increased from 0/5 to 2/0 mA, but it remained at this plateau when the intensity further increased from 2.0 to 3.0 mA. </li></ul><ul><li>Results: EA induces reliable, strain-dependent analgesia in mice. </li></ul><ul><li>The naloxone-reversibility of EA, a measure of whether it is opioid or non-opioid mediated, is dependent upon intensity and frequency. </li></ul><ul><li> Huang C , Wang Y , Han JS , Wan Y . Brain Res . 2002 July26;945(1):20-5 </li></ul>
  20. 20. EA and Acute Pain <ul><li>EA has great value in acute and sub-acute pain (Nociceptive in origin) </li></ul><ul><li>In a comparison study, EA gave better results than MA for acute sprains. </li></ul><ul><li>Heydereich suggested that the front mu points, hwatuojiaji points and auricular points could be useful </li></ul><ul><li>Strong stimulation may cause discomfort for patient since local segmental circuits are already fully activated by the pain. Thus, the distal or contra lateral treatment may be used at fewer points. </li></ul><ul><li>Mayor, David. Electroacupuncture . 2007, P.193 Spain: Elsevier Ltd. </li></ul>
  21. 21. EA and Chronic Pain <ul><li>EA is useful addition to MA when patient not responding well with MA </li></ul><ul><li>Due to multi-factorial nature of chronic pain, need for a multidisciplinary treatment </li></ul><ul><li>Short term pain relieve could be achieved from 50-70% of the patients. </li></ul><ul><li>Long term results are not promising </li></ul><ul><li>Clinical research of poor quality of the studies available for analysis precludes definite conclusions. </li></ul><ul><li>Adrian White, reviewing the clinical application of EA, has concluded that it results in a long-term benefits in around 25% of chronic pain, could that this form of EA was more effective for musculoskeletal conditions that for neuropathic pain. </li></ul><ul><li>EA found to be more effective than MA for both pain reduction and restoration of autonomic and tropic functions in patients with chronic post-traumatic pain. </li></ul><ul><li>EA appeals to be more effective short-term pain relief than MA. </li></ul><ul><li>Mayor, David. Electroacupuncture . 2007, P194 Spain: Elsevier Ltd. </li></ul>
  22. 22. EA and Neuropathic Pain <ul><li>EA used for various neuropathic pains and paraesthesiae where the motor system is particularly affected. </li></ul><ul><li>EA is far more likely for nociceptive than neurogenic pain </li></ul><ul><li>Periosteal: High frequency of EA was more effective for the pain of osteoarthritis than for that associated with phantom limb or disc problems. </li></ul><ul><li>Mayor, David. Electroacupuncture . 2007, P196 , Spain: Elsevier Ltd. </li></ul>
  23. 23. EA and Myofascial pain <ul><li>Myofascial pain associates with muscle shortening, stretching is very important of any treatment </li></ul><ul><li>EA with low frequency (1-5 Hz) and very short pulse in either continues or interrupted mode. </li></ul><ul><li>Stimulation should not be too intense, as this can aggravate myofascial pain </li></ul><ul><li>Treatment may need to be continued for long periods for maximum benefits. </li></ul><ul><li>Mayor, David. Electroacupuncture . 2007, P197, Spain: Elsevier Ltd. </li></ul>
  24. 24. EA and Psychogenic Pain <ul><li>Italian medical acupuncturist with a psychoanalytic background reveals that psychogenic pain is less amenable than other forms to peripheral stimulation techniques </li></ul><ul><li>After one course of therapy, the long term benefits are less likely for psychogenic than nociceptive pain. </li></ul><ul><li>Psychogenic pain responds better to EA than MA, although pain is less frequently exacerbated by electrical stimulation methods. </li></ul><ul><li>Mayor, David. Electroacupuncture . 2007, P 197, Spain: Elsevier Ltd. </li></ul>
  25. 25. Clinical Applications of EA <ul><li>Neurological diseases requires extensive manipulation of acupuncture needles: </li></ul><ul><li>Chronic pain </li></ul><ul><li>Muscle spasms </li></ul><ul><li>Facial paralysis </li></ul><ul><li>Paralysis due to stroke </li></ul><ul><li>Flaccidity syndromes </li></ul>
  26. 26. Headache <ul><li>Acupuncture Points: </li></ul><ul><li>Pain on greater occipital nerve- </li></ul><ul><li> GB 20 and ashi points </li></ul><ul><li>Migraine: GB 20 and GB-8 </li></ul><ul><li>Electrical Stimulation: </li></ul><ul><li>100 Hz low intensity for 20 minutes. </li></ul><ul><li>Treatment protocol: </li></ul><ul><li>As needed or twice a week for five weeks. Followed by once a week for six weeks. </li></ul><ul><li>- </li></ul><ul><li>-Cheng, Xinnong. Chinese Acupuncture and Moxibustion . 5 th ed. Beijing: Foreign Languages Press, 2004 </li></ul>
  27. 27. Trigeminal Neuralgia <ul><li>Acu-points: </li></ul><ul><li>1st branch: BI-2, GB-14 </li></ul><ul><li>2 nd branch: St-2, St-7 or SI-18 </li></ul><ul><li>3 rd branch: CV24, St-7 </li></ul><ul><li>Electrical stimulation: </li></ul><ul><li>2-10 Hz from beginning. </li></ul><ul><li>increase to 40, 50, 60 when treatment progressed </li></ul><ul><li>Treatment Protocol : </li></ul><ul><li>One to two times a week for five weeks. </li></ul><ul><li>-Cheng, Xinnong. Chinese Acupuncture and Moxibustion . 5 th ed. Beijing: Foreign Languages Press, 2004 </li></ul>
  28. 28. Osteoarthritis of the shoulder pain <ul><li>Acupuncture points: </li></ul><ul><li>Li-15 (jian yu) </li></ul><ul><li>TB-14, (jian liao) </li></ul><ul><li>SI-9, (jian zhen) </li></ul><ul><li>TB-13 (nao hui) </li></ul><ul><li>Li-14 (binao) </li></ul><ul><li>Li-11 (quchi) </li></ul><ul><li>Electrical Stimulation: </li></ul><ul><li>low frequency of 2 Hz and continues intensity </li></ul><ul><li>applied for 20 minutes at each session. </li></ul><ul><li>Treatment Protocol: </li></ul><ul><li>Three times a week for two weeks, followed by </li></ul><ul><li>two times a week for two weeks. </li></ul><ul><li>-Green S, Buchbinder R, Hetrick S. </li></ul><ul><li>Cochrane Database Syst Rev.2005 Apr 18: (2):CD005319. </li></ul>
  29. 29. Randomized trial of long term effect of acupuncture for shoulder pain <ul><li>A randomized, placebo controlled trial with independent evaluator set in a primary care clinic in Spain </li></ul><ul><li>Age: 25-83 years with shoulder pain </li></ul><ul><li>Randomly allocate to EA or skin no-penetrating placebo-acupuncture over 8 weeks. </li></ul><ul><li>Primary measurement of pain intensity by lattinen index, in ROM, functional ability (SPADI) and quality of life (COOP-WONCA charts) </li></ul><ul><li>Assessments were performed before, during, 3 and 6 months after treatment. </li></ul><ul><li>Conclusion: 6 months post treatment, the acupuncture group showed a significantly greater improvement in pain intensity. The acupuncture group had consistently better results in every secondary treatment for patients with shoulder pain. </li></ul><ul><li>Guerra de Hoyos, JA et, all , Pain , 2004 Dec;112(3):289-98 </li></ul>
  30. 30. Tennis Elbow <ul><li>Acupuncture points: </li></ul><ul><ul><li>Li-15 (jian yu) </li></ul></ul><ul><ul><li>TB-14, (jian liao) </li></ul></ul><ul><ul><li>SI-9, ( jian zhen) </li></ul></ul><ul><ul><li>TB-13 ( nao hui) </li></ul></ul><ul><ul><li>Li-14 ( binao) </li></ul></ul><ul><ul><li>Li-11 (quchi) </li></ul></ul><ul><li>Electrical Stimulation: </li></ul><ul><li>High and low frequency intermittent for 20 minutes with infrared therapy. </li></ul><ul><li>Treatment Protocol: </li></ul><ul><li>Two times a week for three weeks, followed by once a week for four weeks. </li></ul><ul><li>-Cheng, Xinnong. Chinese Acupuncture and Moxibustion . 5 th ed. Beijing: Foreign Languages Press, 2004 </li></ul>
  31. 31. Sciatica neuralgia <ul><li>Acupuncture points: </li></ul><ul><li>BB-30, </li></ul><ul><li>Bl-54, </li></ul><ul><li>GB34, </li></ul><ul><li>GB-39, </li></ul><ul><li>Bl-37, </li></ul><ul><li>Bl-40 </li></ul><ul><li>Electrical Stimulation: </li></ul><ul><li>DD wave with high and low frequency </li></ul><ul><li>intermittent </li></ul><ul><li>Treatment Protocol: </li></ul><ul><li>20 minutes each session, three times a week for </li></ul><ul><li>four weeks, followed by 2 times a week for two </li></ul><ul><li>weeks. </li></ul><ul><li>-Cheng, Xinnong. Chinese Acupuncture and Moxibustion . 5 th ed. Beijing: Foreign Languages Press, 2004 </li></ul>
  32. 32. Injury of Knee Ligaments <ul><li>Acupuncture points: </li></ul><ul><li>St-34 (liang qiu) </li></ul><ul><li>St 35 (Dubi) </li></ul><ul><li>Electrical Stimulation: </li></ul><ul><li>High and low frequency intermittent for 20 </li></ul><ul><li>minutes, then continued with low frequency for </li></ul><ul><li>10 more minutes. </li></ul><ul><li>Treatment Protocol: </li></ul><ul><li>Acute stage: three times a week for two weeks. </li></ul><ul><li>Chronic stage: Two times a week for 4 weeks. </li></ul><ul><li>- Cheng, Xinnong. Chinese Acupuncture and Moxibustion . 5 th ed. Beijing: Foreign Languages Press, 2004 </li></ul>
  33. 33. Low Back Pain <ul><li>Acupuncture points : </li></ul><ul><li>GB 25, UB-23, UB-25, UB-27, UB-29 </li></ul><ul><li>Ashi points on the hwatuojiaji </li></ul><ul><li>Electrical Stimulation: </li></ul><ul><li>2 Hz, for 15 to 20 minutes or maximum tolerable </li></ul><ul><li>Treatment Protocol: </li></ul><ul><li>Severe pain: three times a week for two weeks, then reduce to two times a week </li></ul><ul><li>Chronic pain: once a week for 6 week, followed by once a month. </li></ul><ul><li>-Cheng, Xinnong. Chinese Acupuncture and Moxibustion . 5 th ed. Beijing: Foreign Languages Press, 2004 </li></ul>
  34. 34. Postoperative Abdominal Pain <ul><li>Acupuncture points: </li></ul><ul><li>St-25 ( tain shu), St-36, bilateral </li></ul><ul><li>Ren 6, Ren 10 and auricular points </li></ul><ul><li>Electrical Stimulation: </li></ul><ul><li>8-10 hz and continues frequency for 20-30 minutes. </li></ul><ul><li>Treatment Protocol: </li></ul><ul><li>Once a day or twice a day for the severe cases that followed withdraw of anesthesia. </li></ul><ul><li>-Mayor, David. Electro acupuncture . 2007, </li></ul><ul><li>P 255, Spain: Elsevier Ltd. </li></ul>
  35. 35. Intestinal adhesion pain <ul><li>Acupuncture points: </li></ul><ul><li>Local points on both ends of the operational scar . </li></ul><ul><li>Electrical Stimulation : </li></ul><ul><li>7-14 hz at the local points </li></ul><ul><li>Treatment Protocols: </li></ul><ul><li>Once a day or on an as needed basis. </li></ul><ul><li>-Mayor, David. Electro acupuncture . 2007, </li></ul><ul><li>P 173, Spain: Elsevier Ltd. </li></ul>
  36. 36. Sports Injury Femoral adductor syndrome <ul><li>Acupuncture points: </li></ul><ul><li>SP-9, CV-2, Lv-11, Bl-36, Bl-32, GB-31, Lv-10 </li></ul><ul><li>Electrical Stimulation: </li></ul><ul><li>Low frequency of 2- 10 Hz for 15-20 minutes per session. </li></ul><ul><li>Treatment Protocol: </li></ul><ul><li>One session every other day, </li></ul><ul><li>10 sessions per course. Evaluate for </li></ul><ul><li>future treatment plan after each course. </li></ul><ul><li>-Mayor, David. Electro acupuncture . 2007, Spain: Elsevier Ltd. </li></ul>
  37. 37. Bone fracture <ul><li>Acupuncture points: </li></ul><ul><li>Humerus fracture: Li-15, Li-11 </li></ul><ul><li>Femoral fracture: Sp10, St-31 </li></ul><ul><li>Use points at the center of the fracture and at the ends of the fracture zone </li></ul><ul><li>Electrical Stimulation: </li></ul><ul><li>High-low frequency intermittent for 30 minutes per session. </li></ul><ul><li>Treatment Protocol: </li></ul><ul><li>Once every other day for 10 sessions, followed by twice a week for four weeks, then reduce to once a week for six weeks . </li></ul><ul><li>-Mayor, David. Electro acupuncture . 2007, Spain: Elsevier Ltd. </li></ul>
  38. 38. Post Herpes Zoster <ul><li>Acupuncture Points: </li></ul><ul><li>Hua tuo jiaji points </li></ul><ul><li>GB 34, (yanglingquan) </li></ul><ul><li>Sp-10, (xuehai) </li></ul><ul><li>Sp-6, (sanyinjiao) </li></ul><ul><li>PC-8, (laogong) </li></ul><ul><li>KI-3, (taixi) </li></ul><ul><li>KI-7, (futu) </li></ul><ul><li>Li-11, (quchi) </li></ul><ul><li>Sp-9, (yinlingquan) </li></ul><ul><li>Electrical Stimulation: </li></ul><ul><li>Low intensity, low frequency </li></ul><ul><li>Treatment Protocols: </li></ul><ul><li>Once every day, five days per week for </li></ul><ul><li>4 weeks. </li></ul><ul><li>-Mayor, David. Electro acupuncture . 2007, Spain: Elsevier Ltd. </li></ul>
  39. 39. Dysmenorrheal <ul><li>Acupuncture Points: </li></ul><ul><li>GV-4 (guanyuan) </li></ul><ul><li>St-29 (guilai) </li></ul><ul><li>SP-6 (sanyinjiao) </li></ul><ul><li>Liv-3 (taichong) </li></ul><ul><li>SP-8 (diji) </li></ul><ul><li>Electrical Stimulation: </li></ul><ul><li>High-low frequency with continues stimulation for 15-20 minutes per session. </li></ul><ul><li>Treatment Protocol: </li></ul><ul><li>Once a week or increased frequency one week before menstruation. </li></ul><ul><li>Mayor, David. Electro acupuncture . 2007, Spain: Elsevier Ltd. </li></ul>
  40. 40. Induction of labor by EA <ul><li>31 patients induction of labor by EA </li></ul><ul><li>Successful 21 cases </li></ul><ul><li>Similar uterine contractions induced to that normal labor </li></ul><ul><li>No serious fetal or maternal complications occurred. </li></ul><ul><li>The delay between the commencement of stimulation and the onset of contractions suggests that a hormonal mechanism may be involved. </li></ul><ul><li>Yip SK, Pang JC (Gard City N Y). 1976 Autumn;4 (3):257-65 </li></ul>
  41. 41. EA for Cancer Pain <ul><li>EA given to cancer patients post chemotherapy </li></ul><ul><li>Acupuncture points: St-36, SP-6, CV-12 and PC-6. </li></ul><ul><li>Methods: EA of G-6805 with disperse –tense wave at an intensity tolerable to the patient. </li></ul><ul><li>Duration: 30 minutes once daily, five days a week with interval of 2 days between the courses. Four courses were administered to evaluate the effects. </li></ul><ul><li>Results: average 5-10 % increase in subsets of T-cells and a 15 % increase in natural killer cell activity. </li></ul><ul><li>There was no control group for comparison. </li></ul><ul><li>Was claimed also to improve appetite and sleep, relieve tumor pain, and alleviate the gastro-intestinal reaction s to chemotherapy. </li></ul><ul><li>Electroacupuncture . Retrieved from world wide web on Apr.25,2008 </li></ul><ul><li>National Cancer Institute http://www , </li></ul>
  42. 42. Safety of use EA <ul><li>The device should not be turned on until after the acupuncture needles are in place and the electrodes are connected. </li></ul><ul><li>Adjust the stimulation gradually until the comfort zone based each individual’s sensitivities. </li></ul><ul><li>Different of the alternative frequency to serve different treatment conditions. </li></ul><ul><li>- Guild lines on basic training and safety in acupuncture : 4-5 </li></ul>
  43. 43. Safety Precautions of EA <ul><li>EA may interact with other devices. (e.g.: hearing aid, cell phones, ECG, EEG monitors) </li></ul><ul><li>Other devices should not be operated <3 meters away from shortwave or microwave devices. </li></ul><ul><li>The electrode leads may act as aerials, and output may be affected to causing burn injury at the site of needles. </li></ul><ul><li>EA should be used with caution when watching TV close up or using a computer. Interaction may occur with micro-current. </li></ul><ul><li>EA with a central press-stud connector or the use of stainless steel acupuncture needles may give problems in those with a nickel allergy. </li></ul><ul><li>Mayor, David. Electroacupuncture . 2007, P332-333,Spain: Elsevier Ltd. </li></ul>
  44. 44. Contraindications -Muscle Spasm <ul><li>High frequency stimulation may cause muscle spasm </li></ul><ul><li>Strong stimulation over a trigger or other points in already spastic muscle, as in torticollis may aggravate the condition. (e.g.. Fibromyalgia) </li></ul><ul><li>-Omura Y. Acupunct Electother.Res . 1985; 10(4): 335-7 </li></ul>
  45. 45. EA in Auricular <ul><li>Treating ear points can have a direct effect on the vagus nerve. </li></ul><ul><li>To avoid vasovalgal effects, the patient is best treated lying down, not seated. </li></ul><ul><li>-Mayor, David. Electroacupuncture . 2007, P333, </li></ul><ul><li>Spain: Elsevier Ltd. </li></ul>
  46. 46. Contraindications to EA <ul><li>Pregnancy: Stimulation over or close to the uterus is forbidden at any stage of pregnancy, except for hypermesis with careful treatment. </li></ul><ul><li>Shock or coma: unless its use has been medically advised. (Du26). </li></ul><ul><li>Acute Febrile disease: Septicemia, tuberculosis and other local active infections. </li></ul><ul><li>Children <12 years old : Stimulation should not be applied to head due to seizure susceptibility. </li></ul><ul><li>Carotid Sinus: in case of hypotensive response, or near larynx in case of airway restriction, especially at high frequencies. </li></ul><ul><li>Cardiac disease: For serious or unstable cardiac (arrhythmia) problems patient, electro-stimulation from the same socket should not be positioned over the anterior chest wall. </li></ul><ul><li>Apparent but undiagnosed sprain : unless ruled out actual fracture. </li></ul><ul><li>Cardiac pacemaker : whether atria or ventricular for a patient use a demand –type. </li></ul><ul><li>Hypertension: High frequency should be avoid if a patient has high blood pressure. </li></ul><ul><li>Mayor, David. Electroacupuncture . 2007, P333Spain: Elsevier Ltd. </li></ul>
  47. 47. Relative contraindications <ul><li>Epilepsy </li></ul><ul><li>Cancer </li></ul><ul><li>Undiagnosed pain or swelling </li></ul><ul><li>Unstable spine </li></ul><ul><li>Pregnancy </li></ul><ul><li>Debilitated patients </li></ul><ul><li>Cerebra vascular accident </li></ul><ul><li>Spinal cord injury </li></ul><ul><li>Defected Skull . </li></ul><ul><li>Acute venous condition : </li></ul><ul><li>Metal implant </li></ul><ul><li>-Mayor, David. Electroacupuncture . 2007, P333-334, Spain: Elsevier Ltd. </li></ul>
  48. 48. Limitations of EA <ul><li>With constant, disabling pain or tend to anxiety or severe depression may response less well. </li></ul><ul><li>More effective in young patients than the elderly who with long-standing pain. </li></ul><ul><li>Parkinson's disease which decreases cerebral levels of 5HT, reduces EA effectiveness </li></ul><ul><li>Multiple operations for pain, may lead to a less positive outcome </li></ul><ul><li>EA do not help everyone, it is difficult to predict which patient will respond well. </li></ul><ul><li>-Mayor, David. Electroacupuncture . 2007, P335, Spain: Elsevier Ltd. </li></ul>
  49. 49. EA and Drug Interactions <ul><li>Be aware of interaction with prescription drugs that affecting neurotransmitters. </li></ul><ul><li>The effectiveness of EA will be reduced in case of drug addiction, and may be limited by use of drugs of diazepam, codeine, corticosteroids or narcotics. </li></ul><ul><li>-Mayor, David. Electroacupuncture . 2007, P335, Spain: Elsevier Ltd. </li></ul>
  50. 50. Questions? <ul><li>Contact Information: </li></ul><ul><li>Cathryn Hu, Ph.D., O.M.D., L.Ac. </li></ul><ul><li>Phone: 310-458-2848 </li></ul><ul><li>Fax: 310-458-2899 </li></ul><ul><li>Http://www. </li></ul><ul><li>Email: </li></ul>