ELECTRICAL ACUPUNCTURE

 

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For thousands of years, the Chinese have used acupuncture as a technique to relieve pain and maintain general health and emotional balance.  In the traditional theory, there were roads of energy flows called meridians that coursed through the body; manipulation of these flows had therapeutic effects.

 

In western medicine, we do not recognize such energy flows but there is no question that acupuncture works.  How does it work?

 

In pain physiology, there is a “GATING” phenomenon where the activity from stimulation of regular sensory nerves can reduce pain.  It is as if there is a gate and only a certain amount of impulses can get through that gate in any period of time.   Therefore, the more non-pain impulses get through, the fewer pain impulses can get through.  This minimizes the number of pain impulses that reach the brain and we are less aware of the pain.  It is why we rub our arms or legs after we get banged or injured; it produces mild pain relief.  Nerve connections in the spine are partly responsible for this but release of endorphins in the spinal cord and brain play a significant role.

 

TENS machines (Transcutaneous Electrical Nerve Stimulation) have a well established role in pain treatment; they take advantage of this process.  However, their effects are slightly different from those of acupuncture.  When the acupuncturist places a needle, he twirls it a bit producing an electrical impulse.  Usually he twirls it only a few times each second.  Hertz is the way we measure the frequency of electrical impulses and acupuncture stimulation is usually is about 2-4 hertz (impulses per second).  TENS machines usually stimulate at 100-150 hertz.

 

As it turns out, the lower hertz preferentially leads to release of certain types of endorphins (B-endorphin and enkephalin) while the higher stimulation produces a different type of endorphin called dynorphin.  We would want to stimulate all the endorphins to get the most pain relief.
 

We can set certain TENS machines to a low hertz and we get an effect similar to acupuncture.  It is not necessary  to use needles; there are self-adhesive electrical pads which conduct the electrical impulse.  These pads can be attached to specific acupuncture points in the body and hands; these points have been used for thousands of years.  This process may be preferable to traditional acupuncture because we avoid the difficulties of placing, cleaning and disposing of needles.  However, what is most important is that is makes it easy to have repeated treatments because the patient can place the pad himself.

 

A lot of people think of acupuncture as a procedure that you have just a few times.  However, acupuncture should be thought of a medication which wears off after a period of time.  Initially, in order to get a maximal effect, the treatment needs to be repeated 3-4 times a day.   After a while, 1-2 treatments daily maintain that effect.   

It seems that our periods of maximal pain occur in the early morning or late at night.  Therefore, when one is most in need of treatment, it becomes impossible to see the acupuncturist soon enough.  With this machine, a treatment can be done anytime.

 

Evidence has shown that alternating between high and low hertz will maximize the therapeutic effects.  Pain can be relieved this way.  I have found hat 2/3 or more of my patients get relief for periods ranging from 6 to 18 hours.

Also, severe opioid withdrawal syndromes can be relieved.  In a study done in a western style detox unit, half the patients were given the acupuncture.  All patients were allowed to use as much Suboxone as they wanted.  Those receiving the treatment used less than 10% of the Suboxone that the control group did.  Their vital signs normalized in 4 days versus 8 days in those patients who did not receive the treatment.

 

The machine that was used had a special setting where the rate of stimulation changed every three seconds.   It switched from 2 Hertz to 100 Hertz and back.  It is unclear whether machines that do not automatically make this switch can produce the same results.  The treatments lasted for thirty minutes.  There had some prior findings that acupuncture stimulation maximized after thirty minutes and that longer periods of stimlation could reduce the relief obtained.
  
 

It is also possible that the longer term use of the machine may reduce drug cravings with some studies showing a lower incidence of relapse.  The benefit here is less marked.

 

One or two trial treatment can be done in the office.   If it works, patients can take a machine home.

I have made the machine available in the office with provisions for patients to take it home for a leasing price of 10 dollars/day.  A $350 security deposit will need to be left.   This may also considered to be the purchase price of the machine if someone wants to use it long term however, at any point with 90 days the machine can be returned for a partial refund of 100 dollars.

The people who will most benefit are those that are undergoing acute withdrawal or those in acute pain or a combination thereof.  The benefit for those who have a more chronic process is unclear.

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