Stimulation-Produced Analgesia
Stimulation-produced analgesia is a concept that has been in use for many years, from the use of acupuncture by the Chinese thousands of years ago to the modern implantable spinal cord stimulators that are common in pain practice today. Described in this
- PDF / 144,737 Bytes
- 3 Pages / 504.567 x 720 pts Page_size
- 72 Downloads / 189 Views
60
Narayana Varhabhatla and Ehren Nelson
Introduction Stimulation-produced analgesia is a concept that has been in use for many years, from the use of acupuncture by the Chinese thousands of years ago to the modern implantable spinal cord stimulators that are common in pain practice today. Described in this chapter are the current methods in pain management that employ this useful tool in providing analgesia to our patients.
Acupuncture Acupuncture is a system of health care developed in China over 3000 years ago, based on the concept that good health comes from harmony among bodily functions. The vital energy of the body, qi (pronounced “Chee”), flows through the body in patterns (called meridians) and free flow of these energies ensures good health. Qi flows in 12 major meridians and eight minor meridians. Change in free flow is believed to lead to pain and disease conditions. Insertion of acupuncture nee-
N. Varhabhatla, MD • E. Nelson, MD (*) Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA e-mail: [email protected]; [email protected]
dles, which are fine metallic needles, along specific meridians restores the proper flow of qi. Traditional Chinese medicine holds that there are 2000 acupuncture points.
Mechanism of Action The exact mechanism of action of acupuncture is unknown. Stimulation of A-delta fibers by needling is thought to release endorphins, enkephalins, dynorphins in the brain and spinal cord, and elevated ACTH in the hypothalamic-pituitary axis. Local anesthesia at the site of acupuncture needle insertion sites negates the therapeutic effect of acupuncture. Therefore, part of the mechanism is through stimulating the areas of innervation. Naloxone reverses low-frequency electroacupuncture-induced analgesia. However, recent systematic reviews have demonstrated that the placebo effect itself is mediated by release of endogenous opioids. Therefore, further studies are needed to determine the exact mechanism of action of acupuncture.
Efficacy Studies have shown efficacy for migraine and tension headaches, chronic neck pain, low back pain, and soft-tissue injuries of peripheral joints.
© Springer International Publishing Switzerland 2017 R.J. Yong et al. (eds.), Pain Medicine, DOI 10.1007/978-3-319-43133-8_60
213
N. Varhabhatla and E. Nelson
214
Meta-analysis done by Furlan evaluated 35 RCTs and 2861 patients with nonspecific chronic LBP and found small improvements in pain relief and functional status. They recommend acupuncture as part of a multidisciplinary approach to low back pain.
Contraindications Bleeding disorders, warfarin use, severe psychiatric disease, and local skin infections. It is not contraindicated in pregnancy, but caution must be used in pregnant patients.
Side Effects Side effects are reported in a wide range in the literature and include needle pain (1–45 %), tiredness (2–41 %), bruising (0.03–38 %), and faintness (0–0.3 %).
TENS TENS is short for transcutaneous electrical nerve stimulation. I
Data Loading...
