Characteristics and Specialties
- Treatment with stronger stimulus;
- Can be working with any other acupuncture techniques;
- Ideal for acute & chronic pain;
- Ideal for obstinate symptoms;
- Ideal for substances addictions.
Electro-acupuncture is quite similar to traditional acupuncture in that the same points are stimulated during treatment. As with traditional acupuncture, needles are inserted on specific points along the meridians. The needles are then attached to a device that generates continuous electric pulses using small clips. These devices are used to adjust the frequency and intensity of the impulse being delivered, depending on the condition being treated. Electro-acupuncture uses pair of needles at time so that the impulses can pass from one needle to the other. Several pairs of needles can be stimulated simultaneously, usually for no more than 30 minutes at a time.
According to the principles of traditional Chinese medicine, illness is caused when qi does not flow properly throughout the body. Acupuncturists determine whether qi is weak, stagnant or otherwise out of balance, which indicates the points to be stimulated. Electro acupuncture is considered to be especially useful for conditions in which there is an accumulation of qi, such as in chronic pain syndromes or in cases where the qi is difficult to stimulate. The procedure for electro-acupuncture is to insert the acupuncture needle as would normally be done, attain the qi reaction by hand manipulation, and then attach an electrode to the needle to provide continued stimulation. The benefits of using electrical stimulation are:
- It substitutes for prolonged hand maneuvering. This helps assure that the patient gets the amount of stimulation needed, because the practitioner may otherwise pause or provide uneven stimulus. Electro-acupuncture may also help reduce total treatment time by providing the continued stimulus.
- It can produce a stronger stimulation, if desired, without causing tissue damage associated with twirling and lifting and thrusting the needle. Strong stimulation may be needed for difficult cases of neuralgia or paralysis.
- It is easier to control the frequency of the stimulus and the amount of stimulus than with hand manipulation of the needles.
- It gives patient a great deal of comfort. After inserting and initially stimulating the needles, acupuncturist periodically leave the patient to rest undisturbed with no need of performing prolonged needle manipulation
Although electro-acupuncture may be used as a component of nearly all acupuncture treatments that require manipulation of the needles, according to the Chinese literature, especially good results are expected from electro-acupuncture treatment of neurological diseases, including chronic pain, spasm and paralysis. In patients with serious cardiac diseases, however, the method should be used with caution. It is generally recommended to avoid placing electrodes near the heart, especially patient with pacemaker. Despite the low current that is used. Some have suggested avoiding placing electrodes to needles on both sides of the spinal cord (e.g., for Hua Tuo Jia Ji or bladder meridian points), because of the possible effect of the electrical stimulus on the nervous system. Points are generally selected in pairs for electrical pulse stimulation, with 1-4 pairs at one time, and the pairs are usually on the same side of the body.
The Use of Electrical Stimulation Devices
The electro-acupuncture device is not intended to provide a significant current between the acupuncture needles: it delivers less than a mill ampere (modern devices usually have an upper level of 0.6 mill ampere), about the same as that produced by a wristwatch battery. But, it will provide a significant voltage: 40-80 volts (with short spikes as high as 130 volts), which is the basis for the patient response. In the commonly-used portable battery devices, this is accomplished by boosting the voltage output of the battery, such as raising the voltage from 9 volts to 45 volts. Thus, there is virtually no current transmitted through the body, but there is enough of a local voltage stimulus for the patient to feel an evident reaction at the point where the needle is inserted.
Duration of standard treatment with electro-acupuncture is usually 10-20 minutes and rarely exceeds 30 minutes. The electrical pulsing stimulus is used in a few cases for an hour or more, especially for difficult to treat neurological disorders. During the stimulation period, the patient may become adapted to the stimulus (this will typically happen after the first minute or two), with a gradual decline in response. The electrical output should then be adjusted in frequency and/or intensity to resume the sensation. Variable frequency output of the electro-acupuncture device is sometimes utilized in an attempt to circumvent this adaptation.
Electro-acupuncture is normally administered with alternating current. Therefore, the two electrodes in any pair are equivalent, even if they are color coded to distinguish them. Some devices allow a direct current (non-alternating) setting, but the use of this has been discouraged, as mild adverse effects might occur if the pulsing of the current ceases for any reason (i.e., device defect). Further, it has been suggested, though it remains to be proven, that the adaptation to the direct current may be more rapid than to the alternating current. When it is said in electro-acupuncture literature that "the negative electrode is attached to what is considered the main point, while the positive electrode is attached to a secondary point," the statement has no relevance when using an alternating current.
The device to be used for electro-acupuncture must have good control over its voltage output to avoid excessive electrical stimulation, namely an unexpected higher voltage pulse that causes pain or muscular contraction, and to assure that the frequency and intensity is maintained as set by the practitioner. Currently, the device commonly used in practice is the G6805 or G6805-2 electric stimulator.
The device should not be turned on until after the acupuncture needles are in place and the electrodes connected. All changes in the electrical stimulus should be carried out gradually. It is normal for the patient to experience responses such as rhythmic spasm or weak twitching of the muscle (frequently visible to the practitioner), as well as the usual "deqi" reactions of acupuncture therapy: sensation of numbness, distention, and/or heaviness. The stimulus intensity, set by a voltage-adjusting knob on the device, should be in the range between the minimum amount needed for the patient to sense its effect and the minimum amount that produces an uncomfortable reaction; care should be taken to limit the muscle twitching to a mild response. Areas that are particularly sensitive to electrical stimulation are the face and the extremities, such as those regions below the elbow and knee. These areas should be treated initially with a very low intensity voltage. Patients who have not had acupuncture previously should receive standard acupuncture first to assure that they adapt to the treatment well, before moving on to electro-acupuncture, which may yield a stronger sensation.
The wave form (squared off or sharp; dense, sparse, mixed dense and sparse, or interrupted) can provide slightly different responses and must be tried for each patient to evaluate their suitability. Claims that one form is tonifying and another is dispersing may not be justified due to lack of adequate testing to support such differentiation of effects. A continuous wave (frequency doesn't change over time) is most similar to what acupuncturists commonly attempt to administer by the manual method. The overall frequency of stimulus (either by continuous wave or pulses of dense waves) should be set similar to the frequency that would be used in manual stimulation by twirling or lifting/thrusting. Frequencies as high as 200 pulses per minute have been recommended for scalp acupuncture, with low frequencies being more commonly mentioned for body acupuncture (e.g., 50 or less). It is believed that electro-acupuncture present differing perspectives on the ideal frequency for various desired effects. All the wave forms and frequencies are claimed to be of value in promoting circulation of qi and blood and alleviating various symptoms, particularly pain.
The Cochrane Collaboration, a group of evidence-based medicine (EBM) reviewers, reviewed eleven randomized controlled trials on the use of electro acupuncture at the P6 acupuncture point to control chemotherapy-induced nauseaor vomiting. The reviewers found that electro acupuncture applied along with anti-vomiting drugs reduced first-day vomiting after chemotherapy more effective than anti-vomiting drugs alone. However, the drugs given were not the most modern drugs available, so the reviewers stated that further research with state-of-the-art drugs was needed to determine clinical relevance. The reviewers concluded:
"This review complements data on post-operative nausea and vomiting suggesting a biologic effect of acupuncture-point stimulation. Electro-acupuncture has demonstrated benefit for chemotherapy-induced acute vomiting, but studies combining electro-acupuncture with state-of-the-art antiemetics and in patients with refractory symptoms are needed to determine clinical relevance. Self-administered acupressure appears to have a protective effect for acute nausea and can readily be taught to patients though studies did not involve placebo control. Noninvasive electro-stimulation appears unlikely to have a clinically relevant impact when patients are given state-of-the-art pharmacologic antiemetic therapy."