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Piezoelectric
Stimulation Of Acupuncture Points For The Treatment Of Back And
Neck Pain: A Discussion Of 3 Case Reports
Dein M. Shapiro, MD
ABSTRACT
Background Back and neck pain are common in medical practice.
Usual treatment involves pharmacotherapy, including narcotics, and takes
days or weeks to effect symptom resolution. In contrast, the application
of piezoelectric stimulation to standard acupuncture points can be a
quick and effective modality for back pain.
Objective To illustrate the use of piezoelectric stimulation
for back and neck pain.
Design, Setting, and Patients Case series of patients
seeking alleviation of back or neck pain.
Intervention Piezoelectric stimulation of acupuncture
points, particularly BL 60, GB 34, and GB 39.
Main Outcome Measure Resolution of pain following treatment.
Results Three patients are discussed who presented with
a range of symptoms, both acute and chronic. After 1 or 2 sessions of
piezoelectric stimulation of acupuncture points, all 3 patients reported
resolution of pain. Long-term follow-up revealed no pain recurrence.
Conclusion Piezoelectric stimulation appears to be an
effective approach for both acute and chronic neck and back pain. While
no adverse effects were seen in this series, controlled trials are necessary
and the device remains investigational.
KEY WORDS
Piezoelectric Stimulation, Back Pain, Neck Pain, Acupuncture
INTRODUCTION
Back and neck pain are common problems in medical practice. The initial
treatment modalities include immobilization, thermotherapy, and medication
that often comprises oral or injectable narcotics. The time frame of
recovery can be days or weeks and frequently requires additional physical
therapy. This article describes a new modality that appears to be safe
and effective. Most patients treated with this method show some improvement
within 30 minutes. They do not require injectable medication and the
use of oral narcotics is curtailed. The author has treated hundreds
of patients for musculoskeletal pain with this technique. The most common
indication has been neck or back pain. This modality is described in
detail, and 3 cases are herein reported: 1 for neck, 1 for mid back,
and 1 for low back pain.
Piezoelectricity
Pierre and Jacque Curie discovered the piezoelectric phenomenon in the
1880s. They showed that some crystals produce electric potentials when
deformed by pressure. Piezoelectric devices have a variety of common
uses. They are found in crystal microphones and diagnostic ultrasound
transducers, and they are often used to produce the spark that ignites
gas grills.
Piezoelectric
stimulators for self-treatment are widely available over-the-counter
(OTC), despite the fact that the US Food and Drug Administration (FDA)
lists them as investigational devices. Unlike the OTC versions, the
medical devices are produced to strict standards and have a defined
output. The device's specifications include a short pulse duration of
12 microseconds, a peak voltage of 10,000, and a monophasic spike waveform.1
It is held in 1 hand and activated by depressing a button with the thumb.
If the examiner is grounded to the patient, both will feel a mild but
tolerable shock. If a grounding device is used, the patient will experience
a mild shock between the device and grounding pole, and the examiner
will feel nothing.
Probable Mechanism of Action
The use of acupuncture needles to induce a flow of electrical energy
along the meridians is well documented.2(pp19-24) Although not as refined
as needles, the piezoelectric device appears to polarize the meridian
and produce a similar effect. The most superficial meridians, tendinomuscular
meridians (TMMs), are commonly stimulated to treat acute strains and
sprains.2(pp103-116) The TMMs exist in broad bands in the superficial
dermis and fascia. Even though the ting and gathering points are not
used, the TMMs appear to be readily activated by piezoelectric devices.
The device may also simultaneously influence the principal meridians.
The TMM of the bladder (BL) courses up the back of the legs, over the
buttocks, up the back and neck, and over the top of the head. Its area
of influence is ideally suited for neck and back pain. The gallbladder
(GB) TMM courses up the side of the legs, over the hip, up the side
of the trunk, across the shoulder, and up the side of the head. Its
stimulation is well suited for lumbar pain that radiates to the hip
and/or down the leg laterally. The small intestine (SI) TMM begins at
the tip of the
5th finger, courses up the medial side of the forearm and arm, over
the shoulder, and up the side of the neck to the side of the face. Its
stimulation is ideally suited for shoulder and neck pain.
TREATMENT
Upper back and neck pain is treated by stimulating SI 4 and BL 58 bilaterally.
A typical treatment involves 10 stimulations (at 1-second intervals)
on each point for a total treatment of 40 stimulations. At the 1st treatment,
half (5 stimulations per point) can be given initially. The 2nd half
of the treatment can be administered 10-15 minutes later, after reassessing
the patient.
Lower and mid-back pain is treated using BL 60, GB 34, and GB 39. An
average treatment involves 10 stimulations on the bladder line (BL 60)
and 10 on the gallbladder line (5 each on GB 34 and GB 39) bilaterally
for a total of 40 stimulations. Severe low back pain or significant
pain in a large patient (weighing >200 lb [90 kg]) may require 60
or 80 stimulations distributed over these points. If the pain is mostly
central, the treatment can be weighted more heavily on the bladder line.
If there is significant lateral radiation of the pain, the gallbladder
meridian can be favored.
It takes only 1-2 minutes to complete a treatment that typically can
be repeated 2 or 3 times the 1st week, 1 or 2 times the 2nd week, and
then weekly until symptoms resolve.
CASE REPORTS
Patient 1. A 52-year-old woman presented with chronic neck pain
of 2 years' duration and recent left-hand numbness. The patient had
limited range of motion in the neck but was neurologically intact. A
magnetic resonance imaging (MRI) scan revealed cervical straightening
due to muscle spasm, and degenerative arthritis at C3-4 and C4-5. This
patient received 10 stimulations to SI 4 and BL 58 bilaterally for a
total of 40 stimulations. Within 20-30 minutes, she noted an increased
range of motion and a modest diminution in pain. She was instructed
to take OTC anti-inflammatory medication and was given a referral for
physiotherapy. The next morning, the patient stated that her neck pain
had resolved completely.
Eleven weeks later, the patient reported the return of neck pain and
stiffness after a symptom-free interval of 9-10 weeks. The physical
examination revealed limited range of motion in the neck with left-sided
tenderness. She also complained of low back stiffness and had tenderness
over the left sacroiliac joint. A 2nd treatment of 40 stimulations was
given, weighted to the left side, and with some attention to the lower
back. Treatment integrated the left side: BL 60 (10), SI 4 (10), GB
34 (5), GB 39 (5); and right side: BL 60 (5), SI 4 (5). Sixteen months
after the last treatment, the patient reported no recurrence of symptoms.
Patient 2. A 34-year-old woman presented with acute, moderately
severe mid-back pain that occurred suddenly as she lifted a heavy object
and rotated her trunk. The physical examination findings were normal
except for limited flexion and rotation of the spine due to pain in
the paraspinous muscles of the mid back. This patient was treated with
10 stimulations on BL 60, and 5 stimulations on both GB 34 and GB 39
bilaterally for a total of 40 stimulations. She reported a 30% reduction
in pain almost immediately. She was instructed in thermotherapy and
rest was advised. Ibuprofen was prescribed at a dosage of 600 mg orally
3 times daily, and a mild narcotic was given for episodes of severe
pain. The patient reported that the pain resolved over 5-7 days after
treatment. She used little ibuprofen and no narcotic. Telephone contact
90 days later revealed that the patient remained symptom-free.
Patient 3. A 275-lb (124-kg) obese 39-year-old man with a history
of chronic low back pain and recurrent episodes of acute low back strain
presented with sudden, severe, and disabling pain that occurred when
he bent over. The pain radiated into the right buttock and prevented
him from climbing onto the examination table. At the time of his initial
examination, he stood at the end of the table leaning slightly forward
and gripping the table with both hands. He was immobile and requested
injectable narcotics that had relieved him previously. Permission was
obtained to treat him with piezoelectric stimulation instead of with
injectable narcotics.
The initial treatment was done in the standing position with 10 stimulations
to BL 60, and 5 stimulations each to GB 34 and GB 39 bilaterally (for
a total of 40 stimulations). Twenty minutes later, the patient had sufficient
relief to allow a proper examination with the patient standing, sitting,
or lying on the table. Due to his size and the severity of the pain,
the initial treatment of 40 stimulations was repeated before he left.
(This total treatment of 80 stimulations was justified by the patient's
size and severity of his pain.) He left the office fully ambulatory
and walking upright. Bed rest was advised, along with his anti-inflammatory
medication.
Seven days later, the patient reported that the treatment had given
him significant relief for 4 days, but the pain had gradually recurred.
He was re-treated only on the affected side with 20 stimulations (10
stimulations each at BL 60 and GB 34). This treatment was also repeated
at the end of the 2nd week; shortly after this 3rd treatment, the patient
reported approximately 80% improvement and returned to work. He was
instructed in home exercise. Resolution of symptoms made further visits
unnecessary.
DISCUSSION
Piezoelectric stimulation of acupuncture points may not be as popular
or detailed a treatment as needle acupuncture, but it appears to be
an effective method for the treatment of acute, subacute, and chronic
back and neck pain. For many acupuncturists who treat adults, it may
be a temporary solution until the patient can be scheduled for a full
treatment. Yet my experience has proven piezoelectric stimulation to
be adequate as primary therapy for many patients. For pediatric practitioners,
it may represent a useful new modality that is not generally perceived
as noxious to children older than 5-6 years. For family practitioners
and other medical generalists, piezoelectric devices could represent
a powerful introduction to the acupuncture-related modalities, and their
usefulness in the treatment of common medical problems.
Despite the fact that this device is available OTC, it is still listed
as "investigational" by the FDA, therefore requiring patients'
informed consent prior to its use clinically by licensed medical personnel.
(In the consent process, it is important to admit that the efficacy
of the device has not been proven and its adverse effects unknown. My
patients described herein consented to treatment and noted no complications
from this procedure.) However, controlled clinical trials are necessary
before this method can be recommended for wide use.
CONCLUSION
Considering that this device delivers a relatively high monophasic voltage
spike, the wisdom of making it available without prescription is questionable.
Experience has shown the OTC devices to be relatively harmless and largely
ineffective. The true medical potential of this device becomes apparent
only when it is used to stimulate a group of distal (below the knee
or elbow) acupuncture points designed to "move energy." To
accomplish this, the therapist must be isolated electrically from the
process and stimulate each point repeatedly. This converts the process
into a potent medical modality that should be performed only under medical
supervision, and which is quite appropriately not recommended in the
instructions for any of the OTC devices. It is possible, nonetheless,
that some patients with proper training could stimulate themselves with
these devices as part of a comprehensive plan of medical management.
REFERENCES
1. OMS Medical Supplies Catalog. Braintree, Mass; 1992-1993:34-35.
2. Helms JM. Acupuncture Energetics: A Clinical Approach for Physicians.
Berkeley, Calif: Medical Acupuncture Publishers; 1995.
AUTHOR INFORMATION
Dr Dein Shapiro is Board-certified in Family Practice and in Medical
Acupuncture, and is a Fellow of the American Academy of Family Physicians.
Dr Shapiro is a Clinical Associate Professor of Family Practice at The
University of Medicine and Dentistry of New Jersey, Robert Wood Johnson
Medical School, Piscataway, New Jersey, and is in private practice in
Branchburg, New Jersey.
Dein M. Shapiro, MD
3461 Route 22
Branchburg, NJ 08876
Phone: 908-526-4499 o Fax: 908-526-4495 o E-mail: Boxwood@aol.com
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