ElectroacupunctureDESCRIPTION OF METHODSElectroacupuncture can be used for virtually all painconditions where manual acupuncture is indicated.The mechanisms behind acupunctureThe effect of both manual and electroacupuncturemainly results from activating the ergoreceptors in themusculature. About 75% of the points stimulated bymanual acupuncture are muscular. Ergoreceptors arealso stimulated by intense muscular activity.Stimulating these receptors releases the body's ownmorphine-like substances - endorphins. Acupuncturealso stimulates the touch fibers, which transfer theeffect inward to the spinal column, according to theGate Control theory.Today we know more about the physiological mecha-nisms behind electroacupuncture than those behindmanual acupuncture. Many studies have been doneon various stimulation frequencies and their effect onthe endorphin systems.In general, electroacupuncture is thought to give amore intense, effective, and pleasant stimulation forthe patient than manual acupuncture. Electrical sti-mulation is also easier to reproduce exactly, which isan advantage when you want to compare treatmentresults, for example in clinical studies.Studies have shown that low-frequency electroacu-puncture (up to 10 Hz) releases beta-endorphins onthe brain-stem level and met-enkephalin on the spinallevel. This effect is general - it occurs regardless ofwhere the needles are applied and stimulated.With high-frequency stimulation (15-200 Hz), dynor-phins are released segmentally on the spinal level.Studies have also shown that high-frequency stimula-tion releases serotonin, which inhibits pain impulseson the spinal level. In contrast to low-frequency sti-mulation, high-frequency stimulation must be appliedin the painful region - or segment.Animal testing has shown that mixed-frequency sti-mulation, such as 2 Hz/100 Hz (Han stimulation), isoptimal for releasing endorphins. Both dynorphin andenkephalin are released on the spinal level and beta-endorphins are released on the brain-stem level. Thisprovides optimal conditions for maximum endorphinrelease, which would benefit for example patients withlong-term pain. However, a risk of developing a tole-rance level has been discussed with this type of stimu-lation.ELECTROACUPUNCTURE TREATMENTSA treatment always begins with one or two manualtreatments to evaluate the patient's reaction to needlestimulation. For optimum effect, the patient must berelaxed and not see the treatment as unpleasant. Forthis reason, it is a good idea to use needles that pene-trate the tissue well when doing electrical stimulation.Since a current has a limited spread in the tissue, theneedles in a pair with current should not be furtherthan 30 cm (12") apart. Since the current spreadsthrough the tissue, 1-3 needle pairs in the painful areaare enough. Never place the needles closer than 3 cm(1-1/4") from each other. For general release of beta-endorphins, stimulate 1-2 needle pairs on extraseg-mental, distal points. The treatment time is 20-40minutes.STIMULATION METHODSBoth high and low-frequency stimulation should befelt clearly, but with absolutely no pain. With high-frequency stimulation (15-200 Hz), the patientshould clearly feel paresthesia - tingling - and withlow-frequency stimulation (up to 10 Hz), visible mus-cle contractions should occur.This can sometimes be difficult to attain withoutpainful stimulation (for example in the facial area),which is why it is important to clearly see muscularfasciculation around the needle.High-frequency stimulation gives a segmental, fast,brief effect and is used primarily with local, segmentalneedles. Usually acute and sub-acute pain conditionsare treated with high-frequency stimulation for rapidanalgesic effect.Low-frequency stimulation has a general, long-lasting,slower effect and is used with distal extrasegmentalneedles. Low-frequency stimulation is used primarilyto amplify the general effect of acupuncture.Mixed-frequency stimulation (such as 2 Hz for 3seconds and 80 Hz for 3 seconds) gives a combinedeffect of low and high-frequency stimulation. Mixed-frequency stimulation is used with local, segmentalneedles to treat primarily long-term pain conditions.1Copyright CEFAR Medical ABEXAMPLES OF TREATMENTS WITH ELECTROACUPUNCTUREThe indication ranges for electroacupuncture treat-ment are usually divided into three levels: acute, sub-acute and long-term pain.Acute painIf the patient is experiencing intense pain, you canchoose to stimulate only strong, distal, extrasegmentalpoints, such as LI4 and TE5, ST36 and SP6, withlow-frequency stimulation.High-frequency stimulation is used in the painful areafor rapid segmental effect. Frequency: Select eitherhigh-frequency, 80 Hz, continuous stimulation; orhigh-frequency, 80 Hz, modulated pulse duration sti-mulation. Combine with stimulation on strong distal,extrasegmental points.Subacute painStimulate local, segmental points in the painful area.Frequency: Select either high-frequency, 80 Hz, cont-inuous stimulation; high-frequency, 80 Hz, modula-ted pulse duration stimulation; or mixed-frequency, 2 Hz/15 Hz or 2 Hz/80 Hz, stimulation. Combinewith stimulation on distal, extrasegmental points withlow-frequency stimulation.Long-term painStimulate local, segmental points in the painful area.Frequency: Use low-frequency stimulation, 2 Hz, ormixed-frequency, 2 Hz/15 Hz or 2 Hz/80 Hz.Combine with stimulation on distal, extrasegmentalpoints with low-frequency stimulation, 2 Hz.Example: Cervical pain that radiates out over the trapeziusEA points: Local points GB20-GB21.Bilateral stimulation is ideal. Distal pointsLI4 and TE5 unilaterally.Example: Elbow painEA points: Local points LI10 and LI12.Distal points LI4 and TE5 on the same side.Copyright CEFAR Medical AB2Distal, extrasegmental pointsStimulate strong points on the upper andlower extremity to enhance the generaleffects of acupuncture. Common EA points:LI4 and LI11, LI4 and TE5, SP6 and ST36.Low-frequency stimulation, 2 Hz.Example: Lumbago and lumbago-sciaticaEA points: Local points BL25 and GB30,BL25 and BL27, GB30 and BL36, BL25and BL37. Distal points ST36 and SP6.Copyright CEFAR Medical AB3PRECAUTIONARY MEASURES FOR ELECTROACUPUNCTURE1. Warning! Patients with pacemakers must not betreated with electroacupuncture.2. Do not apply electroacupuncture while the patientis connected to high-frequency surgical equipment.This can burn the skin at the site of the needles anddamage the stimulator.3. Switch off stimulation before removing the clamps.But if you do get a shock from the stimulator, it isn'tharmful.4. Do not stimulate close to the glomus caroticus, onthe throat near the carotid artery, as this can cause adrop in blood pressure.5. Do not treat pregnant women in the uterine inner-vations segment during the first trimester. 6. Exercise caution if the patient has a damaged lym-phatic system.7. Exercise caution with unwilling, frightened pati-ents, and ones with reduced awareness or dementia.8. Patients with cardiac arrhythmia must be monito-red to ensure that the arrhythmia is not aggravated.9. Do not place needles from the same pair directlyover the heart.10. Do not place needles on or near the head of pati-ents with epilepsy. This might trigger a seizure.11. Note that overstimulation may worsen the patient's pain and general condition.12. Be careful when stimulating patients with a nickelallergy.For complete precautionary measures, see the productmanual.Copyright CEFAR Medical AB4REFERENCESANDERSSON, S., LUNDEBERG, T. 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HUMAN REPRODUCTION (1999)14:2480-2484.THOMAS, M., LUNDEBERG, T., Does acupuncture work?PAIN CLINCAL UPDATES 4, 1996:14.ULETT G.A., HAN S, HAN J.S. Electroacupuncture: mecha-nisms and clinical application. BIOL PSYCHIATRY 1998, Jul15, 44(2):129138.UVNS-MOBERG, K., et al: The antinociceptive effect ofnon-noxious sensory stimulation is mediated partly throughoxytocincergic mechanisms. ACTA PHYSIOL SCAND 149:199-204, 1993.CEFAR Medical AB Mur mansgat an126 SE-21225Mal m SwedenTel +46 (0)40-394000 Fax +46 (0)40-394099 E-mail info@cefar.se www.cefar.se5Copyright CEFAR Medical AB Art.nr. M1000-4