Chronic Pain Syndromes

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SCIENTIFIC ABSTRACTS

Chronic Pain Syndromes

Percutaneous electrical nerve stimulation (PENS): a complementary therapy for the management of pain secondary to bony metastasis.
Ahmed HE, Craig WF, White PF, Huber P.

Department of Anesthesiology and Pain Management, Eugene McDermott Center for Pain Management, University of Texas Southwestern Medical Center at Dallas, 75235-9068, USA.

OBJECTIVE: To evaluate the use of a novel nonpharmacologic analgesic therapy known as percutaneous electrical nerve stimulation (PENS) in the management of opioid-resistant cancer pain. DESIGN: PENS therapy was administered to three cancer patients on three or more occasion using acupuncturelike needle probes that were stimulated for 30 minutes at frequencies of 4-100 Hz. RESULTS: Two of the three patients achieved good to excellent pain relief that lasted 24-72 hours after each treatment session. CONCLUSION: PENS therapy is a useful supplement to opioid analgesics for the management of pain secondary to bony metastasis in terminal cancer patients.

Clin J Pain 1998 Dec;14(4):320-3

Tolosa Hunt Syndrome--intractable pain treatment with acupuncture?
Nepp J, Grdser S, Flarrer S, Spacek A, Mudrich C, Stockenhuber D, Wedrich A.

Dept of Ophthalmology, University of Vienna, Austria. johannes.nepp@akh-wien.ac.at

PURPOSE: The Tolosa Hunt Syndrome (THS) is a painful granular inflammation of the cerebral vessels followed by pain and disorders of the extrabulbar muscles. The therapy consists of corticosteroids and analgetics. There was a 70 year old woman who suffered from painful paresis of the abducent and oculomotor nerves following an infection with Borrelia Burgdorferi--but without ocular symptoms. The treatment with corticosteroids reduced the palsy but she complained of excessively painful attacks in the region of the first branch of the trigeminal nerve. Opiold analgetic therapy did not bring about any relief. Acupuncture is an irritative method with a physical effect on the nervous system: its pain-reducing effect is caused by the activation of transmitters like endorphins in thalamus and brain stem. Knowing this effect, the THS patient, after informed consent, was treated with acupuncture. To measure the extent of pain, a visual analog scale (0: no pain - 10: maximum pain) was used. Acupuncture was performed according to the empirical rules of the Traditional Chinese Medicine (TCM), during a period of 10 weeks and 12 weeks. There was a significant pain relief after acupuncture from VAS 10 to VAS 5. The effect vanished during the next four months. After a second series of 12 sessions pain reduction was reported from VAS 10 to 4. One year after the last Tolosa Hunt Syndrome - intractable pain pain strength ranged between VAS 4 - 6. Therefore acupuncture seems to be a good additional method for reduction of intractable pain.

Acupunct Electrother Res 2000;25(3-4):155-63

Activation of the hypothalamus characterizes the acupuncture stimulation at the analgesic point in human: a positron emission tomography study.
Hsieh JC, Tu CH, Chen FP, Chen MC, Yeh TC, Cheng HC, Wu YT, Liu RS, Ho LT.

Integrated Brain Research Unit, Department of Medical Research and Education, Taipei Veterans General Hospital, No.201, Section 2, Shih-Pai Road, 112, Taipei, Taiwan. jchsieh@vghtpe.gov.tw

We performed a positron emission tomography study, using regional cerebral blood flow as the index of brain activity, to address the specificity of brain activation pattern by acupuncture stimulation of short duration at the classical analgesic point. Needling manipulation at 2 Hz was performed at a classical point of prominent analgesic efficacy (Li 4, Heku) and a near-by non-classical/non-analgesic point, respectively, in normal subjects. Regions activated by acupuncture stimulation at Li 4 included the hypothalamus with an extension to midbrain, the insula, the anterior cingulate cortex, and the cerebellum. Of note, it was only the stimulation at Li 4 that activated the hypothalamus under the similar psychophysical ratings of acupuncture sensation (deqi) as elicited by the stimulation at the two points, respectively. The data suggested that the hypothalamus might characterize the central expression of acupuncture stimulation at the classical analgesic point and serve as one key element in mediating analgesic efficacy of acupuncture stimulation.

Neurosci Lett 2001 Jul 13;307(2):105-8