A Randomized Controlled Trial of Auricular Transcutaneous Electrical Nerve Stimulation for Managing Posthysterectomy Pain

Abstract

Background. A patient- and assessor-blinded randomized controlled trial was conducted to examine the effectiveness of auricular transcutaneous electrical nerve stimulation (TENS) in relieving posthysterectomy pain. Method. Forty-eight women who had undergone a total abdominal hysterectomy were randomly assigned into three groups (n = 16 each) to receive either (i) auricular TENS to therapeutic points (the true TENS group), (ii) auricular TENS to inappropriate points (the sham TENS group), or (iii) 20 minutes of bed rest with no stimulation (the control group). The intervention was delivered about 24 hours after the operation. A visual analogue scale was used to assess pain while resting (VAS-rest) and upon huffing (VAS-huff) and coughing (VAS-cough), and the peak expiratory flow rate (PEFR) was assessed before and at 0, 15, and 30 minutes after the intervention. Result. As compared to the baseline, only the true TENS group reported a significant reduction in VAS-rest (P = .001), VAS-huff (P = .004), and VAS-cough (P = .001), while no significant reduction in any of the VAS scores was seen in the sham TENS group (all P > .05). In contrast, a small rising trend was observed in the VAS-rest and VAS-huff scores of the control group, while the VAS-cough score remained largely unchanged during the period of the study. A between-group comparison revealed that all three VAS scores of the true TENS group were significantly lower than those of the control group at 15 and 30 minutes after the intervention (all P < .02). No significant between-group difference was observed in PEFR at any point in time. Conclusion. A single session of auricular TENS applied at specific therapeutic points significantly reduced resting (VAS-rest) and movement-evoked pain (VAS-huff, VAS-cough), and the effects lasted for at least 30 minutes after the stimulation. The analgesic effects of auricular TENS appeared to be point specific and could not be attributed to the placebo effect alone. However, auricular TENS did not produce any significant improvement in the performance of PEFR.

Acupuncture-Point Stimulation for Postoperative Pain Control: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…A total of 121 full-text articles were reviewed. After application of the inclusion criteria, 59 RCTs [ 3 , 6 , 14 , 19 , 20 , 23 – 25 , 28 – 78 ] conducted between 1986 and 2014 were included in the review ( Figure 1 ; Tables 2 – 4 ). Nine publications were in Chinese, and the remaining 50 publications were in English.…”

“…Fourteen [ 6 , 19 , 24 , 62 – 72 ] RCTs used auricular points for stimulation. Data synthesis from 12 studies showed significantly lower VAS scores in intervention groups than in all types of control group ( P = 0.001), and similar results were obtained in comparison with standard treatment ( P = 0.04) and sham/placebo control ( P = 0.02) groups ( Table 5 ).…”

“…The evidence for manual auricular acupuncture reducing postoperative pain intensity in surgery patients was determined to be of Level II quality based on two overall high quality RCTs [ 68 , 71 ]. Meta-analysis of auricular EA data from three studies [ 19 , 66 , 69 ] showed a significant reduction in VAS scores (including those reflecting pain at rest and on huffing and coughing; P < 0.0001), although two of the four RCTs examining this treatment found no significant difference due to low pain intensity in intervention groups. The evidence for auricular EA reducing postoperative pain intensity in surgery patients was determined to be of Level II quality based on one overall high quality RCT [ 69 ].…”

“…Early studies showed that APS provided postoperative pain relief in comparison with control groups [ 17 , 18 ]. Recently, several small trials [ 3 , 19 ] demonstrated that APS can relieve pain and reduce analgesic requirements associated with hysterectomy and inguinal surgery. However, Sakurai et al [ 20 ] failed to identify any significant change in pain intensity or morphine requirement in surgical patients undergoing acupressure.…”

Preventive Effect of Transcutaneous Acupoint Electrical Stimulation in Treating Postoperative Nausea and Vomiting in Patients Craniotomy

“…Postoperative Nausea and Vomiting (PONV) occurs in up to 30% of unselected surgical patients and is the most frequent side effect after anaesthesia [1][2][3]. PONV not only reduced patient satisfaction but also was rated worse than postoperative pain in some of the patients [4,5].…”