EC Neurology

Acute and chronic pain management is demanding for many healthcare professionals and their patients. Patients need relief. However, physicians must balance the therapeutic benefits of such therapy with the potential or actual adverse effects, including drug dependence, overdose and unintended death. The opioid crisis has reached epidemic proportions, resulting in considerable and un- necessary loss of life. This crisis and other adverse effects of pain medications necessitates applying an individualized, multimodal, and multidisciplinary approach to pain management. Effective non-pharmacological options should be considered and utilized to a greater extent—than they currently are—for more efficacious results for the patient and stem the tidal wave tide of drug dependence and addiction. Electricity has been used for pain relief since ancient times and is becoming more widely used today. Many healthcare providers have heard about electroanalgesia but may know little about how electroanalgesia works (its mechanisms of action), its indications and contraindications, what devices are available, and how to integrate electroanalgesia and electrotherapy into their practices for the benefit of specific, acute and chronic pain patients. This review aims to bridge this knowledge and know-how gap regarding electroanalgesia and electrotherapy by providing an overview of five types of electroanalgesia currently used clinically and how to integrate such therapies into practice; these five types being electroacupuncture (EA), ultrasound-guided acupotomy, transcutaneous electrical nerve stimulation (TENS), percutaneous electrical nerve stimulation (PENS) and peripheral nerve stimula- tion (PNS).

Keywords: Analgesia; Busy Line-Effect; Electroacupuncture; Pain; Electrotherapy; Laser; Opioid Crises; Transcutaneous

1. Pain Management Best Practices Inter-Agency Task Force Report (2020).
2. Web statement on pain management guidance (2020).
3. Teoli D and An J. “Transcutaneous Electrical Nerve Stimulation (2020).
4. Melzack R and Wall PD. “Pain Mechanisms: A New Theory”. Science 150.3699 (1965).
5. Walsh DM., et al. “Current Therapy in Pain”. Current Therapy in Pain (2009).
6. Jun M-H., et al. “Modern acupuncture-like stimulation methods: a literature review”. Integrative Medicine Research 4.4 (2015).
7. Deer TR., et al. “A review of the bioelectronic implications of stimulation of the peripheral nervous system for chronic pain conditions”. Bioelectronic Medicine 6.1 (2020).
8. White PF., et al. “Electroanalgesia: Its role in acute and chronic pain management”. Anesthesia and Analgesia 92.2 (2001).
9. North RB., et al. “Chronic stimulation via percutaneously inserted epidural electrodes”. Neurosurgery 1.2 (1977).
10. White PF., et al. “Use of electroanalgesia and laser therapies as alternatives to opioids for acute and chronic pain management”. F1000 Research (2017): 6.
11. Qi L., et al. “Comparing the Effectiveness of Electroacupuncture with Different Grades of Knee Osteoarthritis: A Prospective Study”. Cellular Physiology and Biochemistry 39.6 (2016).
12. Zhang Q., et al. “Effects of preconditioning of electro-acupuncture on postoperative cognitive dysfunction in elderly”. Medicine 96.26 (2017): e7375.
13. Jeong JK., et al. “Acupotomy versus manual acupuncture for the treatment of back and/or leg pain in patients with lumbar disc herniation: A multicenter, randomized, controlled, assessor-blinded clinical trial”. Journal of Pain Research (2020): 13.
14. Qiu Z., et al. “Acupotomy by an ultrasound-guided technique: A protocol for a systematic review”. Medicine 98.42 (2019): e17398.
15. Cardinali A., et al. “Efficacy of Transcutaneous Electrical Nerve Stimulation for Postoperative Pain, Pulmonary Function, and Opioid Consumption Following Cardiothoracic Procedures: A Systematic Review”. Neuromodulation: Technology at the Neural Interface (2020).
16. KasapoÄa., et al. “The efficacy of transcutaneous electrical nerve stimulation therapy in pain control after cesarean section delivery associated with uterine contractions and abdominal incision”. Turkish Journal of Physical Medicine and Rehabilitation 66.2 (2020).
17. Weatherall MW and Nandi D. “Percutaneous electrical nerve stimulation (PENS) therapy for refractory primary headache disorders: a pilot study”. British Journal of Neurosurgery 33.6 (2019).
18. Rossi M., et al. “A novel mini-invasive approach to the treatment of neuropathic pain: The PENS study”. Pain Physician 19.1 (2016).
19. Li H and Xu QR. “Effect of percutaneous electrical nerve stimulation for the treatment of migraine”. Medicine 96.39 (2017).
20. Khalili Yasir Al and das JM. “Nerve Stimulation (2020).
21. Roberson R., et al. A safe “opioid” – is dry needling an efficacious alternative to opioids? Int J Complement Alt Med. 2019;12(1):6‒8. DOI: 10.15406/ijcam.2019.12.00440.
22. Cummings M. “Percutaneous electrical nerve stimulation--electroacupuncture by another name? A comparative review”. Acupuncture in Medicine. 19.1 (2001): 32-35.
23. Mainkar O., et al. “Pilot Study in Temporary Peripheral Nerve Stimulation in Oncologic Pain”. Neuromodulation: Technology at the Neural Interface 23.6 (2020).
24. Albright-Trainer B., et al. “A Case Report of Peripheral Nerve Stimulation for Acute Neuropathic Pain in Guillain-Barre Syndrome”. A and A Practice 14.11 (2020).
25. Johnson M. “Transcutaneous Electrical Nerve Stimulation: Mechanisms, Clinical Application and Evidence”. Reviews in Pain 1.1 (2007).
26. Cotler HB. “The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain”. MOJ Orthopedics and Rheumatology 2.5 (2015).
27. Abdelbasset WK., et al. “A Randomized Comparative Study between High-Intensity and Low-Level Laser Therapy in the Treatment of Chronic Nonspecific Low Back Pain”. Evidence-Based Complementary and Alternative Medicine (2020).
28. Chung H., et al. “The nuts and bolts of low-level laser (Light) therapy”. Annals of Biomedical Engineering 40.2 (2012).
29. Hayes Jr., et al.. “A Comparison of the Clinical Effectiveness of Specific Neurostimulation and Photobiomodulation Modalities with Therapeutic Nutrition in the Treatment of Peripheral Neuropathy”. EC Neurology 12.6 (2020): 13-26.
30. Akkurt F., et al. “Efficacy of High-Intensity Laser Therapy and Silicone Insole in Plantar Fasciitis”. International Journal of Physical Medicine and Rehabilitation 06.05 (2018).
31. Eriksen J., et al. “Critical issues on opioids in chronic non-cancer pain:. An epidemiological study”. Pain 125.1-2 (2006).
32. Sator-Katzenschlager SM., et al. “The Short- and Long-Term Benefit in Chronic Low Back Pain Through Adjuvant Electrical Versus Manual Auricular Acupuncture”. Anesthesia and Analgesia 98.5 (2004).
33. Carlsson CPO and Sjölund BH. “Acupuncture for chronic low back pain: A randomized placebo-controlled study with long-term follow-up”. Clinical Journal of Pain 17.4 (2001).
34. Zhang R., et al. “Acupotomy versus nonsteroidal anti-inflammatory drugs for knee osteoarthritis: Protocol for a systematic review and meta-analysis”. Medicine 98 (2019).
35. Jauregui JJ., et al. “A Meta-Analysis of Transcutaneous Electrical Nerve Stimulation for Chronic Low Back Pain”. Surgical Technology International (2016): 28.
36. Da Silva Salazar AP., et al. “Electric stimulation for pain relief in patients with fibromyalgia: A systematic review and meta-analysis of randomized controlled trials 20 (2017).
37. Kadhim-Saleh A., et al. “Is low-level laser therapy in relieving neck pain effective? Systematic review and meta-analysis”. Rheumatology International 33.10 (2013)
38. Ramanathan D., et al. “The Use of Transcutaneous Electrical Nerve Stimulation After Total Knee Arthroplasty: A Prospective Randomized Controlled Trial”. Surgical Technology International (2017): 30