Download PDF
Endoscopy
DOI: 10.1055/a-2373-0513
Innovations and brief communications

Effect of transcutaneous electrical nerve stimulation based on wrist-ankle acupuncture theory for pain relief during colonoscopy without anesthesia: a randomized controlled trial

Xiaonan Huang  ‡
1   Department of Rehabilitation Medicine, Changhai Hospital, Naval Medical University, Shanghai, China
2   School of Health Sciences and Engineering, University of Shanghai for Science and Technology, Shanghai, China
,
Hao Wang‡
3   Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
,
Lei Shi
1   Department of Rehabilitation Medicine, Changhai Hospital, Naval Medical University, Shanghai, China
,
Lifan Xu
1   Department of Rehabilitation Medicine, Changhai Hospital, Naval Medical University, Shanghai, China
4   School of Sports and Health, Shanghai University of Sport, Shanghai, China
,
Can Lv
1   Department of Rehabilitation Medicine, Changhai Hospital, Naval Medical University, Shanghai, China
,
Wenjuan Song
1   Department of Rehabilitation Medicine, Changhai Hospital, Naval Medical University, Shanghai, China
,
Lele Huang
1   Department of Rehabilitation Medicine, Changhai Hospital, Naval Medical University, Shanghai, China
2   School of Health Sciences and Engineering, University of Shanghai for Science and Technology, Shanghai, China
,
Feihu Yan
3   Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
,
Ping Shi
2   School of Health Sciences and Engineering, University of Shanghai for Science and Technology, Shanghai, China
,
Mengcheng Cai
5   Department of Rehabilitation Medicine, Naval Medical Center, Shanghai, China
,
Fanfu Fang
1   Department of Rehabilitation Medicine, Changhai Hospital, Naval Medical University, Shanghai, China
› Author AffiliationsSupported by: Shanghai Shenkang Hospital Development Center Medical Enterprise Integration and Transformation Special Project SHDC2022CRD004
Supported by: National Natural Science Foundation of China NSFC62371300
Supported by: Military high-level scientific and technological innovation talent project [2020]NQ06128

Clinical Trial: Registration number (trial ID): ChiCTR2300076524, Trial registry: Chinese Clinical Trial Registry (http://www.chictr.org/), Type of Study: prospective randomized controlled study
› Further Information
Also available at
    Permissions and Reprints


Abstract

Background Colonoscopy is essential for diagnosing colorectal diseases but can cause pain during the procedure. This study explored the analgesic effects of transcutaneous electrical nerve stimulation based on wrist-ankle acupuncture theory (TENS-WAA) in colonoscopy without anesthesia.

Methods This prospective study included 120 participants undergoing colonoscopies without anesthesia. The trial group received low-frequency, high-intensity TENS-WAA adjusted to the maximum tolerable current, while the control group received minimal current. The primary outcome was the retrospective pain score on a visual analog scale (VAS). Secondary outcomes included time, heart rate, and credibility/expectancy questionnaire (CEQ) scores.

Results Participants who received TENS-WAA reported significantly lower pain VAS scores than the control group (estimated median difference –1.1, 95%CI –2 to –0.4; P = 0.002). Male participants in the trial group experienced significantly lower pain scores than the control group (mean difference –1.4, 95%CI –2.41 to –0.39; P = 0.008). The trial group showed significantly less variation in heart rates (P<0.001) and higher CEQ scores (P = 0.001) than the control group. No adverse events were reported.

Conclusion TENS-WAA effectively reduced pain during colonoscopy without anesthesia, especially in male participants, providing a promising noninvasive analgesic method.

Supplementary Material



Publication History

Received: 15 February 2024

Accepted after revision: 24 July 2024

Accepted Manuscript online:
25 July 2024

Article published online:
16 September 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Brahmania M, Park J, Svarta S. et al. Incomplete colonoscopy: maximizing completion rates of gastroenterologists. Can J Gastroenterol 2012; 26: 589-592 DOI: 10.1155/2012/353457. (PMID: 22993727)
    Google Scholar
  • 2 Shaohua X, Junda L, Xiaoling W. et al. Application of abdominal manual pressing in the nursing care of electronic colonoscopy. Nurs Res 2010; 24: 2575-2576
    Google Scholar
  • 3 Xu N, Liu LL, Rong W. Wrist-ankle acupuncture as additional therapy for postoperative multimodal analgesia in orthopedic surgery: systematic review and meta-analysis. Pain Med 2022; 23: 1654-1669 DOI: 10.1093/pm/pnac065. (PMID: 35482527)
    Google Scholar
  • 4 He T, Liu C, Lu ZX. et al. Effect of wrist-ankle acupuncture on propofol dosage during painless colonoscopy: a randomized controlled prospective study. World J Clin Cases 2022; 10: 3764-3772
    Google Scholar
  • 5 Han JS, Chen XH, Sun SL. et al. Effect of low- and high-frequency TENS on Met-enkephalin-Arg-Phe and dynorphin A immunoreactivity in human lumbar CSF. Pain 1991; 47: 295-298 DOI: 10.1016/0304-3959(91)90218-M. (PMID: 1686080)
    Google Scholar
  • 6 Amer-Cuenca JJ, Goicoechea C, Girona-López A. et al. Pain relief by applying transcutaneous electrical nerve stimulation (TENS) during unsedated colonoscopy: a randomized double-blind placebo-controlled trial. Eur J Pain 2011; 15: 29-35
    Google Scholar
  • 7 Song W, Wang X, Zhou J. et al. Rehabilitation of an analgesic bracelet based on wrist-ankle acupuncture in patients with rotator cuff injury: a randomized trial. Pain Res Manag 2021; 2021: 9946548
    Google Scholar
  • 8 Shi P, Liu J, Du J. et al. Pain modulation induced by electronic wrist-ankle acupuncture: a functional near-infrared spectroscopy study. Pain Pract 2022; 22: 182-190 DOI: 10.1111/papr.13076. (PMID: 34519161)
    Google Scholar
  • 9 Du J, Shi P, Liu J. et al. Analgesic electrical stimulation combined with wrist-ankle acupuncture reduces the cortical response to pain in patients with myofasciitis: a randomized clinical trial. Pain Med 2023; 24: 351-361
    Google Scholar
  • 10 Holme O, Bretthauer M, de Lange T. et al. Risk stratification to predict pain during unsedated colonoscopy: results of a multicenter cohort study. Endoscopy 2013; 45: 691-696
    Google Scholar
  • 11 Zhiqin C. Research on the application of floating needle analgesia in colonoscopy [master’s thesis]. Nanjing, China: Nanjing University of Chinese Medicine; 2017
    Google Scholar
  • 12 Huo Y, Chen P, Zhu JN. et al. Curative effect of wrist-ankle acupuncture on postpartum abdominal pain and its influence on serum β-EP level in puerpera. Zhongguo Zhen Jiu 2023; 43: 1257-1260 DOI: 10.13703/j.0255-2930.20230228-k0006. (PMID: 37986248)
    Google Scholar
  • 13 Peng WW, Tang ZY, Zhang FR. et al. Neurobiological mechanisms of TENS-induced analgesia. Neuroimage 2019; 195: 396-408 DOI: 10.1016/j.neuroimage.2019.03.077. (PMID: 30946953)
    Google Scholar
  • 14 Vance CGT, Dailey DL, Chimenti RL. et al. Using TENS for pain control: update on the state of the evidence. Medicina (Kaunas) 2022; 58: 1332 DOI: 10.3390/medicina58101332. (PMID: 36295493)
    Google Scholar
  • 15 Moran F, Leonard T, Hawthorne S. et al. Hypoalgesia in response to transcutaneous electrical nerve stimulation (TENS) depends on stimulation intensity. J Pain 2011; 12: 929-935 DOI: 10.1016/j.jpain.2011.02.352. (PMID: 21481649)
    Google Scholar
  • 16 Huang Z, Lin Z, Lin C. et al. Transcutaneous electrical acustimulation improves irritable bowel syndrome with constipation by accelerating colon transit and reducing rectal sensation using autonomic mechanisms. Am J Gastroenterol 2022; 117: 1491-1501
    Google Scholar
  • 17 Smith TJ, Wang EJ, Loprinzi CL. Cutaneous electroanalgesia for relief of chronic and neuropathic pain. N Engl J Med 2023; 389: 158-164 DOI: 10.1056/NEJMra2110098. (PMID: 37437145)
    Google Scholar
  • 18 Saunders BP, Fukumoto M, Halligan S. et al. Why is colonoscopy more difficult in women?. Gastrointest Endosc 1996; 43: 124-126 DOI: 10.1016/s0016-5107(06)80113-6. (PMID: 8635705)
    Google Scholar
  • 19 Bugajski M, Wieszczy P, Hoff G. et al. Modifiable factors associated with patient-reported pain during and after screening colonoscopy. Gut 2018; 67: 1958-1964
    Google Scholar
  • 20 Clancy JA, Mary DA, Witte KK. et al. Non-invasive vagus nerve stimulation in healthy humans reduces sympathetic nerve activity. Brain Stimul 2014; 7: 871-877 DOI: 10.1016/j.brs.2014.07.031. (PMID: 25164906)
    Google Scholar