Effect of electroacupuncture on pain after periodontal flap surgery: a randomized controlled trial

  • Bulut Emre ,
  • ?zkal Emino?lu Didem ,
  • ?ay?r Yasemin
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  • 1 Department of Periodontology, Faculty of Dentistry, Atatürk University, Erzurum, 25100, Türkiye
    2 Department of Family Medicine, Faculty of Medicine, Atatürk University, Erzurum 25100, Türkiye

Received date: 2023-12-22

  Accepted date: 2024-03-20

  Online published: 2025-01-10

Abstract

OBJECTIVE: To examine the effect of electro-acupuncture (EA) application on postoperative pain levels and the amount of analgesic use in patients who underwent periodontal flap surgery.

METHODS: In this prospective, randomized and controlled study, patients planned for periodontal surgery were divided into two groups [EA group (n = 22): patients who received electroacupuncture and control group (n = 22): patients who did not receive electroacupuncture]. Electroacupuncture was applied bilaterally to the Hegu (LI4), Daying (ST5), and Jiache (ST5) points of the patients in the EA group immediately before and after the flap surgery for 30 min at a frequency of 50 Hz to each point at a current that the patient could tolerate. The patients in the control group underwent flap surgery without applying electroacupuncture. Patients were asked to record their pain levels on the visual analog scale and the number of analgesic tablets they took during the 7 postoperative days on the given form.

RESULTS: The total mean score of pain felt in the EA group (16.60 ± 2.78) was found to be significantly lower than that in the control group (31.37 ± 2.78) (P = 0.001). No significant difference was found between the groups regarding the amount of analgesics taken (4.77 ± 4.72, 5.82 ± 3.11) (P = 0.111).

CONCLUSIONS: Our study shows that electro-acupuncture application is beneficial in reducing pain after periodontal flap surgery. Overall, more research is needed to fully understand the effects of electro-acupuncture on postoperative pain.

Cite this article

Bulut Emre , ?zkal Emino?lu Didem , ?ay?r Yasemin . Effect of electroacupuncture on pain after periodontal flap surgery: a randomized controlled trial[J]. Journal of Traditional Chinese Medicine, 2025 , 45(1) : 184 -191 . DOI: 10.19852/j.cnki.jtcm.2025.01.018

References

1. Pogatzki-Zahn EM, Segelcke D, Schug SA. Postoperative pain-from mechanisms to treatment. Pain Rep 2017; 2: e588.
2. Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res 2017; 10: 2287-98.
3. Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth 2001; 87: 62-72.
4. Stephens J, Laskin B, Pashos C, Pena B, Wong J. The burden of acute postoperative pain and the potential role of the COX-2-specific inhibitors. Rheumatology 2003; 42: 40-52.
5. Kelly DJ, Ahmad M, Brull SJ. Preemptive analgesia I: physiological pathways and pharmacological modalities. Can J Anaesth 2001; 48: 1000-10.
6. Pergolizzi JV, Breve F, Magnusson P, LeQuang JK, Varassi G. Current and emerging COX inhibitors for treating postoperative pain following oral surgery. Expert Opin Pharmacother 2023; 24: 347-58.
7. Feray S, Lubach J, Joshi GP, et al. PROSPECT guidelines for video-assisted thoracoscopic surgery: a systematic review and procedur-specific postoperative pain management recomm-endations. Anaesthesia 2022; 77: 311-25.
8. Patel NP, Bates CM, Patel A, Bates C. Developmental approaches to chronic pain: a narrative review. Cureus 2023; 15: e45238
9. Fan M, Chen Z. A systematic review of non pharmacological interventions used for pain relief after orthopedic surgical procedures. Exp Ther Med 2020; 20: 36.
10. Kefeli ?elik H, Tulgar S, Güler S, et al. Evaluation of postoperative analgesic efficacy of ultrasound-guided suprainguinal fascia ?liaca block in knee arthroplasty: prospective, randomized, feasibility study. J Clin Med 2023; 12: 6076.
11. Gitto E, Pellegrino S, Manfrida M, et al. Stress response and procedural pain in the preterm newborn: the role of pharmacological and non-pharmacological treatments. Eur J Pediatr 2012; 171: 927-33.
12. Nadler SF. Nonpharmacologic management of pain. J Osteopath Med 2004; 104: 6-12.
13. Adams ML, Arminio GJ. Nonpharmacologic pain management intervention. Clin Podiatr Med Surg 2008; 25: 409-29.
14. Snyder M, Wieland J. Complementary and alternative therapies: what is their place in the management of chronic pain? Nurs Clin 2003; 38: 495-508.
15. Wang X, Bao C, Li Z, Yue L, Hu L. Side effects of opioids are ameliorated by regulating TRPV1 receptors. Int J Environ Res Public Health 2022; 19: 2387.
16. Herr KA, Mobily PR. Interventions related to pain. Nurs Clin North Am 1992; 27: 347-69.
17. Seers K, Carroll D. Relaxation techniques for acute pain management: a systematic review. J Adv Nurs 1998; 27: 466-75.
18. Good M, Stanton-Hicks M, Grass JA, et al. Relaxation and music to reduce postsurgical pain. J Adv Nurs 2001; 33: 208-15.
19. Liu L, Zhao G, Dou Y, et al. Analgesic effects of perioperative acupuncture methods: a narrative review. Medicine (Baltimore) 2023; 102: e35759.
20. Fan AY, Alemi SF. Dr. Lian Zhu: a founder of contemporary acupuncture medicine. Med Acupunct 2023; 35: 195-201.
21. Dalamagka MI. Acupuncture and electrotherapy: an alternative and complementary treatment method. WJARR 2023; 17: 556-63.
22. Tavares MG, Machado AP, Motta BG, Borsatto MC, Rosa AL, Xavier SP. Electro-acupuncture efficacy on pain control after mandibular third molar surgery. Braz Dent J 2007; 18: 158-62.
23. Wang SM, Harris RE, Lin YC, Gan TJ. Acupuncture in 21st century anesthesia: is there a needle in the haystack? Anesth Analg 2013; 116: 1356-59.
24. Sardella A, Lodi G, Tarozzi M, Varoni E, Franchini R, Carrassi A. Acupuncture and burning mouth syndrome: a pilot study. Pain Prac 2013; 13: 627-32.
25. Chen HT, Hung KC, Huang YT, et al. Efficacy of electroacupuncture in improving postoperative ileus in patients receiving colorectal surgery: a systematic review and Meta-analysis. Int J Surg 2023; 110: 1113-25.
26. Janssens L, Altman S, Rogers PA. Respiratory and cardiac arrest under general anaesthesia: treatment by acupuncture of the nasal philtrum. Vet Rec 1979; 105: 273-6.
27. Tousignant-Laflamme Y, Laroche C, Beaulieu C, Bouchard AJ, Boucher S, Michaud-Létourneau M. A randomized trial to determine the duration of analgesia following a 15-and a 30-minute application of acupuncture-like TENS on patients with chronic low back pain. Physiother Theory Pract 2017; 33: 361-9.
28. Park S, Lyu YR, Park SJ, Oh MS, Jung IC, Lee EJ. Electroacupuncture for post-thoracotomy pain: a systematic review and Meta-analysis. PloS one 2021; 16: e0254093.
29. Arslan H, Ahmed HMA, Y?ld?z ED, Gündo?du EC, Se?kin F, Arslan S. Acupuncture reduces the postoperative pain in teeth with symptomatic apical periodontitis: a preliminary randomized placebo-controlled prospective clinical trial. Quintessence Int 2019; 50: 270-7.
30. Trindade D, Carvalho R, Machado V, Chambrone L, Mendes JJ, Botelho J. Prevalence of periodontitis in dentate people between 2011 and 2020: a systematic review and Meta-analysis of epidemiological studies. J Clin Periodontol 2023; 50: 604-26.
31. Papapanou PN, Sanz M, Buduneli N, et al. Periodontitis: consensus report of workgroup 2 of the 2017 World Workshop on the classification of periodontal and peri-?mplant diseases and conditions. J Periodontol 2018; 89: 173-82.
32. Gil MLB, Marinho LMRF, de Moraes M, et al. Effectiveness of acupuncture in dental surgery: a randomized, crossover, controlled trial. J Acupunct Meridian Stud 2020; 13: 104-9.
33. Kjeldsen HB, Klausen TW, Rosenberg J. Preferred presentation of the visual analog scale for measurement of postoperative pain. Pain Pract 2016; 16: 980-4.
34. Gallagher EJ, Liebman M, Bijur PE. Prospective validation of clinically important changes in pain severity measured on a visual analog scale. Ann Emerg Med 2001; 38: 633-8.
35. Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' committee on regional anesthesia, executive committee, and administrative council. J Pain 2016; 17: 131-57.
36. Hernandez-Boussard T, Graham LA, Desai K, et al. The fifth vital sign postoperative pain predicts 30-day readmissions and subsequent emergency department visits. Ann Surg 2017; 266: 516.
37. Atchabahian A, Andreae M. Long-term functional outcomes after regional anesthesia: a summary of the published evidence and a recent Cochrane review. Refresh Courses Anesthesiol 2015; 43: 15.
38. Papaioannou M, Skapinakis P, Damigos D, Mavreas V, Broumas G, Palgimesi A. The role of catastrophizing in the prediction of postoperative pain. Pain Med 2009; 10: 1452-9.
39. Kim K, Brar P, Jakubowski J, Kaltman S, Lopez E. The use of corticosteroids and nonsteroidal antiinflammatory medication for the management of pain and inflammation after third molar surgery: a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: 630-40.
40. Elmowitz JS, Shupak RP. Pharmacological and non-pharm-acological methods of postoperative pain control following oral and maxillofacial surgery: a scoping review. J Oral Maxillofac Surg 2021; 79: 2000-9.
41. NIH Consensus Conference. Acupuncture. JAMA 1998; 280: 1518-24.
42. Kim HW, Uh DK, Yoon SY, et al. Low-frequency electro-acupuncture suppresses carrageenan-induced paw inflammation in mice via sympathetic post-ganglionic neurons, while high-frequency EA suppression is mediated by the sympathoadrenal medullary axis. Brain Res Bull 2008; 75: 698-705.
43. Zhang R, Lao L, Ren K, Berman BM. Mechanisms of acupuncture-electroacupuncture on persistent pain. Anesthesiol 2014; 120: 482-503.
44. Kimura K, Ryujin T, Uno M, Wakayama I. The effect of electroacupuncture with different frequencies on muscle oxygenation in humans. Evid Based Complement Alternat Med 2015; 2015: 620785.
45. Cai FH, Li FL, Zhang YC, Li PQ, Xiao B. Research on electroacupuncture parameters for knee osteoarthritis based on data mining. Eur J Med Res. 2022; 27: 162.
46. Lin JG, Lo MW, Wen YR, Hsieh CL, Tsai SK, Sun WZ. The effect of high and low frequency electroacupuncture in pain after lower abdominal surgery. Pain 2002; 99: 509-14.
47. Yang ZL, Ouyang Z, Cheng YG, Chen YX. A neuromagnetic study of acupuncturing LI-4 (Hegu). Acupunct Electrother Res 1995; 20: 15-20.
48. Lewith GT, Machin D. On the evaluation of the clinical effects of acupuncture. Pain 1983; 16: 111-27.
49. Rosted P. Practical recommendations for the use of acupuncture in the treatment of temporomandibular disorders based on the outcome of published controlled studies. Oral Dis 2001; 7: 109-15.
50. Wu MS, Chen KH, Chen IF, et al. The efficacy of acupuncture in post-operative pain management: a systematic review and Meta-analysis. PloS one 2016; 11: e0150367.
51. Chen T, Wang K, Xu J, Ma W, Zhou J. Electroacupuncture reduces postoperative pain and analgesic consumption in patients undergoing thoracic surgery: a randomized study. Evid Based Complement Alternat Med 2016; 1: 2126416.
52. Xie YH, Chai XQ, Wang YL, Gao YC, Ma J. Effect of electro-acupuncture stimulation of Ximen (PC4) and Neiguan (PC6) on remifentanil-induced breakthrough pain following thoracal esophagectomy. J Huazhong Univ Sci Technolog Med Sci 2014; 34: 569-74.
53. Zhao XB, Xing QZ, Han XC. Observation on electroacupuncture at neimadian (extra) and Neiguan (PC 6) for analgesia after thoracic surgery. Zhong Guo Zhen Jiu 2013; 33: 829-32.
54. Zhu Y, Zhou H, Min Y, Shi L. Effect of preoperative acupuncture on peri-operative pain in patients following a thoracotomy. J Acupunct Tu?na Sc? 2011; 9: 79-83.
55. Wong RH, Lee TW, Sihoe AD, et al. Analgesic effect of electroacupuncture in postthoracotomy pain: a prospective randomized trial. Ann Thorac Surg 2006; 81: 2031-6.
56. Chen W, Chen Z, Li J, et al. Electroacupuncture as an adjuvant approach to rehabilitation during postacute phase after total knee arthroplasty: a systematic review and Meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med 2021; 1: 9927699.
57. Shen J, Zhou X, Zhao J, et al. Electroacupuncture at Baliao point alleviates post-operative pain and anal distension after procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy): a prospective randomized clinical trial. Int J Colorectal Dis 2023; 38: 104.
58. Reisli R, Akkaya ?T, Ar?can ?, et al. Pharmachologic treatment of acute postoperative pain: a clinical practice guideline of the Turkish Society of Algology. A?ri 2021; 33: 1-51.
59. Yang J, Huang L, Zhu J, et al. Effects of perioperative electroacupuncture on postoperative gastrointestinal recovery after thoracoscopic lung surgery. Explore (NY) 2024; 3: 450-5.
60. Chen S, Wang S, Rong P, et al. Acupuncture for visceral pain: neural substrates and potential mechanisms. Evid Based Complement Alternat Med 2014; 1: 609594.
61. Sun Y, Gan TJ, Dubose JW, Habib AS. Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. Br J Anaesth 2008; 101: 151-60.
62. Manheimer E, Cheng K, Linde K, et al. Acupuncture for peripheral joint osteoarthritis. Cochrane Database Syst Rev 2010; 1: 1-193.
63. Melzack R. From the gate to the neuromatrix. Pain 1999; 82: 121-6.
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