Transcutaneous electrical acupoint stimulation as an adjunct therapy for obsessive-compulsive disorder: A randomized controlled study

Cortical functional networks of transcutaneous electrical stimulation at acupoints on the pericardial meridian

To explore the relationship between pericardial meridian acupoints and brain, the electroencephalogram (EEG) signals were collected synchronously during transcutaneous electrical stimulation at PC3, PC5, PC7, and PC8 on the pericardial meridian in 21 healthy subjects. The cerebral cortex functional networks were constructed by standard low-resolution electromagnetic tomography (sLORETA), phase-locking value (PLV) and complex network methods. The prefrontal cortex (BA10), the orbitofrontal cortex (BA11), the middle temporal gyrus (BA21), the temporal gyrus (BA22), the temporal pole (BA38), the triangular part (BA44), the dorsolateral prefrontal cortex (BA46), and the inferior frontal cortex (BA47) were activated by electrical stimulation at PC3, PC5, PC7, and PC8 on the pericardium meridian. These activated brain regions are able to modulate both local and remote emotion and cognitive networks. Acupoint stimulation of pericardium meridian mainly activated the frontal and the temporal lobes. Compared with non-acupoint stimulation, the node degree in the frontal lobe of electrical stimulation at PC3 (p < 0.05), PC5 (p < 0.05), PC7 (p < 0.01), PC8 (p < 0.05) and the temporal lobe of PC3 (p < 0.05), PC5 (p < 0.05), PC7 (p < 0.05), PC8 (p < 0.01) were significantly increased. The clustering coefficient in the frontal lobe of the stimulation at PC3 (p < 0.05), PC5 (p < 0.05), PC7 (p < 0.01), PC8 (p < 0.05) and the temporal lobe of PC3 (p < 0.05), PC5 (p < 0.05), PC7 (p < 0.01), PC8 (p < 0.05) were significantly increased. The characteristic path length decreased and the global efficiency increased during acupoint stimulation. The changes of functional network of stimulated pericardium meridian through cerebral cortex may provide theoretical support for the specificity of meridian and acupoints.

Transcutaneous electrical acupoint stimulation for suspected laryngopharyngeal reflux disease

PURPOSE

To determine the efficacy of transcutaneous electrical acupoint stimulation (TEAS) combined with proton pump inhibitor (PPI) therapy on symptoms and signs of patients with suspected laryngopharyngeal reflux disease (LPRD).

METHODS

This was a prospective randomized controlled study. Seventy patients with reflux symptom index (RSI) > 13 and reflux finding score (RFS) > 7 were recruited and received PPI alone (control group) or TEAS combined with PPI (experimental group) for 12 weeks. Patients in the experimental group received TEAS at Tiantu (RN22), Renying (ST9), and Neiguan (PC6) once a day, five times a week. RSI, RFS, throat pain visual analog score (VAS), and LPR-health-related quality-of-life (LPR-HRQL) scores were evaluated at baseline and after 4 and 12 weeks.

RESULTS

The decreases in total RSI and RFS, along with several subscores, were significantly higher in the experimental group than in the control group after 12 weeks (P < 0.05). The throat pain VAS and LPR-HRQL scores decreased significantly at 4 and 12 weeks after treatment in both groups, with significant differences between the groups (P < 0.001). No severe adverse events occurred, and the rates of adverse events were similar between the two groups.

CONCLUSION

Compared with PPI alone, TEAS combined with PPI showed a significantly greater improvement in symptoms, signs, and quality of life in the treatment of LPRD without increasing the occurrence of adverse effects. Therefore, TEAS could serve as a useful and safe treatment method for LPRD.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR2100046755.

Effect of transcutaneous electrical acupoint stimulation on bone metabolism in patients with immobilisation after foot and ankle fracture surgery: a randomised controlled trial study protocol

INTRODUCTION

Fracture is a disease with a high incidence worldwide. Foot and ankle fractures are common among fractures of the lower extremities. Foot and ankle fractures usually require surgical fixation and a period of fixed treatment, which can lead to decreased bone density. Although transcutaneous electrical acupoint stimulation (TEAS) is widely used for movement system diseases, there is minimal evidence to show the effectiveness of TEAS on patients after surgical fixation of ankle and foot fractures. This trial aims to evaluate whether TEAS can reduce bone loss in patients with immobilisation after ankle and foot fractures.

METHODS AND ANALYSIS

A randomised controlled trial will be conducted in which 60 patients will be randomly divided into two groups: (a) the control group will be treated according to the routine procedures of basic orthopaedics treatment; (b) in the treatment group, bilateral SP36, BL23 and ST36 will be performed on the basis of the control group, and the test will be performed for 30 min every other day for a total of 8 weeks. Bone turnover markers will be used as primary outcome. Secondary outcomes are composed of blood phosphorus, blood calcium and bone mineral density. Treatment safety will be monitored and recorded.

ETHICS AND DISSEMINATION

This trial is approved by the Ethics Committee of Beijing University of Chinese Medicine (2020BZYLL0611) and the Ethics Committee of Beijing Luhe Hospital (2020-LHKY-055-02), and inpatients who meet the following diagnostic and inclusion criteria are eligible to participate in this study.

TRIAL REGISTRATION NUMBER

ChiCTR 2000039944.

Efficacy of transcutaneous electrical acupoint stimulation combined with diazepam for acute alcohol withdrawal syndrome: A double-blind randomized sham-controlled trial

Objective

To compare the efficacy of transcutaneous electrical acupoint stimulation (TEAS) combined with diazepam against diazepam alone for treatment of acute alcohol withdrawal syndrome (AWS).

Methods

In this double-blind randomized sham-controlled trial, men with acute AWS were randomly allocated to either a group treated with TEAS combined with diazepam (n = 57) or a control group treated with sham TEAS combined with diazepam (n = 60). Treatment was performed at four acupoints twice a day for 14 days. The Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar), visual analogue scale (VAS), Pittsburgh Sleep Quality Index (PSQI) and modified Epworth Sleepiness Scale (mESS) were used to evaluate treatment efficacy.

Results

All scores improved significantly in both groups during the trial. CIWA-Ar scores were lower in the TEAS group than in the control group from day 3 until the end of observation. VAS and mESS scores were also lower in the TEAS group than in the control group on day 7. VAS and PSQI scores were lower in the TEAS group on day 14.

Conclusion

Combining diazepam with TEAS may result in milder AWS symptoms than diazepam alone, improve sleep quality and reduce sleepiness.

Placebo Effect in Obsessive-Compulsive Disorder (OCD). Placebo Response and Placebo Responders in OCD: The Trend Over Time

BACKGROUND

Placebo response appears to be increasing in antidepressant, antipsychotic and various internal medicine trials. A similar trend has been reported for OCD during 1989-1999. Placebo response is generally considered as the extent to which placebo treatment is associated with core symptom improvement. In this analysis, we used Joinpoint regression to assess the time trend of both placebo response and placebo responder rates according to the year of publication with no time restriction in OCD drug trials.

METHODS

We included drug and/or psychotherapy trials vs. placebo from PubMed, Embase, CINAHL, and PsycINFO retrieved through the search (placebo OR sham) AND (obsessive* OR OCD). We included studies through investigator consensus. We then performed on data of included studies log-linear joinpoint segmented regression models using a p<0.05 cutoff.

RESULTS

We included 113 studies from 112 published papers. Placebo mean annual response rates in OCD studies significantly increased from 1991 to 2017 with an annual percent change (APC) of 0.66%, while placebo mean annual responder rates also significantly increased from 2010 to 2017, with an APC of 5.45%. Drug mean annual response rates in OCD studies significantly increased from 1987 to 2012 with an APC of 0.72%, while the corresponding responder rates did not show statistically significant APC changes between 1984 and 2017.

CONCLUSION

We observed a tendency for placebo to increase both measures of response in OCD clinical drug trials through the years that tend to approximate the responses shown by drugs. Changes in the type of study (moving from classical head to head comparisons to add-on studies in treatmentresistant populations) and countries involved in experimentation may partially account for some portion of these results. It appears that placebo effects are becoming more elusive and out of control.

Combination therapy for rapid treatment of severe obsessive-compulsive disorder: a case report

Objective

A 29-year-old male from Guizhou, China, had been suffering from obsessive–compulsive disorder since graduation from junior high school at 14 years. He was afraid of putting glass substances in his mouth. His main symptoms were repetitive thoughts, inquiries and examinations for more than 6 hours a day. He dropped out of school and stayed at home. He had been taking 60 mg/day paroxetine for 7 consecutive years. Over the past 2 years, his obsessive–compulsive symptoms had increased and were present for 12 hours a day.

Methods

The patient was treated using a combination of drugs, transcutaneous electrical acupoint stimulation–exposure and response prevention therapy (TEAS–ERP) and parental involvement.

Results

After 28 days, his Yale–Brown Obsessive Compulsive Scale score dropped from 40 to 11 points. After 1 month, telephone follow-up showed that he was able to do housework and was ready to go to work. After 6 months, he was able to easily work, and his compulsive behaviour only occurred 1 to 2 times each day for about 0.5 minutes each time.

Conclusions

The combination of TEAS–ERP, sertraline and clomipramine had a rapid effect. There was no resumption of obsessive–compulsive symptoms during post-treatment follow-up.

Transcutaneous electrical acupoint stimulation for post-traumatic stress disorder: Assessor-blinded, randomized controlled study

AIM

Transcutaneous electrical acupoint stimulation (TEAS) has the potential to alleviate post-traumatic stress disorder (PTSD). The purpose of this study was to determine whether adding TEAS to sertraline or cognitive behavioral therapy (CBT) could improve the anti-PTSD efficacy.

METHODS

In this randomized controlled trial, 240 PTSD patients (60 in each group) were assigned to receive simulated TEAS combined with sertraline (group A) or with CBT (group B), active TEAS combined with CBT (group C), or active TEAS combined with CBT plus sertraline (group D) for 12 weeks. The outcomes were measured using the Clinician-Administered PTSD Scale, PTSD Check List-Civilian Version, and 17-item Hamilton Rating Scale for Depression.

RESULTS

While PTSD symptoms reduced over time in all patients, groups C and D had markedly greater improvement in both PTSD and depressive measures than groups A and B in all post-baseline measurement points, with moderate to very large effect sizes of 0.484-2.244. Groups C and D also had a significantly higher rate than groups A and B on clinical response (85.0% and 95.0% vs 63.3% and 60.0%, P < 0.001) and on remission (15.0% and 25.0% vs 3.3% and 1.7%, P < 0.001). The incidence of adverse events was similar between groups A and D and between groups B and C.

CONCLUSIONS

Additional TEAS augments the anti-PTSD and antidepressant efficacy of antidepressants or CBT, without increasing the incidence of adverse effects. TEAS could serve as an effective intervention for PTSD and comorbid depression. This trial was registered with www.chictr.org (no.: ChiCTR1800017255).