Therapeutic Efficacy Observation on Electroacupuncture of Different Frequencies for the Third Lumbar Transverse Process Syndrome

Liang Bo, Chen Pei, Zhang Fu-fang, Zhang Lu-lu

Physical Therapy Department, the 155th Central Hospital of Chinese People's Liberation Army, Henan 475000, China

Therapeutic Efficacy Observation on Electroacupuncture of Different Frequencies for the Third Lumbar Transverse Process Syndrome

Liang Bo, Chen Pei, Zhang Fu-fang, Zhang Lu-lu

Physical Therapy Department, the 155th Central Hospital of Chinese People's Liberation Army, Henan 475000, China

Objective: To observe the clinical effect of electroacupuncture (EA) of different frequencies for the third lumbar transverse process syndrome.

Methods: A total of 80 cases with the 3rd lumbar transverse process syndrome were randomized into two groups, 40 in each group. Ashi points were connected with K8832-T treatment device in the medium-frequency electroacupuncture (EA)group, whereas Ashi points were connected with G6805-2 electric stimulator in the traditional EA group. The curative effects were evaluated after 10 treatment sessions.

Results: The therapeutic efficacy in the medium-frequency EA group was significantly better than that of the traditional EA group (P＜0.05). In addition, the improvement of VAS scores in the medium-frequency EA group was more notable than that of the traditional EA group (P＜0.05).

Conclusion: The medium-frequency EA is an easy and effective therapy for the 3rd lumbar transverse process syndrome and therefore worth popularizing to benefit the patients.

Acupuncture Therapy; Electroacupuncture; Low Back Pain

The third lumbar transverse process syndrome is a common encountered chronic low back pain or lumbar-gluteal condition. It is clinically featured by notable tenderness at the transverse process of L3. Electroacupuncture (EA) and medium-frequency physiotherapy are both effective for this condition[1-2]. We observed the clinical effect of medium-frequency EA (combination of medium-frequency electric current with needling) for the 3rd lumbar transverse process syndrome and compared with the traditional low-frequency EA.

1 Clinical Materials

1.1 Diagnostic criteria[3]

Those with a history of lumbar trauma or strain; pain on one or both sides of the middle lumbar vertebrae and inflexible or rigid lumbar movement, inability to bend forward or sit for long time and the pain aggravated after walking, difficulty turning the body and walking, sensitivity to weather changes and symptoms relieved after rest or treatment; some patients may experience pain radiating along the homolateral buttock or lower leg; notable tenderness on one or both sides of the transverse process apex, possibly coupled with palpable hard nodules or ropy belts at the apex; and X-rays indicating extended or asymmetric third lumbar transverse process.

1.2 Inclusion criteria

Those who met the above diagnostic criteria, agreed to participate in this trial and signed the informed consent.

1.3 Exclusion criteria

Those with lumber intervertebral disc herniation, low back pain due to herniated disc, lumbar fracture, lumbar spondylolisthesis, rheumatism, rheumatoid conditions, bone tuberculosis or tumor; those having severe internal diseases with an inability to lie on one’s chest; those who cannot cooperate because of fearing needles; women during pregnancy or lactation; those who failed to stick to the treatment protocol, still having long-time sitting or forward bending, or having incomplete data for efficacy evaluation; those who received other therapies over the past week.

1.4 Statistical method

The Microsoft Office Excel 2003 version software was used for data analysis, Ridit analysis for ranked data and analysis of variance for inter-group comparison. P＜0.05 indicates a statistical significance.

1.5 General materials

A total of 80 cases who met the inclusion criteria of the third lumbar transverse process syndrome were selected for this trial. Of the 80 cases, the male/female ratio was 73/7; age ranged from 19 to 40 years old; disease duration ranged from 1 month to 2 years. These cases were randomly allocated into two groups (the medium-frequency EA group and the traditional EA group). Then match them with different treatment protocol according to their visiting sequence numbers.

The Chi-square test and analysis of variance showed that there were no statistical significances between the two groups in terms of age and duration (table 1). The clinical process was shown in Fig.1.

Table 1. Comparison of general materials between the two groups ()

Table 1. Comparison of general materials between the two groups ()

Note: MFEA=Medium-frequency EA group; TEA=Traditional EA group

Groups n Gender (case) Male Female Average age (year ) Average duration (month) MFEA 40 37 3 29.1±1.2 6.5±0.6 TEA 40 36 4 28.1±1.3 6.8±0.7

2 Treatment Methods

During this clinical trial, cases in both groups discontinued other therapies. Also, they were asked to conduct appropriate low back movement (without causing low back pain) and limit sitting and forward bending time.

Fig.1 Clinical treatment process in the two groups

2.1 Medium-frequency EA group

Acupoints: Ashi points.

Method: Ask the patient to take a prone position and puncture the most tenderness spot perpendicularly using filiform needles of 0.35 mm in diameter and 40 mm in length, allowing the tip to reach the apex of the 3rd lumbar transverse process. Upon arrival of qi, connect the needle with KK8832-T medium-frequency treatment device (manufactured by Beijing Xiangyun Electronic Equipment Factory) (medium-frequency: 1-10 kHz; output waveforms: square wave, sharp wave, triangular wave, sine wave and exponential wave). Both the doctor and patient hold different silica gel electrodes. The doctor grasped the needle handle with the thumb and index finger of one hand and gradually increased the electric current with the other hand (within the patient’s tolerance). The treatment was conducted once a day, 5 min for each treatment and 10 times made up a course of treatment.

2.2 Traditional EA group

Acupoints: Same as the medium-frequency EA group.

Method: The needles and patient’s position were same as the medium-frequency EA group. Upon arrival of qi, connect needles with the G6805-2 EA device, using continuous wave and frequency of 20 Hz (up to the patient’s tolerance and comfort). For pain on one side, connect the other electrode to the ipsolateral Jiaji (EX-B 2) points. For pain on both sides, connect with bilateral Ashi points. The treatment was conducted once a day, 30 min for each treatment and 10 times made up a course of treatment.

3 Observation of Therapeutic Efficacy

The pain was graded using the Visual Analogue Scale (VAS)[3]before treatment and 1 week after the first course of treatment. 0-3 indicates mild pain; 4-7 indicates moderate pain and 7-10 indicates severe pain. A higher score denotes a more severe pain.

3.1 Therapeutic efficacy criteria

The criteria were based on the Criteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[3].

Clinical recovery: Restoration of normal functions, absence of signs or symptoms.

Marked effectiveness: Almost absence of signs or symptoms except for slight discomfort after physical exertion or fatigue.

Improvement: Improved signs and symptoms, coupled with mild pain.

Failure: The signs and symptoms remain unchanged.

3.2 Treatment outcome

3.2.1 Comparison of clinical effects between the two groups

The clinical effects in both groups were observed 1 week after the first course of treatment. The Ridit analysis showed a statistical significance between the two groups (P＜0.05), (table 2).

3.2.2 Comparison of pain scores between two groups

After treatment, the VAS scores in both groups were significantly reduced (P＜0.01); and there was a statistical significance between the medium-frequency EA group and traditional EA group (P＜0.05). This indicates that both treatment protocols can alleviate pain due to the third lumbar transverse process syndrome; however, medium-frequency EA is a better option (table 3).

Table 2. Comparison of clinical effects between the two groups (case)

Table 3. Comparison of VAS in two groups before and after treatment (, point)

Table 3. Comparison of VAS in two groups before and after treatment (, point)

Note: Compared with the pre-treatment results of the same group, 1) P＜0.01; compared with traditional EA group, 2) P＜0.05

Groups n Before treatment After treatment MFEA 40 6.76±0.67 1.69±0.891)2)TEA 40 6.87±0.95 2.87±0.731)

4 Discussion

The third lumbar transverse process syndrome is a common condition in the Department of Orthopedics and Traumatology. Since the third lumbar vertebra serves as the center for vertebral rotation and forward bending and has attachment to many muscles, lumbar and abdominal contractions may provoke pulling stress to the apex of its transverse process, resulting in acute injury and chronic strain. This can further cause local hemorrhage, exudation or even cicatricial adhesion, thus leading to pain and restricted low back movement[4]. Clinically this condition is often treated with conservative therapies, including high-frequency impulse EA, needle scalpel, warm needling and traditional EA[4-6]. Generally, traditional EA adopts less than 100 Hz in frequency to allow electric current to conduct between two needles. As a result, slightly higher frequency and current intensity can cause intense muscle contraction and discomfort in patients. The effect of medium-frequency EA on this condition has not been reported yet. In this trial, the mediumfrequency of 1-10 kHz (far higher than the traditional EA) was used. This, coupled with the patient-doctor circuit of the electric current, can effectively prevent the aforementioned muscle contraction in patients. Because the third lumbar transverse process syndrome often causes specific pain, medium-frequency EA can be connected with one needle and is therefore an ideal therapy for this condition.

Research findings have suggested that mediumfrequency EA can directly improve the blood circulation of the transverse process apex and relieve pain, since it can increase localized blood and lymph circulation, resolve edema, help eradicate pathological pain-induced factors such as K+, kinase and amine, alleviate the aseptic inflammation and thus relieve pain and adhesion[7]. Clinically, most patients obtained comfort immediately after medium-frequency EA[5].

Although traditional EA can also alleviate pain[8-12], its needling position and depth can only be evaluated by the needling sensation and may not reach the transverse process apex. Also, the low-frequency electric current lacks changes and may cause tolerance, thus failing to improve the blood circulation around the transverse process apex and alleviate the localized aseptic inflammation.

Long-term bed rest cannot benefit patients with low back pain[13]. Appropriate low back movement (without causing low back pain), and avoiding sitting for long period of time or repeated forward bending can repair the strain from life or work and facilitate the efficacy of EA of different frequencies.

Preliminary clinical tests have shown that 5 min of medium-frequency EA can obtain a maximum effectand make patients comfortable. However, extended period of stimulation can cause discomfort.

To sum up, compared to traditional EA, the medium-frequency EA is a better option for the third lumbar transverse process syndrome because of its notable effect, shorter time and milder invasion.

[1] Wu YC, Zhang JF, Li SS, Zhou JH, Zhang SH, Sun YJ. Clinical effect and infrared thermogram on electroacupuncture for acute lumbar sprain. J Acupunct Tuina Sci, 2010, 8(6): 380-383.

[2] Zheng J. Therapeutic efficacy observation on adjunctive medium-frequency electrotherapy for 119 cases with lumbar disc herniation. Shandong Yiyao, 2011, 51(27): 105-106.

[3] State Administration of Traditional Chinese Medicine. Criteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine. Nanjing: Nanjing University Press, 1994: 202-203.

[4] Chen XR, Chen WJ, Tang XJ, Luo DX, Huang WT, Li GT. High-frequency pulse electroacupuncture for 263 cases with the third lumbar transverse process syndrome. Jingyaotong Zazhi, 2009, 30(2): 180-181.

[5] Tang HW, Huang CJ, Xu M, Lou YM, Tang FY. Case control study on combined needle scalpel and local blocking therapy for the third lumbar transverse process syndrome. Jingyaotong Zazhi, 2011, 32(6): 477-478.

[6] Li XL. Warm needling therapy for the third lumbar transverse process syndrome: a randomized controlled trial. J Acupunct Tuina Sci, 2011, 9(3): 196-198.

[7] Ma ZY. Therapeutic efficacy observation on combined medium-frequency electrotherapy and reductive traction for lumbar disc herniation. Zhonghua Wuli Yixue Yu Kangfu Zazhi, 2011, 33(3): 191-192.

[8] Liu YN, Zhang HX, Huang GF, Zou R, Wei W. Observation on the efficacy of electroacupuncture at Huatuojiaji plus pricking-cupping bloodletting in treating herpes zoster. Shanghai Zhenjiu Zazhi, 2009, 28(9): 523-525.

[9] Zhou M, Wang XR. Advances of studies on mechanisms of electroacupuncture analgesia. World J Acu-moxi, 2007, 17(3): 24-30.

[10] Wu YC, Wang CM, Zhang BM. Clinical observations on the treatment of acute lumbar sprain by electroacupuncture of point Houxi. Shanghai Zhenjiu Zazhi, 2005, 24(12): 22-24.

[11] Trinh KV, Sy A. Survey: use of acupuncture for the treatment of acute low back pain by physicians and physiotherapists in Ontario. J Acupunct Tuina Sci, 2010, 8(6): 331-335.

[12] Qi DB, Li WM. Effect of electroacupuncture on expression of NMDA-R1 receptor in the rostral ventromedia medulla of rats with chronic visceral hyperalgesia. Shanghai Zhenjiu Zazhi, 2011, 30(7): 494-494.

[13] Gilbert JR, Taylor DW, Hildebrand A, Evans C. Clinical trial of common treatments for low back pain in family practice. Br Med J (Clin Res Ed), 1985, 291(6498): 791-794.

Translator: Han Chou-ping

R246.2

A

Date: January 20, 2013

Author: Liang Bo, M.M., associate chief physician. E-mail: jiyindna@163.com