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Title: Acupuncture transcutaneous electrical nerve stimulation reduces discomfort associated with barostat-induced rectal distension : A randomized-controlled study
Authors: Leung, WW 
Jones, AYM 
Wong, CYN
Lee, JFY
Issue Date: 21-Jan-2013
Source: World journal of gastroenterology, 21 Jan. 2013, , v. 19, no. 3, p. 381-388
Abstract: AIM: To explore the effectiveness of acupuncture transcutaneous electrical nerve stimulation (Acu-TENS), a non-invasive modality in reduction of rectal discomfort during barostat-induced rectal distension.
METHODS: Forty healthy subjects were randomized to receive 45 min of either Acu-TENS or placebo-TENS (no electrical output) over acupuncture points Hegu (large-intestine 4), Neiguan (pericardium 6) and Zusanli (stomach 36). A balloon catheter attached to a dual-drive barostat machine was then inserted into the subjects' rectum. A step-wise (4 mmHg) increase in balloon pressure was induced until maximal tolerable or 48 mmHg. Visual analogue scale and a 5-point subjective discomfort scale (no perception, first perception of distension, urge to defecate, discomfort/pain and extreme pain) were used to assess rectal discomfort at each distension pressure. Blood beta-endorphin levels were measured before, immediately after intervention, at 24 mmHg and at maximal tolerable distension pressure.
RESULTS: There was no difference in the demographic data and baseline plasma beta-endorphin levels between the two groups. Perception threshold levels were higher in the Acu-TENS group when compared to the placebo group, but the difference reached statistical significance only at the sensations urge to defecate and pain. The distension pressures recorded at the urge to defecate sensation for the Acu-TENS and placebo-TENS groups were 28.0 +/- 4.5 mmHg and 24.6 +/- 5.7 mmHg, respectively (P = 0.043); and the pressures recorded for the pain sensation for these two groups were 36.0 +/- 4.2 mmHg and 30.5 +/- 4.3 mmHg respectively (P = 0.002). Compared to the placebo group, a higher number of participants in the Acu-TENS group tolerated higher distension pressures (> 40 mmHg) (65% in Acu-TENS vs 25% in placebo, P = 0.02). The plasma beta-endorphin levels of the Acu-TENS group were significantly higher than that of the placebo group at barostat inflation pressure of 24 mmHg (1.31 +/- 0.40 ng/mL vs 1.04 +/- 0.43 ng/mL, P = 0.044) and at maximal inflation pressure (1.46 +/- 0.53 ng/ mL vs 0.95 +/- 0.38 ng/mL, P = 0.003).
CONCLUSION: Acu-TENS reduced rectal discomfort during barostat-induced rectal distension and concurrently associated with a rise in beta-endorphin level.
Keywords: Colonoscopy
Rectal discomfort
Transcutaneous electrical nerve stimulation
Visceral pain
Publisher: WJG Press
Journal: World journal of gastroenterology 
ISSN: 1007-9327
EISSN: 2219-2840
DOI: 10.3748/wjg.v19.i3.381
Rights: © 2013 Baishideng. All rights reserved.
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
The following publication Leung WW, Jones AY, Ng SS, Wong CY, Lee JF. Acupuncture transcutaneous electrical nerve stimulation reduces discomfort associated with barostat-induced rectal distension: A randomized-controlled study. World J Gastroenterol 2013; 19(3): 381-388 is available at
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