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LETTERS TO THE EDITOR

Percutaneous Electrical Nerve Stimulation or Acupuncture

Pathways Medical Center Richmond, VA 23235

As a pain specialist who has used acupuncture for 15 yr, I was happy to read about the use of this technique in a prestigious journal (1). Based on my reading of this article, a similar article by the same group published earlier (2), and a television news flash about the earlier article, I can not see a difference between electroacupuncture and percutaneous electrical nerve stimulation. I see no difference between acupuncture needles and "acupuncture-like needle probes." I believe that the brand of needles specified in the second article are sold as acupuncture needles. I wish that we were not afraid of the word acupuncture or electroacupuncture. I see no advantage in using the term percutaneous electrical nerve stimulation.

References

1. Ghoname EA, Craig WF, White PF, et al. Percutaneous electrical nerve stimulation for low back pain. JAMA 1999;281:818–23.[Abstract/Free Full Text]
2. Ghoname EA, Craig WF, White PF, et al. The effect of stimulus frequency on the analgesic response to percutaneous electrical nerve stimulation in patients with chronic low back pain. Anesth Analg 1999;88:841–6.[Abstract/Free Full Text]

Response

Department of Anesthesiology & Pain Management University of Texas Southwestern Medical Center at Dallas Dallas, TX 75325-9068

William F. Craig, MD

Forest Park Institute for Pain Management Ft. Worth, TX 76102

In suggesting that classical acupuncture and percutaneous electrical nerve stimulation (PENS) are the same because both techniques involve insertion of similar appearing needles, Dr. Pinsker has failed to understand the two fundamentally important differences between these two nonpharmacologic analgesic techniques.

1) PENS involves stimulation of dermatomes, myotomes, and/or sclerotomes, which correspond to the specific sensory nerves originating at the site(s) of the painful stimuli (1–5). In contrast, acupuncture involves stimulation at specific acupoints based on classical Chinese medical teachings.

2) PENS involves application of electrical current to the needle probes in differing patterns and frequencies of stimulation from a low-output electrical generator. Without the addition of electrical stimulation, "sham" (or inactive) PENS therapy is no more effective than a placebo treatment (3,4).

Although we have no objection to the use of the term acupuncture (or electroacupuncture), it would be inaccurate to describe PENS therapy by either of these terms (1–5). We would encourage pain specialists like Dr. Pinsker to compare PENS to classical Chinese acupuncture. In a study involving transcutaneous electrical nerve stimulation, we found that dermatomal stimulation was as effective as acupoint stimulation in producing an analgesic-sparing effect (6). It is possible that simultaneous percutaneous electrical stimulation at both acupoints and dermatomes would produce an even more profound and longer-lasting analgesic effect in patients with acute and chronic pain syndromes. Finally, we would encourage our colleagues in pain management to consider the use of these complementary pain-relieving therapies as adjuvants to conventional pharmacologic and nonpharmacologic modalities rather than as alternatives.

In describing a "new" type of pain therapy, it is important to use precise terminology in defining the treatment. Insertion of the thin "needles" per se is not the critically important feature of either acupuncture or PENS. We would hope that the use of more precise terminology will minimize confusion regarding these nonpharmacologic therapeutic modalities in the future.

References

1. Ahmed HE, Craig WF, White PF, et al. Percutaneous electrical nerve stimulation: an alternative to antiviral drugs for acute herpes zoster. Anesth Analg 1998;87:911–4.[Free Full Text]
2. Ahmed HE, Craig WF, White PF. Percutaneous electrical nerve stimulation (PENS): a complementary therapy for the management of pain secondary to bony metastasis. Clin J Pain 1998;14:320–3.[Web of Science][Medline]
3. Ghoname EA, Craig WF, White PF, et al. Percutaneous electrical nerve stimulation for low back pain. JAMA 1999;281:818–23.
4. Ghoname EA, Craig WF, White PF, et al. Effect of stimulus frequency on the analgesic response to electrical stimulation in patients with low back pain. Anesth Analg 1999;88:841–6.
5. Ghoname EA, Craig WF, White PF. Use of percutaneous electrical nerve stimulation (PENS) for treating ECT-induced headaches. Headache. In press.
6. Chen L, Tang J, White PF, et al. The effect of the location of transcutaneous electrical nerve stimulation on postoperative analgesic requirement: acupoint versus nonacupoint stimulation. Anesth Analg 1998;87:1129–34.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Pinsker, M. C. Articles by Craig, W. F. Search for Related Content PubMed PubMed Citation Articles by Pinsker, M. C. Articles by Craig, W. F.