Impact of electroacupuncture on quality of life for patients with Relapsing-Remitting Multiple Sclerosis under treatment with immunomodulators: A randomized study.
Juan G Quispe-Cabanillas, Alfredo Damasceno, Felipe Glehn, Carlos O Brandão, Benito P Damasceno, Wanderley D Silveira and Leonilda M Santos.
31 adult patients with relapsing-remitting multiple sclerosis (RRMS) were randomly and blindly (to patients and evaluators) assigned to receive either Verum or Sham acupuncture. Weekly treatments were administered during regular physician care visits in a Brazilian university hospital outpatient clinic; all patients were on standard immunomodulatory medications (interferon-beta and glatiramar acetate). The sole acupuncturist/ interventionist in the study was a fully Licensed acupuncturist with 10 years of clinical experience.
The protocol consisted of 30 minutes of electro-acupuncture (either verum or sham) once weekly for 6 consecutive months. For the verum group, sterile stainless steel acupuncture needles were inserted at standardized depths and insertion angles bilaterally at the acupuncture points Zusanli (ST-36), Sanyinjiao (Sp-6), Hegu (Li-4), and Quchi (Li-11), and a central extra-meridian point, Yintang (EX-HN-3). “De Qi,” the unique sensation in response to traditional needling was sought at each point. Alternating current Electro-stimulation of 4 Hz, with a pulse width of 0.5 ms and a discontinuous wave was applied to each point except Yintang. For the sham group acu-points were located 1 centimeter lateral to the traditional location, and care was taken that the insertion should not be on a classically identified acupuncture meridian. The depth of insertion was more superficial (0.2 cm) than the verum group, and no electrical stimulation was applied.
Outcome measures were assessed at baseline (prior to any treatment) and at 6 months, after completion of treatment. Instruments used were the Expanded Disability Status Scale (EDSS), and the Functional Assessment of Multiple Sclerosis (FAMS) questionnaires. The FAMS assesses mobility, symptoms, emotional well being, depression, contentment, cognition, fatigue, and family & social well-being. Pain was evaluated using the 10 point Visual Analogue Scale (VAS).
At the end of 6 months of treatment, the sham group showed greater deterioration according to the EDSS scale (P= 0.338). In the verum group, all quality of life scores except cognition and fatigue improved significantly at 3 months (P= .0026) and 6 months (P = <0.0001). Pain in the sham group was reduced after 3 months (P= 0.028), but the effect was not sustained at 6 months. In the verum group, pain was significantly reduced at both 3 (P= 0.014) and 6 (P= 0.0001) months. In addition, although not systematically measured, participants in the verum group reported improved sleep and appetite, and reduced incontinence and constipation. 3 participants in the verum group also reported disappearance of leg spasms. No adverse effects were reported in either group.
Electro-acupuncture does indeed improve the quality of life and reduce pain in persons afflicted with relapsing-remitting multiple sclerosis (RRMS). The degenerative nature of RRMS affecting mobility was held in abeyance over the 6 months of treatment in the active electro-acupuncture group. Pain is often not assessed in other studies on RRMS, however, considering the devastating effect on a person’s QOL and its socially isolating nature, it seems important to assess pain in RRMS studies. Pain was significantly reduced at 3 and 6 months in the active group, which is consistent with many previous studies showing acupuncture’s analgesic effect. As well, important quality of life measures, not the least of which are depression and general contentment, were significantly improved in the true electro-acupuncture group. Completely safe – with no adverse effects reported in either group in the study – and cost-effective according to other previous studies (this study utilized one interventionist and 9 ten-cents-a-piece needles per patient), electro-acupuncture in this small study reduced pain and depression and improved mobility and quality of life in RRMS, and therefore future studies should look to build on this exciting and promising result.
November 5th, 2012; BMC Complementary and Alternative Medicine