Authors (including presenting author) :
Yu CWG (1), Wong KH (2), Yiu HYH (2), Leung LWC (2), Wan PCS (1), Wong HSG (1), Chao YLC (1), Chan CMA (1)
Affiliation :
(1) Physiotherapy Department, Queen Elizabeth Hospital (2) Department of Clinical Oncology, Queen Elizabeth Hospital
Introduction :
Cancer induced bone pain has major impact on the daily functioning of the patients as it is frequently exacerbated by movement or weight bearing leading to decreased mobility. Time of medication management is challenging as the incidental pain is usually movement related. Transcutaneous Electrical Acupoint Stimulation (TEAS) is a novel non-invasive therapy which combines Transcutaneous Electrical Nerve Stimulation (TENS) technique and acupuncture concept but without needle insertion. There was emerging evidence suggesting that TEAS is effective in the management of various painful conditions and it is becoming more popular given its safe and non-operator dependent features.
Objectives :
To evaluate the acute analgesic effects of TEAS on cancer induced bone pain during movement and weight bearing.
Methodology :
It was a randomized, crossover clinical trial. Twenty-nine cancer patients (14 males, 15 females), aged 63.6±9.4 years old, with moderate to severe cancer induced bone pain (scored more than 4 out of 10 in Numeric Pain Rating Scale on aggravating movement) in inpatient setting at the Department of Clinical Oncology of the Queen Elizabeth Hospital from May 2021 to December 2022 were invited to participate in the study. Participants acted as their own control to undergo two testing conditions. In the first testing condition, TEAS was applied to 4 acupoints of Hegu (LI4), Neiguan (PC6), Zusanli (ST36), and Sanyinjiao (SP6) bilaterally for 30 minutes by an experienced acupuncture accredited physiotherapist before conventional physiotherapy mobility training that involve movement and weight bearing exercises. The TEAS parameters were set as 2Hz and 80Hz alternative frequency, pulse width of 180µs, and intensities in the range of 10-15mA for the upper limbs and 15-30mA for the lower limbs. In the second testing condition, participants received usual conventional mobility training without TEAS intervention. The sequence of the 2 testing conditions was randomly assigned and the conditions were tested at least 24 hours apart. Outcome measurements on Numeric Pain Rating Scale (NPRS) on the most painful aggravating movement, Modified Rivermead Mobility Index (MRMI) and Modified Functional Ambulation Classification (MFAC) were measured at baseline and after mobility training. Statistical analysis was conducted using two-tailed Wilcoxon Signed Rank test to compare outcomes before and after each testing condition. Alpha level was set at 0.05.
Result & Outcome :
Adding TEAS before conventional mobility training significantly reduced the NPRS score during most painful aggravating movement from 6.6±2.1 to 5.1±2.1 (p<0.001). The MRMI score and MFAC also significantly improved from 22.6±13.0 to 24.0±13.3 (p=0.001) and 3.5±1.8 to 3.8±1.8 (p=0.011) respectively in the testing condition with TEAS intervention. In contrast, there was no statistically significant change of NPRS, MRMI and MFAC for conventional physical mobility training alone (p>0.05). Our preliminary results demonstrated that TEAS was an effective non-invasive adjunct intervention for the management of cancer induced bone pain during movement and weight bearing. It enhances patients’ functional mobility performance and potentially reduces physical decline due to immobility caused by the pain.
