Effect of Transcutaneous Acupoint Electrical Stimulation on Post-Hemorrhoidectomy-Associated Pain,Anxiety,and Heart Rate Variability: A Randomized-Controlled Study

Abstract

Hemorrhoidectomy is the current best treatment for severe hemorrhoids, but it causes significant postoperative pain and anxiety, which is associated with heart rate variability (HRV). Transcutaneous acupoint electrical stimulation (TAES) was assumed to alleviate pain and anxiety, and modify the autonomic nervous system. This study aimed to examine the effects of TAES intervention on postoperative pain, anxiety, and HRV in patients who received a hemorrhoidectomy. A randomized-controlled trial with five repeated measures was conducted. The TAES group (n = 39) received four 20-min sessions of electrical stimulation at chengshan (BL57) and erbai (EX-UE2) after hemorrhoidectomy, whereas the control group (n = 41) did not. Data were collected using Visual Analogue Scale (VAS), State Anxiety Inventory (STAI), and HRV physiological signal monitor. TAES resulted in a significant group difference in pain scores, anxiety levels, and some HRV parameters. The findings indicate that TAES can help reduce pain and anxiety associated with hemorrhoidectomy. TAES is a noninvasive, simple, and convenient modality for post-hemorrhoidectomy-associated pain control and anxiety reduction.

Keywords

hemorrhoidectomy transcutaneous acupoint electrical stimulation (TAES)postoperative pain postoperative anxiety heart rate variability (HRV)complementary therapy

Get full access to this article

View all access options for this article.

References

Acheson

A. G.

Scholefield

J. H.

(2008). Management of haemorrhoids. British Medical Journal, 336, 380-383.

Arai

Y. C.

Sakakima

Kawanishi

Nishihara

Ito

Tawada

Maruyama

(2013). Auricular acupuncture at the “shenmen” and “point zero” points induced parasympathetic activation. Evidence-Based Complementary and Alternative Medicine, 2013, Article 945063. doi:10.1155/2013/945063

Bjordal

Johnson

M. I.

Ljunggreen

A. E.

(2003). Transcutaneous electrical nerve stimulation (TENS) can reduce postoperative analgesic consumption: A meta-analysis with assessment of optimal treatment parameters for postoperative pain. European Journal of Pain, 7, 181-188.

Camm

A. J.

Malik

Bigger

J. T.

Breithardt

Cerutti

Cohen

R. J.

. . . Schwartz

P. J.

(1996). Heart rate variability standards of measurement, physiological interpretation, and clinical use. Circulation, 93, 1043-1065.

Chen

Y. C.

Liu

H. J.

Lin

J. G.

(2005). Assessment on effect of postoperative acupuncture stimulation to pain relief after total knee replacement. Taiwan Journal of Chinese Medicine, 4, 5-23.

Chiu

J. H.

Chen

W. S.

Chen

C. H.

Jiang

J. K.

Tang

G. J.

Lui

W. Y.

Lin

J. K.

(1999). Effect of transcutaneous electrical nerve stimulation for pain relief on patients undergoing hemorrhoidectomy: Prospective, randomized, controlled trial. Diseases of the Colon & Rectum, 42, 180-185.

Chung

J. W.

Yan

V. C.

Zhang

(2014). Effect of acupuncture on heart rate variability: A systematic review. Evidence-Based Complementary and Alternative Medicine, 2014, Article 819871. doi:10.1155/2014/819871

Chung

Y. C.

Chien

H. C.

Chen

H. H.

Yeh

M. L.

(2014). Acupoint stimulation to improve analgesia quality for lumbar spine surgical patients. Pain Management Nursing, 15, 738-747. doi:10.1016/j.pmn.2013.07.010

Cohen

(1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum.

10.

Gorman

J. M.

Sloan

R. P.

(2000). Heart rate variability in depressive and anxiety disorders. American Heart Journal, 140, 77-83.

11.

Hori

Takamoto

Urakawa

Ono

Nishijo

(2010). Effects of acupuncture on the brain hemodynamics. Autonomic Neuroscience, 157, 74-80. doi:10.1016/j.autneu.2010.06.007

12.

Y. Z.

(2011). The relationship between acupuncture effects and autonomic nervous system by heart rate variability-frozen shoulder patients as examples (Unpublished master’s thesis). Chung Yuan Christian University, Taoyuan City, Taiwan.

13.

Karst

Winterhalter

Münte

Francki

Hondronikos

Eckardt

. . . Fink

(2007). Auricular acupuncture for dental anxiety: A randomized controlled trial. Anesthesia & Analgesia, 104, 295-300.

14.

Lautenbacher

Huber

Schöfer

Kunz

Parthum

Weber

P. G.

… Sittl

(2010). Attentional and emotional mechanisms related to pain as predictors of chronic postoperative pain: A comparison with other psychological and physiological predictors. Pain, 151(3), 722-731. doi: 10.1016/j.pain.2010.08.041

15.

Lee

H. B.

Wang

C. W.

Yang

C. M.

(2008). Observation on therapeutic effect of electroacupuncture at Chengshan (BL 57) and Changqiang (GV 1) on hemorrhoidal pain. Chinese Acupuncture and Moxibustion, 28, 792-794.

16.

Lee

P. C.

Y. W.

Hung

M. H.

Chen

C. C.

Lin

H. C.

Lee

F. Y.

. . . Chiou

T. J.

(2013). The risk of cancer in patients with benign anal lesions: A nationwide population-based study. The American Journal of Medicine, 126(12), 1143.e9-1143e18.

17.

Lin

J. G.

Chen

W. L.

(2008). Acupuncture analgesia: A review of its mechanisms of actions. American Journal of Chinese Medicine, 36, 635-645.

18.

Lohsiriwat

(2015). Treatment of hemorrhoids: A coloproctologist’s view. World Journal Gastroenterol, 21, 9245-9252. doi:10.3748/wjg.v21.i31.9245

19.

Matsubara

Arai

Y. C.

Shiro

Shimo

Nishihara

Sato

Ushida

(2011). Comparative effects of acupressure at local and distal acupuncture points on pain conditions and autonomic function in females with chronic neck pain. Evidence-Based Complementary and Alternative Medicine, 2011, Article 543291. doi:10.1155/2011/543291

20.

Mounsey

Halladay

Sadiq

T. S.

(2011). Hemorrhoids. American Family Physician, 84, 204-210.

21.

E. H. Y.

W. S.

Gao

Wong

Y. Y.

P. C.

(2008). The role of acupuncture in the management of subfertility. Fertility and Sterility, 90, 1-13. doi:10.1016/j.fertnstert.2008.02.094

22.

Perrotti

Dominici

Grossi

Cerutti

Antropoli

(2010). Topical nifedipine with lidocaine ointment versus active control for pain after hemorrhoidectomy: Results of a multicentre, prospective, randomized, double-blind study. Canadian Journal of Surgery, 53, 17-24.

23.

Rakel

B. A.

Zimmerman

M. B.

Geasland

Embree

Clark

C. R.

Noiseux

N. O.

. . . Sluka

K. A.

(2014). Transcutaneous electrical nerve stimulation for the control of pain during rehabilitation after total knee arthroplasty: A randomized, blinded, placebo-controlled trial. Pain, 155, 2599-2611. doi:10.1016/j.pain.2014.09.025

24.

Riss

Weiser

F. A.

Schwameis

Riss

Mittlböck

Steiner

Stift

(2012). The prevalence of hemorrhoids in adults. International Journal of Colorectal Diseases, 27, 215-220. doi:10.1007/s00384-011-1316-3

25.

Solorio-López

Palomares-Chacón

U. R.

Guerrero-Tarín

J. E.

González-Ojeda

Cortés-Lares

J. A.

Rendón-Félix

. . . Fuentes Orozco

(2015). Efficacy of metronidazole versus placebo in pain control after hemorrhoidectomy. Results of a controlled clinical trial. Revista Española de Enfermedades Digestivas, 107, 681-685. doi:10.17235/reed.2015.3926/2015

26.

Spielberger

C. D.

Gorsuch

R. L.

Lushene

R. E.

(1970). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.

27.

Spielberger

C. D.

Gorsuch

R. L.

Lushene

Vagg

Jacobs

(1983). Manual for the State-Trait Anxiety Inventory (STAI). Palo Alto, CA: Consulting Psychologists Press.

28.

Taiwan Ministry of Health and Welfare. (2013). Hospitalized surgery participants statistics-in accordance with distinguish department. Retrieved from http://www.mohw.gov.tw/CHT/DOS/Statistic.aspx?f_list_no=312&;fod_list_no=6012

29.

Ushiyama

Nakatsu

Yamane

Tokutake

Wakabyashi

Ishimura

Maeta

(2008). Heart rate variability for evaluating surgical stress and development of postoperative complications. Clinical and Experimental Hypertension, 30, 45-55. doi:10.1080/10641960701813908

30.

Wang

Y. J.

Hsu

C. C.

Yeh

M. L.

Lin

J. G.

(2013). Auricular acupressure to improve menstrual pain and menstrual distress and heart rate variability for primary dysmenorrhea in youth with stress. Evidence-Based Complementary and Alternative Medicine, 2013, Article 138537. doi:10.1155/2013/138537

31.

Wang

Y. J.

Wang

Y. Z.

Yeh

M. L.

(2016). A prospective comparison study of young women with dysmenorrhea on heart rate variability during menses. Biological Research for Nursing, 18, 465-472.

32.

Yeh

M. L.

Chen

H. H.

Lin

I. H.

(2004). Contemporary meridians and practice. Taipei City, Taiwan: Farseeing.

33.

Yeh

M. L.

Chung

Y. C.

Chen

K. M.

Chen

H. H.

(2011). Pain reduction of acupoint electrical stimulation for patients with spinal surgery: A placebo-controlled study. International Journal of Nursing Studies, 48, 703-709.

34.

Yeh

M. L.

Chung

Y. C.

Chen

K. M.

Tsou

M. Y.

Chen

H. H.

(2010). Acupoint electrical stimulation reduces acute postoperative pain in surgical patients with patient-controlled analgesia: A randomized controlled study. The Journal of Alternative and Complementary Medicine, 16(6), 10-18.

35.

X. H.

Z. B.

(2011). Electroacupuncture for pain after hemorrhoids surgery. Shanghai Journal of Acupuncture and Moxibustion, 30, 304-306.

36.

Zhang

C. Y.

(2010). Observation on therapeutic effect of routine acupoints plus mental activity-adjusting acupoints in the treatment of post-surgical gastroparesis syndrome. Acupuncture Research, 35, 458-461.

37.

Zhang

Lao

Ren

Berman

B. M.

(2014). Mechanisms of acupuncture-electroacupuncture on persistent pain. Anesthesiology, 120, 482-503.

38.

Zheng

S. M.

(2003). Acupuncture on Yaoqi and Chengshan points for patients with hemorrhoid. Chinese Acupuncture and Moxibustion, 23(10), 603.

39.

Zhu

X. M.

(2011). Anorectal diseases with acupuncture points exploration. Chinese Acupuncture and Moxibustion, 31, 1114-1115.