Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Authors (including presenting author) :
Wong GHS (1), Chao CYL (1), Wong KH (2), Yiu HYH (2), Leung CWL (2), Wan SPC (1), Chow SCM(1), Chan ACM (1)
Affiliation :
(1) Physiotherapy Department, Queen Elizabeth Hospital
(2) Department of Clinical Oncology, Queen Elizabeth Hospital
Introduction :
Bone metastasis cancer 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. Transcutaneous Electrical Acupoint Stimulation (TEAS), a combination of transcutaneous electrical nerve stimulation technique and acupuncture concept, is a novel non-invasive therapy for relieving pain via delivering low-frequency pulsed current on specific acupoint skin surface for inducing acupuncture-like effects, causing the central nervous system to secrete enough analgesic substance for achieving better pain-relieving effects. TEAS acted as an attractive alternative for the management of various painful conditions including cancer-related pain as it provides less side effects and good tolerance to the patients as compared to medication.
Objectives :
To evaluate the analgesic effects of TEAS on bone metastasis pain in cancer patients
Methodology :
It was a randomized, crossover study. Thirty-three cancer patients (18 males, 15 females), aged 64.9 9.1 years old, with moderate to severe bone metastasis pain from malignant tumors (scored 4 or above out of 10 in Numeric Pain Rating Scale (NPRS) on aggravating movement) during hospitalization at the Department of Clinical Oncology of the Queen Elizabeth Hospital from May 2021 to December 2023 participated in the study. Participants served 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 measures included Numeric Pain Rating Scale (NPRS) on the most painful aggravating movement, Modified Rivermead Mobility Index (MRMI) and Modified Functional Ambulation Classification (MFAC). Measurement was made at baseline before physiotherapy interventions and after mobility training in each testing condition.
Result & Outcome :
The administration of TEAS before conventional mobility training significantly reduced the NPRS score during the most painful aggravating movement from 6.7+/-2.0 to 4.4+/-2.1 (p< 0.001) and improved the MRMI score and MFAC from 25.8+/-12.7 to 27.5+/-12.3 (p=0.009) and 3.7+/-1.9 to 4.1+/-1.9 (p=0.015) respectively. In contrast, there was no statistically significant change of NPRS, MRMI and MFAC for conventional physical mobility training alone within same session (all p>0.05). Our preliminary results demonstrated that TEAS was an effective non-invasive adjunct intervention for immediate relief of bone metastatic cancer pain. It promotes functional mobility performance of patient that originally limited by the presence of bone pain during movement and weight bearing and hence potentially reduces physical decline due to immobility caused by bone metastatic cancer pain. Further studies are warranted to study the long-term cumulative analgesic effect of TEAS in bone metastatic cancer pain management.
