Electrical Stimulation Over Acupuncture Points in Reduction of Rectal Discomfort Distension
Condition: Pain
MeSH terms: Dilatation, Pathologic
Study type: Interventional

Summary: 
      Colonoscopy is a stressful and unpleasant procedure especially during the passage of the
      endoscope through angulations of colon. Electro-acupuncture is one of the alternative to
      reduce colorectal discomfort. However acupuncture is invasive. This present study explored
      the effectiveness of a non-invasive treatment modality, Transcutaneous Electrical Nerve
      Stimulation over Acupuncture points in reduction of colorectal discomfort during
      barostat-induced rectal distension.
    

Detailed description: 
      Early colonoscopy screening is encouraged in prevention of development of colorectal cancer
      as the colonoscopy procedure allows removal of pathological polyps and reduces the risk of
      cancerous development. While colonoscopy is regarded a minimally invasive procedure, the
      procedure itself is often associated with abdominal pain and discomfort, especially when the
      colonoscope is passed through a colonic angulation. The unpleasant feeling during colonoscopy
      may affect the patient's overall tolerance to the procedure and thereby jeopardizing the
      accuracy of outcome findings. A combination of narcotic analgesia and benzodiazepines is
      often used to decrease the abdominal pain and colorectal discomfort during colonoscopy.
      However these medications are also associated with side effects such as nausea and vomiting.
      Although uncommon, respiratory and cardiac arrests during colonoscopy were reported.
      Colonoscopy is now an outpatient day-procedure, unwanted side effects however could prolong
      recovery time and increase demands of post-intervention nursing care, thereby affecting the
      cost-effectiveness of the medical model. Undesirable pharmacological side effects have
      recently led to exploration of alternative management strategies to minimize patient
      discomfort during colonoscopy.

      Electroacupuncture (EA) is widely accepted in China and is considered worldwide a possible
      treatment option for acute and chronic pain of various origins. The role of acupuncture in
      managing pain and anxiety during colonoscopy however is unclear. A randomized sham-controlled
      study (involving 30 patients) suggested that patients receiving EA to acupoints including
      Zusanli (stomach meridian ST-36) and Hegu (large intestine meridian LI-4) had lower pain
      level during colonoscopy than those receiving sham acupuncture (SA), but the difference was
      non-significant statistically. Recently the investigators have shown that application of 45
      minutes of EA to Hegu (LI4), Neiguan (PC6) and Zusanli (ST36) was able to effectively reduce
      colorectal discomfort during Barostat-induced rectal distension. Acupuncture however is
      invasive, and its application requires an experienced acupuncturist.

      Application of Transcutaneous electrical nerve stimulation (TENS) over acupuncture points
      (Acu-TENS) is a non-invasive modality and a novel analgesic therapy that combines the
      advantages of acupuncture and TENS in management of painful conditions. Acu-TENS has been
      shown to be more effective in reducing postoperative analgesic requirement when compared with
      TENS at nonacupoints. It is postulated that TENS possibly modulates the noxious stimulus of
      pain via the control of the 'pain-gate' or through the release of β-endorphin. The efficacy
      of Acu-TENS in pain-relief during colonoscopy has not been reported.

      This current study aims to investigate the effect of Acu-TENS on barostat-induced rectal
      discomfort. A dual drive barostat device was used to mimic colonoscopy in order to control
      for the nature, intensity and duration of isobaric distension.
    

Intervention name(s): Transcutaneous Electrical Nerve Stimulation (ITO Company )
Intervention type(s): Device
Intervention description(s): A mobile small machine for nerve stimulation
Other intervention name(s): (Model 120Z, ITO Company Limited, Tokyo, Japan)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Pain; Colonoscopy; TENS; Acupuncture