Table Of ContentManual Acupuncture, Electroacupuncture and
Electroauriculotherapy Treatments for Acute
Cervical Disc Herniation: A pilot clinical trial.
Submitted in partial fulfillment of the requirements for the
Doctor of Acupuncture and Oriental Medicine Degree
Oregon College of Oriental Medicine
Hilda Cavalla MTOM, LAc, Dipl OM
June 2009
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Acknowledgements
I would like to thank Dr. Tim Chapman Ph.D for his mentorship and for his expert
help with biostatistics. I would like thank Dr. Richard Hammerschlag, Ph.D
for his mentorship and expert feedback in this project. I would also like
to thank Dr. William Kelly D.C for his mentorship and guidance in my career.
I would like to express my appreciation to the faculty and staff at Oregon College
of Oriental Medicine Doctoral Program for their leadership and professionalism.
Finally, I would like thank my husband, Dr. Michael Cavalla D.C for his help in this
project and for his love, and support.
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Table of Contents
Abstract 5
Specific Aims 6
Introduction 7
Background and Rationale 8
Research/Literature Review 14
Objectives 24
Significance 25
Material and Methods 26
Outcome Measures 32
Results Chart 33
Table 1. Baseline Demographics 33
Table 2. Percent Improvement 34
Figure 1: Change in ROM 35
Figure 2. Change in Oswestry 36
Results 37
Discussion 38
Conclusion 44
Risk 45
References 46
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Oswestry Graph Electroacupuncture Appendex 1
Oswestry Graph Manual Acupuncture Appendex 2
Oswestry Graph Electroauriculotherapy Appendex 3
ROM Graph Electroacupuncture Appendex 4
ROM Graph Manual Acupuncture Appendex 5
ROM Graph Electroauriculotherapy Appendex 6
Oswestry Questionnaire Appendex 7
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Manual Acupuncture, Electroacupuncture, and Electroauriculotherapy
Treatments for Acute Cervical Disc Herniation: A pilot clinical trial
Abstract:
The pilot study investigates the outcome of manual acupuncture,
electroacupuncture, and electroauriculotherapy for the condition of
acute cervical disc herniation. Decompression therapy was used in all groups.
Forty eight patients were randomly selected for manual acupuncture,
electroacupuncture and electroauriculotherapy over a period of two years.
Treatments were given by a single acupuncturist and consisted of a course of 12
sessions, one per week for each patient. The treatment outcome was measured
by Oswestry questionnaire and ROM measured by an inclinometer
before and at last sessions. Forty eight patients were evaluated and all
had successful outcomes. The success rate was higher in the electro-
acupuncture group with 29 % improvement measured by Oswestry
questionnaire, the ROM also had the best outcome with 23%
improvement. The second best outcome was the manual acupuncture
with 27% improvement with Oswestry and ROM measured 21%.
Electroauriculotherapy was third best and showed 20 % for Oswestry
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and 17 % improvement for the ROM. The results indicated that
electroacupuncture is the most effective treatment for selected
patients with acute disc herniation condition.
Principal Investigator: Hilda Cavalla, MTOM, L.Ac, Dipl OM
Specific Aims:
The overall goal of this pilot clinical trial study is to compare effectiveness of
Manual Acupuncture, ElectroAcupuncture and Electro- Auriculotherapy in
treating an acute cervical disc herniations. Each technique will be evaluated in
regards to pain reduction, increased functional scale and mobility. Decompression
therapy was applied to all the groups.
Compare the Effectiveness of adjunctive of Manual Acupuncture,
Electroacupuncture, and Electroauriculotherapy treatments in two years
of case reports from my private practice.
Assess pain reduction, by relieving the spasm, and accelerating healing at
the site of injury as an outcome measure.
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Introduction
Disc herniations are physiological changes in the intervertebral discs, due to
biomechanical changes in the nucleus pulposus, which lessen the water binding
capability in the disc. If the herniated nucleus compresses or irritates the nerve
root, there may be sudden, severe, or insidious pain, numbness and eventually
muscle weakness (Yochum et al, 1987). In addition to neck pain, patients often
have referred pain in areas such as: shoulder, or head the latter presenting as,
interscapular, suboccipital and occipital headaches(Dillin et al, 1985).Cervical
radiculopathy refers to the signs and symptoms that result from nerve root
compression in the neck. A patient may also have a nerve root compression and
only experience neck pain with no radiculopathy. This study will include both
types of patients with these signs and symptoms. This type of neck condition is
less common than lumbar disc herniations. The common spinal sites of disc injury
are at the C6/C7 or C5/C6 levels. These levels are most in danger because of
higher intersegmental mobility.(Yochum et, al, 1987)
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Background and Rationale
Standard Medical Treatment of Acute Disc Herniation
In initial period of acute cervical disc herniation, non operative care is the
standard. This includes immobilization with a soft collar, anti-inflammatory drugs
and non narcotic analgesic medications in the acute phase (Fitz-Ritson et
al,1988). Other therapies include traction, manipulation, trigger point injections,
exercise and transcutaneous electrical nerve stimulation (Dillin et al, 1985).
Physical agents such as ice, moist heat and ultra sound are also used. Patient
education as to posture, lifting mechanics and isometric cervical exercise are
recommended when the pain has diminished (Boden et al, 1989).
Acupuncture Treatment of Acute Disc Herniation
In Traditional Chinese Medicine the condition of acute disc herniation is
considered to be a Painful Obstruction syndrome. The painful obstruction
syndrome is also called “bi” syndrome which means blockage. This syndrome
indicates pain, soreness or numbness of muscles, tendons and joints caused by
exterior invasion and root organ pathologies. In Chinese medicine, the blockage
can occur from the lack of circulation of qi and blood in the channels caused by
invasions of exterior wind, cold or dampness. An accident causes either
stagnation of qi or blood or both in a region. The person may recover perfectly
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well after an accident but some stagnation may remain in the area from the
accident. The exposure to external pathogenic factors can lead to Painful
obstruction syndrome in that area. This explains the unilateral development
where the climatic factors of wind, cold and dampness settle in the area due to
the pre-existing condition of stagnation from the accident (Maciocia et al, 1994).
TCM Causes of Disc Herniation(Maciocia et al,1994):
1. The general deficiency of qi and blood causes the immune system of the body
to be compromised, which allows for the invasion of exterior pathogens.
2. Organ pathology is from the deficiency of liver and kidney which leads to
malnourishment of sinews and bones. This condition causes aches and
stiffness. It also allows for the settling of phlegm in the joints.
3. Formation of phlegm in the joints is due to improper transformation of
body fluids. This condition has an underlying spleen deficiency because there
is an impairment of the transportation of body fluids.
4. Stasis of blood causes stiffness and pain due to lack of circulation and
nourishment in the sinews.
The Summary of 5 types of Painful Obstruction Syndrome(Maciocia et al,
1994):
Wind Painful Obstruction Syndrome: pain moving from joint to joint.
Damp Painful Obstruction Syndrome: fixed pain with heaviness,
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soreness, numbness and swelling of the joints.
Cold Painful Obstruction Syndrome: Severe pain in one joint.
Heat Painful Obstruction Syndrome: very severe pain, hot red swollen
joints.
Bony Painful Obstruction Syndrome: painful joints with swelling and bone
deformities.
Electroauriculotherapy Treatment of Acute Cervical Disc Herniation
Electroauriculotherapy is defined as an electrical stimulation administered on the
auricle of the external ear. This type of therapeutic stimulation is used to treat
health conditions in other areas of the body by using ear acupuncture points. The
ear acupuncture points and all systems of acupuncture began in ancient china.
This classic information was documented in the original Chinese medical text, The
Yellow Emperor’s Classic of Internal Medicine, compiled in 500 BC. In this text, the
ancient ear acupuncture points were not organized, but instead were scattered in
an arrangement of non meridian location. In the ancient text, of Yellow Emperor’s
Classic of Internal Medicine all six yang meridians are said to directly connect to
the auricle. In contrast, all six yin meridians are indirectly connected to the ear,
through the relationship of their corresponding yang meridian.(Oleson et al,1996)
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Description:ear acupuncture points and all systems of acupuncture began in ancient china. This classic .. vibrating equipment and ride in cars.(McPhee et al
