University of Michigan, Ann Arbor, Michigan, USA.
Transtimulation Research Inc., Oklahoma City, Oklahoma, USA.
Neurogastroenterol Motil. 2024 Jul;36(7):e14799. doi: 10.1111/nmo.14799. Epub 2024 Apr 26.
Treatment options for abdominal pain in IBS are inadequate. TEA was reported effective treatment of disorders of gut-brain interaction but its mechanism of action and optimal delivery method for treating pain in IBS are unknown. This study aims to determine the most effective TEA parameter and location to treat abdominal pain in patients with IBS-Constipation and delineate the effect of TEA on rectal sensation and autonomic function.
Nineteen IBS-C patients underwent TEA at acupoints ST36 (leg), PC6 (wrist), or sham-acupoint. Each patient was studied in five randomized sessions on separate days: (1) TEA/ST36-100 Hz; (2) TEA/ST36-25 Hz; (3) TEA/PC6-100 Hz; (4) TEA/PC6-25 Hz; (5) TEA/Sham-25 Hz. In each session, barostat-guided rectal distention (RD) was performed before and after TEA. Patients graded the RD-induced pain and recorded three rectal sensation thresholds. A heart rate variability (HRV) signal was derived from the electrocardiogram for autonomic function assessment.
Studied patients were predominantly female, young, and Caucasian. Compared with baseline, patients treated with TEA/ST36-100 Hz had significantly decreased pain scores at RD pressure-points 20-50 mmHg (p < 0.04). The average pain reduction was 40%. Post-treatment scores did not change significantly with other TEA modalities except with sham-TEA (lesser degree compared to ST36-100 Hz, p = 0.04). TEA/ST36-100, but not other modalities, increased the rectal sensation threshold (first sensation: p = 0.007; urge to defecate: p < 0.026). TEA/ST36-100 Hz was the only treatment that significantly decreased sympathetic activity and increased parasympathetic activity with and without RD (p < 0.04).
CONCLUSIONS & INFERENCES: TEA at ST36-100 Hz is superior stimulation point/parameter, compared to TEA at PC-6/sham-TEA, to reduce rectal distension-induced pain in IBS-C patients. This therapeutic effect appears to be mediated through rectal hypersensitivity reduction and autonomic function modulation.
IBS 患者的腹痛治疗选择不足。 TEA 已被报道为治疗胃肠道-大脑相互作用障碍的有效治疗方法，但 TEA 治疗 IBS 疼痛的作用机制和最佳传递方法尚不清楚。本研究旨在确定治疗 IBS-C 患者腹痛的最有效 TEA 参数和位置，并描绘 TEA 对直肠感觉和自主功能的影响。
19 名 IBS-C 患者在 ST36（腿部）、PC6（手腕）或假穴位进行 TEA。每位患者在 5 个单独的日子的随机会话中进行研究：（1）TEA/ST36-100Hz；（2）TEA/ST36-25Hz；（3）TEA/PC6-100Hz；（4）TEA/PC6-25Hz；（5）TEA/Sham-25Hz。在每个会话中，在 TEA 前后进行直肠扩张（RD）引导的测压。患者对 RD 引起的疼痛进行评分，并记录三个直肠感觉阈值。从心电图中得出心率变异性（HRV）信号，用于评估自主功能。
研究患者主要为女性、年轻和白种人。与基线相比，接受 TEA/ST36-100Hz 治疗的患者在 RD 压力点 20-50mmHg 时疼痛评分显著降低（p<0.04）。平均疼痛减轻了 40%。除了 sham-TEA（与 ST36-100Hz 相比程度较小，p=0.04）外，其他 TEA 方式的治疗后评分没有显著变化。TEA/ST36-100 不仅增加了直肠感觉阈值（第一感觉：p=0.007；排便冲动：p<0.026），而且还增加了直肠感觉阈值（第一感觉：p=0.007；排便冲动：p<0.026）。只有 TEA/ST36-100Hz 治疗可以在有或没有 RD 的情况下降低交感神经活动并增加副交感神经活动（p<0.04）。
与 PC-6/sham-TEA 相比，TEA 在 ST36-100Hz 是治疗 IBS-C 患者直肠扩张引起疼痛的更优刺激点/参数。这种治疗效果似乎是通过降低直肠高敏性和调节自主功能来实现的。
