Percutaneous Electrical Nerve Stimulation or Acupuncture

Abstract

In suggesting that classical acupuncture and percutaneous electrical nerve stimulation (PENS) are the same because both techniques involve insertion of similar appearing needles, Dr. Pinsker has failed to understand the two fundamentally important differences between these two nonpharmacologic analgesic techniques. 1) PENS involves stimulation of dermatomes, myotomes, and/or sclerotomes, which correspond to the specific sensory nerves originating at the site(s) of the painful stimuli (1–5). In contrast, acupuncture involves stimulation at specific acupoints based on classical Chinese medical teachings. 2) PENS involves application of electrical current to the needle probes in differing patterns and frequencies of stimulation from a low-output electrical generator. Without the addition of electrical stimulation, “sham” (or inactive) PENS therapy is no more effective than a placebo treatment (3,4). Although we have no objection to the use of the term acupuncture (or electroacupuncture), it would be inaccurate to describe PENS therapy by either of these terms (1–5). We would encourage pain specialists like Dr. Pinsker to compare PENS to classical Chinese acupuncture. In a study involving transcutaneous electrical nerve stimulation, we found that dermatomal stimulation was as effective as acupoint stimulation in producing an analgesic-sparing effect (6). It is possible that simultaneous percutaneous electrical stimulation at both acupoints and dermatomes would produce an even more profound and longer-lasting analgesic effect in patients with acute and chronic pain syndromes. Finally, we would encourage our colleagues in pain management to consider the use of these complementary pain-relieving therapies as adjuvants to conventional pharmacologic and nonpharmacologic modalities rather than as alternatives. In describing a “new” type of pain therapy, it is important to use precise terminology in defining the treatment. Insertion of the thin “needles”per se is not the critically important feature of either acupuncture or PENS. We would hope that the use of more precise terminology will minimize confusion regarding these nonpharmacologic therapeutic modalities in the future. Paul F. White PhD, MD, FANZCA William F. Craig MD