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JoVE Journal Medicine

Medicine

Acupoint Needle-Embedding Combined with Ironing Therapy for Postoperative Pain After Anal Surgery

Published: June 23, 2023 doi: 10.3791/64852
Automatic Translation
1,2, 1, 1
1Hospital of Chengdu University of Traditional Chinese Medicine, 2Chengdu University of Traditional Chinese Medicine

Summary

The high incidence of pain after anal surgery is due to the physiological structure and pathological status of the anus. At present, the use of painkillers cannot provide satisfactory pain relief, which makes complementary therapy important. This paper proposes acupoint needle-embedding combined with ironing therapy to relieve postoperative pain.

Abstract

Acupoint needle-embedding combined with ironing therapy is a non-drug treatment method to release postoperative pain after anal surgery. The practice is guided by traditional Chinese medicine (TCM) syndrome differentiation theory and employs acupoint stimulation and heat to alleviate pain. Although prior research has shown that these are dependable methods for pain relief, the combined effect of the two techniques has not been described. In our research, we found that compared to using diclofenac sodium enteric-coated capsules alone, adding acupoint needle-embedding combined with ironing therapy was more effective for reducing pain levels at different stages after hemorrhoid surgery. Although this technique is efficient and commonly used in clinics, due to its invasive practice, acupoint needle embedding still carries risks relating to hospital-acquired infections and broken needles. Ironing therapy, on the other hand, can result in burns and connective tissue injuries. Therefore, there is an urgent need to develop a standardized protocol for medical staff. Our protocol refines the traditional techniques and provides detailed instructions on patient preparation, operation techniques, and postoperative care to ensure the therapy is carried out safely and efficiently. By standardizing this therapy, this technique is expected to become an important complementary therapy for postoperative pain relief in hemorrhoids, which will significantly improve patients 'life quality after anal surgery.

Introduction

Postoperative pain is one of the most common complications in anorectal surgery. Among these conditions, pain caused by hemorrhoid surgery is particularly prevalent1. Generally speaking, postoperative pain may be caused by anxiety after surgery2, improper surgical methods3, obstruction of blood and lymph flow4, surgical wound infection, and spasm of the internal anal sphincter5. In most cases, postoperative pain is a normal physiological response, but excessive or persistent pain causes discomfort to the patients, aggravates psychological pressure, and, thus, hinders recovery6.

For mild pain, non-steroid anti-inflammatory drugs (NSAIDs), calcium channel blockers, and surface anesthetics can fulfill the treatment requirements7,8. For severe pain, morphine and tramadol seem to be an appropriate selection9. However, analgesics are associated with poor pain relief effects in anorectal surgery, and the risks of gastrointestinal bleeding or gastric ulcers caused by NSAIDs make clinicians hesitant to prescribe them10,11. Furthermore, the addictiveness of opioids can have a huge impact on the patients' living standards12. Optimizing the surgical procedure to prevent postoperative pain, such as by including lateral internal anal sphincterotomy, has been criticized due to its risk of anal incontinence13.

Acupoint needle embedding is a branch of acupuncture treatment, and its analgesic effect has been recognized for a long time. Ashi acupoint has a good analgesic effect, but its practice is limited because of the anus' physiological function and anatomical structure, as directly stimulating the anus only increases the pain for the patients14. In recent years, stimulation on other acupoints to release pain has been reported15,16. Wang et al.17 achieved significant pain relief effects after hemorrhoid surgery by stimulating acupoints such as Changqiang (DU1), Chengshan (BL57), and Erbai (EX-UE2) with pestle needles. A more comprehensive study found that in the sham acupuncture group, pain relief was lower at 5 h, 7 h, and 8 h after treatment than in the acupuncture stimulation group18. Meanwhile, according to several meta-analyses, stimulation of acupoints can reduce postoperative pain with a better therapeutic effect than NSAIDs19,20. In TCM theory, stimulating acupoints can reduce the anxiety state of patients. In addition, it can promote local blood circulation to accelerate the resolution of inflammation and tissue repair17. A study has reported that acupuncture can also promote the release of endogenous analgesic substances, such as enkephalins and endorphins, to block the transmission of pain signals in nerve cells21. Acupuncture treatment is not only effective in relieving postoperative pain in hemorrhoids, but it has also been reported to be effective in relieving musculoskeletal pain22, back pain23, and primary dysmenorrhea24. Summarizing the previous clinical trials, we believe that acupuncture point stimulation is effective for pain relief after hemorrhoid surgery.

Ironing therapy is one of the most widely used treatment methods throughout human history. It involves using heat to penetrate the skin and accelerate blood flow, promote tissue metabolism, and regulate sensory nerves to reduce pain25. Furthermore, heat can also relieve the contraction of the muscles26. Massage techniques can be added to this treatment to increase the effect of pain relief. A previous clinical trial demonstrated that massage on the suprapubic and sacral regions could relieve pain in the perineal region27. It works by blocking pain signals from reaching the central nervous system while increasing sympathetic nerve activity and reducing the pain caused by negative emotions28,29.

The operating procedures included in the protocol increased the safety of the operation, shortened the hospitalization days, reduced the level of postoperative pain, and decreased the incidence of urinary retention and anal edema. Acupoint needle-embedding combined with ironing treatment is a characteristic traditional Chinese medical method for postoperative pain from hemorrhoids and is recommended for healthy adults with no contraindications. It is expected to become an important complementary treatment for patients with postoperative pain.

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Protocol

A brief graphical flow of the protocol is shown in Figure 1. The protocol was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Hospital of Chengdu University of Traditional Chinese Medicine (code: 470000013, 4300000011). The data were obtained with the informed consent of the patients. The patients voluntarily signed informed consent prior to the study. The inclusion criteria were as follows: the ability to follow the doctor's advice; signing the consent form; diagnosis of hemorrhoids; excision of hemorrhoids with Milligan-Morgan surgery (M-M surgery). The exclusion criteria were as follows: patients with serious organ diseases; patients with anxiety, depression, or other mental disorders; patients with drug allergies; patients who could not cooperate.

1. Instrument preparation

  1. Disinfect all the tools with iodophor cotton swabs, followed by sterile cotton swabs, and then hand sanitizer. No special treatment is needed to disinfect sterile tweezers. Use disposable sterile press needles with dimensions of 0.25 mm x 1.3 mm.
  2. Ensure that the pulverizer can accommodate more than 200 g of the medicine. Maintain the speed between 25,000-30,000 rpm. Choose a gauze bag with at least a length and width of 10 cm x 8 cm and a treatment towel with a length and width of 50 cm x 40 cm.
  3. Select a microwave oven with a rated power of 600-900 W and the capacity for the heat to reach between 80-90 °C in medium or high mode.
  4. Obtain the following ironing medicine for acute pain: Fructus foeniculi 70 g, Fructus aurantii 20 g, Rhizoma curcumae longae 20 g, and Rhizoma corydalis 20 g. Obtain the following ironing medicine for chronic pain: Rhizoma chuanxiong 20 g, Fructus foeniculi 70 g, Radix paeoniae alba 20 g, and Rhizoma curcumae longae 20 g.
  5. Obtain a thermometer that is capable of measuring in the range of 10-110 °C and allows for multiple measurements.

2. Doctor-patient preparation

  1. Before the operation, perform a patient assessment. Evaluate the skin condition in advance. Do not perform the operation when the skin is damaged, infected, or suffering from other skin diseases.
  2. Evaluate all the equipment. Check all the medical consumables if they are within the usage time, and check the press needles to ensure they are not bent, broken, or have burrs or barbs, etc.
  3. Disinfection
    1. Use pre-sterilized operating instruments in the operation. Ensure they are all disposable medical consumables and are not sterilized in advance.
    2. Carry out operator disinfection by using hand sanitizer to perform the seven-step handwashing method30.
    3. Carry out disinfection of the acupoint needle-embedding site using an iodophor cotton swab; perform spiral disinfection of the operation area from the center to the outside. Ensure the diameter of the disinfection site is larger than 3 cm, and let the disinfectant stay for about 1 min until all the iodophor has been volatilized.
      NOTE: Generally, one disinfectant is enough. If the local area is seriously polluted, three disinfections are required. Prepare the ironing site using warm water to remove the residual dirt on the skin. Additional disinfection is not required.
  4. Prepare the ironing site after needle-embedding; do not perform this simultaneously.

3. Operation steps

  1. Needle-embedding
    1. Carry out acupoint selection (international code). Locate three acupoints, including Erbai (EX-UE2), Chengshan (BL57), Sanyinjiao (SP6; see Figure 2) before the operation. Perform acupoint location selection as done in previous studies in the literature16,31.
    2. Use sterilized tweezers to grip the edge of the press needle with the left hand, and aim the needle at the selected acupoint.
    3. After positioning the needle, press the needle's tail (bottom side) with the right thumb within 1 s.
    4. After inserting the needle, use the right thumb to gently rotate the needle 20-25 times clockwise at 40-50 times/min. Then, rotate the needle 20-25 times counterclockwise at the same speed. The operation should last 60-90 s.
      CAUTION: When massaging, the patient may have acid reflux, numbness, swelling, or pain. The practitioner should always ask how the patient feels; if they complain about an obvious pain or discomfort, the practitioner should reduce the strength of the massage or stop imminently.
    5. Fix the needle with tape, and keep it at the acupoint. During the stagnation, press the tail of the needle with up and down floating pressure; the amplitude fluctuates at 1-2 cm, the frequency should range between 40-50 times/min, and each massage lasts 3 min. Perform two sessions per day for 2 weeks, once in the morning and once in the evening.
    6. Change the needles every 48 h.
  2. Needle removal
    1. After performing the seven-step hand disinfection process, remove the tape. Use tweezers to separate the base of the needle from the skin gently. When it is completely peeled off from the area, use tweezers to pull it out gently.
    2. When the operation is done, use an iodophor cotton swab to disinfect the broken skin. Use a sterile cotton swab to press and achieve hemostasis if the broken skin is bleeding.
    3. After completing the operation, perform the seven-step hand-washing method again for disinfection.
  3. Management of acupuncture complications
    1. If the needle is broken and the end is still inside the skin, clamp it out with tweezers.
    2. If the broken end of the needle is flat or slightly depressed within the skin, use the thumb and index finger of the left hand to squeeze the skin vertically downward so that the broken needle will be exposed outside the body, and then remove the needle with tweezers.
    3. If the broken needle is too deep, locate it under the X-ray, and remove it by surgery.
      NOTE: For needlestick injuries or fainting during acupuncture, please see another protocol32.
  4. Ironing
    1. Refer to step 2.3.3 to disinfect the operation site, and make sure that the patient's urine is emptied before the operation.
    2. Operation sites include Qihai (CV29), Tianshu (ST25), and Changqiang (DU1)16,33 (see Figure 2).
    3. According to the characteristics of pain, crush the drug at a room temperature of 10-30 °C and a humidity of 40%-70% for 3 min using a pulverizer at a speed of 25,000-30,000 rpm. After pulverization, pack 130 g of the drug into a gauze bag, and soak in 10-30 °C water until it is fully saturated (about 60-80 s).
    4. Put the gauze bag in a microwave oven, and heat it for 2 min at 90-110 °C. After the temperature drops to 40-45 °C, wrap the medicated gauze bag firmly with a treatment towel.
    5. Place both hands on both sides of the top of the gauze bag, straighten both elbows, lean forward slightly, and press down slowly with the help of part of the body weight. The skin of the abdomen should sink by about 3-5 cm, and on the Changqiang acupoint, 2-3 cm is enough. Hold for 3-5 s, let the heat slowly penetrate the skin and subcutaneous tissue, and then release slowly. Repeat the procedure 60 times.
    6. Massage with the ironing medicine bag clockwise 60 times and counterclockwise 60 times. Each spiral massage lasts 1-2 s; repeat the whole procedure three times.
      NOTE: For RN6 and ST25, the above methods can be applied with no differences. However, it is worth noting that DU1 is close to the anus, so excessive intensity of the operation may aggravate the patient's discomfort. Therefore, the operator can halve the massage time, and the temperature of the drug should be maintained at 35-40 °C. In order to protect patient privacy, operations can be carried out with clothing in DU1.
    7. After the operation is completed, cover the operation part, and keep it warm. Perform the procedure twice per day, once in the morning and once in the evening, and reuse the ironing medicine bag up to four times. The treatment lasts for 2 weeks.
  5. Scald management
    1. For the treatment of burns, prevention is more important than operation. Strictly follow the above protocol, and do not extend the operation time or increase the operation intensity without authorization.
    2. If the burns occur that are limited below a deep partial degree burn, quickly rinse the scalded area with flowing cold water (5-15 °C is preferred) for 30 min. Then, disinfect the damaged spot with iodophor swabs, cover it with gauze, and fix it with medical tape. If the damaged area is large, use antibiotic ointment.
      NOTE: At the injury site, do not perform the treatment until the lesions have fully recovered. Puncturing of the blisters should not be done.
    3. If the scald reaches a deep partial degree, please consult with the burn department immediately.

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Representative Results

Statistical analysis
Collect and analyze the data using SPSS 22.0. In this work, normally distributed continuous variables were expressed as mean ± standard (SD), and comparisons between two groups were made using the Student's t-test. Continuous variables with skewed distributions were described using the median and 25% and 75% interquartile range, M (QL, QU), and comparisons between groups were performed using the Mann-Whitney U-test. Dichotomous variables were tested using the Chi-square test. Values of p < 0.05 were considered statistically significant.

Results
A total of 60 patients who underwent M-M surgery in the Hospital of Chengdu University of Traditional Chinese Medicine from August 2022 to September 2022 were selected as the research subjects, and they were divided into a treatment group and a control group based on the patient preferences, with 30 cases in each group. The control group received oral administration of diclofenac sodium enteric-coated capsules; the treatment group received oral administration of diclofenac sodium enteric-coated capsules and acupoint needle-embedding combined with ironing therapy. Diclofenac sodium enteric-coated capsules were administered every 12 h during hospitalization in both groups. Needle-embedding combined with ironing therapy was simultaneously implemented at every observation node, which strictly followed the same operation flow, steps, and frequency in the protocol.

There were 18 males and 12 females in the control group, with an average age of 47.17 years ± 2.09 years, an average BMI of 24.89 kg/m2 ± 0.77 kg/m2, and a preoperative visual pain score (VAS) of 1.83 ± 0.20. There were 14 males and 16 females in the observation group, with an average age of 44.97 years ± 2.26 years, a BMI of 24.89 kg/m2 ± 0.77 kg/m2, and a preoperative VAS score of 2.01 ± 0.21. There was no statistical difference in the baseline data between the two groups (p > 0.05).

Patients after hemorrhoid surgery often face different degrees of wound pain. We routinely manage the patients' diet, operative area care (keeping the anus dry and hygienic), and emotional well-being. The administration of diclofenac sodium enteric-coated capsules is one of the common treatment measures to relieve postoperative pain of hemorrhoids, and it has a high therapeutic efficiency compared to the external application of surface anesthetics (lidocaine)34. We found that compared with the use of diclofenac sodium enteric-coated capsules alone, patients treated with acupoint needle-embedding combined with ironing had lower VAS scores after the first defecation (5[4,6] vs. 4[3,4], p < 0.001; see Figure 3A). To observe the treatment effect at different time points, we also recorded the VAS scores on the fifth day after surgery and the discharge day. The results showed that on the fifth day after surgery and discharge day, patients with TCM treatment were in less pain than the control group (4[3,5] vs. 2[1,2], p < 0.001; 2[2,3] vs. 1[0,1], p < 0.001; see Figure 3B,C). We also noticed that the treatment group showed a greater decrease in VAS scores between the first defecation and the fifth day after surgery (p < 0.001; see Figure 3D). Pain is one of the main causes of postoperative urinary retention, and nearly 60% (n = 30) of patients in the control group had urinary retention during hospitalization compared to 26.7% (n = 30) in the treatment group, with significant statistical differences (p = 0.009). In addition, the incidence of postoperative anal edema was 33.3% (n = 10) in the treatment group and 63.3% (n = 19) in the control group (p = 0.02). The statistics also revealed that compared with the treatment group, the hospitalization days were shorter in the control group (6[5,6] days vs. 7[6,8] days, p < 0.001).

Figure 1
Figure 1: A graphical flowchart of the protocol. The flowchart describes all the steps performed to carry out the protocol. Please click here to view a larger version of this figure.

Figure 2
Figure 2: Diagram of the distribution of acupoints. The red points indicate the needle-embedding acupoints, and the blue points indicate the ironing therapy acupoints. (A) Erbai (EX-UE2): 4 cun (8 cm35) above the wrist crease of the forearm, on both sides of the flexor carpi radialis tendon, two acupoints in one limb. (B) Chenshan (BL57): Below the belly of the gastrocnemius muscle when stretching the leg and lifting the heel. (C) Sanyinjiao (SP6): Posterior to the mesial border of the tibia, and 3 cun (7 cm35) above the tip of the medial malleolus. (D) Qihai (CV29): On the anterior midline, 1.5 cun (3 cm35) below the umbilicus. (E) Tianshu (ST25): On the same level as the umbilicus, and 2 cun (4.5 cm35) lateral to the anterior midline. (F) Changqiang (DU1): Below the coccyx, at the midpoint between the end of the coccyx and the anus. Cun is a special unit of measurement in TCM theory; it is generally equal to the distance between the distal interphalangeal joint and the proximal interphalangeal joint of the index finger, and according to the literature, 1 cun is about 2.0-2.2 cm in length35,36. Please click here to view a larger version of this figure.

Figure 3
Figure 3: VAS scores at different stages after surgery. (A) VAS score after the first defecation; (B): VAS score on the fifth day after the operation. (C) VAS score on discharge day. (D) VAS score difference between the first defecation and the fifth day; a positive value means the pain is relieved, and a negative value means the pain increased. Please click here to view a larger version of this figure.

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Discussion

Surgical procedures for hemorrhoids have developed rapidly. In addition to the traditional M-M surgery, procedures such as rubber band ligation (RBL), the procedure for prolapse and hemorrhoids (PPH), tissue-selecting therapy stapler (TST), hemorrhoidal artery ligation, and infrared photocoagulation have also been widely used37,38,39. However, the advantages of M-M surgery, such as the high cure rate, low price, and simple operation, make it still one of the most commonly used procedures today40. As one of the most sensitive organs, a slight injury in the anus will bring discomfort to patients41. Relieving postoperative pain remains a major complication of anorectal surgery.

Acupoint needle-embedding and ironing treatments have been utilized as a vital component of TCM for thousands of years. Due to its excellent pain relief advantages, it has received continuous attention in recent years. Research has shown that 59%–90% of patients claim acupuncture is helpful in pain relief42, and multiple randomized controlled trial studies and meta-analysis articles have also proven that compared with non-acupuncture groups, acupuncture treatment has a significant effect in relieving acute and chronic pain43,44,45. During acupuncture treatment, stimulation signals are transmitted to the brain, leading to changes in pain-related cytokines and neurotransmitters46. Otherwise, ironing therapy has been found to promote the reduction of edema and accelerate the reflow of blood and lymph25. Combining traditional Chinese medicine and massage techniques makes it more effective.

However, traditional acupoint needle-embedding and ironing techniques cannot satisfy the treatment of postoperative pain in hemorrhoids. Based on the previous techniques, the protocol standardizes and refines the operation and elaborates on detailed methods for three acupoints for needle-embedding and three acupoints for ironing. Adjustments have been made to the acupuncture massage time, acupuncture technique, ironing temperature, and ironing techniques in this protocol. In general, the intensity of stimulation was reduced. In needle-embedding treatment, one of the most basic and essential points is to ensure the accurate positioning of acupoints. In press needle massage, the protocol should be strictly followed to reduce the incidence of broken or stalled needles. Likewise, as this represents a relatively invasive operation, it is necessary to avoid large blood vessels and major nerves to avoid adverse events of acupuncture. At the same time, temperature measurements must be carried out before the ironing. During the treatment process, the massage techniques, such as the strength, depth, and frequency, should be closely monitored.

In our clinical trial, we discovered that patients who underwent acupoint needle-embedding and ironing treatments had significantly lower VAS scores on their first defecation, the fifth day after surgery, and the discharge day (p < 0.001). The usage of this method also shortened the hospitalization days (p < 0.001) and reduced the incidence of postoperative urinary retention (p = 0.009) and anal edema (p = 0.02). These results are consistent with previous studies, providing evidence that this treatment can effectively alleviate postoperative pain and enhance patients’ postoperative quality of life. 

Although this operation is performed under professional supervision, burns and needlestick injuries are still one of the main points that should be taken care of. In the meantime, the operation is not applicable to special populations (pregnant women, pediatric patients) or patients in special states (surgical inappropriateness, extreme hunger, overfeeding, mental stress, or needle sickness). In previous studies, laboratory or auxiliary tests have not been perfected, so there is an urgent need to elaborate on the microscopic mechanisms through these indicators.

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Disclosures

The authors have nothing to disclose.

Acknowledgments

This research was supported by the Hospital Foundation of Hospital of Chengdu University of Traditional Chinese Medicine (Y2023016) and the Second Postgraduate Research Innovation Practice Project of the School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine (LCYJSKT2023-35) and Sichuan Provincial Administration of Traditional Chinese Medicine General Program (2023MS005).

Materials

Name Company Catalog Number Comments
diclofenac sodium enteric-coated capsules Temmler Ireland Co., Ltd., Kerry, Ireland H20170098
fructus aurantii Traditional Chinese Medicine Co., Ltd., Sichuan, China 220209
fructus foeniculi Traditional Chinese Medicine Co., Ltd., Sichuan, China 220210
gauze bag Anhui Meijianan Household Products Co., Ltd, Anhui, China M921
hand sanitizer Suolang Medical Disinfectants Co., Ltd., Zhejiang, China 200561121Q
iodophor cotton swabs Jiabeier Medical Technology Co., Ltd., Zhejiang, China 20162140536
microwave oven Galanz Group Co., Ltd., Guangdong, China P70D20L-ED(W0)
press needle Suzhou Acupuncture Supplies Co., Ltd. Zhejiang, China 20162200591
pulverizer Zhaofenger Industry and Trade Co., Ltd., Hunan, China J80031
radix paeoniae alba Guoqiang Pharmaceutical Co., Ltd., Sichuan, China 220601
rhizoma chuanxiong Yuankang Pharmaceutical Co., Ltd., Sichuan, China 220603
rhizoma corydalis Xinhehua Pharmaceutical Co., Ltd., Sichuan, China 2206071
rhizoma curcumae longae Traditional Chinese Medicine Co., Ltd., Sichuan, China 220216
sterile cotton swabs Zhongxin Sanitary Materials Co., Ltd., Sichuan, China 20180021
sterile tweezers Weigao Grope Medical Polymer Co., Ltd., Shandong, China 20182640148
thermometer Beierkang Medical Devices Co., Ltd., Guangdong, China 20162200505
treatment towel Sichuan Hualikang Medical Technology Co., Ltd, Sichuan, China 2111901

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References

  1. Hollingshead, J. R., Phillips, R. K. Haemorrhoids: Modern diagnosis and treatment. Postgraduate Medical Journal. 92 (1083), 4-8 (2016).
  2. Li, X. R., et al. A multicenter survey of perioperative anxiety in China: Pre- and postoperative associations. Journal of Psychosomatic Research. 147, 110528 (2021).
  3. Menconi, C., et al. Anal and pelvic floor pain after PPH and STARR: Surgical management of the fixed scar staple line. International Journal of Colorectal Disease. 31 (1), 41-44 (2016).
  4. Rabelo, F. E. F., et al. Benefits of flavonoid and metronidazole use after excisional hemorrhoidectomy: A randomized double-blind clinical trial. Techniques in Coloproctology. 25 (8), 949-955 (2021).
  5. Hite, M., Curran, T. Biofeedback for pelvic floor disorders. Clinics in Colon and Rectal Surgery. 34 (1), 56-61 (2021).
  6. Balciscueta, Z., Balciscueta, I., Uribe, N. Post-hemorrhoidectomy pain: Can surgeons reduce it? A systematic review and network meta-analysis of randomized trials. International Journal of Colorectal Disease. 36 (12), 2553-2566 (2021).
  7. Linares-Gil, M. J., et al. Topical analgesia with lidocaine plus diclofenac decreases pain in benign anorectal surgery: Randomized, double-blind, and controlled clinical trial. Clinical and Translational Gastroenterology. 9 (11), 210 (2018).
  8. Yadav, S., Khandelwal, R. G., Om, P., Ravindra, K., Choudhary, K. L. A prospective randomized double-blind study of pain control by topical calcium channel blockers versus placebo after Milligan-Morgan hemorrhoidectomy. International Journal of Colorectal Disease. 33 (7), 895-899 (2018).
  9. Leinicke, J. A., et al. Opioid prescribing patterns after anorectal surgery. Journal of Surgical Research. 255, 632-640 (2020).
  10. Stessel, B., et al. Metamizole vs. ibuprofen at home after day case surgery: A double-blind randomised controlled noninferiority trial. European Journal of Anaesthesiology. 36 (5), 351-359 (2019).
  11. Kroenke, K., Cheville, A. Management of chronic pain in the aftermath of the opioid backlash. JAMA. 317 (23), 2365-2366 (2017).
  12. Leinicke, J. A., et al. Opioid prescribing patterns after anorectal surgery. Journal of Surgical Research. 255, 632-640 (2020).
  13. Lohsiriwat, V., Jitmungngan, R. Strategies to reduce post-hemorrhoidectomy pain: A systematic review. Medicina. 58 (3), 418 (2022).
  14. Mitidieri, A. M. S., et al. Ashi acupuncture versus local anesthetic trigger point injections in the treatment of abdominal myofascial pain syndrome: A randomized clinical trial. Pain Physician. 23 (5), 507-518 (2020).
  15. Long, Q., et al. Clinical observation of electroacupuncture combined with auricular point sticking therapy for anal pain of mixed hemorrhoid after external excision and internal ligation. Zhongguo Zhen Jiu. 38 (6), 580-585 (2018).
  16. Yeh, M. L., Chung, Y. C., Hsu, L. C., Hung, S. H. Effect of transcutaneous acupoint electrical stimulation on post-hemorrhoidectomy-associated pain, anxiety, and heart rate variability: A randomized-controlled study. Clinical Nursing Research. 27 (4), 450-466 (2018).
  17. Wang, X., et al. Effects of the pestle needle therapy, a type of acupoint stimulation, on post-hemorrhoidectomy pain: A randomized controlled trial. Journal of Integrative Medicine. 18 (6), 492-498 (2020).
  18. Wu, J., et al. Effect of acupuncture on post-hemorrhoidectomy pain: A randomized controlled trial. Journal of Pain Research. 11, 1489-1496 (2018).
  19. Ye, S., Zhou, J., Guo, X., Jiang, X. Three acupuncture methods for postoperative pain in mixed hemorrhoids: A systematic review and network meta-analysis. Computational and Mathematical Methods in. 2022, 5627550 (2022).
  20. Du, B., Xu, Z., Zhong, X. Electroacupuncture for postoperative pain in mixed hemorrhoids: A meta-analysis. Medicine. 101 (50), e32247 (2022).
  21. Patil, S., et al. The role of acupuncture in pain management. Current Pain and Headache Reports. 20 (4), 22 (2016).
  22. Yuan, Q. L., et al. Acupuncture for musculoskeletal pain: A meta-analysis and meta-regression of sham-controlled randomized clinical trials. Scientific Reports. 6, 30675 (2016).
  23. Mu, J., et al. Acupuncture for chronic nonspecific low back pain. Cochrane Database of Systematic Reviews. 12 (12), (2020).
  24. Woo, H. L., et al. The efficacy and safety of acupuncture in women with primary dysmenorrhea: A systematic review and meta-analysis. Medicine. 97 (23), 11007 (2018).
  25. Zhang, Y. Y., et al. Traditional Chinese nursing using fennel with coarse salt for ironing and umbilical moxibustion for epigastric pain with spleen-stomach vacuity cold. Alternative Therapies in Health and Medicine. 28 (7), 88-94 (2022).
  26. Lei, J., Ye, G., Wu, J. T., Pertovaara, A., You, H. J. Role of capsaicin- and heat-sensitive afferents in stimulation of acupoint-induced pain and analgesia in humans. Neuroscience. 358, 325-335 (2017).
  27. Ying, J., et al. Effect of essential oil on patients with chronic prostatitis/chronic pelvic pain syndrome: A pilot randomized controlled trial. Chinese Journal of Integrative Medicine. 25 (2), 91-95 (2019).
  28. Bauer, B. A., Tilburt, J. C., Sood, A., Li, G. X., Wang, S. H. Complementary and alternative medicine therapies for chronic pain. Chinese Journal of Integrative Medicine. 22 (6), 403-411 (2016).
  29. Hatayama, T., Kitamura, S., Tamura, C., Nagano, M., Ohnuki, K. The facial massage reduced anxiety and negative mood status, and increased sympathetic nervous activity. Biomedical Research. 29 (6), 317-320 (2008).
  30. Sarwar, S., Muhammad, J., Shahzad, F. A modified hand washing method for resource limited settings. Frontiers in Public Health. 10, 965853 (2022).
  31. Yeh, M. L., Chung, Y. C., Hsu, L. C., Hung, S. H. Effect of transcutaneous acupoint electrical stimulation on post-hemorrhoidectomy-associated pain, anxiety, and heart rate variability: A randomized-controlled study. Clinical Nursing Research. 27 (4), 450-466 (2018).
  32. Rizk, C., Monroe, H., Orengo, I., Rosen, T. Needlestick and sharps injuries in dermatologic surgery: A review of preventative techniques and post-exposure protocols. Journal of Clinical and Aesthetic Dermatology. 9 (10), 41-49 (2016).
  33. Li, Z. M., Chen, J. Y., Sun, S., Ming, R. K., Wu, S. Brief analysis on pivot effect of Tianshu (ST 25). Zhongguo Zhen Jiu. 40 (12), 1319-1321 (2020).
  34. Linares-Gil, M. J., et al. Topical analgesia with lidocaine plus diclofenac decreases pain in benign anorectal surgery: Randomized, double-blind, and controlled clinical trial. Clinical and Translational Gastroenterology. 9 (11), 210 (2018).
  35. Park, H. J., et al. A comparison between directional and proportional methods in locating acupuncture points using dual-energy X-ray absorptiometry in Korean women. American Journal of Chinese Medicine. 34 (5), 749-757 (2006).
  36. Godson, D. R., Wardle, J. L. Accuracy and precision in acupuncture point location: A critical systematic review. Journal of Acupuncture and Meridian Studies. 12 (2), 52-66 (2019).
  37. Jia, X. Q., et al. Effect of high suspension and low incision surgery based on traditional ligation of Chinese medicine in treatment of mixed haemorrhoids: A multicentre, randomized, single-blind, non-inferiority clinical trial. Chinese Journal of Integrative Medicine. 27 (9), 649-655 (2021).
  38. Mott, T., Latimer, K., Edwards, C. Hemorrhoids: Diagnosis and treatment options. American Family Physician. 97 (3), 172-179 (2018).
  39. Wang, T. H., Kiu, K. T., Yen, M. H., Chang, T. C. Comparison of the short-term outcomes of using DST And PPH staplers in the treatment of grade III and IV hemorrhoids. Scientific Reports. 10 (1), 5189 (2020).
  40. Altomare, D. F., et al. Surgical management of haemorrhoids: An Italian survey of over 32 000 patients over 17 years. Colorectal Disease. 20 (12), 1117-1124 (2018).
  41. Boland, P. A., et al. Management options for chronic anal fissure: A systematic review of randomised controlled trials. International Journal of Colorectal Disease. 35 (10), 1807-1815 (2020).
  42. Urits, I., et al. A comprehensive review of alternative therapies for the management of chronic pain patients: Acupuncture, Tai Chi, osteopathic manipulative medicine, and chiropractic care. Advances in Therapy. 38 (1), 76-89 (2021).
  43. Vickers, A. J., et al. Acupuncture for chronic pain: Update of an individual patient data meta-analysis. Journal of Pain. 19 (5), 455-474 (2018).
  44. Sun, Y., et al. Efficacy of acupuncture for chronic prostatitis/chronic pelvic pain syndrome: A randomized trial. Annals of Internal Medicine. 174 (10), 1357-1366 (2021).
  45. Mao, J. J., et al. Effectiveness of electroacupuncture or auricular acupuncture vs usual care for chronic musculoskeletal pain among cancer survivors: The PEACE randomized clinical trial. JAMA Oncology. 7 (5), 720-727 (2021).
  46. Lee, I. S., Cheon, S., Park, J. Y. Central and peripheral mechanism of acupuncture analgesia on visceral pain: A systematic review. Evidence-Based Complementary and Alternative Medicine. 2019, 1304152 (2019).

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Acupoint Needle-embedding Ironing Therapy Postoperative Pain Anal Surgery Standardized Operation Process Risks Pain Reduction Hemorrhoid Surgery Patient Assessment Skin Condition Equipment Inspection Consumable Validity Press Needle Disinfection Hand Sanitizer Seven-step Hand Washing Method Acupoint Disinfection Iodophor Four Cotton Swab Three Centimeters In Diameter Acupoint Selection EX-UE2 BL-57 SP-6 Sterilized Tweezers Press Needle Insertion Clockwise Rotation Counterclockwise Rotation Needle Securing With Tape
Acupoint Needle-Embedding Combined with Ironing Therapy for Postoperative Pain After Anal Surgery
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Tang, X., Kang, J., Liu, Y. Acupoint … More

Tang, X., Kang, J., Liu, Y. Acupoint Needle-Embedding Combined with Ironing Therapy for Postoperative Pain After Anal Surgery. J. Vis. Exp. (196), e64852, doi:10.3791/64852 (2023).

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