By Bill Huynh, Licensed Acupuncturist, (M.Ac, L.Ac, Dipl Ac, BA)
Acupuncture and electroacupuncture (the addition of electrical current to needles) may be very useful in helping wounds heal faster, because they provide electrical stimulation to the wound. According to a number of research studies and reviews, there is direct evidence that electrical stimulus of wounds causes them to heal better and faster, as demonstrated by the literature. Because acupuncturists often use electroacupuncture for Oriental medicine therapy, there is room to use electroacupuncture therapy for the benefit of wound patients. As an acupuncturist, I make the recommendation that electroacupuncture be studied in further detail for wound healing and applied to more wound healing patients. Below is an article for laymen and acupuncturists alike about the status of research for acupuncture and electrical stimulus for wound healing and how Acupuncture can help promote wound healing.
Research in the field of acupuncture and wound healing is still often times in experimental stages. That just means some research is still being done on animals instead of people, which indicates that the research for acupuncture and wound healing is still in its infancy. Still, it is easier to research animals because to create a study for humans and wound healing would be difficult to create and approve by IRBs (institutional review boards), difficult to create a control group, difficulty to create the double blind, randomized research studies (RCTs), etc. These are all elements of research that have to be accounted for, in order to be considered “good research.” Lots of studies come from China, for example, but they don’t account for all elements and are thrown out when other researchers review RCTs.
One study done in 2013 was by joint American and Korean researchers who studied the effects of acupuncture on wound healing in rats (1). After anesthetizing the rats, they created wounds on the rats. The experiment is designed like this: they had one group with no acupuncture treatment and one group with acupuncture treatments all the way around the wound. Acupuncture was administered on one group of rats for 20 minutes a day, for 7 days. Every few days, the researchers measured the wound sizes with a caliper. The rats that had acupuncture administered daily had smaller wound sizes when they measured with a caliper. That suggests that the wounds healed more quickly with just acupuncture treatments.
Next, they did some microscopic studies. They examined histological stains (tissue microscope stains) and compared measures of certain biochemicals (immunostaining and ELISA). First, they tried to measure whether or not more endogenous tissue had regenerated in the mice with acupuncture. They did this by staining the tissue sample with certain chemicals (anti-PCNA antibody) and then counting the cells area. Cell proliferation was measured, and the PCNA positive cells were counted. There were more PCNA positive cells in those treated by acupuncture. The results were statistically significant, which indicates that the results are valid statistically.
They found some indication that a cell called PCNA labeled CD-31-positive cells were higher in the acupuncture treated group of mice, suggesting to the researchers that angiogenesis (the formation of blood vessels) was more robust in acupuncture treated mice. The CD-31 positive cells indicate that the wound has more blood vessels forming, microscopically.
With these results in the analysis, they concluded that when acupuncture was performed around the edges of a wound, there was an effect on certain biochemicals and cell proliferation in the body of these animals. This included “decreasing inflammatory cytokine release, increasing newly generated cells, and stimulating angiogenesis and granulation-tissue formation.” Practically, this means that the acupuncture seems to increase the healing process of these rats.
Acupuncture with electrical stimulation has been shown in a study to help improve outcomes for patients with wounds from burns, abrasions, and lacerations. In another study performed on humans, this time with electrical stimulation in addition to acupuncture, there were similar results of healing. The study did not test the biochemical analysis of the body, so the analysis is more basic. It is also a nonrandomized clinical trial, so the quality of the study has limited use to the broader scientific community. However, it is still useful to note that there was significant improvement. The researchers added electrical stimulation to the needles. Electrical stimulation has been studied for wound healing for many decades, so it is no surprise that electrical stimulation can help wounds.
This study by Sumanos et al. was published in 2000 in the American Journal of Acupuncture. It paired patients with acupuncturists who then used electrical therapy placed on acupuncture needles around the wound to help heal the wounds (2). The patients previously had resistance to healing during conventional treatment, so they opted for the acupuncture as a type of experimental approach. While the design of the study definitely has its limitations, the researchers indicated that prognosis for these patients was good, with 93% having excellent outcomes. An excellent outcome was defined by the researchers as patients who had greater than 90% recovery of their wound. Again, these results cannot be extrapolated and are preliminary because of the poor design of the study. There was no control group with just acupuncture alone or standard care, and it was designed as an experiment with two interventions- acupuncture with electrical stimulation in or just electrical stimulation with no acupuncture. The first intervention was acupuncture needles hooked up to an electro acupuncture electrical stimulator machine and the second intervention was a group with burn patients who had gauze soaked in saline hooked up to an electrical stimulator and put directly on the wound. Thus further study is needed before strong conclusions can be made. To the defense of the researchers, they cited the reason there was no control group was because they stated there was ample evidence that electrical stimulation has an effect on wounds and they deemed it unethical to not treat the patients that presented (no intervention at all). The participants also failed conventional (standard) care, so that may be a reason they did not implement a model of standard care as a control group.
The use of electricity to heal wounds has been known for decades. In a review from 1991, researchers wrote, “numerous human and animal efficacy studies confirm that electrical stimulation of the proper charge, density, and total energy causes dramatically improved healing of dermal wounds (3).” In 2013, researchers wrote a review that studied clinical trials using electrical therapy procedures to improve wound healing. The application of direct current has been studied, as well as other forms of current, including alternating current, and specific devices like TENS units (transcutaneous electrical nerve stimulation), in addition to other methods. This review article (a review article is a type of cumulative research study) is of interest to acupuncturists because of electroacupuncture. In the review article by Thakral G, LaFontaine J et al., they found that 14 out of the 16 clinical trials that had wounds heal better than with no electrical stimulus. Electroacupuncture may thus be a useful modality to explore as the method of providing the electrical stimulus to wounds.
Recommendations for acupuncturists: treating wound areas such as diabetic ulcers, or lacerations or burns, they can use the following procedure: electroacupuncture. According to a statement by the American Association of Orthopaedic Medicine on its website5, acupuncture with electrical stimulation, in studies, have shown that there is an improvement in wound healing. The list of wound types includes post-surgical wounds, ulcers, burns, sprains and strains, fractures. The mechanism behind this action is to improve the blood supply to the tissue and accelerate repair.
Electroacupuncture should be a safe method to induce electrical current into the wound area. For example, Sumano et al. researchers put needles surrounding the wound, not directly in it, and then they attach the wires to the needle. The amount of current recommended by the researchers was 0.1 to 0.9 coulombs/cm2. What this translates to as settings on an electroacupuncture machine might vary by device, and is unknown to me. Clinicians should use their clinical judgement and training when applying a medical device on their patient. The other method they used was to attach the electrode wire clamps directly to a piece of gauze soaked in saline solution, so this bypassed the needles. The reason why they didn’t use needles was because of the nature of the wound, which was a second degree burn. Because both interventions in the Sumano et al. provided effective therapy, it is unknown whether the use of acupuncture needles further aids the healing process more so than just electrical stimulation in this study. But we can draw some conclusions from the study done on rats that yes, acupuncture can help healing.
Here is a little more information on electro acupuncture machines. This is just a discussion for acupuncturists. A well designed machine will minimize electrolysis of the metal on the needle and the metal clips. This should not be a major concern to patients nor those who use modern electroacupuncture machines, but it is introduced here for the sake of completeness and discussion. The stimulator machines should be biphasic in electrical waveform, so they don’t introduce metals into the skin through electrolysis. If you use a qualified and well built electrical stimulator machine, it will reduce the small risk of metal in the needle bonding microscopically to the needle insertion site or a needle breaking from electrolysis. Some of this information is given on the Pantheon research website6, a reputable brand of electro acupuncture devices. It also happens to be the brand of the machine I use, the 8cPro. The Ito ES 130, another brand, also uses a biphasic pulse that will minimize electrolysis. The AWQ 104L, another brand, also has a biphasic rectangular waveform pulse, so it is probably standard practice for new electro acupuncture machines.
Another possibility for electric stimulation with acupuncture needles is to use a piezoelectric pen. Someone in theory could use this device to provide a small current to needles placed around the wound. However, in actuality, this is probably not practical for practicing acupuncturists to use in their practice, but I really like it as a novel use. The reason is because a piezoelectric pen is manually operated, whereas an electrostim machine automatically discharges a continuous current, predictably and reliably. During a treatment, you might get hundreds of little shocks that happen every minute (depending on the settings). A Piezoelectric pen looks like a pen with a button at one end and a metal tip at the other. When you press on the button, at the other end a small electric current will discharge. The current really small (I could not find an objective number), but it uses the same type of electricity that is found in electric lighters. It is all natural in the sense that there is a piezo crystal that powers the device, similar to how quartz crystals can power a watch.
In short, for potential patients, if you have a wound that is slow healing, you can find a licensed acupuncturist to provide acupuncture with electrical stimulation for helping it to heal faster. A caveat: not all providers of acupuncture are built equally. Acupuncturists have over 3000 hours of training (read: many years worth), whereas other providers such as chiropractors or medical doctors have substantially less training (read: many weeks worth), and they may or may not have an electrostim machine. Note: I have done my best to present the evidence for this medicine here fairly. However, what I have written about does not constitute giving medical advice and you definitely should consult with a licensed provider if you want information for your own particular situation.
- Sang In Park, Yun-Young Sunwoo, Yu Jin Jung, et al., “Therapeutic Effects of Acupuncture through Enhancement of Functional Angiogenesis and Granulogenesis in Rat Wound Healing,” Evidence-Based Complementary and Alternative Medicine, vol. 2012, Article ID 464586, 10 pages, 2012. doi:10.1155/2012/464586 https://www.hindawi.com/journals/ecam/2012/464586/
- Sumano H, Mateos G. The use of acupuncture-like electrical stimulation for wound healing of lesions unresponsive to conventional treatment. American Journal of Acupuncture 1999;27(1/2):5-14.
- Gentzkow GD, Miller KH. Electrical stimulation for dermal wound healing. Clinics in Podiatric Medicine and Surgery. 1991 Oct;8(4):827-41.
- Thakral G, LaFontaine J, Najafi B, Talal TK, Kim P, Lavery LA. Electrical stimulation to accelerate wound healing. Diabetic Foot & Ankle. 2013;4:10.3402/dfa.v4i0.22081. doi:10.3402/dfa.v4i0.22081.