NURSING AT McLEAN

A new twist on an ancient therapy
- by Charlene Nielsen, RN

I first heard about the Transdermal Electro-Acupuncture for Inpatient Opioid Detoxification Study during a staff meeting on Proctor II. Our nurse director, Nancy Merrill, RN, explained that it was a pilot study and the results would determine whether funding for a full study would be forthcoming.

"Electro-Acupuncture." What did that mean? The study would focus on opiate-dependent patients in our program who were receiving Suboxone for detoxification. Patients detoxing from other substances would not be included. Did this type of 'acupuncture' involve needles? Would nurses be administering the treatments? I had so many questions. I looked around the room and could see my peers had questions, too. Nancy told us, "More to come."

Soon after, Ji-Shing Han, MD, the inventor of the transdermal electro-acupuncture machine arrived from China to speak with us. It was standing-room only in the PH1 dinning room. Han is one of China's top neurophysiologists and director of the Neuroscience Research Institute at Peking University.

Han was an animated presenter and captured my attention from the moment he began talking about his noninvasive Han's acupoint nerve stimulator (HANS). He joked about how the acronym for the machine matched his name. His PowerPoint presentation contained graphs explaining how specific endogenous neuropeptides need to be released in order to decrease the physiological effects of withdrawal. He explained how he had developed the Han's acupoint nerve stimulator to precisely stimulate the correct nerves at the current and frequency needed to release these endogenous neuropeptides. The neuropeptides then interact in the CNS with the opioid receptors reducing the pain and craving experienced during opioid withdrawal. Han explained that traditional acupuncture treatment can't stimulate nerves at the rate necessary. A human hand isn't able to twirl a needle fast enough.

Electro-acupuncture, or EAP, for heroin abuse was first studied in Hong Kong in the early 1970s. Additional studies in China showed a decrease in the symptoms of withdrawal with its use. Han explained that his most recent studies showed a 25% abstinence rate in study subjects after one year using HANS to control cravings after detoxification. These were encouraging statistics as opioid dependence has a high rate of relapse.

Han demonstrated his machine on a staff member from Research. We saw the muscle in her thumb twitch. Han explained that the twitching indicated the machine was set at the correct frequency. He assured us the subject was comfortable, and she did, indeed, appear to be comfortable as she held her hand in the air for all of us to see. The machine was small, discreet, inexpensive, and portable. It was easy to use, allowing the patient to carry it with her and use it any time a craving struck. Each treatment, to be maximally effective, took 30 minutes.

Our next exposure to HANS came the day we were trained to use it. We were shown how to hook the electrodes to gel pads that were placed opposite each other on the subject's hand and forearm. It was important to keep track of the placement of the electrodes so they could be reversed for each treatment.

We were shown how to set the frequency of the machine in such a way that study subjects wouldn't be able to tell if they were receiving the treatment or the placebo (this was a single blind study). Once the machine was correctly set, it 'locked' and began a 30-minute countdown. The frequency could not be changed once treatment began.

Subjects were asked to fill out a questionnaire before and after each treatment, rating how they felt pre- and post-treatment. To be eligible for the study, subjects must already have begun detoxification with Suboxone, could not be detoxing from anything other than opiates, and could not have certain medical conditions such as seizure disorders or heart conditions. We would be responsible for administering subsequent treatments. Three treatments needed to be given per day, one on the day shift and two on the evening shift. Subjects had to complete a minimum of nine treatments to be considered successful 'completers.' No gaps or missed treatments were allowed. A minimum of 30 completers was required for the study to be valid.

There was much buzz on the unit after the training session. Some of us decided to practice on each other so we'd be ready when we went live. We took turns being subjects. It was true, if the machine was set correctly, your muscles would twitch. It wasn't an unpleasant feeling.

The study lasted several months. Research assistants posted a large paper thermometer on the wall of the nursing office to record our progress. It wasn't long before we had 30 completers, ending our involvement with the study. It had been exciting to be part of such an interesting project.

The results of the pilot study showed the efficacy of HANS in helping subjects remain free of drugs after discharge. Study subjects who received the active treatments were 2.2 times less likely to use drugs in the first two weeks following discharge. They also abstained from using drugs for a longer duration following discharge. The pilot study showed the feasibility of conducting research on a busy inpatient unit where nurses are able to carry out the additional duties of a research project. A full, two-year study has been funded and is currently awaiting implementation.