Electrical stimulation of acupuncture points for analgesia during bone marrow aspiration and biopsy: A randomized double-blind placebo-controlled trial


1 General Physician, Division of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Anesthesia, Division of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Hematology, Division of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Bone marrow aspiration and biopsy (BMA/BMB) is a painful procedure mostly used in diagnosing and staging of a broad spectrum of hematological diseases. In spite of local anesthesia, the prevalence and intensity of the pain and patient discomfort caused by this procedure are considerable. The effect of acupuncture and electrical stimulation of acupoints (acupuncture points) in the treatment of many medical conditions, including pain, have been approved. The study is designed to evaluate the effect of electrical stimulation of acupoints to decrease the pain during BMA/BMB in adults.
Materials and Methods: In a double-blind controlled clinical trial, 50 patients undergoing BMA/BMB were randomly allocated into two groups, to receive either true or placebo electrical stimulation of acupoints LI-4 (large intestine 4, Hegu) and LI-11 (large intestine 11, Quchi), bilaterally. Both groups received infiltrative local anesthesia. The pain level caused by BMA/BMB was measured using the Visual Analog Scale (VAS).
Results: The means of the VAS in the case and control groups were 41.84 ± 20.54 and 69.40 ± 20.06 respectively (P < 0.001). The systolic and diastolic blood pressure and pulse rate rose significantly in both the groups compared to the basal values. The rise was lower in the acupuncture group compared to the placebo group regarding systolic blood pressure and pulse rate (P = 0.018 and P < 0.001, respectively).
Conclusions: The results of this study show that the electrical stimulation of acupoints significantly decreases the pain caused by BMA/BMB and some of the complications of the pain.


1. Dunlop TJ, Deen C, Lind S, Voyle RJ, Prichard JG. Use of combined oral narcotic and benzodiazepine for control of pain associated with bone marrow examination. South Med J 1999;92:477-80.  Back to cited text no. 1
2. Johnson H, Burke D, Plews C, Newell R, Parapia L. Improving the patient's experience of a bone marrow biopsy - an RCT. J Clin Nurs 2008;17:717-25.  Back to cited text no. 2
3. Vanhelleputte P, Nijs K, Delforge M, Evers G, Vanderschueren S. Pain during bone marrow aspiration: Prevalence and prevention. J Pain Symptom Manage 2003;26:860-6.  Back to cited text no. 3
4. Khurram Ghori M, Zyss. Pathophysiology of Acute Pain. In: Sinatra SR L-COGBVE, editor. Acute Pain Management. England: Cambridge University Press; 2009.  Back to cited text no. 4
5. Milligan DW, Howard MR, Judd A. Premedication with lorazepam before bone marrow biopsy. J Clin Pathol 1987;40:696-8.  Back to cited text no. 5
6. Mainwaring CJ, Wong C, Lush RJ, Smith JG, Singer CR. The role of midazolam-induced sedation in bone marrow aspiration/trephine biopsies. Clin Lab Hematol 1996;18:285-8.  Back to cited text no. 6
7. Wang B, Tang J, White PF, Naruse R, Sloninsky A, Kariger R, et al. Effect of the intensity of transcutaneous acupoint electrical stimulation on the postoperative analgesic requirement. Anesth Analg 1997;85:406-13.  Back to cited text no. 7
8. Fukazawa Y, Maeda T, Kishioka S. The pharmacological mechanisms of electroacupuncture. Curr Opin Investig Drugs 2009;10:62-9.  Back to cited text no. 8
9. Kou W, Bell JD, Gareus I, Pacheco-Lopez G, Goebel MU, Spahn G, et al. Repeated acupuncture treatment affects leukocyte circulation in healthy young male subjects: A randomized single-blind two-period crossover study. Brain Behav Immun 2005;19:318-24.  Back to cited text no. 9
10. Ni YF, Lian QQ, Jiang PW, Xu YQ. Application of acupuncture analgesia in colonoscopy. Zhongguo Zhen Jiu 2007;27:766-8.  Back to cited text no. 10
11. Kerr NW. Acupuncture for therapy and analgesia. A possible application in dental surgery. Br Dent J 1973;134:201-4.  Back to cited text no. 11
12. Chao AS, Chao A, Wang TH, Chang YC, Peng HH, Chang SD, et al. Pain relief by applying transcutaneous electrical nerve stimulation (TENS) on acupuncture points during the first stage of labor: A randomized double-blind placebo-controlled trial. Pain 2007;127:214-20.  Back to cited text no. 12
13. Vachiramon A, Wang WC. Acupuncture and acupressure techniques for reducing orthodontic post-adjustment pain. J Contemp Dent Pract 2005;6:163-7.  Back to cited text no. 13
14. Kitade T, Ohyabu H. Analgesic effects of acupuncture on pain after mandibular wisdom tooth extraction. Acupunct Electrother Res 2000;25:109-15.  Back to cited text no. 14
15. Lu DP, Lu GP, Gabriel PL. Comparing the clinical effect of five varying locations of LI.4 acupoint. Acupunct Electrother Res 2008;33:135-43.  Back to cited text no. 15
16. Li SR, Guo ZR, Liu Y. Clinical study of combined acupuncture-drug anesthesia for anterior approach cervical discectomy. Zhongguo Zhong Xi Yi Jie He Za Zhi 1997;17:148-9.  Back to cited text no. 16
17. Wang BG, Wang EZ, Chen XZ. A study on combined acupuncture and enflurane anesthesia for craniotomy. Zhongguo Zhong Xi Yi Jie He Za Zhi 1994;14:10-3.  Back to cited text no. 17
18. Sun P, Li L, Si M. Comparison between of acupuncture and epidural anesthesia in appendectomy. Zhen Ci Yan Jiu 1992;17:87-9.  Back to cited text no. 18
19. Chiu JH, Chung MS, Cheng HC, Yeh TC, Hsieh JC, Chang CY, et al. Different central manifestations in response to electroacupuncture at analgesic and nonanalgesic acupoints in rats: A manganese-enhanced functional magnetic resonance imaging study. Can J Vet Res 2003;67:94-101.  Back to cited text no. 19
20. Li W, Cobbin D, Zaslawski C. A comparison of effects on regional pressure pain threshold produced by deep needling of LI4 and LI11, individually and in combination. Complement Ther Med 2008;16:278-7.  Back to cited text no. 20
21. Zhang E. Chinese Acupuncture and Moxibustion. Publishing House of Shanghai College of Traditional Chinese Medicine; 1990.  Back to cited text no. 21
22. Che-Yi C, Wen CY, Min-Tsung K, Chiu-Ching H. Acupuncture in hemodialysis patients at the Quchi (LI11) acupoint for refractory uraemic pruritus. Nephrol Dial Transplant 2005;20:1912-5.  Back to cited text no. 22