A Study on Silver Spike Point Therapy (SSP) Stimulation for Low Back Pain

Kohei INAMORI, Toshikatsu KITADE, Akira KAWACHI, Masafumi AKATSUKA, Onaka MASAHIKO, Hidemaro MORI
The Department of Anesthesiology, Osaka Medical College, Pain Clinic.

Keywords: 3Hz continuous SSP Therapy, 1/f rythmic SSP Therapy, SSP electrode

SUMMARY

Changes in various parameters have been compared for 3Hz continuous stimulation SSP Therapy and 1/f rythmic SSP Therapy, which are peripheral stimulation therapies for treatment of chronic low back pain.  SSP Therapy is an acupoint stimulation therapy, in which electrodes are placed at acupoints to perform low frequency current flow.
1)    In both of the two different therapies, improvement of blood circulation at the low extremity has been observed.
2)    More significant pain treatment effect has been observed in 1/f rythmic SSP  Therapy as compared with 3Hz continuous SSP Therapy.
3)    1/f rythmic SSP Therapy has given more comfortableness during treatment that the other therapy to achieve better treatment effect.

INTRODUCTION

The authors have examined changes in local tissue blood stream, surface temperature, and subjective symptoms as treatment effect for low back pain frequently experienced for outpatients, when 3Hz continuous SSP Therapy giving peripheral stimulation and newly developed 1/f rythmic SSP Therapy have been applied.

The subjects have been divided into two groups.
Five subjects belonging to the first group have had measurement of microscopic circulation tissue blood stream and thermograph.  Thirty-two subjects belonging to the second group have been examined on treatment effect to chronic low back pain as well as comfortableness comparison

1.    SUBJECT AND METHOD

a)    Measurement in the first group.

The average age of the five subjects was 42+/-10 years.  To give stimulation, both 3Hz continuous SSP Therapy and 1/f rythmic SSP Therapy have been applied by placing the SSP electrodes on the acupoints of kidney and colon and using TRIMIX303H manufactured by Nihon Medix Company with current flow for a period of twenty minutes.  After 30 minutes of quiet rest, the foot sole temperature of the subjects has been measured before stimulation, immediately after stimulation, 10, 20, 30, 40 minutes after stimulation given by the both therapies (six times in total), using a Laser Doppler Microscopic Circulation Tissue Blod Stream Meter manufactured by Advance Company, an Infra-Eye 160 Colour Thermograph, and Coretemp CTM201 manufactured by Teruma Co.  The measurement has been performed at Yu-sen, which is the acupoint at the center of the foot sole, and examination has been made what effect the stimulation at the low back gives to the surface temperature and the depth temperature at a remote part.  The measurement condition has been room temperature of 25+/-0.5 degrees C with humidity of 60+/-5%(Table 1).  The statistical estimation has been done by T test for temperature and blood stream and by Mann Whiney method as to treatment effcct.  The risk ratio has been less than 5% with a significant difference observed.
 
 

Table 1 - Test Method 1.    Subjects; 5 healthy persons (average age +/-sd: 42.4+/-10.1) 2.    Measurement device:         a)    Surface/depth temperature meter, Coretemp CTM201 by Teruma Company.         b)    Colour thermograph, Infra-eye 160, manufactured by Fujitsu         c)    Laser Doppler Microscopic Circulation Tissue Blood Stream Meter, manufactured by Advance Co. 3.    Stimulation method:          a)    left and right kidney and colon.         b)    3Hz continuous SSP stimulation and 1/f rhythmic SSP stimulation, each independently.         c)    Current flow times 20 minutes. 4.    Measurement region: Foot sole. 5.    Measurement time: six times (before stimulation, immediately after stimulation, 10/20/30/40 minutes after stimulation). 6.    Measurement conditions: 25+/-0.5 degree C, humidity 60+-5%

b)    Measurement in the second group.

 i)    Treatment effect
The measurement has been performed with 32 patients with chronic low back pain (10 male and 22 female), whose average age was 54+/-14 years.  3Hz contimuous SSPTherapy and 1/f rhythmic SSP Therapy have been carried out in crossover method with 4 days interval.
SSP electrodes have been placed at Jin-yu, Daicyo-yu, Jin-ryo, and I-cyu, which have been chosen as treatment holes, with current flow for 20 minutes.
To grade treatment effect, 10 points have been given to low back pain before treatment and the results immediately after treatment have been graded in four ranks; significant effect 0 - 1 points, ordinary effect 2 - 5 points, slight effect 6 - 8 points, and no effect 9 - 10 points.  Significant effect and ordinary effect have been judged as improvement cases.

ii)    Comparison of comfortableness
The two different therapies have been applied to the 32 patients with low back pain to compare comfortableness during treatment.  Evaluation has been done in eleven grades between 'most uncomfortable' 0, and 'most comfortable' 10, in accordance with VAS method and comparison between the two groups has been performed in Mann Whitney method.

2.    RESULT

a)    Microscopic circulation tissue blood stream

Examination of anachronic changes in microscopic circulation tissue blood stream has resulted in observation of blood stream increase at foot soles after stimulation as compared with before stimulation in both 1/f rythmic SSP Therapy and 3Hz continuous SSP Therapy (p<0.05) with no significant difference observed between the two groups.

b)    Thermograph

Immediately after stimulation, increase of the surface temperature has been observed at the peripheral part of the lower extremity in the both therapies.  After that time, 1/f rythmic SSP Therapy has shown a little more temperature rise (Fig. 2).

c)    Comparison of skin temperature

Rise of the skin temperature has been observed at the surface as well as the depth from immediately after the stimulation to 20 minutes after stimulation (before stimulation - 0).  Significant difference has not been observed between the two groups.

d)     Comparison treatment effect

3Hz continuous SSP Therapy has resulted in 15 cases of improvement (Significantly effective: 1case, and effective: 14 cases; 43.8% +/-3.1%) with 16 cases slightly effective (50%) and 1 case not effective.  On the other hand, 1/f rhythmic SSP therapy has resulted in 27 cases of improvement (significantly effective: 2 cases and effective: 25 cases; 84.3%) with slightly effective: 4 cases and not effective: 1 case.
It has thus been observed that 1/f rythmic SSP Therapy is statistically more effective than conventional 3Hz continuous SSP Therapy with constant frequency. (p<0.05)

3.    CONSIDERATION AND CONCLUSION

SSP Therapy represents surface acupuncture point stimulation therapy with Silver Spike Point electrode placed on an acupoint and low frequency current flow.  SSP electrodes are made of silver plated brass to ensure good current flow.  The electrode is place on an acupoint, fixed with a plaster or belt.  This provides compression effect on the acupoint with such stimulation effect as needles used.  SSP Therapy is often called 'needleless acupuncture'.  An acupoint represents a region corresponding to a vital point for diagnosis and treatment.  The acupoint can morbidly appear in any number and region.  Physiologically, electric resistance is low at any acupoint.  SSP Therapy definately came into existence through a practice of acupunctural anesthesia, with its development originated on a basis of acupoints.  For current flow, low-frequent low cycle is mainly used, which can also be used jointly with highly frequent low cycle.  Any number of SSP electrodes can be used for SSP Therapy.  The SSP electrode has a shape of a reverse cone.  The cone point shows an acute angle of 90 degrees, which, however, does not aim to pierce the skin, but is connected with a cord for purpose of low frequency current.  Except for use on the face, SSP electrodes with suction device are usually used.  Since a rubber cap, which can produce negative pressure around the electrode, is attached to the electrode, it can firmly adhere to the skin surface without a plaster, maintaining compression effect almost unchanged.  The authors have examined how current flows in the body, when electricity is turned on to the SSP electrode with such a characteristic shape.  The study has revealed that current flow depends upon compression to the skin.  Therefore, current concentrates at the electrode tip and hence can flow in high density to the treatment site.

At the same time, some current flow occurs at the edge of the circle disk, as pressure is added there, too.  This helps to fulfill automatic protection function to over-current.  At such a stiff part as directly over a bone, strong pressure is added to the electrode tip and hence current enters into the body chiefly from there.  Therefore, it is important to fit the electrode to the treatment point.  At a tender body part, there is hardly any pressure difference between at the electrode tip and the circle seat and consequently current flows into the body widely from the electrode circumference.

Meanwhile, 1/f rythmic SSP Therapy aims to enhance pain killing effect in electric stimulation by setting stimulation pulse at the 1/f 'yuragi' rhythm.  In pain killing treatment, such stimulation with a monotonous constant rhythm as 3Hz continuous low frequency acupuncture therapy tends to result in becoming inured.  To prevent this from occurring, various tests have been carried out such as changing stimulation strength into sine curve or saw tooth like shape.  It has led to a conception that a better result might be achieved, if stimulation to be given should have 1/f 'yuragi'(fluctuation) which is similar to bio-genic rhythm.  It is reported that a better effect would be achieved by stimulation accompanied by music at the same time.