Acupoint Massage in Relieving Pain after Ureteroscopic Holmium Laser Lithotripsy

Tongxiang Hospital of Chinese Medicine, Zhejiang 314500, China

CLINICAL STUDY

Acupoint Massage in Relieving Pain after Ureteroscopic Holmium Laser Lithotripsy

Xia Wei-qin

Tongxiang Hospital of Chinese Medicine, Zhejiang 314500, China

Author: Xia Wei-qin, associate chief nurse.

E-mail: xwq9158@126.com

Objective: To observe the effect of acupoint massage in relieving pain after ureteroscopic holmium laser lithotripsy.

Methods: Ninety-two patients undergone ureteroscopic holmium laser lithotripsy were enrolled and randomized into a treatment group and a control group, 46 in each group. Patients in the control group were given regular nursing care, while patients in the treatment group were intervened by acupoint massage in addition to the regular nursing care. The pain was evaluated by visual analogue scale (VAS) at 6 h, 12 h, and 24 h after operation, and compared between the two groups.

Results: There was no significant difference in comparing the VAS score at 6 h after operation between the two groups (P＞0.05). The VAS scores in the treatment group at 12 h and 24 h after operation were significantly lower than those in the control group (bothP＜0.05). Fewer patients in the treatment group used analgesics compared with those in the control group.

Conclusion: Acupoint massage can effectively relieve the pain after ureteroscopic holmium laser lithotripsy, reduce the use of analgesics, and promote the recovery.

Acupoint Therapy; Tuina; Massage; Ureteroscope; Lasers, Solid-State; Pain, Postoperative

Ureteroscopic holmium laser lithotripsy has been widely regarded as a safe and highly-efficient treatment for ureteral calculus. Because of its safety, minimal invasion and a high success rate (87%-97%)[1], this treatment has gradually become the optimal choice for calculus in the upper urinary tract. However, after the operation, patients usually experience pain to different extent, not only affecting the comfort of the patients, but also influencing the treatment result. Therefore, early intervention to ease or reduce the post-operative pain has become one of the important tasks in the clinical work. Our Urinary Surgery Department adopted acupoint massage for reducing or relieving the post-operative pain in the patients undergone ureteroscopic holmium laser lithotripsy. The report is now given as follows.

1 Clinical Materials

1.1 Inclusion criteria

Diagnosis of ureteral calculus was confirmed before operation by Ultrasound, X-ray, or intravenous pyelography (IVP); patients with clear consciousness, and able to accurately express his or her own will, andcooperative in evaluating pain; no wounds or other skin lesions at locations of the acupoints for massage; well-informed of the study and willing to accept it.

1.2 Exclusion criteria

Mental disorders or mental retardation, dementia, or those with trouble in verbal communication; complications involving heart, brain, lung, liver, or kidney; skin lesions in the to-be-treated topical areas; aged over 75 years old.

1.3 Statistical analysis

The SPSS 13.0 version statistical software was adopted for statistical analyses. The enumeration data were analyzed by Chi-square test.P＜0.05 indicated a statistically significant difference.

1.4 General data

Totally 92 subjects were enrolled, all from the Urinary Surgery Department of our hospital receiving the ureteroscopic holmium laser lithotripsy between March of 2013 and February of 2014. They were numbered by the admission sequence and then randomized into a treatment group and a control group, 46 cases in each group. In the control group, 3 patients had histories of receiving extracorporeal shock wave lithotripsy (ESWL), while there were 2 cases in the treatment group. There were no significant differences in comparing age, gender, or calculus site between the two groups (allP＞0.05), indicating the comparability (Table 1).

Table 1. Comparison of general data

2 Treatment Methods

Before intervention, the subjects were trained to use the visual analogue scale (VAS).

2.1 Treatment group

2.1.1 Regular nursing care

After operation, patients were given regular treatment and nursing care, such as antiinflammation, analgesia, and fluid supplement, associated with health education, including the disease-related knowledge, relevant therapies, causes and rules of the onset of pain, techniques to maintain a healthy mental state, methods to regulate sleep, significance of keeping a proper posture and doing exercises, and self-management of pain. Pain of moderate or above degree would be managed by medications according to the doctor’s prescription.

2.1.2 Acupoint massage

Acupoints: Zhigou (TE 6), Zusanli (ST 36), Yanglingquan (GB 34), and Kunlun (BL 60).

Operation: First, the objective, function and operation of acupoint massage were explained to the patient, for obtaining the trust and cooperation. Then, while the patient took a comfortable posture, the practitioner perpendicularly pressed the acupoint with thumb, gradually increasing the strength then gradually reducing the strength, better to produce dull pain, distending or numb sensations. Each acupoint was treated for 3 min. Patients were told to take deep breaths and relax the whole body during the process.

从马克思历史哲学视野分析和把握马克思以“世界历史”理论形式阐发的全球化思想，其内在逻辑理路主要体现为三个有机统一的层面:

Operation time: The massage was given for the first time in 2-3 h after the lithotripsy and before the relief of anesthesia, the second time at 6 h after the lithotripsy, and the 3rd and the fourth were conducted respectively at 10 h and 20 h after lithotripsy.

Cautions: When giving massage, the thumb must closely cling to the skin, with proper rhythm, gentle and even force, and a comparatively low speed. During the operation, pay attention to the expressions and general condition of the patients, and also keep them warm. Communicate with the patient so that the practitioner can adjust the manipulation and force according to the patients’tolerance, to achieve the best result.

2.2 Control group

3 Observation of Therapeutic Efficacy

3.1 Observation indexes

3.1.1 VAS score

VAS was adopted to evaluate the post-operative pain degree with a 10-centimeter scale marked with 0-10 to express the pain degree. The patient marked on the back of the scale to represent his or her pain, and the length from 0 to the marked point would be considered as the pain value. 0 represent no pain, 1-3 for mild pain, 4-6 for moderate pain, ＞6 for severepain[2]. The nurse in-charge was responsible for observing and recording the pain scores respectively 6 h, 12 h, and 24 h after the operation.

3.1.2 Use of analgesics

In the two groups, the cases that used analgesics were recorded.

3.2.1 Observation of pain degree at different time points

Six hour after the operation, there was no significant difference in comparing the pain degree between the two groups (P＞0.05). Twelve hours and 24 h after the operation, patients in the treatment group majorly present absence of pain or mild pain, and there were no patients presenting severe pain; while patients in the control group had more cases with moderate pain, and there were patients presenting severe pain. Significant differences were found in comparing the pain degree between the two groups (P＜0.05).

Table 2. Comparison of pain degree at different time points (case)

3.2.2 Use of analgesics after operation

Regarding the use of analgesics, 1 case in the treatment group and 7 cases in the control group used analgesics, and there was a significant difference between the two groups.

4 Discussion

Pain is an unpleasant feeling and a subjective emotional perception. It’s not only a symptom, but also a disease. Currently, with the rise of physicpsycho-social medical pattern, there is a high demand for individualized care, and thus pain has become the fifth physical sign following body temperature, pulse rate, breath, and blood pressure. There are multiple measurement tools for pain. Among which, VAS is the most commonly used one because of its convenient operation[3]. Injuries during ureteroscopic holmium laser lithotripsy, placing double-J stent, as well as ureteral cramps caused by blood stasis and broken stones, and expelling of stones all can lead to pain, even colic pain. Traditional Chinese medicine (TCM) holds that post-operative pain is basically caused by impairment of Yuan-Primordial qi, and stagnation of qi and blood. Stagnation of qi and blood in organs will lead to the blockage of the meridians and dysfunctions of Zang-fu organs, and pain will then occur. Mental irritation, tension, and anxiety brought by pain will promote the production of catecholamine, subsequently leading to increased heart rate, hypertension, arrhythmia, nausea, and vomiting. These reactions interact with pain both as cause and effect, thus interfering with the rehabilitation of the patients. Intensive pain may also cause sudden cardiac arrest[4], threatening life. Therefore, effective early intervention to reduce the post-operative pain can not only decrease the physiological discomforts brought by pain, but also can improve appetite and sleep quality, reduce the risk of complications, which are significant for the post-operative rehabilitation of the patients.

According to the conventional TCM theories, acupoint massage can dredge and unblock meridians and collaterals, activate qi and blood flow, diminish stagnation and kill pain[5-6]. The modern medicine believes that acupoint massage can evoke the pain-modulatory system, inhibit the perception of pain and emotional reactions[7]. Zhigou (TE 6) is the Jing-River point of the Triple Energizer Meridian. The three jiao is in charge of regulation of waterways, and hence massage to Zhigou (TE 6) can dredge and unblock meridians and collaterals, regulate qi activity. When qi and blood flow smoothly, pain can be arrested. Yanglingquan (GV 34) works to unblock the Gallbladder Meridian, promote the flow of qi and blood, and unblock collaterals to stop pain. Kunlun (BL 60) functions to regulate the meridian qi of the Bladder Meridian, harmonize qi and blood, thus guaranteeing the smooth flow of meridians and collaterals. Zusanli (ST 36) can modulate qi activity, activate blood flow and unblock collaterals, relieve cramps and ease pain. Modern researches indicate that stimulation to Zusanli (ST 36) can promote the release of endorphin and inhibit the transduction of pain perception, thus producing an analgesic effect. The combination of the above points can regulate the qi of the Bladder Meridian, activate collaterals and kill pain, tonify kidney and relieve water, clear heat and expel stones. They work in a synergetic way to kill pain, not only treating the symptoms but also thecauses. Meanwhile, acupoint massage can distract the patients’ attention, release the tension, and enhance the pain threshold, beneficial to the release of pain. What’s more, it’s free of adverse effects brought by analgesics[8-9].

Far more than a kind of physical touch, acupoint massage also bridges the relationships[10]between the patients and medical staff. Nowadays, both nursing skills and humanistic concern are paid much attention. While acupoint massage relieves pain, it also promotes the communication between nurse and patient. Gentle talk and determined sights of the nurse also can release patients’ tension and anxiety, bring delight to the patients to approach the best physiological and mental condition.

This study shows that acupoint massage can effectively reduce pain after ureteroscopic holmium laser lithotripsy, reduce the use of analgesics, and promote the rehabilitation of the patients. It’s easy-to-operate, free of injuries, and welcomed by the patients. Therefore, it’s a safe, effective and valuable analgesic method, worthy of further promotion in clinic.

Conflict of Interest

The author declared that there was no potential conflict of interest.

Acknowledgments

This work was supported by Tongxiang Hospital of Chinese Medicine.

Statement of Informed Consent

All of the patients in the study signed the informed consent.

[1] Triantafyllidis A, Kalaitzis C, Giannakopoulos S, Papatsoris AG, Pantazis T, Papathanasiou A, Touloupidis S. Holmium laser lithotripsy of ureteral calculi: our initial experience. Urol Int, 2007, 79(1): 24-27.

[2] Fadaizadeh L, Emami H, Samii K. Comparison of visual analogue scale and faces rating scale in measuring acute postoperative pain. Arch Iran Med, 2009, 12(1): 73-75.

[3] Aicher B1, Peil H, Peil B, Diener HC. Pain measurement: visual analogue scale (VAS) and verbal rating scale (VRS) in clinical trials with OTC analgesics in headache. Cephalalgia, 2012, 32(3): 185-197.

[4] Wu JM, Zhang LP, Chen XC. Pay attention to nursing for post-operative pain. Guowai Yixue Hulixue Fence, 2005, 24(7): 393-395．

[5] Li ZL. Therapeutics for Pain. Tianjin: Tianjin Scientific and Technology Press, 1994: 107．

[6] Wu M, Wang YJ. Clinical study of finger kneading to point Hegu (LI 4) for the prevention and treatment of nausea and vomiting induced by breast cancer chemotherapy. Shanghai Zhenjiu Zazhi, 2013, 32(9): 724-725.

[7] Dai LH, Shi JJ. Acupoint massage in relieving abdominal pain after induced abortion. Quanke Huli, 2011, 9(10): 2566-2567.

[8] Yang J, Long Y, Yang J. Effect evaluation of massage to points on hands and feet for pain due to uterectomy. Zhonghua Xiandai Huli Zazhi, 2013, 19(31): 3889-3891.

[9] Liu GF, Sang DY, Chen DQ. Application of acupoints massage in nursing of stomachache. Zhongguo Minjian Liaofa, 2003, 11(1): 5.

[10] LI Y, Wang XG, Liu YM, Liu JY. Effect of touching and acupoint massage on growth and development of children with hypoxic-ischemic encephalopathy. Hulixue Zazhi, 2003, 18(4): 246-248．

Translator: Hong Jue

Received Date: July 6, 2014

R244.1

: A

in the control group only

the same regular nursing care as that in the treatment group.