The Electrical Alternative - Acupuncture-Like Transcutaneous Nerve Stimulation for Dry Mouth

The Study:  

This phase 2/3 study looked at acupuncture-like transcutaneous nerve stimulation (ALTENS) to treat dry mouth, or xerostomia, in 47 patients with previous head or neck cancer that received radiation therapy who had residual salivary gland function.  A total of 7 points were selected to stimulate using this non-invasive ALTENS technique and was adjustable depending on the patient response. All patients received twice weekly ALTENS sessions (with 20 minutes of stimulation per session) for a total of 24 sessions given in 12 weeks.  Points included Large intestine 4 (LI4), Spleen 6 (SP6), Stomach 36 (ST36), and Conception vessel 24 (CV24).   

There was 94% compliance overall with the ALTENS sessions.  Changes in xerostomia quality of life score, as measured by a standardized survey, was - 35.9% + or - 36.1% at 6 months from registration.  Treatment response, as measured by a 20% improvement in symptoms, was achieved in 85% of patients.   

There were no significant acute adverse events. 1 patient had a facial pain event and 5 patients experienced increased dry mouth during treatment but did not have residual worsening xerostomia at 6 month follow-up.   One patient reported worsening xerostomia at 6 month follow-up. Based on the potential benefit, this study will be continued in a phase 3 setting.

Limitations: 

The study population is somewhat small, and has some demographic trends including 84% men and 70% over 12 months post-radiation.  There is some variability in the amount of power used in stimulation for each person; the electrical stimulation was increased until the study participant experienced a dull ache at the point.  In addition, the outcome measure was subjective and did not measure actual saliva flow or volume.  There was no control group, placebo, or comparison group to see if the improvement in dry mouth was greater than what was to be expected.

What this Means:   

 The study’s discussion is focused on the use of ALTENS as an alternative to acupuncture.  According to the authors, ALTENS is a non-invasive technique that can be used in people with needle fear.  In addition, the article states that ALTENS is easily trainable to people with knowledge of simple anatomical landmarks and requires minimal technical training.  In addition, it claims that ALTENS removes the risk of deep tissue injury that is inherent in  acupuncture treatment.

My Take: 
While the ALTENS is presented as a simple and accessible alternative to acupuncture, the intervention also removes some aspects that are integral to traditional Chinese medicine (TCM) and acupuncture.  With the proposed use of ALTENS, treatment is standardized and does not vary according to a patient’s state that current day.  In addition, the technicians applying the ALTENS are not trained in TCM or acupuncture meridians, just the anatomic landmarks.  While this standardized treatment is easily to implement and to spread to other centers, it also removes the personalized aspect that many patients love in TCM.  One of the reasons so many people flock to TCM and acupuncture is the wholisitic approach that incorporates psychosocial, emotional, and physical health.  ALTENS could be a good alternative in medical centers where access to an acupuncturist is limited, but I think I would find it unnerving to get treated by a technician instead of a practitioner.  It just wouldn't feel like acupuncture anymore.  

Wong RK, James JL, Sagar S, Wyatt G, Nguyen-Tân PF, Singh AK, Lukaszczyk B, Cardinale F, Yeh AM, Berk L.  Phase 2 results from Radiation Therapy Oncology Group Study 0537: A phase 2/3 study comparing acupuncture-like transcutaneous electrical nerve stimulation versus pilocarpine in treating early radiation-induced xerostomia. Cancer. 2012 Jan 17. doi: 10.1002/cncr.27382. [Epub ahead of print]