johanna biemans , msc

PTNS (Percutaneous tibial nerve stimulation):an evaluation of it’s possibilities

Johanna Biemans, MSc

5-12-2013Johanna Biemans, MSc. ASA TCM-Kongress 2013 1

Historical perspective

Overactive bladder Sanyinjiao Needling concepts The Needle App

5-12-2013Johanna Biemans, MSc.

ASA TCM-Kongress 2013 2

Overview ASA-TCM Das Leben ab 40

Percutaneous Tibial Nerve Stimulation

PTNS

34-gauge needle inserting at Sp6

Other elektrode on area Sp4 or sole feet

Electric current 0-10mA/20Hz/motoric sens.

30 min, once weekly, 12 weeks.





b.Chr.2500-Sanyinjiao-2013 a.Chr. 2013 History

Riddle of Bagdad’s Batteries

Pain killing effect electric fish Ancient Greek

Needle like objects were found near some of the batteries.

Electric stim. = manual

stim.: 3 times in 30 min. stim. during 2 min.



Where it all started. McGuire et al, 1983 Electrical stimulation at Sp6 improves urgency and incontinence in people

with detrusor overactivity.

Stoller, 1998 EA on Sp6 in rats decreases c-fos protein in neural pathways that lead to

micturition centre while giving noxious stimuli.

Improvement blood supply pelvic floor.

Modulation of autonomous and somatic nerves.

SANS: Stoller Afferent Nerve Stimulation



Research mainly: -the Netherlands and Italy.

-overactive bladder -refractory patients2 promovendi:Dr. vanBalken and Dr. vanDoninck

Research



Results

Observational. 60-80% impr.on OAB symptoms

OAB OAB/IC0

20406080

100Stoller1999Klinger et al.2000Govier2001vanBalken2001VanDoninck2003Kolom2Kolom1



Implemented in Hospitals for refractory OAB.

Code for reimbursement. Submitted to Guidelines Notification: different from acupuncture

because of energy concept.

Introduced in Health Care



Inspiration

Conventional medicine

The proof.



Uroplasty brings Urgent PC to the market. Sponsoring two big trials.

Meanwhile in the U.S.

Randomized Trial of Percutaneous Tibial Nerve Stimulation Versus Sham Efficacy in the Treatment of Overactive Bladder Syndrome: Results From the SUmiT Trial.

Randomized Trial of Percutaneous Tibial Nerve Stimulation Versus Extended-Release Tolterodine: Results From the Overactive Bladder Innovative Therapy Trial(OrBIT).



OrBIT SumIT Global response assessment of OAB symptom improvement after 12 weeks of therapy

p=0,01

0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%

PTNS

Tolterodine

Results

p<0,001

0.0%10.0%20.0%30.0%40.0%50.0%60.0%

PTNS N=110Sham N=110



Stock exchange listed company with;

25 million dollar revenu 2013

Break-through Uroplasty Inc.



(overactive) bladder5-12-2013

Johanna Biemans, MSc. ASA TCM-Kongress 2013 14

Back to the origin

TCM/Bladder Lower burner: Regulations of fluids Fire Ming Men Ni Yg

heats the Sp cooks and

condensates At Lu level Bl. Function:

storage, drainage overflow



Pathogenic

Incontinence mainly through Qi Xu. Lower burner loses the upward assisting

function Qi Xu: lo/mi/Ni PE:damp/heat/cold





Lo Qi Xu- Loss of vaporising function Tonify Lo Qi: Bl 13 ,

DM 12 -Cycle fluids disturbed Tonify watercycle : Lo 7

Mi Qi Xu-Transformation disturbed Tonify Sp Qi St 36, RM 12, -Downward movement, bladder overload. Bl 20 Ki Qi Xu Yin Tonify Ki Qi Ki 3, RM 4,Sp6Yang Bl23,DM4,Ni7, RM4

General Bl23, tonify Ki Qi Bl28, tonify Bl Qi Bl53, idem RM1 Mg28



Segmental

RM1 Bl29,30,31,32, 33,34tot54 Wisselwerking

sympatisch en para-sympatisch/ somatisch



4 symptoms: frequency( > 8 times a day), urgency, incontinence, nocturia

Treatment: medication, bladdertraining, PTNS, botox, operation.

Prevalence: 29.8 million Americans >40yrs have bothersome OAB symptoms= highly prevalent.

Women>men.



Overactive bladder western perspective

SanyinjiaoSpecified



Traditional Chinese Medicine

Huang di nei tsjing ling stju: once Strongly weakened person to stop sweating. Pubmed: 369 hits

Sp6

Lower burner

Expels damp

Clears heat

Moves XueCalms shen

Tonicum Yin/Xue



Sp6: core point

Sp9: dampness

St 27 : damp bladder

RM 3: cool

Interstitiel cystites

RM 4: warm

Sp10: blood

Li 11: cool blood

Ki5/Rm 3: cool blood uterus

Regulate short cycle

St36: Qi/shen

Ht 7: shen

Ht 3: joy de vivre

Depression

Clinical decisions: poetry



Clinical desicions PTNS

Research Guidelines

Overactive bladderFecal incontinence

NICE guidelinesUS



Fixed point choice.

Clinical desicions PTNS

Hypothesis Theory

Could PTNS be supportive in sexual dysfunctions or impotence?

Could it calm an overactive bladder?

Blood flow pelvis Neurophysiological

changes.



Efficacy and Effectiveness of Percutaneous Tibial nerve Stimulation in the Treatment of Pelvic organ Disorders: A Systematic Review.

Neuromodulation, Technology at the Neural Interface, Jan/Feb 2013, Vol 16, No.1. pg 25-34.

J.M.A.E.Biemans MSc, M. van Balken, PhD

Open for research



Urologic Incontinence UrgeStressMixed

Pain Bladder pain/ICPelvic pain

Voiding obstruction Urinary retentionRectal Incontinence FecalGyneacological Menstrual Dysmenorhea

MenorrhagiaPain Chronic pelvic painSexual Vaginism

PGAS( Persistent genital arousal syndrome)Dyspareunia

Andrological Prostate Chronic ProstatitisIIIB/CPP

Sexual

(Possible) Indications PTNS



pacemakers or implantable defibrillators. patients prone to excessive bleeding. patients with nerve damage that could impact

either PTNS or pelvic floor function. patients who are pregnant or planning to become

pregnant during the duration of the treatment.

Risks: low. Most common side-effects are temporary and include mild pain or skin inflammation at or near the stimulation site.



Contra indications PTNS

Summarize?



Merging5-12-2013


Needling concepts

Su Wen: Acupuncture or ‘needling’ consists of the insertion of needles of various materials into particular points of the body.

Needles are from the yin-yang point of view, charged with the activity of Yin. Needles for the excess of Yang.



TCM

Earacupuncture

Neuromodulation

Triggerpoi

nt



Theoretical models

Other Models?

Implement?Discard?Replace?



Rethink concepts of needling?

Different theory/different needle manipulation.

Specific theory > specific disorders Scientific maturation> necessity to

differentiate



Scientific necessity

Differentiating5-12-2013


The Needle App

Johanna Biemans, MSc. ASA TCM-Kongress 2013

Practical App

Right theory-- Right Needle-- Right Technique-- right Condition

WM/EBM/TCM

Friendly for practitioner.First release: April 2014

5-12-2013 36

Thanx for your attention



johanna biemans , msc

Documents

de epidemiologie de

de basis

de effecten

de kosten

de succesratio

de mensheid

de combinatie

de polikliniek