A Novel Integrative Protocol for Pain Management

Potential Clinical Applications

The proposed integrative pain management protocol, combining simultaneous high and low frequency TENS, concurrent electroacupuncture, and follow-up cupping therapy, holds promise for a range of pain conditions.

This section outlines potential clinical applications, focusing on fibromyalgia, sciatica, carpal tunnel syndrome, endometriosis-related pain, and tendonitis, and explains how the protocol’s mechanisms of action may address the specific pain characteristics of each condition.

Fibromyalgia

Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal pain, often accompanied by fatigue, sleep disturbances, and cognitive dysfunction. The pathophysiology of fibromyalgia involves central sensitization, altered pain processing, and neuroendocrine abnormalities (Универсал, 2023).

Application of the Protocol

The proposed protocol may offer a multi-faceted approach to managing fibromyalgia.

• TENS and Electroacupuncture: The low-frequency TENS and electroacupuncture components may help modulate central sensitisation by influencing neurotransmifler release (e.g., serotonin, norepinephrine) and enhancing descending inhibitory pathways (Zhang et al., 2014). High-frequency TENS can provide temporary pain relief, improving patient comfort during the electroacupuncture session.
• Cupping Therapy: Cupping therapy may address the myofascial pain and trigger points commonly associated with fibromyalgia, improving local circulation and reducing muscle tension (Cao, 2013).

Potential Advantages

This integrative approach may provide more comprehensive pain relief than single-modality treatments by simultaneously addressing both the central and peripheral pain mechanisms involved in fibromyalgia.

Sciatica

Sciatica is a type of radicular pain that radiates along the sciatic nerve, typically caused by compression of a nerve root in the lower spine. It often presents with neuropathic components, including burning, tingling, and numbness, in addition to musculoskeletal pain (Ropper & Zafonte, 2015).

Application of the Protocol:

• TENS and Electroacupuncture: Both TENS and electroacupuncture have been shown to be effective in the treatment of radicular pain. Low-frequency electroacupuncture can help modulate neuropathic pain by affecting nerve excitability and reducing inflammation around the nerve root (Cheng et al., 2020). TENS can also help to reduce pain and muscle spasm.
• Cupping Therapy: By targeting the muscles of the lower back and buttocks, cupping therapy may help to release tension and improve blood flow, which may contribute to the reduction of nerve compression and associated pain (Kim et al., 2011).

Potential Advantages

The combination of TENS, electroacupuncture, and cupping may provide a synergistic effect by addressing both the neuropathic and musculoskeletal components of sciatic pain.

Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a common condition characterized by pain, numbness, and tingling in the hand and wrist, caused by compression of the median nerve within the carpal tunnel.

Application of the Protocol

• TENS and Electroacupuncture: TENS and electroacupuncture can be used to modulate the neuropathic pain associated with CTS. Electroacupuncture, in particular, may help to reduce inflammation and improve nerve function (Zhang et al., 2014).
• Cupping Therapy: Cupping therapy applied to the forearm and wrist may help to release myofascial restrictions, improve local circulation, and reduce swelling, potentially alleviating pressure on the median nerve (Hou et al., 2012).

Potential Advantages

The proposed protocol may offer a non-surgical approach to managing CTS symptoms by addressing both the nerve compression and the surrounding soft tissue factors.

Endometriosis-Related Pain

Endometriosis is a condition characterized by the presence of endometrial-like tissue outside the uterus, which can cause chronic pelvic pain. The pain associated with endometriosis can be nociceptive, inflammatory, and neuropathic (Vercellini et al., 2014).