Dr Burmen on ‘How electro-stimulation/microstimulation assists in smoking cessation’

Dr Burmen holds a Bachelors’ degree in Human Medicine and Surgery, a Masters’ Degree and Doctorate in Public Health. She kindly spent time answering this Q&A to help explain why electrostimulation therapy works for smoking eddiction, and the science behind it all.

What happens when you smoke a cigarette?

When a cigarette is smoked, it delivers 1.2-2.9 mg of nicotine to the body.1 Nicotine is then transported via the lungs blood vessels to the brain where it activates receptors leading to the release of dopamine (dopamine release also occurs through direct stimulation mechanism) which leads to a pleasurable response. With repeated exposure to nicotine, tolerance/neuroadaptation occurs with upregulation of the number of receptors and development of addiction 2 which makes it difficult for smokers to quit without help.3

How do smoking cessation programs address nicotine tolerance?

Such programs attempt to revert the receptors to a normal state 2 by using nicotine replacement therapies and non-pharamcological therapies with a view to 3  reduce physical nicotine withdrawal symptoms, desensitize nicotinic receptors, eliminate the immediate reinforcing effects of nicotine and allowing patients to focus on behavioral and psychological aspects of tobacco cessation. 4

What is the role of auriculotherapy?

Auriculotherapy is a health care modality whereby the external surface of the ear, or auricle, is stimulated to alleviate pathological conditions in other parts of the body. This therapy is partially based on the ancient Chinese practice of body acupuncture.5 However, rather than using traditional needles it relies on an undetectable electrical current to stimulate prescribed points on the ear that are thought to facilitate smoking cessation6 Stimulation in turn leads to the production of endorphins necessary to compensate for the bodies request for nicotine to restore the pycho-physical balance that has been altered by intoxication from cigarettes. The duration of therapy will be personalised depending on the age of the patient, the number of cigarettes smoked, the number of years smoked and the results of spirometry. 7The World Health Organisation has, since 1997, accepted that auriculotherapy (AT) has a place in clinical care.8

How does auriculotherapy work?

Three theories underlie the mechanism of action of auriculotherapy; the anatomical representation of the inverted fetus on the pinna as a somatotopic map representing reflex parts of body stimulation; the meridian theory in which the ear is connected to 12 meridians of the body explained by Asian culture by the regulation of vital energy, which circulates through the meridians and collateral channels. When there is an imbalance of a person’s  vital energy, he/she becomes vulnerable to disease, and AT would be able to harmonize such flow by minimizing symptoms (TCM concept)9, 10 and the relationship between the pinna and embryological origins of the fetus. 10

Stimulation of different parts of the ear leads to changes in the autonomic nervous system, antinflammation, antioxidation. For these reasons, it has been used clinically in management of substance abuse 10

Smokers have higher neurotransmitters like endorphin, dopamine and serotonin in the blood compared to non-smokers. When a smoker stops smoking, these neurotransmitters will be reduced thus withdrawals set in. Auriculotherapy triggers the Brain to stimulate the release of neurotransmitters naturally and the Auricular points nearest to the Brain, therefore the effect to activate the Autonomous system to change its Bio-chemistry effectively.

What are the results of electrotherapy/ auriculotherapy?

The result is a no invasive treatment, has no side-effect profile, is less expensive than pharmaceuticals, and is acceptable by a large proportion of patients. 11 Auriculotherapy is known to be effective10 and has shown to be more beneficial than placeabo. In a research study, an auriculotherapy group achieved a rate of 20.9% abstinence compared to 17.9% that was attained by the placebo arm after 6 weeks. 6

Guest Bio

I holds a Bachelors’ degree in Human Medicine and Surgery, a Masters’ Degree and Doctorate in Public Health. I am research fellow at Harvard University and the University of Cape Town with over 16 years’ experience in clinical, programmatic, research and science policy fields with interests in health services research and professional (clinical, research, science policy) and personal career mentoring. I have authored 30 publications and made 25 international conference presentations with the support different grants and received international recognition awards for: innovations in clinical practice, policy and research mentorship focused on HIV and Tuberculosis, promoting the clinician-laboratory interface and influencing laboratory policy development, professional performance in sustainable public health, for interdisciplinary sciences that cuts across traditional paradigms, making a significant contribution to her field in resource limited settings, contributing to research and the international community and society at large, volunteer research mentoring and for being an outstanding young leader; and national recognition for immense contribution to lung health issues and diverse scientific work in Kenya. I am an affiliate of TYAN and AAS, a fellow of AREF, ASLP, and is IAP (Eunice Kennedy Shriver National Institutes of Child Health and Development Policy fellowship)

References

1. Lande GR. Nicotine addiction Available from: https://emedicine.medscape.com/article/287555-overview#a3.2018.

2. Benowitz NL. Pharmacology of nicotine: addiction, smoking-induced disease, and therapeutics. Annu Rev Pharmacol Toxicol. 2009;49:57-71.DOI: 10.1146/annurev.pharmtox.48.113006.094742.

3. Giulietti F, Filipponi A, Rosettani G, Giordano P, Iacoacci C, Spannella F, et al. Pharmacological Approach to Smoking Cessation: An Updated Review for Daily Clinical Practice. High Blood Pressure & Cardiovascular Prevention. 2020;27(5):349-62.DOI: 10.1007/s40292-020-00396-9.

4. Prochaska JJ, Benowitz NL. The Past, Present, and Future of Nicotine Addiction Therapy. Annu Rev Med. 2016;67:467-86.DOI: 10.1146/annurev-med-111314-033712.

5. Oleson T. 1 – Overview and History of Auriculotherapy. In: Oleson T, editor. Auriculotherapy Manual (Fourth Edition). Saint Louis: Churchill Livingstone; 2014. p. 1-24.

6. Fritz DJ, Carney RM, Steinmeyer B, Ditson G, Hill N, Zee-Cheng J. The Efficacy of Auriculotherapy for Smoking Cessation: A Randomized, Placebo-Controlled Trial. The Journal of the American Board of Family Medicine. 2013;26(1):61.DOI: 10.3122/jabfm.2013.01.120157.

7. Brandimarte B. A report method of an antismoking Elektromeridian. L’Aquila, Italy: Universita Degli Studi 1990. p. 23.

8. Quah-Smith I, Litscher G, Rong P, Oleson T, Stanton G, Pock A, et al. Report from the 9th International Symposium on Auriculotherapy Held in Singapore, 10-12 August 2017. Medicines (Basel). 2017;4(3):46.DOI: 10.3390/medicines4030046.

9. Artioli D, Tavares A, Bertolini G. Auriculotherapy: neurophysiology, points to choose, indications and results on musculoskeletal pain conditions: a systematic review of reviews. Brazilian Journal Of Pain. 2019;2.DOI: 10.5935/2595-0118.20190065.

10. Hou P-W, Hsu H-C, Lin Y-W, Tang N-Y, Cheng C-Y, Hsieh C-L. The History, Mechanism, and Clinical Application of Auricular Therapy in Traditional Chinese Medicine. Evidence-Based Complementary and Alternative Medicine. 2015;2015:495684.DOI: 10.1155/2015/495684.

11. De Marchi CE, Concina D. Auriculotherapy for Smoking Cessation: An Observational Study of Outcomes. Medical Acupuncture. 2014;26(3):180-8.DOI: 10.1089/acu.2014.1044.

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