Heart Rate Variability in the Acupuncture Clinic: Correlation with Outcomes
Background: Heart Rate Variability (HRV) analysis is a non-invasive method of assessing autonomic tone and has been studied in conjunction with acupuncture in a number of contexts. Poor health outcomes such as impaired immunity, lowered pain thresholds, mood disorders, and even accelerated aging accompany chronic stress. Acupuncture has been shown to lower sympathetic tone and enhance vagal activity, i.e decrease the stress response. The author has used HRV in the clinic for over a decade in an attempt to identify a biomarker correlate for successful and unsuccessful treatment. Artifact in data samples continues to be a huge problem in the utility of HRV analysis in the clinic. This study will look at a small series of patients (diagnoses-headache-5, peripheral neuropathy 1, knee pain 2, insomnia 1) report the data obtained and the clinical outcomes. Because of monitoring artifacts, the author hypothesized that analysis using nonlinear analysis with the capabilities now available through the Kubios HRV shareware system in addition to the frequency analysis will give a more sensitive and dependable evaluation of the patients’ autonomic state and show a more consistent correlation with clinical outcomes.
Objectives: 1. Assess the feasibility of evaluating HRV across frequency and nonlinear domains in the acupuncture clinic setting. 2. To compare intra-treatment HRV response in patients who have positive treatment outcomes to those who do not.
Design, Setting, and Patients: Though 20 patients were evaluated, only 8 were included for this report. Case study of 9 patients presenting to a private acupuncture clinic, representing 34 treatments. Intervention: All patients received body acupuncture prescribed by the tenets of Traditional Chinese Medicine. Sometimes electro acupuncture (2Hz) was used if manual acupuncture was not effective. HRV data was collected after needle placement for 20 minutes using J and J Engineering I 330 2 Biofeedback Device. . HRV data were analyzed after each treatment. Main Outcome Measure: Patients were assessed by symptom resolution. Their HRV data were compared using Kubios shareware evaluating the following data for the time frames 60 sec to 360 sec, and, 360 sec to 660 sec, and if available 660 s to960 s 1. Frequency Domain: FFT (LFR/HFR) ratios and HF msS 2. J and J calculated LFR/HFR graphed 2. Nonlinear results: Poincaré Plots (SD1/SD2) and Sample entropy
Results: Patients who responded to their acupuncture treatment tended to exhibit a decrease in LFR/HFR, an increase in HF, an increase in their Sd1/SD2, and an increase in their Sample Entropy during treatment. Non-responders, or patients who were aggravated by a particular treatment tended to show no change or an increase in their LFR/HFR from and a decrease in their SD1/SD2 and Sample Entropy during treatment.
Conclusions: In this study the correlation between increased HRV suggesting vagal enhancement during acupuncture treatment and positive response to acupuncture was supported. Use of nonlinear analysis in addition to frequency domain measures added to the sensitivity of HRV outcome measures. To the acupuncture practitioner, the most vexing of all problems is the non-responder. One does their best, with the formulas and point prescriptions to alleviate pain, help with anxiety and stress, help with sleeping, menstrual difficulties, allergies or IBS only to have their best efforts stymied.