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Johanna Biemans , MSc

Johanna Biemans , MSc. PTNS ( Percutaneous tibial nerve stimulation) : an evaluation of it’s possibilities. Overview. Historical perspective Overactive bladder Sanyinjiao Needling concepts

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Johanna Biemans , MSc

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  1. Johanna Biemans, MSc PTNS (Percutaneoustibial nerve stimulation):an evaluation of it’s possibilities Johanna Biemans, MSc. ASA TCM-Kongress 2013

  2. Overview • Historicalperspective • Overactive bladder • Sanyinjiao • Needlingconcepts • The NeedleApp ASA-TCM Das Lebenab 40 Johanna Biemans, MSc. ASA TCM-Kongress 2013

  3. PercutaneousTibialNerveStimulation PTNS Johanna Biemans, MSc. ASA TCM-Kongress 2013

  4. b.Chr.2500-Sanyinjiao-2013 a.Chr. 2013 History Johanna Biemans, MSc. ASA TCM-Kongress 2013

  5. Riddle of Bagdad’sBatteries • Pain killing effect electricfishAncientGreek • Needlelikeobjectswerefoundnearsome of the batteries. • Electric stim. = manualstim.: 3 times in 30 min. stim. during 2 min. Johanna Biemans, MSc. ASA TCM-Kongress 2013

  6. Whereit all started. • McGuire et al, 1983 • Electrical stimulation at Sp6 improves urgency and incontinence in people with detrusoroveractivity. • 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 Johanna Biemans, MSc. ASA TCM-Kongress 2013

  7. Research • Research mainly: -the Netherlands and Italy. -overactive bladder -refractory patients 2 promovendi: Dr. vanBalken and Dr. vanDoninck Johanna Biemans, MSc. ASA TCM-Kongress 2013

  8. Results • Observational. 60-80% impr.on OAB symptoms Johanna Biemans, MSc. ASA TCM-Kongress 2013

  9. Introduced in Health Care • Implemented in Hospitalsforrefractory OAB. • Code forreimbursement. • Submitted to Guidelines • Notification: different fromacupuncturebecause of energy concept. Johanna Biemans, MSc. ASA TCM-Kongress 2013

  10. Inspiration • Conventional medicine • The proof. Johanna Biemans, MSc. ASA TCM-Kongress 2013

  11. Meanwhile in the U.S. • Uroplastybrings Urgent PC to the market. • Sponsoring two big trials. Randomized Trial of PercutaneousTibial Nerve Stimulation Versus Sham Efficacy in the Treatment of Overactive Bladder Syndrome: Results From the SUmiT Trial. Randomized Trial of PercutaneousTibial Nerve Stimulation Versus Extended-Release Tolterodine: Results From the Overactive Bladder Innovative Therapy Trial(OrBIT). Johanna Biemans, MSc. ASA TCM-Kongress 2013

  12. Results • OrBITSumIT • Global response assessment of OAB symptom • improvement after 12 weeks of therapy Johanna Biemans, MSc. ASA TCM-Kongress 2013

  13. Break-throughUroplastyInc. Stock exchange listedcompanywith; 25 million dollar revenu 2013 Johanna Biemans, MSc. ASA TCM-Kongress 2013

  14. Back to the origin (overactive) bladder Johanna Biemans, MSc. ASA TCM-Kongress 2013

  15. 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 Johanna Biemans, MSc. ASA TCM-Kongress 2013

  16. Pathogenic • Incontinence mainly through QiXu. • Lower burner loses the upward assisting function • QiXu: lo/mi/Ni • PE:damp/heat/cold Johanna Biemans, MSc. ASA TCM-Kongress 2013

  17. Lo QiXu • Loss of vaporisingfunctionTonify Lo Qi: Bl 13 , DM 12 • -CyclefluidsdisturbedTonifywatercycle : Lo 7 Mi QiXu -TransformationdisturbedTonifySpQiSt 36, RM 12, -Downwardmovement, bladder overload. Bl 20 Ki QiXu Yin Tonify Ki Qi Ki 3, RM 4,Sp6 Yang Bl23,DM4,Ni7, RM4 Johanna Biemans, MSc. ASA TCM-Kongress 2013

  18. General • Bl23, tonifyKiQi • Bl28, tonifyBlQi • Bl53, idem • RM1 • Mg28 Johanna Biemans, MSc. ASA TCM-Kongress 2013

  19. Segmental • RM1 • Bl29,30,31,32, • 33,34tot54 • Wisselwerking sympatisch en para-sympatisch/ • somatisch Johanna Biemans, MSc. ASA TCM-Kongress 2013

  20. Overactive bladder western perspective • 4 symptoms: frequency( > 8 times a day), urgency, incontinence, nocturia • Treatment: medication, bladdertraining, PTNS, botox, operation. • Prevalence: 29.8 millionAmericans >40yrs have bothersome OAB symptoms= highlyprevalent. • Women>men. Johanna Biemans, MSc. ASA TCM-Kongress 2013

  21. Sanyinjiao Specified Johanna Biemans, MSc. ASA TCM-Kongress 2013

  22. Traditional Chinese Medicine • Huangdineitsjinglingstju: once • Stronglyweakenedperson to stop sweating. • Pubmed: 369 hits Johanna Biemans, MSc. ASA TCM-Kongress 2013

  23. Clinicaldecisions: poetry Johanna Biemans, MSc. ASA TCM-Kongress 2013

  24. Clinicaldesicions PTNS Guidelines Research Fixed point choice. Overactive bladder Fecalincontinence NICE guidelines US Johanna Biemans, MSc. ASA TCM-Kongress 2013

  25. Clinicaldesicions PTNS • Could PTNS besupportive in sexualdysfunctionsorimpotence? • Coulditcalmanoveractive bladder? • Bloodflowpelvis • Neurophysiologicalchanges. Hypothesis Theory Johanna Biemans, MSc. ASA TCM-Kongress 2013

  26. Open for research • Efficacy and Effectiveness of PercutaneousTibialnerveStimulation in the Treatment of Pelvicorgan Disorders: A SystematicReview. • Neuromodulation, Technology at the Neural Interface, Jan/Feb 2013, Vol 16, No.1. pg 25-34. • J.M.A.E.BiemansMSc, M. van Balken, PhD Johanna Biemans, MSc. ASA TCM-Kongress 2013

  27. (Possible) Indications PTNS Johanna Biemans, MSc. ASA TCM-Kongress 2013

  28. Contra 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. Johanna Biemans, MSc. ASA TCM-Kongress 2013

  29. Summarize? Johanna Biemans, MSc. ASA TCM-Kongress 2013

  30. Needlingconcepts Merging Johanna Biemans, MSc. ASA TCM-Kongress 2013

  31. 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, chargedwith the activity of Yin. Needlesfor the excess of Yang. Johanna Biemans, MSc. ASA TCM-Kongress 2013

  32. Theoretical models Johanna Biemans, MSc. ASA TCM-Kongress 2013

  33. Rethinkconcepts of needling? Johanna Biemans, MSc. ASA TCM-Kongress 2013

  34. Scientificnecessity • Different theory/different needlemanipulation. • Specifictheory > specific disorders • Scientificmaturation> necessity to differentiate Johanna Biemans, MSc. ASA TCM-Kongress 2013

  35. The NeedleApp Differentiating Johanna Biemans, MSc. ASA TCM-Kongress 2013

  36. Practical App Right theory-- Right Needle-- Right Technique-- right Condition WM/EBM/TCM Friendlyforpractitioner. First release: April 2014 Johanna Biemans, MSc. ASA TCM-Kongress 2013

  37. Thanx for your attention Johanna Biemans, MSc. ASA TCM-Kongress 2013

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