1. Center for Pain & Stress Research, Toronto, Canada
2. Emeritus Professor of Medicine and Consultant Nephrologist (retired), University of Manchester and Royal Infirmary, Manchester, England, UK
Academic Editor: Im Quah-Smith
Special Issue: Acupuncture for Women’s and Children’s Health
Received: March 25, 2019 | Accepted: September 20, 2019 | Published: September 25, 2019
OBM Integrative and Complementary Medicine 2019, Volume 4, Issue 3, doi:10.21926/obm.icm.1903056
Recommended citation: Armstrong K, Gokal R, Todorsky T. Treatment of Chronic Post Surgical Pain Using Micro-current Point Stimulation Applied to C-Section Scars. OBM Integrative and Complementary Medicine 2019;4(3):11; doi:10.21926/obm.icm.1903056.
© 2019 by the authors. This is an open access article distributed under the conditions of the Creative Commons by Attribution License, which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is correctly cited.
C-section is the most common surgical procedure performed in the US with 1.3 million such operations performed annually accounting for 32% of all births. [1,2] During this medical procedure, a surgical incision is made through the abdomen. A C-section requires cutting through skin, connective tissue, muscles, the uterus, and adjusting the organs to deliver the baby. The trauma from childbirth can be minimal to severe. Typically, the recovery from a C-section is much slower than from a vaginal birth. 
C-section scars are linked to internal adhesion formation; the incidence of detection of adhesions after visceral surgery is almost universal (97%-100%). [4,5,6] Abdominal adhesions often lead to irregular bowel movements,  chronic abdominal pain, [8,9,10] digestive disorders,  endometriosis, [11,12,13,14] intestinal obstruction,  blocked circulation, [15,16] stagnant energy flows, [17,18] and negatively influence the sympathetic nervous system, [19,20] enteric nervous system, [21,22,23] and the fear reflex. [24,25]
It is reported that C-section scars can cause the systemic centralization of pain, [8,9,10] as these are geographically located in the core of the body and reported in literature to negatively influence the psoas muscle  and spinal and skeletal alignment(s). [26,27,28]
C-sections may be a hidden cause for millions of women suffering from chronic pain, as the procedure has been reported to be linked to Chronic Post-Surgical Pain (CPSP), [8,9,10] back pain,  shoulder pain,  and neuropathic pain. 
DC Micro-current therapies which involve applying weak direct currents (80 µA - <1 mA), are now being increasingly recognized for pain management and autonomic nervous system regulation. [32,33,34,35,36,37] DC Micro-current therapies below 1 milliamp (>=1.0 ma) are reported to activate ATP, protein synthesis and increased metabolism , three key factors in cellular healing. Higher amplitude AC currents, (>1ma), inhibited these three key elements,  suggesting that low amplitude DC micro-current is more beneficial to cellular regeneration than the higher amplitude AC stimulation.
Sufficient evidence supports the application of DC micro-current for chronic pain and stress management [32,33,34,35,36,37], however, there is limited evidence in the literature to support the application of MPS to C-section scars for post surgical pain reduction. The purpose of this study was to assess the impact and longevity of MPS applied to C-section scars on the pain levels in a sample of N=47 chronic pain patients, after a single application.
2. Patients, Materials and Methods
This study entailed the use of MPS in 47 female patients (mean age 44.19 years, SD 10.27) with chronic non-specific pains with a mean pain duration average of 8.63 years (SD 9.58) (Table 1) presenting to us for therapy of their problem. Location of the pain location sites are shown in Table 2. The sole inclusion criteria was: patients who were currently suffering from chronic pain for greater than 3 months after birth, with a recorded >4 VAS Pain Scale score and have visible C- section scar(s). The diagnoses of pain location or severity, sex, previous interventions or surgeries were not considered exclusion criteria. Informed consent was obtained to partake in treatment and the study assessments by all patients.
Patient pain scores were recorded immediate pre treatment and twice post treatment: immediately after application, and again 48 hours later. There were no controls in this study, as this was a cohort analysis, with the subjects acting as their own controls relating to pre, post and follow-up pain assessments.
MPS Scar release protocol is a patented process developed as a non-invasive alternative to currently invasively applied scar management techniques, such as corticosteroid injections, excisions, and neural therapies. The protocol entailed simultaneous application of two Dolphin Neurostim devices (Center for Pain & Stress Research Ltd, Ontario, Canada), on each side of the scar [33,39]. This is an FDA-approved device which applies low frequency, concentrated, DC micro-current stimulation for the relief of chronic pain and stress.  Application time was 30 seconds per point at approximate one-quarter (1/4) inch intervals along the length of C-section scars.
It is reported in Neural Scar therapy that damaged scar tissue cells lose their normal membrane potential, leaving scar tissue positively poled. [41,42] Therefore, the electro-polarity direction of DC micro-current application is important for this procedure. On one side of the scar, the first device is set to negative pole (-) and on the other side of scar, the second device is set to a positive-negative pole (+/-). The intent of this methodology is to force a negatively charged current back and forth through a positively charged (oriented) scar tissue. (Figure 1) For the purpose of this study, only C-section scars were treated. Scar Release Protocol was applied once to each patient for an average duration time of 30 minutes per patient.
The Visual Analogue Scale (generic one-dimensional pain questionnaire - VAS) was used to evaluate the patient’s pain. The VAS is an 11-point scale from 0-10 with 0 being no pain and 10 being the most intense pain imaginable. [43,44,45] Patient verbally selects a value that is most in line with the intensity of the pain that they have experienced in the last 24 hours or is often reported as a rating during a specific movement pattern or functional task. The VAS has good sensitivity and excellent test-retest reliability. 
Table 1 MPS Applied to C-Sections N=47 Descriptive Statistics.
Table 2 MPS Applied to C-Sections N=47 Pain Location.
2.1 The Aim of this Cohort Preliminary Study was to Evaluate whether
Micro-current Point Stimulation, when applied to C- section scars
1) Can modulate or improve the VAS pain scale in patients suffering with chronic post surgical pain.
2) Is a valid alternative for the opioid pain management of chronic post surgical pain conditions.
Figure 1 Polarity and Direction of Current During Scar Application.
3.1 Outcome Measures
The VAS response of the 47 patient sample with chronic pain reflected a statistically significant reduction in mean post pain levels of 4.117 points or 67.5% in mean pain levels post MPS application to C-Section scars, when compared to initial pain levels [95% CI (3.388, 4.8461); p=0.000]. When VAS was measured at the 48 hour follow-up, there was a further statistically significant reduction of 0.8936 points or 45.2% in mean pain levels post treatment [95% CI (0.5612, 1.2260); p=0.000], for a total pain reduction of 5.0106 points or 82.2% in mean pain levels post MPS treatment, when compared to initial pain levels [95% CI (4.3904, 5.6308); p=0.000]. (Figure 2). There was no correlation between pain location and site of the C-Section scars (Tables 1 and 2).
Figure 2 N=47 Pre-Post and follow-up pain outcomes.
C-section scars have the potential to negatively impact the body leading to sexual dysfunction, women’s health issues, and chronic post surgical pain even years after the surgery. The scar affects the fascia, structural and muscular components of the body and also interrupts the electrical, neurological, and energetic flow within the body. A scar alone can produce cellular imbalance at the local tissue site that can upregulate the nervous system causing or feeding the chronic pain cycle. [41,42]
For many health care professionals, the underlying cause of chronic post surgical pain has been difficult to diagnose and therefore to impart proper treatment. Post-operative management of scar related pain continues to lag behind decades-old research, with few viable clinical options available currently for physicians to offer patients relief. 
The data from this study clearly shows that the application of MPS Scar Release Protocol to C- section scars had a marked improvement in CPSP outcomes when compared to baseline pain measurements. The improved outcomes were even more impressive given the patient sample for pain duration (mean 7.61 years) and the intensity (mean 6.33/10). Furthermore, there was continued pain reduction between post application and 48 hours later, suggesting that internal functional changes may have occurred that persisted despite no further therapy.
The considerable systemic influence of C-section scars on chronic post surgical pain within this data collection is illustrated by the fact that only 10% of the pain reported by patients was localized to the abdomen and area of the scar (Table 1), suggesting C-sections may be playing a larger catalyst role in the current chronic pain crisis throughout the USA than previously believed.
It is suggested in the literature that DC micro-current mimics human bio-cellular communications, enhancing autonomic nervous system regulation and the production of beta-endorphins, resulting in systemic, body-wide therapeutic benefits. [33,36,39,48] These biochemical processes may provide a plausible explanation for the improved pain modulation over time after MPS is applied, and is an area where future research is required. We have previously reported, in several published studies, reduction in pain and salivary cortisol with improvements in autonomic nervous system functionality in patients using MPS. [33,36,39]
At the cellular level it is theorized in literature that scar size, as measured by grey mean depth, may have a linear relationship with post surgical pain levels experienced by post-operative patients. It has been previously reported that MPS had reduced both cicatrix size and post operative pains in patients,  and it is possible the same mechanisms may be responsible for the reported pain reduction in this study.
Data reported in this paper adds further scientific evidence supporting a global view of the body in both diagnosis and treatment of CPSP, ushering in a new era of medicine. The impact of MPS scar release on distant post surgical pains, challenge the traditionally held pathophysiology concepts of pain management, which often connects symptoms to localized tissue trauma.
It is now imperative to holistically include the whole body in terms of both diagnosis and treatment of post surgical pain to in order to have a more functional approach to patient care. By applying this new philosophy, abdominal C-section scars may now be viewed as significant systemic contributors to post surgical pain dysfunction throughout the entire body.
Chronic post surgical pain can limit quality of life, restrict work and social engagement, and is often blamed for the development of drug dependency of various forms. This study showed MPS therapy applied to C-section scars provided statistically significant reduction in initial post-surgical pain levels with a further reduction after a 48-hour follow-up.
These significant changes help validate the potential application of MPS to C-section scars as a viable option to treating patients with non-specific soft tissue chronic post-surgical pain. However, this single cohort analysis warrants a more long-term investigation with a larger treatment group to confirm these results and to assess their duration of effectiveness.
Statistical analyses were done by 3rd party freelance statistician using SPSS software version 24, a widely used program for statistical analysis in social and medical science.
KA was the lead author and key contributor to the paper. Both KA and WT were the two therapists responsible for performing treatments and collecting data. RG is research consultant with a passion for science who overviewed and edited this paper.
This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This study was funded by The Center for Pain & Stress Research.
None of the authors have any commercial associations that create a conflict of interest in connection with the submitted manuscript. All authors received financial compensation as educational or research consultants from the sponsoring company that may create the appearance of a conflict of interest in connection with the submitted manuscript.
- MacDorman MF, Menacker F, Declercq E. Caesarean birth in the United States: Epidemiology, trends, and outcomes. Clin Perinatol. 2008; 35; 293-307. [CrossRef]
- Repeat c-sections climb by more than 40 percent in 10 years. AHRQ News and Numbers. 2009. Available from: http://ww.ahrq.gov/new/nn/nn041509.htm.
- Zakerihamidi M, Roudsari RL, Khoei EM. Vaginal delivery vs. caesarean section: A focused ethnographic study of women’s perceptions in the north of Iran. Int J Community Based Nurse Midwifery. 2015; 3: 39-50.
- Brüggmann D, Tchartchian G, Wallwiener M, Münstedt K, Tinneberg HR, Hackethal A. Intra-abdominal adhesions: Definition, origin, significance in surgical practice, and treatment options. Dtsch Arztebl Int. 2010; 107: 769-775. [CrossRef]
- Hedley G. Notes on visceral adhesions as fascial pathology. J Bodyw Mov Ther. 2010; 14: 255-261. [CrossRef]
- Bove GM, Chapelle SL. Visceral mobilization can lyse and prevent peritoneal adhesions in a rat model. J Bodyw Mov Ther. 2012; 16: 76-82. [CrossRef]
- Chaitow L. Fibromyalgia Syndrome. A Practitioners guide to treatment. Edinburgh: Churchill Livingstone; 2000.
- Lihua P, Qibin C, Dong Z, Li R, Peipei Q, Su M. Prevalence and risk factors for chronic pain following Caesarean section: A prospective study. BMC Anesthesiol. 2016; 16: 99. doi:10.1186/s12871-016-0270-6.
- Natalia de CB, Varanda LP, Louise Amália de Moura L, Thuany Cavalcante TS, Fortunato CP. Predictors for moderate to severe acute postoperative pain after caesarean section. Pain Res Manag. 2016; 2016: 5783817. doi:10.1155/2016/5783817.
- Weibel S,Neubert K,Jelting Y, et al. Incidence and severity of chronic pain after caesarean section: A systematic review with meta-analysis. Eur J Anaesthesiol.2016; 33: 853-865. [CrossRef]
- What are abdominal adhesions? National institue of diabets and digestive and kidney disorders [Internet]. Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/abdominal-adhesions.
- Morris H. Surgical pathology of the lower uterine segment caesarean section scar: Is the scar a source of clinical symptoms? Int J Gynecol Pathol. 1995; 14: 16-20. [CrossRef]
- Marsden NJ, Wilson-Jones N. Scar endometriosis: A rare skin lesion presenting to the plastic surgeon. J Plast Reconstr Aesthet Surg. 2013; 66: e111-e113. [CrossRef]
- Biswas BK, Gupta N, Magon N. Incisional endometriosis: A rare cause for a painful scar. Niger Med J. 2012; 53: 257-259. [CrossRef]
- Dosch P.Manual of neural therapy according to Huneke. 2nd ed. New York, NY: Thieme Medical Publishers; 2007. [CrossRef]
- Declarcq E, Norsigian J. Troubling data on infant deaths. The Boston Globe. 2008.
- Kidd RF. Interference fields. In:Neural therapy. Renfrew, ON: Custom Printers of Renfrew Ltd; 2005.
- Sollars D. The Complete idiot's guide to acupuncture and acupressure. New York: Alpha; 2000.
- Jin JY, Peng LH, Chen QB, Zhang D, Ren L, Qin PP, et al. Prevalence and risk factors for chronic pain following Caesarean section: A prospective study. BMC Anesthesiol. 2016; 16: 99. doi:10.1186/s12871-016-0270-6.
- Schlereth T, Birklein F. The sympathetic nervous system and pain. Neuromolecular Med.2008; 10: 141-147. [CrossRef]
- Whitehead WE, Bosmajian L, Zonderman AB, Costa PT, Schuster MM. Symptoms of psychologic distress associated with irritable bowel syndrome. Comparison of community and medical clinic samples. Gastroenterology. 1988; 95: 709-714. [CrossRef]
- Whitehead WE, Crowell MD, Robinson JC, Heller BR, Schuster MM. Effects of stressful life events on bowel symptoms: Aubjects with irritable bowel syndrome compared with subjects without bowel dysfunction. Gut. 1992; 33: 825-30. [CrossRef]
- Camilleri M. Autonomic regulation of gastrointestinal motility. Clinical autonomic disorders. Philiadelphia: Lippincott-Raven; 1997. p. 135-145.
- Adolphs R. The biology of fear. Curr Biol. 2013; 23, R79-R93. [CrossRef]
- Wilbanks B, Hunt A, The ‘Muscle of the Soul” may be triggering your fear and anxiety, waking times [Internet]. 2015. Available from: https://bodydivineyoga.wordpress.com/2011/03/23/the-psoas-muscle-of-the-soul/.
- Norton-Old KJ, Schache AG, Barker PJ, Clark RA, Harrison SM, Briggs CA. Anatomical and mechanical relationship between the proximal attachment of adductor longus and the distal rectus sheath. Clin Anat. 2013; 26: 522-530. [CrossRef]
- Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R. The thoracolumbar fascia:Anatomy, function and clinical considerations. J Anat. 2012; 221: 507-536. [CrossRef]
- Bordoni B, Zanier E. Anatomic connections of the diaphragm: Influence of respiration on the body system. J Multidiscip Healthc. 2013; 6: 281-291. [CrossRef]
- Chia YY, Lo Y, Chen YB, Liu CP, Huang WC, Wen CH. Risk of chronic low back pain among patients who undergo caesarean delivery with neuraxial anesthesia. Medicine (Baltimore). 2016; 95: e3468. [CrossRef]
- Cift T, Ustunyurt E, Yilmaz C, Olmez F. Shoulder tip pain after caesarean section. J Clin Diagn Res. 2015; 9: QC04-QC06. doi: 10.7860/JCDR/2015/13841.6314. [CrossRef]
- Dualé C, Ouchchane L, Schoeffler P, EDONIS Investigating Group, Dubray C. Neuropathic aspects of persistent postsurgical pain: a French multicenter survey with a 6-month prospective follow-up. J Pain. 2014; 15: 24.e1-24.e20. doi: 10.1016/j.jpain.2013.08.014. [CrossRef]
- Armstrong K. Electro-therapy exposed [Internet]. 2016. Available from: http://www.rehabpub.com/2016/01/electrotherapy-exposed.
- Chevalier A, Armstrong K, Norwood-Williams C, Gokal R. DC electroacupuncture effects on scars and sutures of a patient with postconcussion pain. Med Acupunct. 2016; 28: 223-229. PMID: 27610209. [CrossRef]
- Chevalier A, Armstrong K, Gokal R. Micro-current point stimulation applied to acupuncture points or the treatment of non-specific lower back pain. J Altern Complement Integr. 2016, 2: 016. [CrossRef]
- Armstrong K, Gokal R, Chevalier A, Todorsky WM, Lim M. Micro-current point stimulation applied to lower back acupuncture points for the treatment of nonspecific neck pain. J Altern Complement Med. 2017; 23: 295-299. DOI: 10.1089/acm.2016.0313. PMID:28266863 [CrossRef]
- Armstrong K, Gokal R, Durant J, Todorsky WM, Chevalier A, FaShong B. Detailed autonomic nervous system analysis of micro-current point stimulation applied to battlefield acupuncture protocol. Med Acupunct. 2017; 29. DOI: 10.1089/acu.2017.1214. [CrossRef]
- McMakin C. Micro-current therapy: A novel treatment method for chronic low back myofascial pain. J Bodyw Mov Ther. 2004; 8: 143-153. [CrossRef]
- Cheng N, Van Hoof H, Bockx E, Hoogmartens MJ, Mulier JC, De Dijcker FJ, et al. The effects of electric currents on ATP generation, protein synthesis, and membrane transport in Rat Skin. Clin Orthop Relat Res. 1982; 264-272. [CrossRef]
- Gokal R, Armstrong K, Durant J, Todorsky W, Miller L. The successful treatment of chronic pain using micro-current point stimulation applied to scars. Int J Complement Alt Med. 2017; 10: 00333. DOI: 10.15406/ijcam.2017.10.00333. [CrossRef]
- Dolphin MPS. FDA 510K. 2015. Available from: http://www.accessdata.fda.gov/cdrh_docs/pdf13/K133789.pdf
- Kidd RF. Interference fields. In:Neural therapy. Renfrew, ON: Custom Printers of Renfrew Ltd; 2005.
- Baker R, Urso-Baiarda F, Linge C, Grobbelaar A. Cutaneous scarring: A clinical review. Dermatol Res Pract. 2009; 2009: 625376. [CrossRef]
- Krebs EE, Carey TS, Weinberger M. Accuracy of the pain numeric rating scale as a screening test in primary care.J Gen Intern Med.2007; 22: 1453-1458. [CrossRef]
- Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005; 14: 798-804. doi:10.1111/j.1365-2702.2005.01121.x. [CrossRef]
- Jensen M, McFarland C. Increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain. 1993; 55: 195-203. doi: 10.1016/0304-3959(93)90148-i. [CrossRef]
- Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthrit Care Res. 2011; 63: S240-S252. [CrossRef]
- Sidgwick GP, McGeorge D, Bayat A. A comprehensive evidence-based review on the role of topicals and dressings in the management of skin scarring. Arch Dermatol Res. 2015; 307: 461-477. doi: 10.1007/s00403-015-1572-0. [CrossRef]
- Chang R, Pomeranz B, Electroacupuncture analgesia could be mediated by at least two pain-relieving mechanisms: Endorphin and non-endorphin systems. Life Sci. 1979; 25: 1957-1962. [CrossRef]
- Bard R, Sadick N. Single center prospective study evaluating the reduction of scar with direct current micro-current. Submitted: In press. J Dermatol Treat. 2018.