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Measurement of electrical resistance at the skin surface over Jing-well acupuncture points in chronic… Turner, Linda Catherine 2010

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 MEASUREMENT OF ELECTRICAL RESISTANCE AT THE SKIN SURFACE OVER JING-WELL ACUPUNCTURE POINTS IN CHRONIC PAIN STATES by Linda Catherine Turner B.N, The University of Manitoba, 1984 BSc (Chemistry), The University of Winnipeg, 1986 M.N, The University of Manitoba, 1989  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF  DOCTOR OF PHILOSOPHY  in The Faculty of Graduate Studies (Interdisciplinary Studies) THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) October, 2010  © Linda Catherine Turner, 2010   ii  Abstract  The purpose of this project was to investigate an energy-based model of chronic pain. Given skepticism about the domain of energy-based healing as a treatment for chronic pain, it has been suggested that research can only be furthered by the use of laboratory methods that allow for rigorous and controlled studies of the hypothesized biological pathways. A review of the literature established several measurement devices that could be used to measure the human energy field (biofield) but only an ohmmeter measuring electrical resistance at 24 Jing-well points showed promising biometrics. A reliability study conducted as a part of this larger study demonstrated an impressive mean Cronbach‟s alpha of .88 for the ohmmeter used in this study. Participants in the experimental group with rheumatoid arthritis and a pain level of at least 3 (0-10 scale) were compared to participants in the control group who had no medical diagnosis and were pain free. The measurements from the ohmmeter were compared to heart rate, heart rate variability, blood pressure, Pain Catastrophization Scale, McGill Melzack Pain Questionnaire, and Profile of Mood States. There were significant differences between the experimental group and the control group on conventional markers of pain except heart rate variability. Similarly, there were significant differences between Jing-well measurements for the acupuncture points labeled „Bladder‟, „Gall Bladder‟ and „Small Intestine‟ thus differentiating between the experimental and control groups.  iii Ingesting an analgesic did not lead to significant between group changes in acupuncture point activity after one hour. Electrical resistance at all Jing-well points was highly correlated with one another suggesting that they tap a global level of physiological activation. In summary, electrical resistance at acupuncture points was significantly correlated with total pain (McGill Melzack Pain Questionnaire) and some acupuncture point activity was correlated with the „Tension/Anxiety‟ and „Friendly‟ dimensions of the Profile of Mood States. It was concluded that the ohmmeter and its measurements possessed criterion validity for distinguishing pain from no pain states. This research protocol appears to be suitable for further validation research on the criterion validity of energy-based models of disease and can be seen as a bridge between Western and Chinese medicine.           iv  Table of Contents Abstract ..........................................................................................................................ii Table of Contents .......................................................................................................... iv List of Tables ................................................................................................................. vi Acknowledgements ....................................................................................................... vii Dedication ................................................................................................................... viii Introduction .................................................................................................................... 1 Conceptual Framework .................................................................................................. 3 Literature Review ........................................................................................................... 8 Energy-Based Models of Illness and Healing: ...................................................................... 8 Measurement of Chronic Pain .............................................................................................. 9 Evidence for Acupuncture Points and Meridians .............................................................. 13 Acupuncture Points Compared to Trigger Points ............................................................. 17 Proposed Measurement Choice: ......................................................................................... 23 Hypotheses.................................................................................................................... 25 Method.......................................................................................................................... 26 Research Design .................................................................................................................. 26 Participants ......................................................................................................................... 27 Inclusion Criteria ........................................................................................................................... 27 Measures ............................................................................................................................. 28 Physiological Measures ................................................................................................................. 28 Procedure ............................................................................................................................ 37 Measurement with Prognos ............................................................................................................ 40 Ethics Review ...................................................................................................................... 41 Data Analysis and Results ............................................................................................ 42 Analytical Strategy .............................................................................................................. 42 Results ................................................................................................................................. 43 Discussion .................................................................................................................... 47 Conclusions ......................................................................................................................... 58 Further Research ................................................................................................................ 59 Bibliography ................................................................................................................. 77 Appendix A - Definition of Terms - Physics ............................................................... 116 Appendix B – Ethics Certificate ................................................................................. 118  v Appendix C - Human Energy Field (Biofield) Measurement ..................................... 120 Appendix D – Publication - Applied Psychophysiology and Biofeedback .................. 142   vi  List of Tables Table 1: Laboratory Schedule ...................................................................................... 61 Table 2: Demographics................................................................................................. 62 Table 3: BP, HR, Heart Rate Variability, MPQ and POMs at Baseline ....................... 63 Table 4: Location of Acupuncture Point Used to Treat Pain Compared to Pain Location in Experimental Subjects ............................................................................... 65 Table 5: Mean Resistance in Kilo ohms over Jing-well Acupuncture Points at Baseline (Mean value of 5 measurements taken for each participant) ....................................... 66 Table 6: Mean resistance in Kilo Ohms over Jing-well Acupuncture Points Comparing Pain and No Pain for Jing-well points hypothesized to be pain-sensitive ..................... 68 Table 7: Correlation among Jing-well Acupuncture Point Activity and MPQ score .... 69 Table 8: Correlations among the “Friendly” dimension (POMS) and Jing-well Acupuncture Point Resistance ...................................................................................... 70 Table 9: Correlations among Jing-well Acupuncture Point Resistance and “Tension /Anxiety” (POMS) ........................................................................................................ 71 Table 10: Correlation Coefficients for Jing-well Acupuncture Points with each other (the numbers in each cell below indicate how many correlation coefficients fell within this range) .................................................................................................................... 72 Table 11: Electrical resistance Pre Medication (i.e., baseline) vs. Post Medication (1 hour later) in     K Ohms over Jing-well Acupuncture Points ...................................... 74 Table 12: Residualized Change Scores for medication effects on BP, HR, POMs and MPQ ............................................................................................................................. 76  vii  Acknowledgements  I would like to thank Dr. John Beatty who helped me greatly during a difficult time in my academic career. His assistance and kindness were greatly appreciated. I would like to offer enormous gratitude to Dr. Wolfgang Linden who adopted me into his laboratory and supported my work over the past 5 years. His patience and guidance have been never ending and words cannot express my appreciation. I would also like to express gratitude beyond words to Mark and Isabelle Godsy who offered so much of themselves to this work. I could not have done any of this without their help. I have great appreciation for Dr. Lynda Balneaves and Dr. Romayne Gallagher who offered their unique perspectives and their time to this project. I owe a huge debt of gratitude to two research assistants who helped so much in the data collection - Candace Marshall whose work was meticulous and Roanne Millman who helped to start up this study. I would like to thank Dr. Melinda Connor who offered excellent advice throughout the process and also helped me to gain some perspective in difficult times. Last but not least is a huge thank you to the Lotte and John Hecht Memorial Foundation who provided funding for this work.    vii i     Dedication This work is dedicated to my goal of incorporating complementary and alternate therapies into the mainstream of health care to ease the suffering of those in pain.  1 Introduction The purpose of this project, in the broadest sense, was to investigate energy-based or biofield models of chronic pain. Among complementary and alternative methods for treating pain one finds energy-based healing modalities such as healing touch and integrative energy healing.  Results of research in this area have been inconclusive, in large part, because there is no objective and widely accepted measures of the human energy field that can be reliably quantified. Without such quantification it is not possible to clearly establish the outcome of the energy-based treatments. The human energy field or biofield may be defined as “an electromagnetic field generated by a living system” (Hintz, Yount, Kadar, Schwartz, Hammerschlag & Lin, 2003, p.5). A review of the literature established several measurement devices that could be used to measure this human energy field or biofield. A comparison of the various measurement devices (details see below) suggested that an ohmmeter measuring electrical resistance at acupuncture points shows the most promise for yielding meaningful and sensitive results. The acupuncture points that are measured by an ohmmeter are named Ting (Jing- well) acupuncture points. Throughout the remainder of this document I will refer to these as Jing-well points. They are located at the beginning and the end of the twelve main meridians of the body. These main meridians of the body are described by the World Health Organization nomenclature on acupuncture and have remained constant over the past 2500 years (World Health Organization, 1991). Following recommendations from Jonas and Crawford (2003) this project aimed to explore the use of well-established technology to measure the biofield. According to  2 the theories of energy flow in the body when an individual is unwell as would be expected in a pain state, there is a disruption in the energy flow through the meridian system. If an instrument can differentiate between a pain-free state and a state of pain, then the instrument may be helpful in documenting results of energy-based healing modalities.  3 Conceptual Framework The proposed project is meant to create a bridge between traditional Chinese medicine concepts and Western Medicine and can benefit greatly from a working model that is capable of embracing both approaches. There is a paucity of literature that attempts to describe the scientific basis of energy-based healing or the human energy field. The National Center for Complementary and Alternative Medicine (NCCAM) commissioned a think tank (March 29-31, 2006) in Bethesda, Maryland to evaluate biofield medicine based on the fact that “biofield research has produced some preliminary results supporting the continued examination of a biofield” (NCCAM, 2006). The results from this think tank suggested that what is already known is the fact that the human body emits a range of veritable energies including thermo energy measurable with a thermometer and infrared detectors, and electrical energy that is measured by an electrocardiogram and an electroencephalogram. Lin (2006) concluded that “the emission of veritable energy by the human body is a well-established phenomenon that is the basis for many technologies commonly used for clinical diagnosis and biomedical research” (p. 4).  For example, electric field therapy between two and 50 Hertz is commonly used in mainstream health care for wound healing (Cujkjati et al, 2001), bone fracture and regeneration, and cartilage repair (Becker, Spadaro & Marino, 1977; Brighton, 1981; Brighton, Sharma, Heppenstall, Esterhai & Pollack, 1995). The concept of a biofield is over 3000 years old in Chinese medicine and not new to Western medicine either. It was first introduced to Western Medicine as an electromagnetic field by Burr and Northrup (1935).  Burr and Bullock (1941/1942) stated  4 that “steady state differences of electrical potential… have been found in virtually every living membrane, cell, tissue, and organism which has been explored, although some (electrical potentials) are at the lower limit of the sensitivity of the available instruments” (p.51). For example, the magnetoencephalogram (MEG) measures the magnetic field induced by neuronal currents in the brain which is extremely weak. In order to do this, the MEG employs the accuracy of the super conducting quantum interference device which can detect extremely weak signals despite the competing environmental noise (Oschman, 2000). A large amount of literature has been built up using theorizations about the electromagnetic properties of the biofield (Hintz et al 2003, Rubik, 2002, Liboff, 1994, 2004, Oschman, 2000). Liboff (1994, 2004), Hintz et al (2003), Rubik, 2002 and Oschman (2000) all describe such an electromagnetic paradigm for a human energy field. Liboff (2004) suggests that the connection between living things and an electromagnetic field is based on physical laws (Liboff, 2004). There are four known types of forces recognized in physical science which include gravitational force, strong force, weak force and electromagnetic force (Liboff, 1994, 2004, 2007; Tipler & Mosca, 2008). Liboff (1994, 2004, and 2007) argues that the electromagnetic force makes the formation of “atoms, molecules and organic polymers inevitable” (p.76). Support for an electromagnetic theory of the biofield derives from discoveries in basic science. For example, when an individual is wounded, an extremely low electrical current appears to direct the cells to heal the area and another current directs the cell to stop the healing process (Liboff, 1994; Oschman, 2000). Bones that are broken heal in response to activation of an electric field and the development of different types of bone  5 cells (osteoclast vs. osterblast) is directed by an electromagnetic field (Liboff, 1994; Oschman, 2000). Developing chick embryos as well as human embryos appear to respond to the presence of an electromagnetic field and there is some suggestion in the literature that the electromagnetic field directs the expression of genes in the human organism (Liboff, 1994, 2004, 2007; Hintz et al, 2003, Rubik, 2002, Oschman, 2000). Liboff (1994) describes an ion cyclotron resonance hypothesis which suggests that this electromagnetic field is directly related to the presence of charged ions in the human body including calcium (Ca 2+) , magnesium (Mg 2+) and potassium (K + ). The result of the movement of ions in a biological system is an extremely low frequency electromagnetic field (Liboff, 1994, 2004). Liboff (1994) presents a unique field vector described by Hertz over 100 years ago. This “Hertz vector II can be regarded as a single expression covering the joint distributions of magnetic and electric fields” (p.78).  Using mathematical calculations it is possible to arrive at a precise measurement for the sum total of all the charge densities distributed throughout the body at any given time. This calculated value essentially describes all of the moving and static charge distributions in a living system (Liboff, 1994). The electromagnetic field theory presents a unifying whole for exploring the human organism (Liboff, 2004, 2007, Hintz et al, 2003, Rubik, 2002, Oschman, 2000). Liboff (1994) states: “an electromagnetic field only exists when the system contains source distributions of charge density and current density. Every living thing carries these two sources, which ensures that every living thing, by definition, also caries an associated electromagnetic field” (p.44).  Liboff (2004) goes on to suggest that the life process itself is an expression of the electromagnetic field.  6 Liboff (2004) puts forth the following two postulates: 1. Every living organism is completely described by an electromagnetic field vector II0 that is specifically determined by a transformation from the genome. 2. All pathologies, abnormalities and traumas are manifested by deviations from the normal field II0 and, within limits, these deviations are compensated for by the homeostatic tendency of the system to return to II0 (p. 45).  Liboff (2004), Hintz et al (2003), Rubik (2002), and Oschman (2000) suggest that the electromagnetic field expresses the common property of extending beyond the physical body and have significant support for their existence in traditional medicine. Examples of their use include multiple medical diagnostic tools such as electrocardiograms and electroencephalograms and the use of electronic devices that stimulate bone growth (Liboff, 1994, 2004, 2007, Hintz et al, 2003, Rubik, 2002, Oschman, 2000). There is evidence in the literature that it is possible to calculate the parameters of an electromagnetic field around a biological system and that this electromagnetic field changes when there is a deviation from normal health in the human organism (Liboff, 2005; Vincze, Szasz & Liboff, 2008). Research emanating from and supportive of this model, includes diatom motility (Smith, McLeod, & Liboff, 1987), embryonic bone development (Regling, Brueckner, Liboff, & Kimura, 2002), plant growth (Smith, McLeod, Liboff, 1993) and rat behaviour (Lovely, Creim, Miller & Anderson, 1993 & Zhadin, Deryugina, & Pisachenko, 1999). Recently, Cellini et al (2008) demonstrated that  7 E. coli bacteria exposed to 50 Hertz electromagnetic fields demonstrated increased cell viability as a result of genetic mutations. According to the Ion Cyclotron Resonance hypothesis it should be possible to demonstrate differences between the electromagnetic biofield properties of individuals in varying health states.  The phenomenon of pain is both pervasive and widely studied and likely represents a good area of investigation. The electromagnetic field around the body of a person in chronic pain would likely be different from the electromagnetic field surrounding a healthy organism and should be measurable using a device which measures electromagnetic properties.  8 Literature Review Energy-Based Models of Illness and Healing:   If the project is successful, the result may assist in the measurement of energy- based healing approaches that remain highly controversial in Western Medicine. The National Center for Complementary and Alternative Medicine (NCCAM) in the United States provides a definition and assumptions about energy-based healing or energy medicine on their Web site. Energy Medicine is a domain of complementary and alternative medicine that deals with two types of energy; veritable energy which can be measured and putative energy which has yet to be reliably measured (NCCAM, 2007) Veritable energies include the use of specific, measurable wavelengths and frequencies to treat or diagnose patients (NCCAM, 2007). Examples of the use of veritable energy fields are electromagnetic fields in magnetic resonance imaging, sound energy for example music therapy and light energy such as that used to treat patients with psoriasis (NCCAM, 2007; Davidson et al, 2003). Putative energy fields in humans, also called biofields, have yet to be measured in any reproducible fashion. Therapies involving putative energy are based upon the assumption that human beings are infused with a vital energy or life force. This life force or putative energy is known by different names in different cultures including qi in traditional Chinese medicine, ki in the Japanese kampo system and doshas in ayurvedic medicine (NCCAM, 2007). Therapists claim they can work with this subtle energy and use it to effect change in the human body; however, putative energies have not been measured by means of conventional instrumentation (NCCAM, 2007) and many of the claims made by healing practitioners are unfounded, and at times even proven wrong.  9 Bringing clarity and solid scientific backing to this field is a fundamental requirement for sustainability of the energy medicine approach. Practitioners of energy-based healing believe that illness is a result of a disturbance in the flow of the biofield energies. Practices such as acupuncture, acupressure, moxibustion and cupping are believed to work by unblocking the flow of energy through the meridian system of the body. The meridian system forms the basis of traditional Chinese medicine, and reflects the channels or pathways that carry the qi through the body and maintain harmonious balance (Kaptchuk, 1983).  Other practices involving the putative energy fields are reiki, qi gong, healing touch, distance healing and intercessory prayer. By far the most studied and trusted body of literature in this domain is that of acupuncture (see details below). Measurement of Chronic Pain Why choose chronic pain as a phenomenon to be studied? It is difficult to assemble a group of patients with exactly the same pathology and therefore most of the imaging studies to date have been conducted with acute experimental pain. It is not known how much actual chronic clinical pain imaging differs from the acute experimental models of pain, but recent literature suggests considerable differences in the processing of information related to chronic pain. For example, Godinho, Magnin, Frot, Perchet and Garcia-Larrea (2006) suggest that emotions play a significant role in modulating chronic pain and that seeing other people‟s pain significantly increases the pain activated by the actual painful experience. Most of the research conducted to date is based upon animal models of pain and this severely limits what is known about human chronic pain. The mechanism for the  10 development of chronic pain in humans, though poorly understood is thought to develop through a number of processes including peripheral sensitization and neural plasticity. Pain transmission begins at the periphery when some sort of injury including trauma, surgery, infection or cancer stimulates the production of an inflammatory or sensitizing soup containing among other substances potassium ions (K+), substance P, bradykinin and prostaglandins. This soup stimulates the receptors of the peripheral nerve to transmit the impulse to the dorsal horn of the spinal cord. In chronic pain states the dorsal horn of the spinal cord and the receptor N methyl D aspartate (NMDA) becomes important in pain transmission via the spinothalamic tract to the brain. NMDA is responsible for hyper excitability of the dorsal horn neurons, which results in activation of A delta and C fiber pain neurons both within the injured area and also in the surrounding uninjured tissue (Petersen-Felix & Curatolo, 2002). Activation of normally non-painful nerve fibers by thermal or mechanical stimuli may then be perceived as pain. This abnormal physiological process of pain transmission is known as central sensitization. If the pain remains untreated the situation may progress further, wherein A fibers may start to synthesize receptors that are normally only found in C fibers (Petersen-Felix & Curatolo, 2002). Recently, immune and glial cells have been found to contribute to exaggerated pain states (Watkins & Maier, 2002). Watkins and Maier (2002) suggest immune- produced alterations in the peripheral and central neural system can lead to alterations in the perception of pain. This may be especially important in individual with auto immune disorders such as rheumatoid arthritis.  11  Supraspinal modulation of the pain transmission pathway inhibits spinal cord transmission due to the action of the periaquductal grey matter, endogenous opiates, serotonergic and noradrenergic systems (Petersen-Felix & Curatolo, 2002). In chronic pain states recent evidence suggests cortical reorganization in response to chronic pain. For example in patients with phantom limb pain, a reorganization of the cortical body map has been demonstrated. There are similarities between this reorganization and the process of learning and memory (Petersen-Felix & Curatolo, 2002). The process of reorganization of the cortical map through the creation of new nervous tissue links as a result of learning or disease is known as neuroplasticity. The primary somatosensory cortex contains a body map or homunculus that changes or remodels throughout life. In chronic pain states, this body map reorganizes and chronic pain may be maintained even after the peripheral injury is healed (Kerr, Wasserman & Moore, 2007). Pain due to arthritis is a common and disabling problem for many older adults. The pathophysiology of chronic pain has been studied in the past 10 years and much of this research has been conducted in models of inflammatory arthritis (Dessein, Shipton and Budd, 2000). As previously stated, chronic pain syndrome is known to involve the processes of peripheral sensitization and central sensitization whereby the excitatory amino acid NMDA establishes nociceptive input via neurons formerly responsible for detecting light pressure, position and movement (Dessien, Shipton and Budd, 2000). According to Dessein, Shipton and Budd (2000), arthritis is a classic example of chronic pain syndrome involving nociceptive pain from the acute inflammatory response to new and ongoing tissue damage, central sensitization from abnormal functioning of the pain transmission pathway and neurogenic inflammation.  12 Research indicates that patients with autoimmune disorders such as rheumatoid arthritis frequently seek out complementary and alternative strategies particularly to manage pain (Wooten and Sparber, 2001; Horowitz, 2005; Hart, 2008).  Saydah and Eberhardt (2006) report that adults with arthritis were the most likely patients with chronic illness to seek out complementary therapies. Modalities that are frequently used are energy-based modalities including magnet therapy, acupuncture and qi gong (Wooten and Sparber, 2001; Chen, Hassett, Hou, Staller and Lichtbroun, 2006). A recent study by Kerr, Wasserman and Moore (2007) suggests a possible mechanism for the treatment of chronic pain by energy based therapies. Chronic pain as previously stated is partially centrally maintained in that the pain continues despite the absence of local tissue damage. In chronic pain states, the map in the somatosensory cortex that represents the painful region becomes enlarged. The authors suggest that energy-based healing may make a difference by reorganizing the body maps in the somatosensory cortex. They term this action “therapeutic plasticity” (Kerr, Wasserman & Moore, 2007, p. 61). Zhang et al (2005) suggests that electro-acupuncture attenuates inflammation such as that found in rheumatoid arthritis in a rat model and this may happen in human beings as well.  Gordon, Merenstein, D‟Amico, and Hughes (1998) report significantly reduced pain and improved function in patients with osteoarthritis of the knee compared to controls when using energy-based healing as an intervention. The pathophysiology of chronic pain involves numerous well documented mechanisms that cause altered movement of electrically charged ions such as (K+) and (Ca++). One could reasonably expect that the physiological changes from the process of  13 the development of chronic pain could lead to an altered electromagnetic field around the body of a person in chronic pain. This combined with the fact that energy-based healing modalities are purported  to alleviate pain in individuals with rheumatoid arthritis suggests that one may be able to detect a difference between the electromagnetic field of someone in chronic pain compared to someone who is pain free. As described in the previous section, Eastern philosophies of healing maintain that any illness is caused by either a blockage in the flow of qi energy or vital life force or an alteration of this qi flow. According to Eastern theories of healing any blockage or alteration of qi flow should be detectable in the meridian pathways. Presumably a measurement taken from the meridian pathway in a pain free person would differ from that of a person experiencing pain. From the perspective of Western medicine the problem with a model based on meridians and qi flow is that meridians are not directly measurable. This raises the question of which accepted physiological measurement system is best able to permit inferences about meridians.  Based upon a review of the literature and the availability of appropriate devices to measure the energy field, a choice was made to focus on acupuncture points as a reflection of the energy based meridian system. Evidence for Acupuncture Points and Meridians Traditional Chinese medicine (TCM) is based upon the meridian and acupuncture point system but is not recognized in Western medicine because they are not documentable by allopathic medical techniques such as a microscope or anatomical dissection of the human body. In TCM, qi is thought to flow through the meridians much like blood flows through the vascular system. The meridian system is a communication  14 link between the surface of the body and the internal organs and provides a network to transport the vital energy or qi (Yung, 2004). As in the vascular system any blockage or change in the flow of qi energy leads to a deviation in normal health of the organism. For the purpose of this paper some clarification about acupuncture points and meridians is required. According to TCM there are twelve main meridians with a left and right branch of each. Classical Chinese medical theory recognizes an additional two meridians named the left and right Governing Vessel. The 12 main meridians include the Lung, Spleen Pancreas, Heart, Kidney, Circulation, Liver, Large Intestine, Stomach, Small Intestine, Bladder, Triple Heater and Gall Bladder. These names are agreed upon by the World Health Organization nomenclature (WHO, 1991). Acupuncture points exist along the main meridian channels and are believed to be distinguishable by their lower electrical resistance although evidence is inconclusive (Ahn et al, 2008). The Jing-well acupuncture points are located either at the beginning or end of the 12 main meridian channels. Acupuncture points, distributed along the meridian channels, are believed to become blocked prior to the onset of illness and in illness states (Yung, 2004). An acupuncturist manipulates the acupuncture site with needles, massage or electrical stimulation to unblock the qi flow in order to help the body heal itself (Benor, 1993). Acupuncture has been practiced in TCM for over 3000 years but before acupuncture points and meridians can be recognized in Western medicine, scientific evidence of their existence must be demonstrated. There is a substantial body of studies on the anatomy and physiology of acupuncture sites.  Voll (1978) first demonstrated that there are numerous locations over  15 the body that has lower electrical resistance and greater conductivity than the surrounding tissue (Yung, 2004). When these points are mapped out they lie along the channels described in TCM as the meridian system (Yung, 2004). Electrical impedance values have been determined to be approximately 0.8 MOhms at the acupuncture points and 1.4 MOhms at the surrounding tissue (Yung, 2004). Zhang, Jeong, Lee and Lee (2004) also demonstrated that electrical conductance at acupuncture points was significantly lower than resistance at control points. Using laser doppler flowmetry Hsin et al (2007) demonstrated that acupuncture points have a significantly increased blood supply in the microvascular bed compared to that found in surrounding tissues. Lo (2002) was able to differentiate the acupuncture point system from surrounding tissue using the optical methods of the biophoton technique and infrared diffuse reflectance spectroscopy. Yang, Xie, Liu, Li and Guo (2007) suggest that human meridians can be viewed as good pathways for electrical conduction and electromagnetic wave propagation. Their research demonstrated that light of certain wavelengths propagated more easily along the pericardium meridian compared to the non-meridian path and that the optical properties of meridians are significantly different from those of the surrounding tissue (Yang, Xie, Liu, Li and Guo, 2007) Colbert, Hayes, Aickin and Hammerschlag (2006) found that electrical skin resistance at acupuncture points demonstrates a 24 hour physiological variability. The values of electrical skin resistance increase dramatically and significantly during sleep and decrease upon awakening (Colbert, Hayes, Aickin & Hammerschlag, 2007). A recent review by Ahn et al (2008) included nine studies that explored acupuncture sites and nine studies that explored the existence of a meridian system. They  16 indicated that five out of nine studies showed a positive association between lower electrical resistance and acupuncture points, and seven out of nine studies showed a positive association between acupuncture meridians and lower electrical impedance and higher capacitance (Ahn et al, 2008). They caution, however, that the quality of the research in the area is poor and that the evidence that acupuncture points and meridians are electrically distinguishable is not conclusive (Ahn, 2008). On the other hand, they do conclude that the preliminary findings are consistent and recommend that further research is needed to confirm these findings. Hui et al (2000) conducted a study using functional magnetic resonance imaging (fMRI) to investigate the effects of acupuncture in normal subjects. They investigated 13 subjects by stimulating acupuncture point large intestine 4 on the hand and simultaneously conducting fMRI investigation. Hui et al (2000) found that stimulation of the acupuncture points resulted in modulation of the activity of the limbic system and subcortical structures. Similarly Li et al (2006) studied acupuncture point stimulation of different durations and found that acupuncture point stimulation of longer duration could induce broader central nervous system responses as demonstrated with fMRI. The mechanisms by which acupuncture modifies physiological function to relieve pain and provide symptom relief are not fully understood. Due to the popularity of acupuncture as a treatment for common ailments and health complaints, several Cochrane Reviews have been conducted to evaluate the efficacy of acupuncture. A review of 26 trials, including 1151 patients, demonstrated acupuncture to be effective in treatment of idiopathic headache (Melchart et al, 2001). One limitation noted is that the methodology  17 used in some of the studies reviewed was not of high quality and that further research is needed in this area.  Based on results from 35 randomized controlled trials, Furlan et al (1999) concluded that acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment for chronic back pain.  This is true only immediately after treatment and in the short-term (Furlan et al, 1999).  Acupuncture Points Compared to Trigger Points Is there any thing in Western Medicine that compares to acupuncture points? Western researchers interested in the treatment of pain have coined the term trigger points to describe differential electrodermal resistance activity at various surface points of the body (Melzack, Stillwell, & Fox, 1977). Trigger point therapy is embraced by Western medicine and is included in the core curriculum recommended for pain physicians by the International Association for the Study of Pain (Charlton, 2005). Intending to build a bridge between the Chinese medicine concept of acupuncture points and the Western medicine concept of trigger points, Melzack and his collaborators conducted a study comparing the location of trigger points related to the location of acupuncture points. Trigger points are points located on the surface of the skin that are recognized and have been used in Western medical practice for the diagnosis and treatment of chronic pain (Melzack, Stillwell & Fox, 1977). When stimulated, trigger points frequently produce a change in the pain sensation at the local point as well as at a distant location in the body. An example of pain experienced at a distant location is cardiac pain which is frequently felt at the left arm or jaw. Trigger points are also  18 associated with visceral structures such as McBurney‟s point which is a characteristic site of pain associated with appendicitis (Melzack, Stillwell & Fox, 1977). The location of trigger points can be described by investigating the anatomy of the muscular and neural systems. For example, trigger points are nodules of fibrous tissue that are thought to arise in areas of muscular stress or strain, areas of exposed blood vessels or neural tissue or in areas of past injury. Short-acting local anesthetic blocks, brief intense stimulation such as dry needling or intense cold or electrical stimulation of trigger points often produce relief of pain. The effects at trigger points resemble those of stimulation of acupuncture points and Melzack, Stillwell, and Fox (1977) conclude that both intense stimulation of trigger points and acupuncture points can produce prolonged relief of pain. Melzack, Stillwell and Fox (1977) mapped acupuncture points from two different Traditional Chinese medical text books (Kao & Kao, 1973; Mann, 1966). They were able to distinguish and map only the acupuncture points used exclusively for the treatment of pain and found that trigger points and the nearest acupuncture point were located with in 3 centimeters of each other. Using trigger point sources from 3 different authors the researchers found that acupuncture points and trigger points corresponded in 64%, 100% and 88% of cases respectively with an overall correspondence of 71%. The pain syndromes associated with each acupuncture point were consistent with the pain syndromes associated with each trigger point  For example, trigger point B7 associated with cardiac syndromes corresponded with acupuncture point Bladder 15 that is associated with cardiac pain. Using this work, it is possible to predict which acupuncture points and potentially underlying meridians may reveal blockage with  19 various pain syndromes (Melzack, Stillwell & Fox, 1977). Another example - Accessory Nerve XI and branches of Cervical 3-4 are associated with shoulder, arm and neck pain, headache and stiff neck. This area corresponded with the acupuncture point labeled „Gall Bladder 21‟ located on the Gall Bladder meridian and is associated with stiff neck, shoulder and back pain, rheumatism and arm pain (Melzack, Stillwell & Fox, 1977). Melzack, Stillwell and Fox (1977) go so far as to hypothesize “that trigger points and acupuncture points for pain, though discovered independently and labeled differently, represent the same phenomenon” (p.16). Trigger points like acupuncture points are identifiable using electrical skin resistance. Shultz, Driban and Swanik (2007) were able to find myofacial trigger points using an ohmmeter to measure electrical skin resistance. They found that the difference between the trigger point and the surrounding tissue is clearly differentiated by lower electrodermal skin resistance. Likewise identification of acupuncture points has been accomplished in numerous studies using a device to detect electrical skin resistance. Ahn et al (2009) investigated 14 participants with laparoscopically diagnosed endometriosis and compared pre-and-post acupuncture treatment measurements.  They obtained electrical resistance at 24 Jing-well acupuncture points before and after treatment and found that the „Liver‟, „Spleen‟ and „Kidney‟ acupuncture point measurements changed over time. They found that pain and the results of treatment were reflected in electrodermal skin resistance changes. Research specifically investigating acupuncture point resistance and linking it to defined disease processes is very limited but similar research investigating electrodermal skin resistance may be useful.  There is research that measures electrical resistance at  20 organ projection areas. French neurologist Paul Nogier‟s work first led to the development of a somatotopic mapping of the body which is represented upon the external ear in the form of an inverted fetus. Each area of the hypothetical map corresponds to a specific body part in a somatotopic map.  Oleson, Kroening and Bressler (1980) experimentally evaluated skin resistance on the external ear related to painful conditions.  When there is a pathological condition in a body area, the corresponding area on the ear demonstrates increased electrical conductivity and increased tenderness to touch. In their study, forty patients with pain syndromes underwent medical examination of the ear auricle with a device to measure electrical resistance and sensitivity at the ear surface. There was a 75.2% concordance between established medical diagnosis and auricular diagnosis based on electrodermal skin resistance at the auricular site corresponding to that organ (Oleson, Kroening and Bresler, 1980). A group of South-African researchers conducted three studies using an instrument that measured electrical resistance at the ear‟s surface (Szopinski, Pantanowitz, & Jaros; 1998).  Their research compared 630 measurements of auricular electrical resistance and compared the results to medical diagnoses. They suggested that there is a connection between the state of health of the internal organ and the electrical characteristics of remote skin areas called organ projection areas wherein acupuncture points associated with the internal organs are located. Szopinski, Pantanowitz and Lochner (2004) found that skin resistance is significantly higher for a diseased organ and that impedance in electrical resistance corresponded to the amount of pathology present in the organ but could not indicate what type of pathology was present. Pathological conditions detected included inflammation, neoplasms, immunological and metabolic disorders (Szopinski,  21 Pantanowitz and Jaros, 1998; Szopinski, Pantanowitz and Lochner, 2004; Szopinski, Lochner, & Pantanowitz, 2006). Their research suggests that measurements of electrical impedance taken at the skin surface may reflect an inflammatory process occurring underneath the skin surface. Given that inflammation is the first physiological process associated with nociceptive pain, it may be possible to identify the physiological alterations including inflammation that are associated with pain. The studies outlined above all measured electrical skin resistance with an ohmmeter and related changes in electrical resistance at the skin surface to a disease process occurring below the skin surface. In some cases the disease process involved pain or the treatment of pain. Ahn (2009) identified three meridians associated with the pain of endometriosis. Oleson, Kroening and Bressler (1980) found that the electrodermal skin resistance at an organ projection area varied consistently with the pain associated with confirmed medical diagnosis. Szopinski, Pantonowitz and Locher (2004, 2006), Szopinksi, Pantanowitz and Jaros (1998) found that they were able to identify disease processes beneath the skin related to electrical skin resistance at the skin surface. Specifically they suggest that electrical skin resistance may reflect inflammatory processes beneath the skin surface. Since the pain related to rheumatoid arthritis (RA) is correlated at least in part with the amount of inflammation present, an instrument that measures this at the skin surface may shed some light on the pain experience of patients with RA. The available evidence measuring electrodermal skin resistance, though limited, suggests that some disease processes including painful conditions and inflammation can be measured at the skin surface with a device to measure electrodermal skin resistance.  22 Evidence for the existence of acupuncture points and a meridian system is not conclusive but given the available evidence their presence does seem plausible. There is the suggestion by Melzack, Stillwell and Fox (1977) that acupuncture points may in fact not be different from trigger points which are known and accepted by Western medicine. Ahn (2008) recommends that further research be conducted to clearly establish the existence of acupuncture points and a meridian system. It seems reasonable that to establish a reliable method for measuring acupuncture points that can differentiate between disease states would represent a significant first step in establishing the presence of a meridian system. The purpose of the current study was to choose one example of a fairly well studied disease state and determine whether or not Jing-well point activity can differentiate between a disease state and a healthy state. I chose to use the phenomenon of pain for a first investigation into this question because there is a solid foundation of research to support the rationale for this study.  23 2 3  Proposed Measurement Choice: A literature review was conducted as part of a comprehensive exam and is included in Appendix C.  This review and personal communication with device vendors and developers led to the conclusion that most existing systems are unwieldy and do not allow ready quantification of resulting information. The literature review included 9 types of devices including electrophysiological measures, functional magnetic imaging, superconducting quantum interference device (SQUID), Kirlian photography, gas discharge visualization, biophoton emission, gamma radiation, intention imprinted devices and electrodermal screening devices. These instruments were compared according to reliability and validity measures. No literature indicating specificity or sensitivity of the instruments was available except for the SQUID. Many of the instruments did not have sound reliability or validity data available (Kirlian photography, biophoton emission, gamma radiation and intention imprinted devices) and others provided data that were difficult to quantify (gas discharge visualization). The SQUID magnetometer emerged clearly as the superior device used to map the electromagnetic fields in the space around the body and is preferred when extreme precision is required (Oschman, 2000). It has demonstrated reliability, validity and sensitivity through common use in medicine, geology and engineering (Oschman, 2000; (Romani, Williamson, Kaufman, 1982).  Unfortunately for purposes of this study the cost of using a SQUID was prohibitive in that the cost was upwards of four million dollars. Since the SQUID has demonstrated that measurement of the electromagnetic field around the body is possible it was thought that the next best device would be an electrodermal screening device.  24 2 4  The instrument that demonstrated the greatest promise in this category is the Prognos diagnostic system which provides electrodermal resistance measurement at acupuncture points (Jing-well points) in the human body. The Prognos had established reliability measures from the Colbert et al laboratory and some indication of validity from technical reports published in German (Colbert, Hammerschlag, Aickin & McNames, 2004 and see Appendix C). Electrodermal testing of acupuncture points is based on the underlying assumption that electrical resistance and /or conductivity at acupuncture points exist although it is much smaller than that detected by an electroencephalogram or electrocardiogram (Colbert, Hammerschlag, Aickin & McNames, 2004 and see Appendix C). Recall the fact that past research has demonstrated that skin surface sites corresponding to acupuncture points demonstrate lower electrical resistance or impedance and consequently higher conductance than surrounding sites (Colbert, Hammerschlag, Aickin & McNames, 2004). A range of clinical trials in animals and humans has demonstrated that changes in the electrical resistance are reflective of various disease states (Colbert, Hammerschlag, Aickin & McNames, 2004).   Following recommendations put forth by Jonas and Crawford (2003) and Ahn (2008), in this study, electrical resistance at the skin surface over Jing-well acupuncture points was measured using the Prognos ohmmeter. These 24 measurements were compared to other well established indicators for chronic pain states. The specific hypotheses that were tested are included below.  Jing-well acupuncture points were measured in keeping with the requirements for the Prognos ohmmeter because these are the only points that can be accessed by the Prognos ohmmeter. As previously stated the Jing-well acupuncture points are located in  25 2 5  the corners by the nail beds of the fingers and toes. Their location across individuals is consistent and the easiest to locate (Dr. M. Doepp, personal communication, October 13, 2010). According to traditional Chinese medicine philosophy, the qi comes to the surface at these points and is easiest to assess by instrumentation ((Kaptchuk, 1983).  Hypotheses Stated as null hypotheses 1. There will be no difference between individuals with an acute pain level of at least 3 (experimental group) using a subjective pain scale of 0-10 where 0 is no pain and 10 is the worst pain imaginable (Jacox, Carr & Payne, 1994) versus individuals with 0 pain on the same scale (control group)  related to the following measures: i) Electrical resistance at Jing-well acupuncture points ii) Heart rate iii) Blood Pressure iv) Heart Rate Variability v) McGill Pain Melzack Pain Questionnaire vi) Pain Catastrophizing Scale vii) Profile of Mood States  2. There will be no difference between measurements taken at baseline versus those taken after ingestion of an oral analgesic in participants with pain in the following parameters:  26 2 6  i) Electrical resistance at Jing-well acupuncture points ii) Heart rate iii) Blood Pressure iv) Heart Rate Variability v) McGill Melzack Pain Questionnaire vi) Pain Catastrophizing Scale vii) Profile of Mood States  3. Measurements taken with the Prognos ohmmeter will not correlate with the following measurements: i) Heart rate ii) Blood Pressure iii) Heart Rate Variability iv) McGill Melzack Pain Questionnaire v) Pain Catastrophizing Scale vi) Profile of Mood States  Method Research Design An experimental group was compared with a control group in a 2X2 repeated measures design. The main factors of interest were the electrical resistance at Jing-well points and how these correlated with two well established psychophysiological variables that are sensitive to chronic pain and one general measure of affect.  Physiological  27 2 7  measures included heart rate, blood pressure and heart rate variability. Psychological measures included the Pain Catastrophization Scale, the McGill-Melzack Pain Questionnaire and the Profile of Mood States. Measurements were completed for each participant in one 3-hour session at a Behavioral Medicine laboratory at the University of British Columbia. Participants  Participants for the experimental group who had a diagnosis of rheumatoid arthritis and a pain level of at least 3 were recruited on a volunteer basis from the Arthritis Society of British Columbia. Participants who had a medical diagnosis of Rheumatoid Arthritis for at least one year were asked to participate.  An advertisement was placed in their communication newspaper and information about the study was provided to all participants at regularly held Arthritis Society meetings by the group leader. Participants for the control group who had no medical diagnosis and a pain level of 0 were recruited by an advertisement placed in a local Vancouver newspaper. All participants were given a $50.00 honorarium for their participation in the study. Inclusion Criteria 1. All clients spoke and understood English. 2. All clients in the control group were pain free and had no diagnosis of a painful condition or other chronic health condition such as cancer, heart disease, kidney disease, diabetes, or autoimmune disease. 3.  All participants in the experimental group had pain which they rated at a level of at least 3 using a 0-10 scale (Jacox, Carr & Payne, 1994) at the beginning of their study  28 2 8  participation. This pain was reasonably well controlled using one or a combination of oral analgesics. Reasonably well was defined as analgesics that reduce the pain at least two points on a 0-10 scale. 4. All participants in the experimental group had a diagnosis of rheumatoid arthritis for at least one year and had no other health conditions such as heart disease, cancer, kidney disease, or diabetes. Participants for the experimental group were asked to provide information about the year of their medical diagnosis with RA. 5. All subjects in the experimental group experienced pain from rheumatoid arthritis and had no other diagnosed conditions.  Their pain from RA had persisted since their original diagnosis with RA.  Measures Physiological Measures Prognos Ohmmeter The Prognos is an ohmmeter (MedPrevent, Waldershof, Germany) consisting of a power source connected by a cable to the measuring probe and a reference electrode (6 x 3.5 cm) that is attached with a Velcro strap to the anterior surface of the forearm. Impedance measurements recorded as direct current analogue values are taken while holding the probe at a 90 degree angle to the acupuncture point (Colbert, Hammerschlag, Aickin & McNames, 2004, p. 611).  The analogue values are fed into an amplifier in the Prognos and transformed into a digital value by an A/D converter.  A digital screen displays the measured resistance  29 2 9  values in kilo-ohms and the data are imported into a laptop computer via a serial cable (software by MedPrevent, Waldershof, Germany). The Prognos instrument utilizes a 4.57 mm diameter flexible spring loaded probe tip and calculates an average electrical skin resistance value from 400 measurements taken in approximately 200 milliseconds ( ).  The probe tip, has a maximum excursion of 6.91 mm, is connected to a linear spring and lies flush to the plastic insulation at the end of a plastic cylinder.  Within the cylinder a light emitting diode transmits a light beam to a photo detector and the spring loaded probe disrupts the light beam and triggers a reading at an average deflection of 2.90 mm with an average force of 2.68 ± 0.05 Newton (Colbert et al, 2004). When triggered, the Prognos applies 1.1 mille Amperes of current from the lower forearm strap to the probe tip for an average of 223 ± 3 milliseconds. The Prognos Ohmmeter makes a “cash register” sound when the measurement is taken. This sound is optional and can be turned off. The meaning of the sound is assurance that a measurement has been taken by the machine. As previously stated the Prognos calculates an average electrical skin resistance value from 400 measurements taken in approximately 200 milliseconds ( ). The actual location for the placement of the probe is determined by the experimenter and not the machine (personal communication, Dr. Agatha Colbert, October 13, 2010; personal communication, Dr. Manfred Doepp, October 13, 2010)  Reliability The Prognos had been tested in 31 healthy participants (17 females and 14 males) with an age range 24 to 63 years, in whom electrical resistance was measured at 24  30 3 0  acupuncture points (Colbert, Hammerschlag, Aickin & McNames, 2004).  Two hundred and eighty eight measurements were subjected to statistical analysis. All subjects completed three trials. The mean reliability for trial one was 0.758 with a range of 0.538 to 0.882 When the acupuncture point was marked with nontoxic washable ink and remeasured, the mean reliability of a single measurement increased to 0.850 (range 0.690 to 0.963). The highest mean reliability of 0.959 (range 0.891 to 0.987) was made in trial 3 when four measurements were made in rapid succession (Colbert et al.). The authors report that higher reliability correlated with lower mean electrical skin resistance. They also suggest that the reliability of measures made for acupuncture points on the right side of the body (considered “yang” or male in Chinese medicine) were less reliable than measurements on the left side of the body (considered “yin” or female in Chinese medicine) (Colbert et al.).  As part of this project, I also undertook a reliability study with twenty-one healthy subjects using the specific Prognos ohmmeter that was going to be used for the main study. The location of Jing-well acupuncture points was marked with a paper circle to ensure that the location of each measurement was consistent. The results of this study indicated that when 5 readings were taken in rapid succession, Cronbach‟s alpha scores ranged between .84 and .95 with a mean of .88. Reliability scores with 5 measurements were superior to 3 measurements (Turner, Linden, Talbot, Millman, 2010). A PDF of the full manuscript is found in Appendix D. Validity Initial validity data were provided from research conducted in Germany and described in German unpublished technical reports. The papers were reviewed by Dr.  31 3 1  Wolfgang Linden (whose mother tongue is German) and considered encouraging but none of these studies was peer reviewed.  Furthermore, these technical reports were considered as offering support for content validity but were judged as insufficient evidence for criterion validity of the Prognos (Dr. W. Linden, personal communication, January, 2008). The technical papers did not provide empirical support for instrument reliability and only one other study had provided reliability data (Colbert, Hammerschlag, Aickin & McNames, 2004). Therefore it was necessary to first establish reliability of the instrument to support my own work.  Blood Pressure, Heart Rate and Heart Rate Variability Heart rate variability for patients in chronic pain is usually reflective of a state of sympathetic overdrive. This is considered to be due to the stress of coping with chronic pain although some authors argue that the sympathetic overdrive may be due to chronic anxiety (Martinez-Lanvin and Hermosillo, 2000). Spectral analysis of heart rate variability is a method for quantifying autonomic nervous system (ANS) function.  Heart rate is not constant but fluctuates within a range. The fluctuations are due to ANS activity via the sympathetic and parasympathetic nervous system in response to factually changing demands. The cyclic changes are termed heart rate variability. In normal subjects heart rate variability reflects reaction to postural changes, physical exercise and emotional stress. Spectral analysis demonstrates three components: very low frequency, low frequency and high frequency. Experimental evidence suggests that high frequency is a marker of vagal activity; low frequency a  32 3 2  marker of both sympathetic and parasympathetic activity and very low frequency has no known physiological meaning but appears to be associated with mental activity (Cohen et al, 2000). Martinez-Lanvin and Hermosillo (2000) indicate that an increased low- frequency/high-frequency band indicates sympathetic hyperactivity.   A VSM-100 BpTRU automatic blood pressure device was attached to the participant‟s non-dominant arm for the duration of this study to allow for easy access to BP, heart rate and heart rate variability.  The VSM-100 BpTRU automatic blood pressure device has been found to be a reliable non-invasive measure within pediatric and adult populations ages 3-83 years (Mattu, Heran & Wright, 2004). Specifically, when compared to standard auscultatory mercury sphygmomanometer measurements, 89.2% of the BpTRU measurements were within 5 mmHg, with 96.4% and 99.3% of these measures being within 10 and 15 mmHg, respectively (Mattu, Heran & Wright, 2004). Furthermore, in a sample of hypertensive patients, the BpTRU clinic blood pressure monitor was found to correlate significantly better with daytime ambulatory BP (r = .57) than clinic averages (r = .15) ( Mattu, Heran & Wright, 2004). The signal processing software program for heart rate variability and corresponding hardware is referred to as the ProComp system (Thought Technology; Montreal, Canada). It possesses multi-modal biological measurement and feedback capability of heart rate, respiration, skin temperature, and on-line calculation (using spectral analysis) and display of the relative dominance of different frequency bands. Prior to computation of HRV mean values, researchers need to review each data file to identify and remove outliers that arise from skipped heartbeats.   33 3 3    Psychological Measures McGill-Melzack Pain Questionnaire The MPQ was chosen to assess the specific pain experience for participants with RA because it has been demonstrated to be able to differentiate between different types of pain (Turk, 2001). It was considered the best instrument because it tapped into the sensory and affective dimensions of pain (Melzack, 1987). The McGill Melzack Pain Questionnaire (MPQ) is used to specify subjective pain experience using sensory, affective and evaluative word descriptors. There are three major measures. The first, the pain rating index is based on two types of numerical values that can be assigned to each word descriptor. The first numeric value is the number of words chosen and the second numeric value is the present pain intensity based on a 1-5 intensity scale. The short form of the MPQ (SF-MPQ) contains 11 questions referring to the sensory dimension of the pain experience and four related to the affective dimension. Each descriptor is ranked on a four-point intensity scale (0 = none, 1 = mild, 2 = moderate, 3 = severe). The pain rating index of the standard MPQ is also included as well as a visual analogue scale. Melzack (1976) reported that consistency of word choices by ten cancer patients over three days ranged from 50% to 100%, with a mean of 70.3%.  Repeated administrations of the MPQ to cancer patients revealed a consistency index of 75% (range 35 to 90%) between the first two administrations, which decreased to 66% and then increased to 80% over the course of weekly assessments. Graham, Bond, Gerkovich  34 3 4  and Cook (1980) found the MPQ to be highly replicable in two subjective samples, with similar findings to Melzack in a different cancer pain patient sample. Over four administrations, Graham (1980) found the consistency of pain descriptor subclass to be high, ranging from 66% to 80.4%. The distinction between sensory and affective dimensions has been well documented, but debate exists on the separation of the affective and evaluative dimensions. The sensory, affective, and total scores of the MPQ and SF- MPQ were found to be significantly correlated (Melzack 1987). The MPQ was developed to indicate the extent of change in pain quality and intensity as a result of an intervention. Both the MPQ and SF-MPQ demonstrate the effects of analgesic drugs, epidural blocks, and Transcutaneous Electrical Nerve Stimulation. The MPQ has been widely used, including application in numerous studies of terminally ill patients (Melzack et al 1976). Studies have shown that MPQ descriptor patterns can discriminate between known pain syndromes, major types of known back pain, and facial pain (Turk, 2001). A comparison of MPQ scores for acute pain and chronic pain revealed that patients with acute pain displayed a greater use of sensory word groups while chronic pain patients used affective and evaluative groups with greater frequency. The MPQ takes 5-10 minutes to administer, and the SF-MPQ 2-5 minutes. The SF-MPQ was developed to provide a brief assessment. Both the MPQ and SF- MPQ can be interviewer administered or self-administered. The Pain Catastrophizing Scale (Sullivan, Bishop & Pivik, 1995) The Pain Catastrophizing Scale (PCS) was chosen for this study because of recent research findings linking catastrophizing‟s influence on pain in the context of rheumatic  35 3 5  disease.  Campbell and Edwards (2009) suggested that catastrophizing may be associated with systemic inflammatory processes and that there is an association between helplessness and physiological inflammatory indices including erythrocyte sedimentation rates and C-reactive protein levels.  Overall catastrophizing is thought to exhibit a broad influence on the perception of pain. Campbell and Edwards (2009) report that “fMRI studies strongly suggest that catastrophizing cognitions are associated with amplification of cortical activation in the context of pain” (p. 3).  The Pain Catastrophizing Scale (PCS) is a 13-item questionnaire developed by Sullivan, Bishop and Pivik (1995). Eight statements of the PCS were derived from examples of catastrophizing ideation provided by Spanos et al (1979); Spanos, Brown, Jones & Horner (1981) and Chaves & Brown (1987). In addition, five items from the catastrophizing subscale of the Coping Strategies Questionnaire (CSQ; Rosenstiel & Keefe (1983) were included in the PCS. The first components, labeled rumination, accounted for 41% of the total variance and contained four items describing ruminative thoughts worry, and an inability to inhibit pain-related thoughts. The second component, labeled magnification, accounted for 10% of the total variance and contained three items reflecting magnification of the unpleasantness of pain situations and expectancies for negative outcomes. The third component, labeled helplessness, accounted for 8% of the total variance, and contained the five items from the CSQ and one item reflecting the inability to deal with painful situations. Scale items loaded negatively on the third component so that higher scores indicate lower levels of helplessness. Rumination and helplessness were highly correlated, r = -.50. Rumination and helplessness also showed moderate relations to magnification, r =. 32 and r = -.30 respectively.  36 3 6  The three subscales corresponding to the component structure of the PCS were computed by summing items within each factor. Coefficient alphas were .87, .60 and .70 for the rumination, magnification, and helplessness subscales, respectively. Coefficient alpha for the total PCS was .87 (Sullivan, Bishop & Pivik, 1995). The moderate correlations among the three components of the PCS and the high internal consistency of the total PCS suggest that rumination, magnification, and helplessness can be viewed as different dimensions of the same underlying construct. This tool has been validated in a sample of chronic pain outpatients where the three subscales have shown good reliability with Cronbach's alpha coefficients of .85, .75 and .86 respectively (Schutze, Rees, Preece & Schutze, 2010). The total PCS score in the outpatient group had good criterion-related validity and internal consistency with a reliability coefficient of .92 (Schutze, Rees, Preece & Schutze, 2010). Profile of Mood States Though the POMs is not specific to the experience of pain, it was thought that a measure reflecting the level of other factors influencing pain was important to include in this study. Campbell and Edwards (2009) suggest that the experience of pain results from complex interactions of biological, psychological and social factors that are not easy to separate. The Profile of Mood States (POMS) is a self-administered instrument with 65 adjective rating scales, rated on a five point intensity scale from “0-4”.  The test can be completed in 3 to 5 minutes for most participants. The scales are designed to assess transient and fluctuating mood states and include: Tension – Anxiety; Depression - Dejection; Anger – Hostility; Vigor – Activity; Fatigue – Inertia; and Confusion –  37 3 7  Bewilderment (McNair, Lorr & Droppleman, 1996). A total score is possible by adding all of the scales and weighing Vigor negatively (McNair, Lorr & Droppleman, 1996). The POMS is recommended for assessing mood for research purposes in individuals over the age of 18 (McNair, Lorr & Droppleman, 1996). Normative data for the revised POMS (1992) were based on 235 normal college students and 350 male and 650 female psychiatric outpatients. Internal consistency reliabilities range from .84 - .95 among six factors in two studies. Test, retest reliability estimates among the factors range from .65 to .74 in a sample of 100 patients over periods ranging from three to 110 days. The six factors of the POMS are not totally independent as there are high inter-correlations between the factors. For this reason the POMS is considered a global estimate of affective state (McNair, Lorr & Droppleman, 1996). Concurrent validity was determined in the normative samples.  The expected correlations were found among POMS factors and appropriate factor correlates from the modified Hopkins Distress Scales, the Minnesota Multiphasic Personality Inventory 2 and/or the Schizophrenia scale (McNair, Lorr & Droppleman, 1996). Three factor analytic studies have been conducted using the current five- point intensity modifier scale. In all of these studies the same six mood factors emerge (McNair, Lorr & Droppleman, 1996).  Procedure No power calculation was undertaken to determine the sample size because there were no previous data available from the Prognos ohmmeter related to pain from RA to estimate effect sizes and then calculate sample size. A sample size of 30 for each group was targeted because the likely increases in power arising from larger sample sizes begin  38 3 8  to „flatten‟ when sample size rises above n=20 (Dr. W. Linden, personal communication, April 22, 2008). The pain level of 3 was chosen as a cut off point for participants with RA to be experiencing. The definition of pain provided by the International Association for the Study of Pain (IASP) provides the following definition for pain  “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" (Charlton, 2005). Every effort is made by the IASP not to objectify the subjective experience of pain as rated by the patient. That being said a general quantification for pain scales from older literature indicates that mild pain falls in the range of 1-3 and is on the border between tolerable pain and distressing pain. The pain level of 3 may be considered the upper most level of lowest category of pain and sit on the border between mild pain and moderate pain (McCaffrey & Beebe, 1989). Thirty- two participants with RA and an acute pain level of at least 3 on 0-10 scale were compared with 28 subjects who were pain free and had absolutely no medical diagnosis.  Two control subjects were experiencing pain at a level of less than 1 from a headache or muscle strain.  Participants were contacted by the Principal Investigator by telephone to determine their eligibility for the study.  An appointment was made at the University of British Columbia laboratory between the hours of 9 AM and 12 Noon. A research assistant met with each participant to obtain informed consent and collect demographic data. All data were collected within a similar time of day given that previous evidence suggested systematic diurnal variations of meridian activity (Colbert, Hayes, Aickin and Hammerschlag, 2006)  39 3 9  Participants with RA were asked to schedule their pain medication intake so that they would require a dose of analgesic soon after arriving at the laboratory.  Most but not all patients with RA were taking a short acting pain medication. Five subjects were well maintained on long acting medication such as methotrexate and were unwilling to interrupt their pain management regime for participation in this study. The remaining subjects (N=28) took a short acting medication during the rest period of one hour. Medications taken included plain Tylenol, aspirin, Tylenol with codeine, Advil, a variety of non-steroidal anti-inflammatory medications and herbal remedies. Participants were asked to continue with their regular medication regime. If they were taking a long acting pain medication they continued with their regular regime. A research assistant asked each participant to complete the MPQ, the PCS and the POMs. Each participant was measured for heart rate, blood pressure, heart rate variability and electrical resistance at Jing-well acupuncture points using the Prognos Ohmmeter. Participants with Rheumatoid Arthritis were asked to take their short acting pain medication if they were prescribed one.  Experimental and control subjects were asked to wait an hour during which they relaxed in a chair and then the measurements of heart rate, blood pressure, heart rate variability and ohmmeter were repeated along with the MPQ pain score only and the POMS. The PCS was not repeated as it was felt that no change could reasonably take place during the one hour period. Table 1 outlines the time spent at the laboratory to complete all required measurements.  40 4 0  Measurement with Prognos  The principal investigator was trained to take measurements with the Prognos ohmmeter by a representative from the MedPrevent Company, Waldershof, Germany and practiced taking measurements for 9 months prior to beginning this study. The representative from Med Prevent determined that the principal investigator was proficient in both taking measurements and in teaching others how to take the measurements according to standards set by the company related to operation of this device. Both research assistants were trained by the principal investigator for three weeks in several supervised practice sessions. At the end of the training period both research assistants met the criteria set by MedPrevent. Criteria included the ability to operate the ohmmeter, obtain and retrieve measurements from the computer program, basic trouble shooting and knowledge of available resources (MedPrevent Company, Waldershof, Germany) Testing took place between the hours of 8:00 AM and 12:00 PM to account for the diurnal rhythm described by Colbert et al, 2006. Ambient temperature during testing ranged from 19 – 22 degrees Centigrade. Participants were asked to sit quietly in an upright reclining chair.  When data were collected from the toes, the reclining chair was activated so that the feet were elevated.  Participants were told that the measurements would be repeated 5 times in rapid succession. Coloured reinforcers for 3-hole punch note paper were used to mark the points of the Jing-well acupuncture points.  All data collection was done with the research assistant wearing clean white cotton gloves to prevent any contamination of measurements by the research assistant‟s skin oils. Research assistants cleansed the participants‟ skin with  41 4 1  alcohol for 30 seconds and allowed the skin to dry. They placed the coloured rings on the fingers and toes of each participant at each of the 24 Jing-well locations.  This ensured the correct placement of the Prognos probe with each measurement and saved time (see Appendix D for a picture of this process). The reference electrode was secured to the left wrist with a Velcro strap.  All measurements were taken with the subject sitting in the reclining chair.  Participants were not able to see the computer screen as measurements were taken.  Electrical resistance at the 24 Jing- well acupuncture points was recorded during 5 rapid repeat measurement cycles.  Once a participant was prepared and the marker rings were placed over the acupuncture points, each complete measurement cycle took about 2 minutes. All 5 measurements were used in the calculation of the average results presented in this study (Colbert et al, 2004; Turner, Linden, Talbot-Ellis & Millman, 2010). Ethics Review This proposal was submitted to the University of British Columbia Clinical Research Ethics Board. The study was given approval (H08-01890) on February 9, 2009 after a full review. Please see Appendix B for a copy of the ethical approval.  42 4 2  Data Analysis and Results Analytical Strategy This results section has three subsections: [1] Description of the sample and validation check (i.e., answering the question whether or not the pain sample, at rest, is truly distinct from the pain-free control sample) in terms of traditional markers of pain; [2] Evaluation of group differences in acupuncture point activity at rest, and determination of the nature of the associations of acupuncture point readings relative to traditional pain measures; [3] Assessment of change over time (i.e., testing the hypothesis that pain patients show a distinct change in pain measures and acupuncture point activity after taking an analgesic). The first two sets of questions were assessed by one-way ANOVAs with group as the independent variable. Given that the measures comprised different classes (i.e., self- report and biological) no correction for family-wise was undertaken except for the acupuncture point data which were suspected to be inter-correlated. Given that they represent 24 likely linked variables they call for attention regarding a potential family- wise error problem.  Analysis of group differences for acupuncture point activity was subjected to multivariate testing using MANOVA (Hotelling‟s t-test) that corrects for family-wise error. The third set of questions related to change over time, was assessed via multivariate one-way residualized change score analysis controlling for group differences at rest. In this research, given its exploratory nature, it was determined that a level of .05  43 4 3  level of significance would be considered significant support for the hypotheses of a group difference.  Results Description of the Sample A description of the sample is found in Table 2. All subjects in the experimental group experienced joint pain and 4 subjects experienced additional musculo-skeletal pain. Two control group participants reported pain at a level of less than 1 from headache or musculoskeletal pain.  All experimental subjects reported using a wide variety of analgesic and other types of medication. The following list provides the number of experimental subjects who reported using each medication: Vitamins, glucosamine, herbal medication, (N=18); Non-steroidal anti inflammatory medication, (N=13); Methotrexate, (N=12); Tylenol, (N=11); Plaquenil, (N=9);  Prednisone, (N=8); Ativan, (N=5) ; Enbrel, (N=4); Amitriptyline, (N=4); Oxycodone, N=3); Leflunomide, (N=3); Baclofen, (N=2); Orencia, N=2); Arthrotec, (N=2); Myochrisine, (N=1); Lamictal,(N=1); Acterma, (N=1) and other ,(N=12) (numbers exceed 32 due to participants taking multiple medications). Subjects in the control group reported the following medications: Synthroid, (N=2); Aspirin and Non-steroidal anti-inflammatory medication, (N=3); and Vitamins and Herbal preparations, (N=4).    44 4 4  Comparison of pain/no pain groups at rest: Validation check It was critical for this study to show that the experimental group was indeed distinguishable from the control group on traditional indicators of pain.  The data (see Table 3) show significant group differences on all traditional measures of pain including heart rate, blood pressure, MPQ and PCS. There were also significant differences in some aspects of the POMs which provides a general measure of affect.  No significant difference was found between the groups related to heart rate variability scores.   Comparison of pain/no pain groups at rest and association of acupuncture point measures to other pain markers All participants in the experimental group marked the location of their pain on the diagram of the MPQ. These locations were identified and tabulated. See Table 4 for an outline of the types of pain experienced by this group of experimental participants. Recall that Melzack, Stillwell and Fox (1977) had mapped all known acupuncture points associated with pain treatment and identified that acupuncture points associated with the type of pain experienced by these experimental participants with RA pain would likely be found in three meridians, left and right side respectively.  These acupuncture points were located on meridians „Gall Bladder‟, „Small Intestine‟ and „Bladder‟.  This research study provided a theoretical basis of where in the 24 meridian measures to look for differences between the two groups. The multivariate F test for 6 dependent variables in my data set revealed an overall significant difference between experimental and control groups (F  [6,54]) = 2.22,  45 4 5  p = .05). The pertinent mean scores for all acupuncture point measurements are listed in Table 5. Post hoc t-tests indicated a significant difference in the „Left‟ and „Right Small Intestine‟ acupuncture point between subjects with pain and those who were pain free. This acupuncture point according to Melzack, Stillwell and Fox (1977) is related to joint pain in the neck and hands which most subjects in the experimental group experienced. All acupuncture point measurements had a large standard deviation. In order to correct for this the log of each measurement was taken and a subsequent t-test of the logarithms remained significant between the groups. Pearson Product Moment Correlation Coefficients were calculated between each meridian and heart rate, blood pressure, heart rate variability, MPQ, PCS and POMs. This null hypothesis was partially supported by the data. There was no correlation of acupuncture point activity with heart rate, blood pressure, heart rate variability or the PCS.  There was, however, a correlation of the meridian measures with the MPQ. Pearson product moment correlation values for each meridian are presented in Table 7. Three Jing-well acupuncture point resistance scores were significantly correlated with the „Friendly‟ dimension of the POMs. Five meridians were significantly correlated with the „Tension- Anxiety‟ dimension of the POMs. There was no other correlation between meridians and total POMs score or any other POM‟s dimension. (See table 8) All Jing-well acupuncture point resistance scores were significantly correlated with each (p = .001) other except the following. The „Left Bladder‟ score was not significantly correlated with the „Right Heart‟ score.  The „Right Heart‟ score was correlated with the „Right Liver‟ score at .05 level of significance and the „Left Spleen‟  46 4 6  and „Pancreas‟ was correlated with the „Right Large Intestine‟ at the .05 level of significance. For the sake of simplicity, Table 10 clusters the correlation coefficient into categories for each Jing-well acupuncture point; otherwise we would have to inspect a correlation matrix of 24 X24 / 2=288 numbers. There is a correlation of each Jing-well acupuncture point with almost every other acupuncture point. This fact suggests that the Prognos Ohmmeter provides a global measure of presumed energy balance which may be consistent with a whole systems theory of the human body.  Comparison of Experimental (pain) /Control (no-pain) groups, one -hour interval Residualized change score analysis was used to determine the difference between pain and no pain groups for the repeated measures taken before and after the 1-hour interval during which the pain patients ingested an analgesic. One hour is considered to be an adequate amount of time for a short acting oral analgesic to take effect (Brunton, Lazo & Parker, 2006). Residualized change score analysis is a type of covariance analysis that individually adjusts for any potential confound of differences in baselines that may affect subsequent degree of change. Residualized change scores are derived by calculating the predicted change score as a function of the correlation between baseline and subsequent change scores. Residualized change scores are superior to covariance analyses because they have no requirement of parallel regression slopes and it is not necessary to have high intercorrelations of baseline values with change scores (Linden, Lenz & Con, 2001).  Recall that there were five participants who did not take a short acting medication during the break as they were maintained on long acting medications. Analyses were  47 4 7  preformed including and excluding the five participants. None of the analyses were significant. The multivariate F test for the 24 Jing-well acupuncture point measurements between pre-medication and post- medication was not significant (F [24, 35] = 1.28, p = .250).  The multivariate F test when participants who did not take a short acting medication are removed from the group is also non-significant F (24, 30) = 1.04, p = .452. The multivariate F test for only the acupuncture points labeled “Bladder”, “Gall Bladder” and “Small Intestine” was also non-significant both when all subjects are included (F [6,53] = .43, p = .859) and when subjects who did not take a short acting medication are removed (F [6.48] = .77, p = .597). Table 12 outlines the group differences in change over time related to traditional markers of pain and the non specific measure of affect provided by the POMs.  The Multivariate F for these 12 dependent variables (F [11,31]= 3.329, p = .004) indicates a significant difference between pre and post measurements related to systolic blood pressure, diastolic blood pressure, heart rate, Profile of Mood States and components and the MPQ. Discussion The purpose of this study was to explore electrical skin resistance at acupuncture (Jing-well) points and its ability to distinguish pain from non-pain states. An experimental protocol aiming at high internal validity was chosen to assure interpretability of findings. The main finding of this study was that electrodermal measurements at Jing-well points were significantly different between the experimental group of arthritis patients with an acute pain level of at least 3 (out of 10) and the control group with a pain level of  48 4 8  0. This difference reached significance in a multivariate analysis and revealed group differences on the specific acupuncture points suggested by Melzack, Stillwell and Fox (1977). These group differences on the electrical resistance measure were matched by group differences on pain self-report as well as other biological markers. All measurements except heart rate variability were significantly different between the experimental group with pain and the control group without pain. With respect to the hypothesized change over time, there was no significant difference between electrodermal resistances taken at baseline compared to one hour later after the ingestion of an oral analgesic medication (in the arthritis group). Prognos measurements did correlate significantly with the McGill Pain Questionnaire (MPQ) and with the „Friendly‟ and „Tension Anxiety „dimensions of the POMs Scale. All 24 Prognos measurements correlated significantly with each other.  Baseline differences of the sample  Critical to the internal validity of this protocol was that the experimental group was clearly different from the control group related to traditional measures of pain including blood pressure, heart rate, PCS, MPQ and also a general measure of affect, i.e., the POMs.  The results indicate that this requirement was consistently met with the exception of heart rate variability and that the groups were very distinct a priori. That heart rate variability was not significant was a little surprising; on the other hand, the literature related to heart rate variability and pain is inconsistent. Applehans & Luecken (2008) suggest that heart rate variability may not directly reflect pain sensitivity. It is also possible that the measurements taken were not over a long enough period of time.  49 4 9   Electrical Resistance at Jing-well Acupuncture Points-Differences over time There was no significant difference between Prognos measurements taken at rest compared to measurements taken one hour after taking an analgesic medication.  While disappointing, this result is not particularly surprising. Subjects were instructed to take a pain medication that they used for short term pain relief. No attempt was made to control what type of medication the subject took. In five cases, the participant was pain controlled by a long acting pain medication.  In order to find a difference between rest and post analgesic medication, it would be important to control the type of medication taken. Jing-well measurements taken at baseline and compared to those taken one hour later showed a non-consistent tendency to reduce during the hour of laboratory wait time, irrespective of group, and this generic habituation effect made it difficult to show group- specific differences.  This is likely the response to the subject not being engaged on motor activity and possibly relaxing.  Relationship of Electrical Resistance over Jing-well Acupuncture Points to Location of Acupuncture Points for Pain Recall that this study used Melzack et al‟s work (1977) to make specific predictions about which acupuncture points would likely differentiate the pain from the no-pain group.  Melzack and collaborators had mapped acupuncture points used in the treatment of pain from two separate traditional Chinese medical textbooks. They had found that each acupuncture point corresponded with a trigger point and had outlined the pain syndromes associated with each acupuncture point. Subjects in this study  50 5 0  experienced pain from RA located in the legs, shoulders, neck, back, arms, legs and most joints. According to Melzack et al. (1977) these pain locations would be treated using Jing-well points located on the meridians „Small Intestine‟, „Bladder‟ and „Gall Bladder‟. Using the Chinese medicine framework, one could then interpret these results as confirming that these three meridians may be blocked or show some disruption of qi energy flow. When a multivariate analysis was conducted considering the electrical resistance over Jing-well acupuncture points reflecting the Small Intestine, Bladder and Gall Bladder, the results indeed demonstrated a significant F for groups (F[6,54] = 2.217, p = .05) between pain patients and pain-free control participants. This indicates that the groups differed with respect to the specific selection of acupuncture points for which predictions had been made given the evidence offered by Melzack et al. (1977).  I consider the confirmation of the specificity of this finding to be the most important and exciting finding of this study.  Implications of the Findings for a Theory of an Electrical Resistance Biofield All Prognos measurements were correlated with one another. This suggests that the electrical resistance at the skin surface may represent a whole body response to health and illness which in the case of chronic pain is characterized by wide-spread sympathetic activation; this observation is supported by the observed group differences in cardiovascular activity.    This result is consistent with the Ion Cyclotron Resonance hypothesis suggested by Liboff (2004), Hintz et al (2003), Rubik (2002), and Oschman (2000) and theories of traditional Chinese medicine and qi flow. A likely candidate  51 5 1  explanation is that arthritis pain is marked by extensive inflammatory processes that show itself in pervasive changes in skin surface resistance. According to the Ion Cyclotron Resonance hypothesis, such an inflammatory process is evident at the skin surface and, as demonstrated here, is detectable with an instrument that measures electrodermal skin resistance. As previously stated, this biofield can be described by a single vector that takes into account all of the moving charge and current densities. This hypothesis also predicts that “all pathologies, abnormalities and traumas are manifested by deviations from the normal field” (Liboff, 2004, p.45). Results obtained from this study support the prediction of a deviation from the normal field as a result of a change in the content and movement of the biological fluids. The result of the movement of the biological ions is an extremely low frequency (ELF) electromagnetic field that is detectable at the skin surface and reflects disease processes going on below the skin surface (Liboff, 1994, 2004).  Other Supportive Research The study results are consistent with those obtained by Fukuda et al, 1996 who were able to detect medically diagnosed breast cancer at the skin surface using a breast biofield device that measured electromagnetic skin resistance at the skin surface. As well Ng, Ng, Sim and Acharya (2006) used a Biofield Diagnostic System and found that electromagnetic skin resistance at the skin surface may indicate abnormally reproducing cells associated with breast cancer. The results are also consistent with Ahn, Schnyer, Conboy, Laufer and Wayne‟s work (2008); these researchers used a Hibiki -7 device to detect electrodermal skin  52 5 2  resistance at 24 Jing-well points. They found that endometriosis related chronic pelvic pain was reflected in the Liver, Spleen and Kidney Jing-well acupuncture points. Similarly, Shultz, Driban and Swanik (2007) found that electro dermal skin resistance differentiated myofacial trigger point locations.  The current study is further consistent with the results of Szopinsky, Pantanowitz and Jaros‟s (1998) work.  Lochner and Pantanowitz (2004, 2006) and Szopinski, Pantanowitz and Jaros (1998) found a connection between the states of health of internal organs when measured at organ projection areas located in the homunculus in the ear. Electrical resistance was lower for diseased organs than for healthy tissue. Oleson, Kroening and Bressler (1980) also measured electrical resistance at organ projection areas in an auricular somatotopic mapping of musculo-skeletal pain. They found a 75.2% concordance between confirmed medical diagnosis and auricular diagnosis obtained by measuring electro dermal resistance at the auricular point corresponding to a specific internal organ.  Relationship of Electrical Resistance over Jing-well Acupuncture Points to Traditional Measures of Pain Theories of TCM suggest that the entire body is in a delicate balance.  A block in one meridian is believed to lead to an overall adjustment in all other meridians to compensate for the altered qi flow.  According to theories of traditional Chinese medicine, illnesses usually result in excess energy or a depletion of energy (Kaptchuk, 1983). The results obtained seem to indicate that pain is reflected by an excess of energy.  53 5 3  The correlation between all 24 Prognos measures seems to reflect that resistance is increased in all meridians creating an excess of energy overall.  Along these lines, there is a linkage between Jing-well acupuncture point measurements and self-report pain and mood measures. Jing -well point activity was highly correlated with the MPQ total pain scores and the Tension – Anxiety and Friendly dimension of the POMs. This result seems to indicate that mood states also map onto the electromagnetic skin resistance measured by the Prognos. Given that mood states are associated with physiological changes in charged ions and neurotransmitters, it is not surprising that mood states can alter the electromagnetic field surrounding the body. That this can be detected by the Prognos ohmmeter suggests an interesting pathway for future research. The total pain score was highly correlated with most Prognos measurements although there also were high correlation of meridians other than those predicted by Melzack, Stillwell and Fox (1977). The Total McGill Melzack Pain Score was correlated significantly at .001 level of significance with Jing-well point activity at the Right Stomach, Left Spleen and Pancreas, Right Spleen and Pancreas, Left Liver and Right Liver sites. A weaker linkage (p<.05) was apparent in correlation coefficients for activity of Left Lung, Left Stomach, Left Small Intestine, Right Small Intestine, Left Bladder, Left Kidney, Right Kidney, Left Triple Heater and Right Gall Bladder scores. The other 10 acupuncture point scores had no significant correlation with the total pain score. These findings are a little difficult to explain. Given that the Small Intestine, Bladder and Gall Bladder meridians were suggested to be involved in the experience of joint pain related to subjects with RA (Melzack, Stillwell & Fox, 1977); one would have  54 5 4  thought that these acupuncture points would demonstrate the most significant correlations with subjective pain ratings whereas activity at the majority of acupuncture point sites did correlate with pain ratings.  I posit that this is best explained by arguing that Jing-well point activity represents a blend of general arousal (see their high intercorrelations) but also allows for some specificity in that the predicted pain-sensitive sites (Small Intestine, Bladder, and Gall Bladder)  were indeed revealing heightened activation. Also of interest is the link between mood states and Jing-well scores. Some Jing- well scores, namely Left Small Intestine, Left Kidney, Left Circulation, Right Gall Bladder and Left Liver, correlated with the Tension Anxiety aspect of the POMs. This is partly consistent with other findings in that the Left Small Intestine and Right Gall Bladder are implicated in all joint pain. Other linkages are difficult to explain and may relate to the fact that self-report of pain is more likely a direct reflection of presumed underlying inflammation whereas mood states may result in a more indirect process from pain and various attempts at coping with pain. Given the multitude of physiological processes going on simultaneously it is quite possible that the meridian measurements may be reflecting other underlying processes. For example, the meridian measurements may be reflecting other dimensions of pain or mood that have not been accounted for. Another possibility is that other pre-clinical medical conditions may be present in some members of the experimental group. It is also possible that the medications taken by the experimental group may be influencing the meridian measurements. Given the complexities of physiological processes that are occurring simultaneously it may be difficult to isolate only one process when the electromagnetic field is changing moment to moment.  55 5 5   Weaknesses and Strengths The readings in KOhms obtained with the Prognos Ohmmeter in this study were high in comparison to those obtained by Colbert, Hammerschlag, Aicken and NcNames (2004). The results are consistent with the literature provided by the Med Prevent Company for Prognos Ohmmeter in that they suggest that each person has a unique pattern of electrodermal resistance related to their overall health. The Colbert laboratory used the natural log of the kilo ohm values to reduce the variability in their data (Dr. A. Colbert, personal communication, August 15, 2010).  Colbert also suggests that the size of the probe may have differed from the size of probe that was used in her laboratory. The absolute values may not be important due to the high degree of variability between subjects (Dr. A. Colbert, personal communication, August 15, 2010). Age may be a critical factor in that Colbert et al‟s participants were much younger. Also, even though the control group was pain free, they may not have been in excellent health. Criteria for inclusion in the pain group were to be pain-free and without a diagnosed physical ailment. According to literature from Med Prevent each person‟s electrodermal skin resistance will fluctuate and indicate a lack of balance well before a diagnosis can be made. It is possible that subjects in the control group may have been in the pre-clinical stage of disease. This study had a relatively small sample size. Subjects were gathered based upon self identified criteria of having pain or not and having a medical diagnosis of RA. In some cases the control group may have been less than completely balanced and healthy  56 5 6  as indicated by the high variability of electromagnetic impedance at Jing-well Meridian points even in the control group. The mean scores obtained for the main study described here, were very similar to the scores of participants in the pilot study where reliability had been established (Turner et al., 2010). The findings obtained here allowed meaningful interpretations of measured data. Differences in Jing-well means may therefore have resulted from [a] unique device features, [b] age differences between samples, and/or [b] reflect that the Jing-well activity cannot be directly compared between individuals because norms are not available as they would be for blood pressure for example. It was impossible during this study to keep research assistants fully blinded to the patient category of control or experimental. Research assistants found that individuals in pain needed help to settle into the chair and were recognizably different from control participants. It is possible but not likely that measurements were taken in a different way between experimental and control group given that experimenters followed a written manual for the protocol steps. Every effort was made to standardize all training and data collection. (See a description of the measurement taking process in the Procedure section). Data were collected relating to the social situation of each participant. These were not taken into consideration in analyzing this data. For example the experimental group with pain was less likely to be in a stable relationship than the participants in the control group. These factors may have confounded the results of this study. Stress levels, however, were considered and there was no difference related to any of the Prognos measurements related to level of stress.  57 5 7  Strengths of the study include that the reliability of the same Prognos Ohmmeter that was in the main study had been clearly established prior to the beginning of the experimental procedure. The reliability results with a Cronbach‟s alpha of .88 were consistent with those obtained by Colbert, Hammerschlag, Aickin and McNames (2004). The location of the each Jing-well Point was clearly marked and ensured that repeated measurements were taken in exactly the same location each time. All measurements were taken between 9 AM and 12 Noon to account for the potential of diurnal rhythm changes.  Important but unanswered questions It would be important and interesting to investigate if other pain syndromes were measurable with the Prognos Ohmmeter using the acupuncture points suggested by Melzack, Stillwell and Fox (1977). For example Ahn, Schnyer, Conboy, Laufer and Wayne (2008) found the Liver, Spleen and Kidney meridian to be implicated in pain from endometriosis. Melzack, Stillwell and Fox (1977) suggest that the Liver meridian is implicated in lower lumbar pain and the Spleen meridian is involved in pain from dysmenorrhea. It should be possible to map various pain syndromes with the Prognos Ohmmeter to create a data base for reference.  Clinical Implications  The clinical implications of being able to detect painful conditions at the skin surface may be easy to over-interpret given that this was the first exploration of it kind. Nevertheless, there are many possibilities especially as our findings get replicated. These types of technology have the potential to offer painless and easy screening tools for  58 5 8  detecting imbalances before they manifest as clinical conditions. This would allow for early detection of clinical conditions. After extensive testing with multiple disease conditions, this type of technology may be useful for health promotion.  The changes that do occur in the Jing-well points may reflect differences in inflammatory process, pain and emotional states. It is possible that the subtle changes induced by energy-based healing modalities may be measurable by an ohmmeter. There may be potential for using this instrument to detect changes in the meridian system and electromagnetic field around the body when an energy-based therapy is applied. Furthermore, this measurement approach can be used to objectively evaluate whether or not experienced integrative energy healing or therapeutic touch practitioners can actually produce change in skin resistance.  Conclusions  An ohmmeter previously shown to have good reliability is able to differentiate between a state of pain and a non pain state; it thus possesses criterion validity. The meridians presumably connected to those acupuncture points associated with the RA pain syndrome include Right and Left Small Intestine, Bladder and Gall Bladder.  This work represents a bridge between traditional Chinese medicine and Western medicine and the inter-related concepts used by both types of approaches. It demonstrates that TCM principles can be empirically tested given that this work found support for the validity of acupuncture points associated with a specific pain syndrome.   59 5 9  Further Research This work offers a generic strategy for mapping acupuncture points and specific disease conditions. An investigation of multiple disease conditions related to acupuncture points would be a first step in solidifying the bridge between TCM and Western medicine.  An exploration of the resistance at Jing-well points related to each disease condition would provide a firm foundation for linking TCM and Western medicine. That there was no change between the „at rest‟ Jing-well points and the measurement one hour later after ingesting an analgesic seems to indicate that a  meridian balance is not instantaneously achieved or changed.  Perhaps if medication intake had been carefully controlled and standardized, and studied over a longer period of time, it would be possible to demonstrate a difference. The possibility exists that the Prognos does not measure pain but multiple processes associated with pain. Certainly one hour was not sufficient to demonstrate a significant change in the electrical resistance at acupuncture points.  The high level of correlation among all resistance measurements at Jing-well points supports the theory of a whole organism response and the Ion Cyclotron Resonance hypothesis. As Liboff (1994, 2004) suggests deviations from normal are compensated for by the homeostatic tendency of the organism. In summary, the Prognos Ohmmeter provided reliable (i.e., internally consistent) and valid (content and criterion validity was shown) results about the physical state of the human organism when experiencing arthritis pain. Furthermore the technology may be helpful in measuring the results of complementary and alternate therapies that are based on models of the human energy field. . For example, energy-based healing modalities such as healing touch or integrative energy healing acupuncture and acupressure may be  60 6 0  evaluated using the Prognos Ohmmeter, possibly together with other measurement methods. Altogether this research adds to the criterion validity of acupuncture point activity as a marker of a disease state. Lastly, the experimental protocol used here has potential for continuing efforts at mapping Jing-well point activity for disease states other than pain from RA.   61 6 1   Table 1: Laboratory Schedule Stage Activity Minutes Arrival at Laboratory Orientation to facilities 10 Pre-Data Gathering POMs 10  MPQ 10  PCS 10  Skin resistance  Measurement 10  Heart Rate Variability 10 Rest Time Subjects with pain ingested analgesic. All subjects sat in a room with neutral magazines and water and were asked to relax. 60 Post-Data Gathering POMs 10  MPQ pain score only 10  Electrical resistance  Measurement 10  Heart Rate Variability 10 Debrief Debriefing – paid $50.00 cash 20 Total Time  180 minutes or 3 hours         62 6 2   Table 2: Demographics   Experimental Control Sample Size (N =) 32 28 Age 54.9 (15.7) 47.3 (11.8) Pain Level at baseline 4.45 (2.09) 0.21 (0.46) Usual Pain Level 4.45 (1.92) 0.15 (0.46) Pain Level, 1 hour later 2.66 (2) 0.36 (0.86) Male (N=) 8 7 Female (N=) 25 21 Married or Stable Relationship (N=) 4 17 Living alone (N=) 25 11 Participants with Children (N=) 14 11 Has Pets (N=) 10 15 Religious (N=) 18 19 Regular Exercise (N=) 14 8   63 6 3   Table 3: BP, HR, Heart Rate Variability, MPQ and POMs at Baseline  No Pain N = 28 Pain N = 32 Significance Systolic BP, mmHg 107 (10) 117 (16) .005 Diastolic BP, mmHg  69 (8) 74 (8) .021 Heart Rate, beats per minute 63 67 .037 Heart Rate Variability SDNN 81.9 (73) 73.7 (60.6) .638 NN50 40.8 (44) 41.4 (52.9) .961 PNN 50 .11 (.1) .1 (.1) .5 RMSSD 75.1 (94.5) 68.9 (62.4) .8 Very low frequency 972.4 (2321.4) 580.3 (1339) .419 Low frequency 755.5 (1091.5) 493.4 (882.4) .308 High frequency 648.5 (1525.5) 562.5 (1321) .816 LF/HF 3.3 (3.3) 35.0 (184.8) .372 Power 2376 (4336.7) 2168 (5363.2) .870 McGill Pain Questionnaire 6 (7) 30 (20) <.001 Pain Catastrophization  8 (8) 21 (11) <.001 POMs total 118 (21) 135 (33) .033 Anger 14 (3.9 16 (6.8 .124 Tension Anxiety 14 (2.9) 17 (6) .04 Depression 19 (7.6) 25 (12.3) .03 Confidence 24 (5.3) 22 (7) .295  64 6 4   No Pain N = 28 Pain N = 32 Significance Fatigue 12 (5.1) 15 (8) .09 Clear 11 (3) 15 (5) .008 Friendly 25 (4) 25 (5) .71   65 6 5    Table 4: Location of Acupuncture Point Used to Treat Pain Compared to Pain Location in Experimental Subjects  Pain Location Pain Location in (N) Experimental Subjects Acupuncture Point and Meridian Implicated  Legs Musculo Skeletal 2 Gall Bladder Shoulder Back Arm 2 Gall Bladder, Bladder Neck  14 Small Intestine, Gall Bladder Joint Pain Feet 14 Bladder Joint Pain Ankles 13 Gall Bladder Joint Pain Knees 16 Gall Bladder Joint Pain Hips 6 Gall Bladder Joint Pain Hands 25 Small Intestine Joint Pain Lower Back 25 Bladder    66 6 6   Table 5: Mean Resistance in Kilo ohms over Jing-well Acupuncture Points at Baseline (Mean value of 5 measurements taken for each participant)  No Pain N = 28 Pain N = 32 Left Lung 14703 (10257) 18875 (11326) Right Lung 14806 (11140) 19477 (11946) Left Large Intestine 14938 (10906) 18950 (11976) Right Large Intestine 15040 (11756) 20280 (14265) Left Stomach 10418 (6008) 13889 (9896) Right Stomach 9682 (8781) 12436 (11503) Left Spleen Pancreas 10001 (8340) 15206 (13929) Right Spleen Pancreas 10721 (7859) 16654 (13205) Left Heart 15808 (12029) 18361 (11424) Right Heart 14718 (9911) 15950 (9532) Left Small Intestine 12263 (8133) 18641 (12509) Right Small Intestine 12528 (9676) 18373 (9394) Left Bladder  14951 (10562) 21955 (14606) Right Bladder 14892 (10788) 16648 (11858) Left Kidney 11482 (9337) 14033 (11548) Right Kidney 11207 (10201) 13529 (11369) Left Circulation 16460 (10348) 19577 (12544) Right Circulation 16839 (11415) 21414 (13459) Left Triple Heater 17189 (12532 21855 (13624) Right Triple Heater 18878 (14199) 23417 (11681)  67 6 7   No Pain N = 28 Pain N = 32 Left Gall Bladder 12388 (9425) 15125 (11078) Right Gall Bladder 9554 (6414) 14755 (12069) Left Liver 10022 (8050) 13499 (10698) Right Liver 8759 (5640) 12772 (11829)   68 6 8   Table 6: Mean resistance in Kilo Ohms over Jing-well Acupuncture Points Comparing Pain and No Pain for Jing-well points hypothesized to be pain-sensitive  No Pain Pain Significance Left Small Intestine 12263 (8133) 18641 (12509) .037 Right Small Intestine 12528 (9676) 18373 (9394) .026 Left Bladder  14951 (10562) 21955 (14606) .058 Right Bladder 14892 (10788) 16648 (11858) .652 Left Gall Bladder 12388 (9425) 15125 (11078) .375 Right Gall Bladder 9554 (6414) 14755 (12069) .063    69 6 9   Table 7: Correlation among Jing-well Acupuncture Point Activity and MPQ score MerMMeridian Correlation Coefficient Left Lung .294 Right Lung .225 Left Large Intestine .222 Right Large Intestine .192 Left Stomach .320 Right Stomach .360* Left Spleen Pancreas .391* Right Spleen Pancreas .348* Left Heart .181 Right Heart .096 Left Small Intestine .310 Right Small Intestine .259 Left Bladder  .228 Right Bladder .287 Left Kidney .258 Right Kidney .276 Left Circulation .228 Right Circulation .093 Left Triple Heater .261 Right Triple Heater .246  70 7 0  MerMMeridian Correlation Coefficient Left Gall Bladder .247 Right Gall Bladder .300 Left Liver .391* Right Liver .450* *= p <.001   Table 8: Correlations among the “Friendly” dimension (POMS) and Jing-well Acupuncture Point Resistance Meridian Pearson Coefficient Significance Right Large Intestine .264 .05 Right Stomach .280 .05 Left Gall Bladder .270 .05         71 7 1   Table 9: Correlations among Jing-well Acupuncture Point Resistance and “Tension /Anxiety” (POMS) Meridian Pearson Correlation Coefficient Significance Left Small Intestine .257 .05 Left Kidney .262 .05 Left Circulation .310 .05 Right Gall Bladder .259 .05 Left Liver .289 .05  .  72 7 2   Table 10: Correlation Coefficients for Jing-well Acupuncture Points with each other (the numbers in each cell below indicate how many correlation coefficients fell within this range)  .20 - .39 .40 - .49 .50- .59 .60 - .69 .70 - .89 Left Lung  1 2 12 9 Right Lung 2 3 4 7 7 Left Large Intestine  3 5 7 8 Right Large Intestine 2 3 5 6 7 Left Stomach  1 5 4 13 Right Stomach 1 1 9 6 6 Left Sp Pancreas 5 7 6 4 1 Right Sp Pancreas 3 2 7 6 5 Left Small Intestine   4 12 7 Right Small Intestine 1 1 8 9 4 Left Heart 1 4 6 6 6 Right Heart 8  4 2 7 2 Left Bladder 2  9 8 3 Right Bladder  2 2 9 10 Left Kidney 1 2 11 5 4 Right Kidney 1 7 6 3 6 Left Circulation  2 4 9 8 Right Circulation 2 6 5 8 2  73 7 3   .20 - .39 .40 - .49 .50- .59 .60 - .69 .70 - .89 Left Triple Heater  1 7 8 7 Right Triple Heat 1 2 6 7 7 Left Gall Bladder  2 5 9 7 Right Gall Bladder  1 3 8 11 Left Liver 1 1 6 7 8 Right Liver 2 3 6 5 7   74 7 4   Table 11: Electrical resistance Pre Medication (i.e., baseline) vs. Post Medication (1 hour later) in K Ohms over Jing-well Acupuncture Points  Pre Med  Post Med Left Lung 16711 (10992) 16316 (12904) Right Lung 17137 (11269) 14908 (10516) Left Large Intestine 16901 (11556) 15156 (11671) Right Large Intestine 17586 (13339) 14587 (11164) Left Stomach 12116 (8442) 11919 (7777) Right Stomach 11012 (10302) 10081 (7898) Left Spleen Pancreas 12639 (11809) 11575 (9925) Right Spleen Pancreas 13712 (11336) 12152 (9866) Left Heart 17084 (11602) 15274 (10291) Right Heart 15211 (9652) 14446 (10151) Left Small Intestine 15457 (11107) 14109 (10515) Right Small Intestine 15551 (9837) 14244 (10483) Left Bladder  18436 (13284) 17446 (11749) Right Bladder 15613 (1342) 15282 (10417) Left Kidney 12724 (10517) 12364 (9013) Right Kidney 12433 (10722) 12794 (9157) Left Circulation 17900 (11615) 16374 (11186) Right Circulation 19045 (12680) 16589 (12421) Left Triple Heater 19450 (13234) 18117 (13495)  75 7 5   Pre Med  Post Med Right Triple Heater 21155 (12947) 17122 (12313) Left Gall Bladder 13675 (10347) 12600 (9013) Right Gall Bladder 12162 (10108) 12367 (9323) Left Liver 11721 (9632) 11753 (8802) Right Liver 10749 (9591) 10173 (6769)   76 7 6   Table 12: Residualized Change Scores for medication effects on BP, HR, POMs and MPQ Measurement F Value Significance Systolic Blood Pressure .040 .843 Diastolic Blood Pressure 1.619 .210 Heart Rate 1.821 .185  Profile of Mood States 3.595 .065   Anger  1.973 .168   Tension Anxiety 3.055 .088   Depression 2.862 .098   Confidence .109 .743   Fatigue .745 .393   Clear 7.152 .011   Friendly .001 .982  McGill Pain Questionnaire 20.23 < .001  77 7 7  Bibliography Aaron, R. 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M., Lee, Y. H., & Lee, M. S. (2004). Measurement of subcutaneous impedance by four-electrode method at acupoints located with single- power alternative current. The American Journal of Chinese Medicine, 32(5), 779- 788.  11 5 1 1 5  Zhang, W., Jeong, D., Lee, Y., & Lee, M. S. (2004). Measurement of subcutaneous impedance by four-electrode method at acupoints located with single-power alternative current. American Journal of Chinese Medicine, 32(5), 779-788. Zhvirblis. (1982). Asymmetry versus chaos, or 'what is the biofield?'. San Francisco: Washington Research Center and the Foundation for Human Science. Zimmerman, J. (1999). Laying-on-of-hands and therapeutic touch: A testable theory. Journal of Bio-Electric Magnetics Institute, 2, 8-17. Zimmerman, J. E. (1972). Josephson effect devices and low frequency field sensing. Cryogenics, 12, 19-31. Zimmerman, J. E., Thiene, P., & Harding, J. T. (1970). Design and operation of stable rf- biased superconducting point-contact quantum devices, and a note on the properties of perfectly clean metal contacts. Journal of Applied Physics, 41, 1572-1580. Zimmerman, J. E. (1972). Josephson effect devices and low-frequency field sensing. Cryogenics, 12(1), 19-31. Zinina, E. (2006). Microwave propagation on acupuncture channels. Acupuncture Electro-Therapeutics Research, 31(1-2), 1.     11 6 1 1 6  Appendix A - Definition of Terms - Physics Capacitance: “The potential V of a single isolated conductor due to the charge Q on it is proportional to Q and depends on the size and shape of the conductor…. It is a measure of the capacity to store charge for a given potential difference. The SI unit of capacitance is coulomb per volt or farad” (Tipler and Mosca, 2008, p. 802)  Force exerted by a magnetic field – “It has been experimentally observed that when a particle that has charge q and velocity v in a region with magnetic field B, a force acts on the particle that is proportional to q, to v, to B and to the sine of the angle between the directions of v and B” (Tipler and Mosca, 2008, p.888).  The force is perpendicular to both the velocity and the magnetic field (Tipler and Mosca, 2008).  Ohmmeter:  This is a device that measures electrical resistance in a material that consists of a battery connected in series with a galvanometer and a resistor (Tipler and Mosca, 2008).  Resistance: “Current in a conductor is driven by an electric field Ē inside the conductor that exerts a force q Ē on the free charges. In electrostatic equilibrium, the electric field must be zero inside a conductor, but when there is a current in a conductor, the conductor is no longer in electrostatic equilibrium. The free charge drifts down the conductor, driven by forces exerted on the charges by the electric field. In a metal, the free charges are negatively charged, so the free charges are driven in a direction opposite to the direction of the electric field Ē. If the only forces on the free charge were the electric  11 7 1 1 7  forces, then the free charge would gain speed indefinitely. However, this does not happen because the free electrons interact with the lattice of ions that make up the metal, and the interaction forces oppose the drifting motion of the free electrons.  The ratio of the potential drop in the direction of the current to the current is called the resistance of the segment” (Tipler and Mosca, 2008) The SI unit of resistance is the volt per ampere or the ohm (Tipler and Mosca, 2008).  11 8 1 1 8  Appendix B – Ethics Certificate   The University of British Columbia Office of Research Services Clinical Research Ethics Board – Room 210, 828 West 10th Avenue, Vancouver, BC V5Z 1L8  ETHICS CERTIFICATE OF FULL BOARD APPROVAL  PRINCIPAL INVESTIGATOR: INSTITUTION / DEPARTMENT: UBC CREB NUMBER: Wolfgang Linden UBC/Arts/Psychology, Department of H08-01890 INSTITUTION(S) WHERE RESEARCH WILL BE CARRIED OUT: Institution Site UBC Vancouver (excludes UBC Hospital) Other locations where the research will be conducted: N/A  CO-INVESTIGATOR(S): Linda C. Turner SPONSORING AGENCIES: - Lotte & John Hecht Memorial Foundation PROJECT TITLE: Measurement of Meridian Activity at the Skin Surface over Acupuncture points in Chronic Pain States  THE CURRENT UBC CREB APPROVAL FOR THIS STUDY EXPIRES:  January 13, 2010 The full UBC Clinical Research Ethics Board has reviewed the above described research project, including associated documentation noted below, and finds the research project acceptable on ethical grounds for research involving human subjects and hereby grants approval.  REB FULL BOARD MEETING REVIEW DATE:  January 13, 2009 DOCUMENTS INCLUDED IN THIS APPROVAL: DATE DOCUMENTS APPROVED: Document Name Version Date Protocol: Measurement of Meridian Activity at the Skin Surface over Acupuncture points in Chronic Pain States N/A February 9, 2009 Consent Forms: Prognos Consent  N/A February 9, 2009 Advertisements: Recruit Control N/A November 17, 2008 Recruit Experiment N/A November 17, 2008 Questionnaire, Questionnaire Cover Letter, Tests: Pain Catastrophization Scale N/A October 9, February 23, 2009  11 9 1 1 9  2008 Prognos Operating Instructions N/A October 9, 2008 McGill Pain Questionnaire N/A October 9, 2008 Prognos Debriefing Sheet N/A November 17, 2008 Typical Day Questionnaire N/A November 17, 2008 Profile of Mood States N/A November 17, 2008 Demographic Data Sheet N/A November 17, 2008 Other Documents: Prognos study N/A December 9, 2008 Letter of support, Dr. Melinda Connor 1 February 1, 2009 Prognos Eurocat N/A October 14, 2008 Prognos Eurocat N/A October 14, 2008 Health Canada email N/A November 10, 2008 Prognos Approval from Eurocat N/A October 10, 2008 Prognos Eurocat N/A October 14, 2008 Prognos certificate N/A October 14, 2008 Letter of Support, Dr Melinda Connor 1 February 1, 2009  CERTIFICATION: In respect of clinical trials: 1. The membership of this Research Ethics Board complies with the membership requirements for Research Ethics Boards defined in Division 5 of the Food and Drug Regulations. 2. The Research Ethics Board carries out its functions in a manner consistent with Good Clinical Practices. 3. This Research Ethics Board has reviewed and approved the clinical trial protocol and informed consent form for the trial which is to be conducted by the qualified investigator named above at the specified clinical trial site. This approval and the views of this Research Ethics Board have been documented in writing.  The documentation included for the above-named project has been reviewed by the UBC CREB, and the research study, as presented in the documentation, was found to be acceptable on ethical grounds for research involving human subjects and was approved by the UBC CREB.  Approval of the Clinical Research Ethics Board by :   Dr. Gail Bellward, Chair    12 0 1 2 0  Appendix C - Human Energy Field (Biofield) Measurement The concept of a biofield was first introduced and described as an electromagnetic field by Burr and Northrup (1935).  Burr and Bullock (1941/1942) stated that “steady state differences of electrical potential… have been found in virtually every living , membrane, cell, tissue, and organism which has been explored, although some [electrical potentials] are at the lower limit of the sensitivity of the available instruments” (p.51). Burr proposed the assumption that “every living thing had as one of its characteristics an electrodynamic field. This field was to be thought of as a primary property of protoplasm; just as significant a property as its irritability, its metabolic capacities, and similar attributes. Such an assumption requires experimental validation in the laboratory of the existence of the field in measurable form, of the relationship of this field to the design of the whole organism, and the modification of development through change in the field of the organism and applied external field” (Burr, 1941, p. 354). Burr proposed that these electrodynamic fields were the “fields of life” or “L-fields” and were the organizing matrix of all living organisms.  His methodology of measuring and mapping these fields with standard voltmeters demonstrated that changes in the electrical potential of the L-field preceded changes in the health of the organism. Burr‟s experiments, examining changes in L-fields with various trees at Yale university spanned decades, and demonstrated effects of lunar changes and sunspots on the L-fields (Burr, 1946-1947; Burr, 1944 – 1945; Burr, 1944/1945; Burr, 1941-1942; Burr & Mauro, 1948-1949). Burr‟s technology was extended to cancer populations in two publications (Burr,1941; Burr & Mauro, 1948/1949) Burr  was part of a team from Bellevue and New York University hospitals who measured voltage differences between the tip of the cervix and the ventral abdominal wall in 428 patients with gynecologic cancers and healthy controls. A reversal of these polarities was demonstrated in almost 99% of patients as compared to the controls. This study was replicated in 860 women (Burr, 1946/1947) and the authors suggested that such electromagnetic patterns may allow for atypical cell growth in patients. Later in his life, Burr‟s work was strongly criticized and this line of work does not appear to have been continued.  In the 1960‟s and 70‟s, Leonard Ravitz, Burr‟s student, demonstrated that L-fields are strongly influenced by emotional stimuli, and that the L-field disappears shortly before death (  April 13, 2007).  12 1 1 2 1  Burr contended that the electromagnetic field around the human body could not be explained away on the basis of body chemicals alone. He stated that “ionic mobilities, concentrations, and the like provide important information, but there remains a body of phenomena which they do not explain” (p.359). Rubik in more recent times (2002) describes the biofield as a “complex, extremely weak electromagnetic field of an organism hypothesized to involve electromagnetic bioinformation for regulating homeodynamics of the organism” (p.703). She suggests that the human biologic field is “an organizing field within and emanating from the body which hypothetically regulates the biochemistry and physiology of the body” (Rubik, 2002, p.709). Rein (2004) suggests that the human energy field or biofield permeates the whole organism and organizes individual cellular processes during embryonic morphogenesis. These descriptions are remarkably similar to that proposed and demonstrated by Burr from 1941 to 1949. McReynolds (1985) suggests that the nature of the biofield is electromagnetic in nature and the information contained within this field contains all the information necessary to sustain biological activity. He indicates that: “it is an accepted fact that everything in the universe living and non-living emits radiation” (p.1). The human cell is an electromagnetic resonator capable of emitting and absorbing very high frequency radiations. The radiation or electromagnetic field of a living organism is the outward manifestation of the electrical processes going on the each cell. Romani, Williamson, and Kaufman (1982) suggest that there are “three principle sources of biomagnetic fields: electrical currents associated with the movement of ions; remnant magnetic moments of contaminants; and paramagnetic or diamagnetic constituents of the body when subject to an applied magnetic field” (p. 1816). Ionic fields are detected in heart muscle to produce the magnetocardiogram; in brain tissue to produce the magnetoencephalogram; in skeletal muscle to produce the magnetomyogram and in currents around the eye to produce the magneto-occulogram (Romani, Williamson, and Kaufman, 1982). The typical field strengths are minute compared to ambient magnetic fields and are in the range of 10 -15 Tesla (Romani, Williamson, and Kaufman, 1982).  Ambient magnetic noise in remote areas is a result of the interaction of the ionosphere with the solar wind and is considerably above the strength of many biomagnetic fields of interest (Romani, Williamson, and Kaufman, 1982). Ambient magnetic field strength  12 2 1 2 2  is increased dramatically in civilized areas by ventilation fans, motors, elevators, automobiles and subways (Romani, Williamson, and Kaufman, 1982).  Potential Measures of the Biofield: A literature review was conducted to discover potential methods to measure the human energy field or biofield. Searches were performed using CINAHL, Medline, Pro Quest Dissertation and Theses, Psych Info, Pub Med and Web of Science. A general internet search was conducted and conference proceedings were accessed. Keywords used were Measurement of Biofield, Human Energy Field, and Meridian System. The literature review revealed 153 papers which described multiple modalities to assess the human energy field. A decision was made to exclude papers that merely described the biofield and studies that investigated healers who emitted energy. Methodologies that did not have at least one clinical trial to evaluate the technology were also excluded. Excluded modalities were a Sypris model 4080 Triaxial Extra Low Frequency Magnetic Field Meter  (Connor, 2005, cited in Lin, 2006) used to measure healing energy from healers and an electromyography unit described in a case study to measure acupuncture pointss (Forbes, Rust and Becker, 2004). A total of 56 papers were reviewed to produce the literature review relating to measurement of the biofield. The section that follows will discuss the reliability and validity of each instrument with respect to the measurement of the biofield. Guyatt, Walter and Norman (1987) suggests that Whether the test consistently yields more or less the same results when administered on several occasions to stable subjects and whether the test actually is measuring what it is supposed to measure… is referred to as reliability and validity, respectively; when referring to physiological measurements the terms precision and accuracy are usually used (p.171). Guyatt, Walter and Norman (1987) recommend that another measure of instrument usefulness is sensitivity. This is the likelihood that the instrument can detect a clinically important treatment effect. The following modalities were reviewed from the available literature.     12 3 1 2 3  Measures of the Biofield 1. Electrophysiological Measures Devices to measure the electromagnetic field around the human body are in common use in medical practice including the electrocardiogram (ECG) and the electroencephalogram (EEG). Electrodes are placed on the skin where a sensitive galvanometer collects electrical signals which are then amplified and recorded on a graph (Dr. Melinda Connor, personal communication, April 13, 2007).  If there is a problem in the functioning of the heart or brain, the recorded waves will be distorted in a characteristic manner which can be used for diagnostic purposes (Oschman, 2000). The cost of an electroencephalogram is approximately 500 dollars and the cost of an electrocardiogram is approximately 100 dollars.  Reliability All of these diagnostic modalities have established reliability for changes related to heart and brain function in the human body. The available literature does not support the use of these modalities to detect healing energy or the transmission of intuition.  Validity The literature reviewed does not support the validity of these methods for recording the transmission of energy or intuition. The studies reviewed are described below.  Standish, Kozak, Johnson and Richards (2004) recorded electroencephalograms from the occipital area of pairs of subjects separated by at least 10 meters. The pairs were randomly designated as sender or receiver of distant intentionality such as an image or a thought. Thirty pairs of subjects who knew each other well and claimed to have a connection with their partner participated in this study and subjects alternated sending a distant intention and receiving a distant intention. Results demonstrated correlated electroencephalogram activity with a p value < 0.01 for 5 subjects. The researchers then asked subjects who had at least one significant result to duplicate the study.  Radin (2004) also tested 13 pairs of subjects who were unrelated in any way. Subjects were isolated from each other behind an electromagnetic shield and subjects were randomly divided into sender and receiver. The sender was asked to maintain a sense of connection with the receiver. Periodically the  12 4 1 2 4  sender was shown a video of the receiver. Three of the 13 pairs of subjects showed significant correlations with each other during the times that the sender was sending a distant intention to the receiver (Radin, 2004). McCraty, Atkinson and Bradley (2004) suggest that the process of receiving information about distant events involves the “body‟s connection to a field of information beyond normal conscious awareness” (Bohm, 1980). McCraty, Atkinson and Bradley (2004) investigated 26 participants using a counterbalanced crossover design under the experimental conditions of normal psycho physiologic functioning and physiological coherence. Primary outcome measures included skin conductance, electroencephalogram from which cortical event-related potentials and heartbeat evoked potentials were calculated, and electrocardiograms from which cardiac accelerations and decelerations were derived (McCraty, Atkinson, & Bradley, 2004a; McCraty, Atkinson, & Bradley, 2004b). Each participant viewed 45 pictures in each experimental session where 30 pictures were calm and 15 were of an emotional nature. Data from a total of 2340 trials were collected across two sessions for all participants. Their data suggested that the future emotional stimulus was received by the heart about 4.75 seconds before the stimulus was presented (McCraty, Atkinson & Bradley, 2004 a & b).  2. Functional Magnetic Resonance Imaging  Functional Magnetic Resonance Imaging (fMRI) has developed over the past 15 years to become a method for localizing brain function in individual patients (Hart, Rao & Nuwer, 2007). The fMRI is based on blood-oxygenation level-dependent (BOLD) contrast which reflects regional changes in blood flow and oxygenation levels in response to cognitive, sensory, and motor activation procedures (Hart, Rao & Nuwer, 2007; Peyron, Laurent and Garcia-Larrea, 2000)  Reliability  Reliability of fMRI as a measure of changes in the brain oxygenation has been established in research related to activation of the brain by cognitive, sensory, and motor activation (Hart, Rao & Nuwer, 2007; Peyron, Laurent & Garcia-Larrea, 2000).  The use of fMRI is used in activation studies and identifies regions involved in performing the task, but does not differentiate between those regions that are essential  12 5 1 2 5  to the task and those that are not (Hart, Rao & Nuwer, 2007). Hart, Rao & Nuwer (2007) suggest that fMRI measures only relative changes in magnetic resonance signal intensity which is not a measure of quantitative measures of blood flow or oxygenation.  Validity Achterberg, Cooke, Richards, Standish Kozak and Lake (2005) explored fMRI results in recipients of distant intentionality. Distant intentionality was used as a phrase that included “prayer, energy healing, healing at a distance, spiritual healing, Therapeutic or Healing Touch, transpersonal imagery, remote mental healing and other practices based on putative connection in the absence of mechanisms of sensory contact” (p.965). The authors studied 22 participants with 11 pairs of healer and recipients of distant intentionality. Healers, practitioners of Healing Touch, Hawaiian Pale, Peruvian Shamanic Healing, Reiki and other forms of distant intentionality were asked to name a person with whom they had a close bond with. These individuals became the recipients of distant intentionality and underwent a fMRI scan for 34 minutes while the healers randomly sent distant intentionality to the recipients during “on – off” periods. Healers described what was sent as “sending energy, prayer, or good intentions, or as thinking of the individual in the scanner and wishing them the highest good” (Achterberg, Cooke, Richards, Standish Kozak and Lake, 2005, p. 967).  Recipients were blind to the order of healers sending distant intentionality. The fMRI results of the recipients were analyzed and indicated statistically significant differences between “on – off” periods of healers transmitting distant intentionality at the p = 0.000127 level.  Recipient analysis revealed significant activation in the anterior cingulate cortex, frontal superior areas and the precuneus. The authors suggest that the rostral anterior cingulate cortex has been shown to be activated during the height of opioid and placebo analgesia response (Petrovic, Kalso, Petersson, 2002).  The precuneus and the anterior cingulate gyrus may be part of a neural network involved in resting consciousness and self-reflection (Achterberg, Cooke, Richards, Standish Kozak and Lake, 2005).  Li et al (2006) used an fMRI to evaluate the effects of manual acupuncture lasting 30 seconds, 60 seconds and 180 seconds respectively. Eighteen healthy volunteers were randomly divided into three groups and received manual acupuncture at the Hegu L14 point which is between the thumb and the  12 6 1 2 6  forefinger. The results demonstrated differences in the three periods of time. The common areas of activation were bilateral temporal gyri, left secondary somatorsensory cortex, right inferior parietal lobe (Li et al, 2006). Deactivation was noted in bilateral orbital gyri, anterior of inferior gyri and bilateral occipital lobes. The results suggest that the central nervous system is modulated by the acupuncture stimuli (Li et al, 2006).  Hui et al (2004) conducted whole brain fMRI in 24 acupuncture naïve healthy adult volunteers. They found that the cerebellar regions involved in cognition, affect, nociception, and autonomic control responded to acupuncture stimuli (Hui et al, 2004). Similar results were also found by Napadow et al (2004) using electroacupuncture. These studies on acupuncture demonstrate some validity for the use of fMRI to detect changes related to acupuncture stimulation.  3. Superconducting Quantum Interference Device (SQUID) A SQUID magnetometer consist of a thin insulating barrier placed between two superconductors such as two metals cooled in liquid helium. A SQUID contains one or more Josephson junctions which allow a super current consisting of pairs of electrons to flow across the gap junctions (Oschman, 2000). The device was developed by Zimmerman and his colleagues and is used to measure extremely weak signals such as changes in the human body‟s electromagnetic field (Zimmerman et al, 1970; Zimmerman, 1972). This device can detect a change in energy which is 100 times weaker than the electromagnetic energy that moves a compass needle (Oschman, 2000). Essentially human tissues are completely permeable to magnetic fields and therefore biomagnetic measurements are much more informative than bioelectric measurements. The SQUID as an extremely sensitive magnetometer is used to map the biomagnetic fields in the space around the body and is preferred whenever extreme precision is needed (Oschman, 2000).  The instrument has demonstrated reliability, validity and sensitivity through common use in medicine, geology and engineering (Oschman, 2000).  Sensitivity The first biological application of a SQUID was to measure the heart‟s magnetic field (Oschman, 2000; Romani, Williamson, Kaufman, 1982).  The magnetocardiogram measures the z component of local  12 7 1 2 7  magnetic fields at 36 positions in a plane. The reported sensitivity of the system is 20 fTesla/Hertz .05  in the frequency range of clinical interest of 1-100 Hertz (Fenici, Brisinda, Nenonen& Fenici, 2003). The principal challenge to SQUID measurement has not been the sensitivity of the instrument but the discrimination against the high level of ambient noise (Romani, Williamson, Kaufman, 1982).  Reliability  The SQUID reliably measures low level electromagnetic fields in medicine and geology (Romani, Williamson, Kaufman, 1982).  Validity Zimmerman (1999) demonstrated significant evidence of shifts in the energy emission by therapeutic touch practitioners using a SQUID device. A practitioner of therapeutic touch and his patient were placed in a SQUID detector. A baseline recording was made prior to the beginning the therapeutic touch session. The therapeutic touch practitioner entered into a meditative healing state and a measurement was again made around the hands of the practitioner. The measurement was so large that the SQUID detector had to be adjusted. The therapeutic touch signal pulsed at variable frequency from 0.3 – 30 Hertz with most activity between 7-8 Hertz. The same measurement technique was repeated 8 times with practitioners of therapeutic touch and with a control group of individuals with no healing experience. No change from baseline was detected in the control group. Seto et al (1992) used a simple magnetomer consisting of two 80,000 turn coils and a sensitive amplifier to measure an extraordinarily large biomagnetic field from the hands of practitioner of a variety of healing and martial arts traditions. The measured field had a strength of 10-3 gauss which is 1000 times stronger that the field measured from the heart at 10-6  gauss.  The measured field pulsed at a variable frequency centered around 8-10 Hertz.  The cost of a SQUID is approximately 4.5 million US dollars and the device must be used in a lead shielded room to block out the earth‟s magnetic fields. Though the accuracy of a SQUID is unquestionable, the cost of using this equipment is prohibitive.   12 8 1 2 8  4. Kirlian photography: Electophotography was used to describe the images produced by Kirlian photography named after Kirlian and Kirlian, a Russian electrician and his wife who began investigating its possible significance in the early 1900‟s (Korotkov, 2004). Kirlian photography is described as “a method for the conversion of non-electrical properties of an object into electrical properties which are then captured on film” (Rubin & Kripner, 1973, pxxi). There is a direct transfer of charge from the object to the photographic plate (Moss & Johnson, 1972). The potential of the electric field used to create a Kirlian image is approximately between 10 kilovolts and 30 kilovolts. This type of an electric field causes negatively charged free electrons to be ejected from the person and accelerate towards the positively charged discharge plate of an electro photographic device. The greater the difference between the discharge plate and the person, the faster the electrons are accelerated. As the electrons are accelerated towards the discharge plate they collide with the nitrogen molecules in the air. Valence electrons of the nitrogen molecule are excited to a higher valence due to the collision and when they return to their ground state, nitrogen emits a photon with a specific quantum of energy. Each quanta of energy is specific to a frequency of light as described by Planck‟s constant which is E=hv where E is energy, h is Planck‟s constant and v is the resulting light emitted. If a film is placed between the discharge plate and the person, the light from the discharge will create an image known as Kirlian photography (Russo et al, 2001).  Reliability Moss and Johnson (1973) from the University of California investigated Kirlian photography extensively with mineral, plant and human subjects. They were concerned that most of the original research was conducted in Russia by the inventor of the technique. Moss and Johnson (1973) carefully standardized their equipment for voltage, frequency, pulse, and wave form and exposure time. Each time they photographed an object a corona appeared around the object even though their equipment was slightly different from that used by Kirlian and Kirlian. In carefully controlled laboratory conditions, Moss and Johnson (1973) discovered that non-organic materials maintained a consistent corona whereas photographs of organic subjects exhibited a constantly changing corona. They undertook a series of experiments to  12 9 1 2 9  discern the nature of the corona around organic subjects. Thought they could only hypothesize what the corona was due to their research determined that the corona around human subjects was not due to galvanic skin response, skin temperature, and peripheral vascular changes or sweat (Moss & Johnson, 1973).  Validity Moss and Johnson (1973) undertook a series of experiments with human subjects. They randomly selected subjects and found that their apparatus could detect the difference between control subjects and subjects in states of meditation, hypnosis, alcohol intoxication, drug intoxication and strong emotional states such as anger. Moss & Johnson (1972) also indicated that they believed they found some indication of differences in the corona as a result of different interactions between people. Moss and Johnson (1972) conducted research which demonstrated a difference before and after an acupuncture treatment in multiple subjects.  Their investigations included several hundred subjects in carefully controlled laboratory situations (Moss & Johnson, 1972). The available research provides some validity for the use of Kirlian photography to detect some changes in the human organism.  5. Gas Discharge Visualization The GDV is thought to work by interacting with the electromagnetic field that surrounds the body and captures an aspect of it on video for diagnostic evaluation. The light from electrical coronal discharge patterns are measured at each of the 10 fingers which act as electrical termination points for each of the 12 main meridians of the body. The GDV technique is thought to measure the electrical conductance along the main meridians of the body. Acupuncture points, points used in acupuncture are located along the meridians of the body.   Reliability of Gas Discharge Visualization Reliability of gas discharge visualization has not been established in the available literature. Bascom, Buyantseva, Qian, Dolina and Korotkov (2002) attempted to address reliability and described sources of variation in GDV images in a convenience sample of clinicians and scientists. Forty two pairs of  13 0 1 3 0  GDV images were taken from 14 participants at a computer workshop. Workshop conditions were chosen to maximize the sources of variability in the measurements. Their findings indicated that proper calibration of the GDV machine is imperative for measurement to be accurate. As well, they recommend that the same GDV machine be used to measure subjects over time.  Sensitivity of the Gas Discharge Visualization Technique: Roberts, Shealy & Tiller (2004) suggested if energy is added or redistributed in the body via true acupuncture needing vs. sham needling, a worthy instrument should be able to discriminate this energy change. They investigated 33 randomly chosen, clinically health subjects who were utilized in a fashion such as to act as their own control. Subjects experienced real and sham acupuncture 3 days apart in random order. Needling was conducted at the acupuncture points of L1-4 Right and Left Large Intestine, Right and Left Liver and GV-20 The Governor Vessel. The needles were left in place for 15 minutes. Subjects had a GDV measurement pre-acupuncture and again at 5 minutes and 30 minutes post needle removal. Each subject had 100 measurements using GDV. The GDV results were statistically significantly different for real vs. sham acupuncture of the right side of the body only. P-values were 0.0032 at 5 minutes and 0.0078 at 30 minutes post needling for real acupuncture.  Criterion Validity with Gas Chromatography Korotkov et al (2004) used GDV parameters to differentiate drops of strong electrolyte and nonconductive liquids. The investigated substance was a liquid drop of volume 4x10-3 ml placed on a glass plate. Temperature and relative humidity were kept constant. The GDV technology was applied to the drop and the measurement was repeated 30 times for each drop. The measurements made provided statistical reliability at the confidence level of 0.95 with an experimental sensitivity of 95%. Fourteen substances were measured. The finding suggest that both conductive and weakly conductive liquids demonstrated that dynamic GDV technique does reveal small differences between chemically close liquids. This is so even when the traditional Gas Chromatography does not differentiate the liquids. Korotkov et al (2004) discovered that the GDV was effective in identifying differences between strong electrolytes up the  13 1 1 3 1  concentration of 2x10-16 Normal. After this level of dilution the difference between the substance and distilled water disappeared. The GDV was able to differentiate between drops of chemically similar substances derived from natural and synthetic sources. This was true even thought the Gas Chromatography which is the gold standard of measurement cannot make this differentiation. Bell, Lewis, Brooks, Lewis and Schwartz (2003) utilized GDV techniques to differentiate homeopathic medicines under blinded, controlled conditions. They compared 5 different homeopathic solutions and found that GDV may allow differentiation of ultra low molecular doses of homeopathic remedies from solvent control and from each other at specific voltage amplitudes.  Criterion Validity with Physiological Diagnostic Criteria: Gagua et al (2004) explored the potential of GDV in monitoring patient state during complex cancer treatment. All subjects were diagnosed with cancer by conventional means including biopsy. All subjects had GDV measures taken at 10 fingers of both hands before any oncology treatment and 2 and 6 weeks after complex treatment including surgery, chemotherapy and radiation. All subjects had Stage III cancer and included 109 subjects of both genders with lung cancer, 140 women with breast cancer and a control group including 44 healthy individuals and 54 people with non-oncological health conditions. The GDV parameters were able to statistically significantly differentiate healthy controls from patients with cancer. The GDV grams demonstrated a shift towards “healthy” after treatment regardless of the type of treatment. Abnormalities in the GDV images occurred in the lower portion of the little finger with lung and breast cancer. This area is consistent with the theories put forth by Traditional Chinese Medicine where the lung and breast are reflected by the little finger. Polushin, Strukov, Levshankov, Shirkov, and Korotkov (2004) investigated the functional status of patients in the post-operative period. Ninety-six patients with chronic surgical pathology of the abdominal organs were divided into 3 groups according to the degree of severity of their pathology. Criteria accepted by military – medical institutions of the armed forces of the Russian military were used. These patients were compared to 35 healthy individuals. Measures of GDV were taken the day before the surgical  13 2 1 3 2  intervention, in the first post-operative hour, in the early post-operative period and on the 5th post-operative day. Subjects and controls were age matched. The GDV gram parameters showed reliable differences depending on the degree of the severity of the somatic state. Patients who were diagnosed with an “unfavorable prognosis” based on laboratory data, clinical picture and electrocardiogram demonstrated differences in GDV parameters from the rest of the group. These changes were present in the GDV in the pre-operative period suggesting the GDV may provide predictions about surgical outcome. Cioca & Giacomoni (2004) explored the GDV as a measure of sympathetic nervous system activity. Heart rate variability and GDV measures were taken from 24 healthy volunteers and 43 athletes in three different physiological conditions including deep breathing followed by rapid standing, ten minutes of strenuous exercise and consumption of chocolate. In all three situations, the sympathetic component of heart rate variability was statistically significantly correlated with the GDV. Gimbut (2004) investigated GDV parameters in 226 pregnant women. The women were divided into 3 groups by diagnostic ultrasound which included 58 patients with normal pregnancy, 79 patients with deviations of utero-placental blood flow from normal and 82 women with a reliably diagnosed danger of miscarriage. The parameters of GDV correlated with the diagnostic ultrasound parameters. Alexandrova, Fedoseev, Kortokov, Philoppova Zayzev, Magidov, & Petrovsky (2004) investigated bronchial asthma in 247 patients compared to 56 healthy individuals using GDV. GDV parameters of patients with bronchial asthma demonstrated a consistent difference from normal healthy control subjects. Subjects with an acute bronchial asthma attack demonstrated a consistent GDV pattern.  Bundzen & Korotkov (2004) investigated GDVs in a group of 150 members of the Russian Olympics team. Seventy-nine students specializing in track and field were used as average performance level controls. Participants were evaluated using the profile of moods states (POMS), functional state with maximum oxygen consumption test, physical endurance tests and heart rate variability. Genotype related to angiotensin converting enzyme which is shown to be correlated with elite athletes was also measured. Athletes were divided into elite and average athletes based upon their performance results from 1998 to 2002. The GDV measures correlated with all other measures and were effective in differentiating elite from average athletes. Correlations were revealed between psychological state of the person measured by the POMS, the GDV parameters and the heart rate variability.  13 3 1 3 3   Buyantseva, Korotkov, Qian, Bascom and Ponomarenko (2002) compared GDV images and heart rate variability in 24 healthy young adults compared to 26 patients hospitalized for hypertension. Six GDV indices were statistically significantly different between the control and diseased group at baseline. The GDV measures correlated with the differences seen in heart rate variability.  Rizzo-Roberts (2002) compared the GDV with other FDA approved equipment for measuring the electromagnetic field around the human body. First was the Meridian Stress Assessment (MSA-21) which is a highly advanced galvanic skin response testing device used for meridian stress assessment.  She indicated that the GDV measures the same response in a slightly different way. The MSA-21 records a time varying resistance as a result of applied voltage whereas the GDV records ionization as a digital image resulting from the current through the meridian.  The GDV was also compared to the Liss stimulator and Transcutaneous Electrical Nerve Stimulator (TENS) which produces a low dosage external current that combines with the body‟s bulk capacitance properties to generate internal biocurrents that in turn modulate the level of neurotransmitters.  Rizzo-Roberts (2002) indicates that the GDV is similar in that they apply and elicit a small current to and from the body.  She also compared the GDV to the Magnetoencepalogram that is capable of recording minute alterations in the body‟s electromagnetic field. Rizzo-Roberts (2002) suggests that the GDV is similar to the MEG in that it measures a change in the body‟s electromagnetic field. The currents used to elicit the responses are very small as are the recorded output currents. Rizzo- Roberts (2002) indicates that the GDV “is able to reliably and safely measure the changes in the electromagnetic field of the body” (p.30)  Relation with psychological measures  Shealy, Gibson, Rizzo-Roberts and Dunlop (2002) explored the effects of music and focused meditation as measured by the GDV and the Profile of Mood States (POMS). Forty-five participants had GDV measurements and POMS testing done before and after different experimental conditions including music, music with focused meditation, combined with viewing the participants own energy field, and no music and no focused meditation. There was significant improvement indicated by the POMS total score and the GDV in conditions of music and music with focused meditation. The GDV anxiety measures decreased significantly with music and focused meditation but this effect did not occur when subjects  13 4 1 3 4  viewed an image of their own GDV scores. The available literature provides some support for the validity of the GDV to detect some conditions in the human organism.  6. Biophoton Emission Biophotonics is the study of the photon output produced by the metabolism in a living system. They are found in all living cells; plant, animal and human but they are unseen by the naked eye and require sensitive detectors such as a Biophoton imaging system with low noise, high gain and cooled to - 100 degrees C.  Images are captured on a computer (Connor, personal communication, April 13, 2007). “Biophoton emission (BPE) is a quantum event characterized by a relatively stable but ultra low rate of emission of visible photons from living organisms” (Hossu and Rupert, 2006, p.119). Photon emission is usually associated with high energy processes such as cell metabolism, cell growth, stress and nervous system activity. Photon emission is decreased when the cell or human is healthy. A darkened room is required to detect BPE because there is a low rate of emission.  Reliability Choi et al (2002) presented data on biophoton emission (BPE) from the palms and dorsal surface of 20 healthy volunteers. They measured the palms and dorsal surfaces of the hand and compared the emission rates for subjects ranging in age from teens to middle age. They also compared male and female BPE. Each measurement was taken 4 times. Their findings suggest that the average biophoton count per second ranges from 30.8   1.36 to 31.2  1.61. Their research suggests that biophoton count is not age or gender sensitive.  Validity Hossu and Rupert (2006) describe a change in biophoton emission related to three chiropractic interventions. They measured biophoton emission at the neck and or lower back of three asymptomatic male volunteers. Their results indicated a statistically significant reduction in biophoton emission post chiropractic intervention as measured by a photomultiplier and counting unit connected to a personal computer.  13 5 1 3 5    Criterion Validity with Physiological Measures Van Wijk, Koch, Bosman, and Van Wijk (2006) measured photon emission at 12 sites in 20 healthy non smokers and 20 subjects who had practiced transcendental meditation for at least 10 years. Other research suggests that meditation practitioners demonstrate significant changes in physiological measures including electroencephalographic activity, blood pressure, pulse and measures of immune system function (Davidson et al, 2003). Van Wijk, Koch, Bosman and Van Wijk (2006) found significant differences in biophoton emission in the right palm (p=.003), left palm (p=.05) and at the throat (p=.02) between meditators and healthy controls. Cohen, Popp and Yan (2003) measured biophoton emission from the arm of a person suffering from psoriasis. They indicated a difference between the healthy areas of the arm vs. the area with psoriasis. Kim et al (2005) measured biophoton emission from 20 samples of previously frozen samples of human cancerous tissue. They indicated that they could differentiate between normal healthy tissue and cancerous tissue by biophoton emission. Kim et al (2005) did not provide any statistical data relating to the differences they found and the tissue used came from a broad range of types of cancer diagnoses. Creath and Schwartz (2005) investigated biophoton emission around the leaves of plants recorded on a white background. Thousands of leaves were examined for this research. They used a special camera cooled to -100 degrees C mounted upon a light tight chamber. Each image required 2 hours exposure in total darkness in a light tight container. Their findings suggest that when the plant is placed in darkness, the chlorophyll fluoresces for a few moments but the biophoton emission persists as a by-product of metabolic function of the plant. The available literature provides some support for the use of biophoton imaging to measure the field around an organism.   7. Gamma Radiation  Gamma radiation detectors can be used to monitor changes that take place in the biofield during a healing treatment (Connor, personal communication, April 13, 2007).  13 6 1 3 6  Researchers hypothesize that energy based therapy may promote absorption of gamma radiation into the body through unblocking energy channels (Benford, Talnagi, Doss, Boosey, & Arnold, 1999).  Reliability No data was found to establish reliability.  Validity One study was found that used gamma radiation as a measure of biofield change. Polarity therapy, a type of energy based healing, resulted in marked decreases of gamma radiation counts from the crown, heart, abdomen and pelvis of subjects in a study conducted by Benford, Talnagi, Doss, Boosey, & Arnold (1999).  Researchers used a gamma radiation detector to take measurements before and after a polarity therapy treatment in 10 subjects. The results were compared to 10 subjects in the control group and 10 subjects who participated in a sham treatment. Measurements were taken three times in 100 second time periods and background gamma radiation was monitored at the experimental site. The results indicated statistically significant (no p value reported) reduction in gamma radiation measured at the abdomen and pelvis (Benford, Talnagi, Doss, Boosey, & Arnold, 1999).  There is insufficient evidence to support the validity of gamma radiation detection to measure changes in the human energy field.  8. Intention Imprinted Device:  Tiller (2004), Tiller Dibble, Shealy and Nunsley (2004), Tiller (2006; 2006) and Tiller and Dibble (2007) describe experiments over the past 15 years that test the power of intention. Tiller et al (2004, 2006, 2006, and 2007) used intention to imprint an electronic device so that it would measure the concentration of hydrogen ions (pH) of neutral water as 1 pH unit higher and then 1 pH unit lower. The intention was provided by a highly skilled meditator from a deep meditative state. All other variables were controlled during the experiments which were repeated in several different laboratories across the US and Europe. In each experiment intention imprinted electronic devices produced highly statistically significant results. The pH meter measured the requested 1 pH unit higher or 1 pH unit lower consistently.  13 7 1 3 7  Tiller (2006) describes how the intention imprinted device “conditions” the experimental space that it occupies so that the  “conditioned” space, modulated by human intention becomes a sensitive instrument for registering human biofield effects (Tiller & Dibble, 2007). Tiller and Dibble (2007) indicate that the conditioned space demonstrates an elevation of thermodynamic free energy in relation to the biofield healing that is occurring in the room. In thermodynamics, one of the most important quantities is the Gibbs free energy per unit volume of a material. Primary variables are pressure, temperature, and chemical composition and secondary variables are electric, magnetic, and gravitational fields. An important derivative quality is the chemical potential or electrochemical potential for electrically charged species. The electrochemical potential is the chemical potential plus an electrical energy term (Tiller and Dibble, 2007). Deviations in the measurement of pH of neutral water by a commercial pH meter reflect an increase in free thermodynamic energy which in turn reflects a change in the thermodynamic energy of the conditioned space. This they suggest is a result of healing taking place in an energy healing clinic.  Reliabilty They indicate that the work has been repeated in 7 sites in the US and Europe (Tiller, 2004, Tiller Dibble, Shealy and Nunsley, 2004), Tiller, 2006; 2006 and Tiller and Dibble, 2007). Their work has been replicated by two laboratories in England and in Italy. The studies conducted however were not independent of the original laboratory which provided the intention imprinted device.  Validity No data to support validity was reported in any of these studies.  9. Electrodermal Screening Devices a) Prognos  The Prognos Meridian Diagnostic System provides electro dermal screening of acupuncture points in the human body. Electrodermal testing of acupuncture points is based on the underlying assumption that electrical resistance and or conductivity at acupuncture points exist although it is much smaller than that detected by an electroencephalogram or electrocardiogram (Colbert, Hammerschlag, Aickin & McNames,  13 8 1 3 8  2004). Past research has demonstrated that skin surface sites corresponding to acupuncture points demonstrate lower electrical resistance or impedance and consequently higher conductance than surrounding sites (Colbert, Hammerschlag, Aickin & McNames, 2004). A range of clinical trials in animals and humans has demonstrated that changes in the electrical resistance are reflective of various disease states (Colbert, Hammerschlag, Aickin & McNames, 2004). The prognos is an ohmmeter (MedPrevent, Waldershof, Germany) consisting of a power source connected by a cable to the measuring probe and a reference electrode (6 x 3.5 cm) that is attached with a Velcro strap to the volar surface of the forearm. Impedance measurements recorded as direct current analogue values are taken while holding the probe at a 90 degree angle to the acupuncture points (p. 611).  Reliability The Prognos was tested in 31 healthy participants, 17 females and 14 males, age range 24 to 63 years, in whom electrical resistance was measured at 24 acupuncture points. Two hundred and eighty eight measurements were subjected to statistical analysis. All subjects completed three trials. The mean reliability for trial one was 0.758 with a range of 0.538 to 0.882 (Colbert, Hammerschlag, Aickin & McNames, 2004). When the acupuncture points was marked with nontoxic washable ink and remeasured, the mean reliability of a single measurement increased to 0.850 (range 0.690 to 0.963). The highest mean reliability of 0.959 (range 0.891 to 0.987) was made in trial 3 when four measurements were made in rapid succession (Colbert, Hammerschlag, Aickin & McNames, 2004). The authors report that higher reliability correlated with lower mean electrical skin resistance. They also suggest that the reliability of measures made for acupuncture points on the right side of the body (considered yin or female in Chinese medicine) were less reliable than measurements on the left side of the body (considered yang or male in Chinese medicine) (Colbert, Hammerschlag, Aickin & McNames, 2004).  Validity  Research from Germany was reviewed by Dr. W. Linden and suggested some validity for the use of the Prognos Ohmmeter.   13 9 1 3 9  b) Ryodoraku The Ryodoraku (Neurometer Model D-410) is from the Ryodoraku Research Institute in Tokyo, Japan. The instrument provides a digital readout of electrical conductivity and consists of two electrodes; one is held in the hand of the subject and the other is applied to a suitable acupuncture points (Sancier, 2003).  Reliability No data to support reliability could be found.  Validity No data to support validity could be found  Only one study was found which used the Ryodoraku to measure relative electrical conductivity for 29 subjects participating in a 2-day qigong workshop. Measurements were taken along 24 energy points that lay along the 12 principal meridians based on traditional Chinese medical theory. Subjects served as their own controls and the results focused on measured changes in individuals and in the group. The 2-day qigong workshop resulted in two statistically significant differences which indicated improved energy balance in all participants (Sancier, 2003). Subjects were self-selected and engaged in ongoing study with the qigong master (Sancier, 2003).  c) Electro interstitial Scanner  The electro interstitial scanner is used to apply a small electric current to the body via one or more surface electrodes. The resultant current passing through the body is detected at other surface electrodes placed elsewhere on the body. A drop in voltage occurs as the current encounters impedance or resistance in the bloodstream, the intracellular space, the lymphatic system, the interstitial space and the organs. The drop in voltage is thought to provide information about the physical and chemical properties of the body (Electro Interstitial Scanner Technical File, 2007). The device produces graph readout of the electrical impedance found which is called an Electrosomatogram.  14 0 1 4 0   All of the available research for this device has been conducted in Russia and France. The studies are reported in the Electro Interstitial Scanner Technical File (2007) (  Reliability: A study conducted in the Department of Functional Medicine at the S.P. Botkin Hospital in Russia was carried out from November, 2003 to September, 2004. Twenty groups of patients with a range of 25 to 54 patients in each group were investigated and an electrosomatogram developed for each of the illness categories. The specificity of the electrosomatogram in detecting various illnesses at a confidence interval of 95% illnesses is reported as follows: Diabetes – 98%, Viral Hepatitis – 96%, Hypertension – 95%, Myocardial Infarction – 93%, Chronic Bronchitis and Asthma – 84%, Cerebral Circulation – 83%, Circulation – 83%, Colitis – 81%, Arrhythmia – 81%, Depression – 76%, Gastritis – 76%, Duodenal Ulcer – 76%, Hypothyroid – 72%, Angina – 71%, Diabetes II -70%, Pancreatitis – 70%, Hepatitis – 70%, COPD – 57% and Cancer – 30%. The authors suggest that the electrosomatogram can be retained as a marker for all but COPD and Cancer (Electro Interstitial Scanner Technical File (2007) (  Validity No data are presented on validity of the measurements obtained from the Electro Interstitial Scanner.  d) Biofield Breast Exam:  The Biofield Breast Examination (BBE) or Biofield test is a diagnostic system that consists of 7 sensors for each breast, one for each axilla, one reference for each palm and an electromagnetically shielded cable and a device platform (Fukuda et al, 1996). Each of the 16 sensors is sampled 150 times over the course of one minute (Fukuda et al, 1996).   Fukuda et al (1996) conducted a study related to the efficacy of the biofield breast examination. Fukuda et al (1996) indicate that recent clinical trials related to breast tissue suggests that the measurement of breast epithelial potentials using an array of signal-specific skin surface sensors may be a useful  14 1 1 4 1  adjunctive modality for breast cancer diagnosis” (p. 1092). Epithelial cell membranes are electrically polarized and undergo depolarization when the cell is stimulated to proliferate and it is found that breast cancer produces a greater electro potential differential than benign and normal tissue (Fukuda et al, 1996). The available evidence suggests that cancer develops within a dysregulated proliferation of cells the field of which extends beyond the tumor itself to the surface of the skin (Faupel et al, 1997).  Reliability Fukuda et al (1997) indicated that clinical trials conducted in the United States and Europe indicated that breast cancer produced significantly greater electro potential differentials than benign and normal tissue. The biofield breast exam can be represented by the receiver operating characteristic curve. The area under the curve is 0.783 which represents a significant increase in diagnostic performance over chance (p ≤ 0.01) (Fukuda et al, 1997)  Sensitivity A total of 101 patients with a palpable breast lesion were tested prior to histological examination. The overall sensitivity was 90% where 44 of 49 malignancies were correctly identified and the specificity was 60% (Fukuda et al, 1996). This clinical trial was replicated in a multisite clinical trial in five European countries. Six hundred and sixty one patients were evaluated with the biofield test and histopathology test using a prospective design under double blind conditions. The pathology review was also blinded. The results indicated 90% sensitivity and 50% specificity (Faupel et al, 1997). The authors indicate that a multisite trial is underway in the United States to evaluate this instrument.  Criterion Validity with Physiological Diagnostic Criteria: A report by Ng, Ng, Sim and Acharya (2006) undertook a numeric modeling of the biopotential field for detection of breast cancer. They found that significant changes in the potential distribution were recorded in normal and malignant regions of breast tissue (Ng, Ng, Sim & Acharya, 2006). They also found that the biofield test could differentiate the size of the malignant tumor and that the reduction in surface potential follows a fourth order polynomial equation (Ng, Ng, Sim & Acharya, 2006).  14 2 1 4 2  Appendix D – Publication - Applied Psychophysiology and Biofeedback  14 3 1 4 3    144  145   146  147 


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