neck pain is a major public health problem , in terms of both personal health and overall well - being as well as indirect expense . for instance , the total cost of neck pain in the netherlands in 1996 was estimated to be about 1% of the total health care expenditure or 0.1% of the dutch gross domestic product . acupuncture , a physical intervention that involves placement of small needles in the skin at different acupoints , has been practiced for thousands of years and is commonly used for many types of chronic pain . the literature supports that acupuncture relieves pain by regulating the autonomic nervous system , activating the release of beta - endorphins , regulating the central nervous system , and producing local effects on the peripheral nervous system . electroacupuncture has been used as an adjunctive pain management in acupuncture for decades , and may be applied invasively or noninvasively . traditionally , the modality of choice for electroacupuncture has been alternating current ( ac ) . however , there are two known types of electrical currents , ac and direct current ( dc ) . dc is unidirectional and is applied microamp or millionth of amp ( 106 amperes ) range and is called microcurrent . ac moves back and forth and is applied in the milliamperage range ( 103 amperes ) , and is usually called transcutaneous electrical nerve stimulation or electroacupuncture . it is theorized that ac and dc electrocurrents have different modulating affects on the autonomic nervous system and the bodies healing processes . dc microcurrent therapies involve applying weak dcs ( 80  a to < 1  ma ) , and are now being increasingly recognized as an adjunct for pain relief and autonomic nervous system regulation . there is no consensus in the literature identifying the best practice measures for application of dc microcurrent to acupuncture points for chronic neck pain patients . although sufficient evidence supports the application of ac electroacupuncture and acupuncture needles for neck pain , there is no standardized acupuncture protocol  and limited repetitive evidence in the literature to support the use of dc electrotherapies for the treatment of neck pain . the purpose of this pilot study was to ascertain the impact of dc microcurrent point stimulation ( mps ) on the neck pain levels of a cohort of patients immediately postapplication and 48  h later after a single mps application . this study entailed the use of mps in 34 patients ( 24 female , 10 male ; mean age 46 years , sd 9.76 ) with chronic nonspecific neck pain averaging 7.33 years ( mean 7.33 years , sd 11.62 ) , presenting to us for therapy of their neck problem . inclusion criteria were simple : patients who were currently suffering from chronic neck pain for greater than 3 months , with a recorded > 4 visual analog scale ( vas ) pain scale score . the diagnoses of pain , location , severity , sex , previous interventions , or surgeries were not considered exclusion criteria . patient pain scores were recorded pretreatment and twice post - treatment : immediately after application and again 48  h later . patients , who consented to be part of the study , were enrolled from a group of professional therapists attending educational seminars run by one of us ( k.a . ) . they were asked to report pain levels before and after and 48  h after a single mps application . there were no controls in this study , as this was a cohort analysis , with the subjects acting as their own controls relating to prepain and postpain assessments . mps was applied to standard protocol using dolphin neurostim ( acumed medical ltd , ontario , canada ) device . this is an fda - approved device that applies low frequency , concentrated , microcurrent stimulation ( at 10k ohms ) for the relief of chronic pain . mps application time was 30  sec per point , for a total of 18 points located in the lower back , hips , and legs ( fig . lower paraspinal acupuncture points urinary bladder ( bl ) ( left ) and gall bladder ( gb ) points ( right ) . the vas is an 11-point scale from 0 to 10 with 0 being no pain and 10 being the most intense pain imaginable . the patient verbally selects a value that is most in line with the intensity of the pain that they have experienced in the past 24  h or is often reported as a rating during a specific movement pattern or functional task . standard acupuncture pain protocol ( sp ) was developed by one of us , b.f . , as treatment approach to provide a simple , easy to apply , nonpharmaceutical solution for the treatment of chronic pain . the protocol involves the application of concentrated microcurrent stimulation ( mps ) to acupuncture points located in the paraspinal lumbar , hips , and legs that isolate the key nerves and muscles that influence core of the body . when these points ( fig . 1 ) are collectively treated with concentrated microcurrent , it has been reported that a wide variety of neuromyofascial pain syndromes can be effectively relieved in a timely basis . the practitioner applying the mps therapy was the sole person imparting the intervention and is a coauthor of  functional acupuncture for pain management ,  and has more than 5,000  h of practical instruction in integrative neuromyofascial pain management . ( 1 )  mps , when applied to standard protocol , can modulate vas pain scale in patients suffering with chronic neck pain , ( 2 )  mps applied to standard protocol is a valid option for the nonpharmacological pain management of neck pain conditions . this study entailed the use of mps in 34 patients ( 24 female , 10 male ; mean age 46 years , sd 9.76 ) with chronic nonspecific neck pain averaging 7.33 years ( mean 7.33 years , sd 11.62 ) , presenting to us for therapy of their neck problem . inclusion criteria were simple : patients who were currently suffering from chronic neck pain for greater than 3 months , with a recorded > 4 visual analog scale ( vas ) pain scale score . the diagnoses of pain , location , severity , sex , previous interventions , or surgeries were not considered exclusion criteria . patient pain scores were recorded pretreatment and twice post - treatment : immediately after application and again 48  h later . patients , who consented to be part of the study , were enrolled from a group of professional therapists attending educational seminars run by one of us ( k.a . ) . they were asked to report pain levels before and after and 48  h after a single mps application . there were no controls in this study , as this was a cohort analysis , with the subjects acting as their own controls relating to prepain and postpain assessments . mps was applied to standard protocol using dolphin neurostim ( acumed medical ltd , ontario , canada ) device . this is an fda - approved device that applies low frequency , concentrated , microcurrent stimulation ( at 10k ohms ) for the relief of chronic pain . mps application time was 30  sec per point , for a total of 18 points located in the lower back , hips , and legs ( fig . lower paraspinal acupuncture points urinary bladder ( bl ) ( left ) and gall bladder ( gb ) points ( right ) . the vas is an 11-point scale from 0 to 10 with 0 being no pain and 10 being the most intense pain imaginable . the patient verbally selects a value that is most in line with the intensity of the pain that they have experienced in the past 24  h or is often reported as a rating during a specific movement pattern or functional task . standard acupuncture pain protocol ( sp ) was developed by one of us , b.f . , as treatment approach to provide a simple , easy to apply , nonpharmaceutical solution for the treatment of chronic pain . the protocol involves the application of concentrated microcurrent stimulation ( mps ) to acupuncture points located in the paraspinal lumbar , hips , and legs that isolate the key nerves and muscles that influence core of the body . when these points ( fig . 1 ) are collectively treated with concentrated microcurrent , it has been reported that a wide variety of neuromyofascial pain syndromes can be effectively relieved in a timely basis . the practitioner applying the mps therapy was the sole person imparting the intervention and is a coauthor of  functional acupuncture for pain management ,  and has more than 5,000  h of practical instruction in integrative neuromyofascial pain management . ( 1 )  mps , when applied to standard protocol , can modulate vas pain scale in patients suffering with chronic neck pain , ( 2 )  mps applied to standard protocol is a valid option for the nonpharmacological pain management of neck pain conditions . the vas response of an n  =  34 patient sample with chronic neck pain having mps applied to lower back acupuncture points reflected an initial 68% reduction in pain [ 3.9050 points ; 95% ci ( 2.9480 , 3.9050 ) ; p  =  0.0001 ] , immediately postapplication and another 35% reduction in pain [ 0.5588 points ; 95% ci ( 0.2001 , 0.9176 ) ; p  =  0.03 ] , between post - treatment and the 48-h follow - up , for a total average pain relief of 80% ( table 1 ; fig . neck pain scores before , immediately after , and 2 days after treatment with mps applied to low neck and gall bladder meridian . chronic neck pain often equates to stress and pain that can make our daily lives miserable , and can lead to significantly impaired physical health . conventional management now includes advice to stay active and continue daily activities , exercise therapy , analgesics ( e.g. , paracetamol , nonsteroidal anti - inflammatory drugs , and opioids ) , muscle relaxants , corticosteroid spinal injections , and referral for consideration of surgery . however , there is a lack of strong evidence of effectiveness for most of these interventions . literature suggests that both acupuncture and physiotherapy are similarly effective for neck pain , with an average reduction of 40%50% in mean pain scores . the data in this cohort study clearly show that the application of mps to standard back protocol provided statistically significantly improved pain outcomes , both immediately postapplication and 48  h follow - up for the treatment of nonspecific neck pain . although it is well supported that abdominal exercising and improved core strength reduce neck pain , the consistency of neck pain outcomes produced through the treatment of acupuncture points of the standard protocol suggests that there may be a stronger relationship between neck pain and lower back and leg acupuncture points than the literature reports . it is of interest that the effect of a single application as per protocol continued to show further pain reduction at the 48-h postevaluation . how long this effect persists needs further study and will help to set guidelines for the frequency of mps therapy . it is suggested that low - amplitude dc current mimics human biocellular communications , and its application may produce regulation of the autonomic nervous system , resulting in body wide therapeutic benefits . it is also further suggested that low - frequency dc microcurrent may activate the pituitary to release endorphins . both these biochemical processes may provide a plausible explanation for the prolonged pain relief after dc microcurrent and is an area where future research is required . we have already reported , in a single case study , a modification in autonomic nervous system parameters ( sympathetic and parasympathetic balance ) parallel to a reduction in pain score in a patient with postconcussion symptomology using mps . it is possible that this same mechanism of action is at play in this cohort analysis , as the pain was not at the same location ; this has to be confirmed in other patients . since there were no controls within this study design , it is difficult to determine whether the point selection process or the microcurrent therapy , or a combination of both , was responsible for the significantly improved pain outcomes . further study is needed in this direction to determine roles of efficacy between these modalities . in conclusion , this study showed mps provided significant ( 62% ) overall improvements in patient pain levels immediately after initial treatment , and a further significant ( 30% ) at the 2-day follow - up , for a total 80% pain relief overall improvement when applied to a standard protocol in patients with chronic neck pain , suggesting a possible future role for these modalities in the management of nonspecific neck pain . this study showed that mps provided statistically significant 68% improvement ( p    0.0001 ) in patient pain levels immediately after initial treatment , and a further statistically significant 35% ( p    0.0001 ) at the 2-day follow - up , for a total 80% pain relief . these significant changes help validate the potential application of mps to standard protocol as an option to clinicians treating patients with chronic neck pain . however , long - term further investigation is warranted with a larger focus group to confirm these results and to assess their duration .
abstractobjectives : although acupuncture and microcurrent are widely used for chronic pain , there remains considerable controversy as to their therapeutic value for neck pain . 
 we aimed to determine the effect size of microcurrent applied to lower back acupuncture points to assess the impact on the neck pain.design : this was a cohort analysis of treatment outcomes pre- and postmicrocurrent stimulation , involving 34 patients with a history of nonspecific chronic neck pain.subjects and settings : consenting patients were enrolled from a group of therapists attending educational seminars and were asked to report pain levels pre - post and 48 hours after a single mps application.interventions and measurements : direct current microcurrent point stimulation ( mps ) applied to standardized lower back acupuncture protocol points was used . 
 evaluations entailed a baseline visual analog scale ( vas ) pain scale assessment , using a vas , which was repeated twice after therapy , once immediately postelectrotherapy and again after a 48-h follow - up period . 
 all 34 patients received a single mps session . 
 results were analyzed using paired t tests.results and outcomes : pain intensity showed an initial statistically significant reduction of 68% [ 3.9050 points ; 95% ci ( 2.9480 , 3.9050 ) ; p  =  0.0001 ] , in mean neck pain levels after standard protocol treatment , when compared to initial pain levels . 
 there was a further statistically significant reduction of 35% in mean neck pain levels at 48  h when compared to pain levels immediately after standard protocol treatment [ 0.5588 points ; 95% ci ( 0.2001 , 0.9176 ) ; p  =  0.03 ] , for a total average pain relief of 80%.conclusions : the positive results in this study could have applications for those patients impacted by chronic neck pain .