Accidental Burns Caused By Infra-Red Heat Lamp Following Electroacupuncture Treatment: A Case Report

Introduction: Infra-red (IR) heat lamp is commonly used to enhance acupuncture therapy. This approach may induce nitric oxide release that improves local microcirculation and triggers biochemical and physiological responses for analgesic effect.[1] This work report a case study on adverse events after exposing to IR heat lamp during electroacupuncture (EA) that combines electrical stimulation via an electrical acupuncture machine in acupuncture needling. Methodology: A retrospective case report of adverse event (burns) caused by IR heat lamp following EA treatment was conducted. The study data were extracted from medical records of the patient. Blood pressure (BP), pulse rate (PR), random blood glucose (RBG) level and pain score using Visual Analogue Scale (VAS) was assessed before initiation of EA treatment at T&CM Unit as part of the routine practice. The adverse event occurred during the EA treatment was reported using Patient Safety Incident Reporting Form. The study was registered with the NMRR and approved by the Medical Research and Ethics Committee, Ministry of Health, Malaysia (KKM/NIHSEC/ P21-966(4)). Results: A 39 year-old wheelchair-bound male diabetic patient experienced second-degree burns with blisters on the right lower limb few hours after receiving the 3rd EA treatment combined with heat therapy (Figure 1). The lesions were developed at the site exposing to the IR heat lamp. He was initially referred to the T&CM Unit for post-spinal cord injury pain. On the first two EA treatments, there was no heat therapy. During the 3rd therapy, an IR heat lamp with timer (Figure 2) was applied to relieve uncomfortable numbness and muscle spasms in his lower legs. He was present with normal vital signs including BP at 127/95 mmHg, PR at 99 beats/min and RBG level at 4.8 mmol/L. Four disposable, sterile, filiform stainless steel acupuncture needles were inserted at needling area/acupoints – neiguan (PC6), hegu (LI4), qiuxu (GB40) and jiexi (ST41). The whole EA treatment lasted for 30 min. At the same time, he was having both oral and external application of multiple analgesic medications. He was unaware of the burns and did not complain any unusual pain at the end of treatment session. The pain due to iatrogenic burns caused by the IR heat lamp was possibly masked by the analgesic medications. The burns were treated with neomycin cream and proper dressings. After changing regular dressings, the wound healed well but hyperpigmentation was present. Discussion/Conclusion: IR heat lamp emits IR electromagnetic radiation that can penetrate the skin and improve blood circulation. The distance between IR heat lamp and treatment site can be adjusted depending on the patient’s condition. A treatment distance of 20 – 46 cm and a duration of 20 – 40 min are usually recommended for acupuncture therapy. [2] Filiform needle allergies may occur with symptoms such as redness and swelling, itchiness and even blister at the needling area following EA treatment but these symptoms usually disappear after stopping the treatment. [3] A recent review has highlighted locally electrical burns associated with EA therapy and third degree burns with large blisters, pain and necrosis at the needle insertion site.[4] However, the information about the electrical stimulator device/ electrical acupuncture machine, type of acupuncture needles used, depth of needling and needle retention time were not reported.The risk of accidental burns by IR devices was higher for patients with sensory impairment such as paraplegia, diabetes and vascular disease.[5] Adverse events due to IR devices such as burns should be preventable. Therefore, it is crucial for healthcare workers and T&CM practitioners to be cautious on the risk factors that may potentiate adverse events caused by IR devices. Following this, protective measures may be implemented accordingly.