Original paper Acupunct Med 2012;30:89–95. doi:10.1136/acupmed-2011-010082 89 Abstract Objective To assess the effects of electroacupuncture on stress-related symptoms⎯sleep disorders, anxiety, depression and burnout⎯in medical students, and provide data to inform a power analysis to determinate numbers for future trials. Methods Twenty-five students were randomly assigned to an electroacupuncture (n=12) group or control group (n=13) that did not receive treatment. Electroacupuncture was applied at a continuous frequency 2 Hz for 20 min once a week for 8 weeks at sites on the extremities, face, ear and scalp. The outcomes of the students treated with electroacupuncture were compared with those of the control group at the endpoint, controlling the influence of baseline scores. The instruments used were self-administered questionnaires that comprised the validated Portuguese version of the mini-sleep questionnaire (MSQ), the Pittsburgh sleep quality index (PSQI), the Epworth sleepiness scale (ESS), the Beck depression inventory (BDI), the Beck anxiety inventory, the Maslach burnout inventory–student survey (MBI–SS), and World Health Organization quality of life assessment – abbreviated version (WHOQOL–bref). Results The medical students treated with electroacupuncture showed a significant decrease compared with the control group for MSQ scores (p=0.04) and PSQI (p=0.006). After treatment, 75% students in the electroacupuncture group presented a good sleep quality, compared with 23.1% of the students in the control group. No significant difference on daytime sleepiness was shown by the ESS. The electroacupuncture group showed significant improvement on depressive symptoms (BDI), the emotional exhaustion and cynicism dimensions of burnout (MBI–SS) and physical health (WHOQOL–bref). Conclusions Electroacupuncture was associated with a significant reduction of stress-related symptoms, but because of the study design the authors cannot say what proportion of the reduction was due to needle stimulation. Stress has been defined in terms of stimulus, response and process. In particular, psycho- Effects of electroacupuncture on stress-related symptoms in medical students: a randomised controlled pilot study Marcio Dias, 1 Daniel Pagnin, 1 Valéria de Queiroz Pagnin, 1 Regina Lucia Ribeiro Reis, 1 Beni Olej 2 1 Community Health Institute, Fluminense Federal University, Rio de Janeiro, Brazil 2 Clinical Research Unit, Fluminense Federal University, Rio de Janeiro, Brazil Correspondence to Professor Marcio Dias, Clinical Research Unit, Antonio Pedro University Hospital, Rua Marques do Paraná, 303 4o. andar – Prédio da Emergência, Niterói – RJ – 24033-210, Brazil; mdiasmdias@gmail.com Received 14 September 2011 Accepted 8 February 2012 Published Online First 29 March 2012 logical stress can be defined as a state that is harmful to wellbeing when the stressors are perceived by the individual as surpass- ing his or her coping resources. 1 Stressors are potential threats to the homeostasis of the individual, and activate a stress response that produces physiological and behavioural changes integrated by the limbic system, hypothalamic–pituitary–adrenal axis and autonomic nervous system. The threats or stressors may be real or perceived, and may be traumatic, degenerative, infectious, auto- immune, mental and other. Moreover, the intensity and duration of the stress can trig- ger several heath disorders or worsen pre- existing diseases. 2 3 Techniques such as transcutaneous nerve stimulation, acupuncture with manual or elec- trical (electroacupuncture) stimulation of the needles has been used to treat stress-related symptoms, including psychiatric symptoms (insomnia, depression, anxiety), disorders of visceral functions (cardiovascular, diges- tive, respiratory, urinary tract) and disorders of endocrine, immune and musculoskeletal systems. 4–7 Recent publications have described the onset of burnout in medical students and resi- dent physicians because of continuous stress. In the USA, the prevalence rate of burnout is high, affecting up to 50% of medical students and 23–76% of residents. 8 9 In Brazil, the prev- alence rates of symptoms of stress and depres- sion are 50% and 79% in medical students and residents, respectively. 10 11 Similarly, the prevalence rate of sleep disorders is high in medical students. 12 13 In a longitudinal study in progress, medical students from different aca- demic years showed similar prevalence rates (unpublished data) in the Fluminense Federal University, Niterói, Brazil. The objective of this study was to assess the effects of electroacupuncture on stress-related symptoms including sleep disorders, anxiety, depression and burnout in medical students. As part of this, the study will provide data to inform a power analysis to determine sample sizes for future trials.