定量评估经皮神经电刺激促进周围神经的再生和功能恢复

目的:探讨经皮电刺激对周围神经损伤后组织修复和功能恢复的作用,以神经传导速度为量化恢复指标,以髓鞘增生数目定量分析再生神经纤维数目。方法:实验于1998-09/1999-06在复旦大学附属华山医院实验动物部和显微外科实验室、复旦大学上海医学院手外科研究所肌电图研究室、复旦大学上海医学院电镜中心和病理实验室完成。雄性SD大鼠20只随机分成2组,每组10只。用显微外科手术造成大鼠坐骨神经损伤模型后电刺激组行神经吻合术并进行经皮电刺激,对照组只固定于和电刺激组相同的固定装置上,不进行干预。采用电生理学方法和组织学方法分别观察经皮电刺激对损伤周围神经的神经电位参数和髓鞘结构及数目的影响。结果:实验过程中对照组1只大鼠和电刺激组2只大鼠在麻醉过程中死亡,进入结果分析对照组9只大鼠,电刺激组8只大鼠。①电刺激组大鼠受损坐骨神经的潜伏期较对照组缩短[(0.58±0.33)ms,(2.27±0.88)ms,(t=5.12,P<0.001)]。电刺激组的神经传导速度较对照组增快[(21.44±8.31)m/s,(16.74±22.82)m/s,P>0.05],波幅低于对照组[(1.95±1.56)mV,(6.64±8.42)mV,P>0.05]。②电刺激组可见大量新生髓鞘,其数目较对照组明显增多[9900.86±1433.65,6505.83±779.50,(t=5.16,P<0.001)]。结论:电刺激定量检测的大鼠坐骨神经潜伏期缩短,神经髓鞘计数增高。说明电刺激可能通过促进许旺细胞增殖和髓鞘形成来改善受损周围神经再生和修复的作用。     

经皮电神经刺激配合微波治疗痛性糖尿病周围神经病变疗效观察

目的:观察经皮电神经刺激(TENS)配合微波治疗痛性糖尿病周围神经病变的效果,制定出痛性糖尿病周围神经病变(PDN)的康复治疗模式.方法:将61例痛性糖尿病周围神经病变患者随机分为治疗组(30例)与对照组(31例),两组患者均接受常规糖尿病治疗,另外实验组给予TENS配合微波治疗.在治疗前和治疗1个疗程(15d)后,分别对两组患者进行问卷调查、定量感觉阈值、神经传导速度的评定,并随访观察预后及进行疗效评价.结果:TENS配合微波治疗痛性糖尿病周围神经病变的治疗组与对照组相比,经随访的问卷调查,治疗组患者对四肢末梢神经的感觉异常恢复满意度及疼痛改善程度显著高于对照组;两组间比较,治愈率治疗组(26.7％)优于对照组(9.6％)(P＜0.05),总有效率治疗组(93.3％)优于对照组(48.3％)(P＜0.05).结论:TENS配合微波治疗,能有效治疗痛性糖尿病周围神经病变,用此疗法比患者单纯药物治疗疗效显著.     

Effect of burst-mode transcutaneous electrical nerve stimulation on peripheral vascular resistance

BACKGROUND AND PURPOSE: Based on changes in skin temperature alone, some authors have proposed that postganglionic sympathetic vasoconstrictor fibers can be stimulated transcutaneously. Our goal was to determine the effects of low-frequency (2 bursts per second), burst-mode transcutaneous electrical nerve stimulation (TENS) on calf vascular resistance, a more direct marker of sympathetic vasoconstrictor outflow than skin temperature, in subjects with no known pathology. SUBJECTS: Fourteen women and 6 men (mean age=31 years, SD=13, range=18-58) participated in this study. METHODS: Calf blood flow, arterial pressure, and skin temperature were measured while TENS was applied over the common peroneal and tibial nerves. RESULTS: Blood flow immediately following stimulation was not affected by TENS applied just under or just above the threshold for muscle contraction. Transcutaneous electrical nerve stimulation applied at 25% above the motor threshold caused a transient increase in calf blood flow. Regardless of stimulation intensity, TENS had no effect on arterial pressure; therefore, calf vascular resistance decreased only during the trial that was 25% above the motor threshold. Regardless of stimulation intensity, TENS failed to alter dorsal or plantar skin temperature. DISCUSSION AND CONCLUSION: These results demonstrate that the effects of TENS on circulation depend on stimulation intensity. When the intensity was sufficient to cause a moderate muscle contraction, a transient, local increase in blood flow occurred. Cooling of the dorsal and plantar skin occurred in both the stimulated and control legs, most likely because skin temperature acclimatized to ambient room temperature, rather than because of any effect of TENS on circulation. The data, therefore, call into question the idea that postganglionic sympathetic efferent fibers are stimulated when TENS is applied at clinically relevant intensities to people without symptoms of cardiovascular or neuromuscular pathology.     

经皮神经电刺激对周围神经侧侧缝合后神经再生作用的实验研究

目的：研究经皮神经电刺激对周围神经侧侧缝合后神经再生的影响.方法：健康大耳白兔18只,显露坐骨神经及其分叉处,胫神经和腓总神经相邻神经束膜及外膜缝合.将动物肢体分为实验侧与对照侧.实验侧术后第2天,经皮神经电刺激右下肢,刺激参数：方波,波长0.3ms,频率5Hz,电流峰值3-10mA.刺激时间：每日1次,每次30min,持续6周.左后肢不给予电刺激.实验动物分组：A组（术后电刺激3周）,B组（术后电刺激6周）,C组（术后电刺激16周）;每组6只.结果：通过观察电镜、肌电图,实验侧明显优于对照侧.神经侧侧吻合各组在各时间点依次切开原手术切口,检测C组动物腓总神经的运动传导速度,CAMP的振幅及潜伏期,实验侧神经传导速度及CAMP振幅均优于对照侧,两者差异有显著性意义（P＜0.05）.实验侧CAMP的潜伏期慢于对照侧,两者差异无显著性意义（P＞0.05）.切断各组标本,距吻合口处下方5mm,腓总神经中再生有髓纤维数目实验侧再生有髓纤维均多于对照侧,两者差异有显著性意义（P＜0.05）.结论：神经侧侧吻合后有神经侧支发芽生长,可作为修复神经损伤的一种方法;经皮神经电刺激在提高神经侧侧吻合后神经侧支发芽能力有积极作用.     

Electrode placements for transcutaneous electrical nerve stimulation.

Even though transcutaneous electrical nerve stimulation is gaining increasing acceptance as a noninvasive method of pain modulation, many professionals have not been adequately instructed in the many techniques involved in electrode placement. Alternative methods are presented that can be used when more commonly used methods fail to obtain satisfactory results. Anatomical and physiological considerations for determining appropriate electrode placement sites are stressed.     

Alteration of interferential current and transcutaneous electrical nerve stimulation frequency: effects on nerve excitation.

OBJECTIVES: To investigate the effects of different interferential current (IC) and transcutaneous electrical nerve stimulation (TENS) frequencies on sensory, motor, and pain thresholds. STUDY DESIGN: Single blind, repeated measures design. SETTING: Laboratory. PARTICIPANTS: Women students 18 to 30 years old (n = 24). INTERVENTIONS: Premodulated IC and square-wave TENS pulses (125micros phase duration) were applied over the median nerve at a range of frequencies in all subjects. MAIN OUTCOME MEASURES: The peak current (in milliamperes) was recorded twice at each threshold for each frequency, and averaged. RESULTS: Both IC and TENS displayed a statistically significant effect of frequency for each threshold. However, frequency effects with IC were not well defined and were of small magnitude. Pure 4kHz current (0Hz amplitude modulated frequency) with IC did not produce effects different from those produced when an amplitude modulated frequency was included. With TENS, frequency effects were very clearly observed, with a distinct increase in the current intensity at each threshold as frequency decreased. CONCLUSIONS: It is postulated that the medium frequency component of IC is the main parameter in stimulation, contrary to traditional claims of the amplitude modulated frequency being important. TENS was shown to be a more adaptable method of stimulating these nerve pathways than IC.     

Use of transcutaneous electrical nerve stimulation for postoperative pain

This study examined the effects of transcutaneous electrical nerve stimulation (TENS) on incisional pain caused by the procedure of cleaning and packing an abdominal surgical wound. Seventy-five subjects (mean age 56.9 years) were randomly assigned to one of three intervention groups: TENS, placebo-TENS, or no-treatment control. The appropriate experimental treatment was administered during the routine dressing change which took place two mornings after surgery. Using an 11-point, visual analogue pain scale, subjects described pain experienced during the dressing change. Subjects who received TENS reported a significantly lower level of pain after dressing change than did those subjects who received either placebo-TENS or no-treatment. Drug administration variables did not contribute significantly to level of reported pain.     

Relationship of selected clinical variables to current delivered during transcutaneous electrical nerve stimulation.

Nineteen normal subjects were given transcutaneous electrical nerve stimulation to the hypothenar eminence, back, or legs, using a selected constant-current device. Stimulation characteristics from this unit were measured. Stimulation, at 20- microsec or 80- microsec pulse widths, was provided at increasing strengths until subject tolerance or muscle contraction was reached. The current delivered at each stimulus setting for single or repeated intrasubject trials was reliable at each anatomical landmark. For intersubject single trials, current levels proved reliable in the hand and back but not at any of the three interelectrode distances evaluated in the leg. Possible explanations for this latter finding are offered. This study showed that, for those stimulation settings evaluated, at least one constant-current transcutaneous electrical nerve stimulation unit reliably delivers current of specific stimulus strengths to the hypothenar eminence or back.     

A review of the treatment of chronic low back pain with acupuncture-like transcutaneous electrical nerve stimulation and transcutaneous electrical nerve stimulation

A meta-analysis of published studies was carried out to evaluate the effectiveness of acupuncture-like transcutaneous electrical nerve stimulation (ALTENS) and transcutaneous electrical nerve stimulation (TENS) in controlling pain and improving function in patients with chronic low back pain. Studies in English were identified by searches of EMBASE, MEDLINE, CISCOM and AMED. Other studies were located by citation tracking, searching by hand bibliographies and conference reports, and direct contact with subject experts. Studies were included in the meta-analysis if they were randomized controlled trials comparing ALTENS or TENS with a credible placebo in patients with low back pain of more than 8 weeks duration. Two reviewers extracted data on reduction in pain, changes in range of movement and functional status as well as determining the power of the included studies. Sixty-eight studies were initially identified, of which six (two using ALTENS and four using TENS) involving a total of 288 patients with mixed low back pathologies met the inclusion criteria for meta-analysis. The odds ratio (OR) of improvement in pain was calculated: ALTENS/TENS vs placebo OR = 2.1 (95% Cl 1.3–3.4) ALTENS vs placebo OR = 7.2 (95% CI 2.6–20.1), TENS vs placebo OR = 1.5 (95% CI 0.9–2.6). OR for range of motion (ROM) on ALTENS vs placebo was 6.6 (95% CI 2.4–18.6). There were insufficient data to assess the effect of TENS alone on ROM, functional status and return to work. Similarly there were not enough data to assess ALTENS and functional status and return to work. There is limited statistical evidence that ALTENS and TENS reduce pain and improve function in patients with chronic low back pain, at least in the short term. This review and analysis is severely restricted by the lack of quality, randomized controlled trials. Even 25 years since the introduction of these treatments, powerful randomized controlled studies on the most appropriate use of TENS/ALTENS for the management of chronic low back pain have yet to be produced.     

Telethermographic findings after transcutaneous electrical nerve stimulation

The purpose of this study was to determine whether some types of transcutaneous electrical nerve stimulation cause local vasodilation. The amount of vascular perfusion was monitored using telethermography to gauge the skin temperature of the area to which TENS was applied. We studied the effects of four different modalities of TENS (intensities of 1.5 and 3 times the sensory threshold and frequencies of 3 pulses per second [pps] and 100 pps), delivered through small and large electrodes (1.5 cm and 4 cm in diameter), on 10 healthy subjects. Stimulation at 3 times the sensory threshold produced local hyperthermia, which was maximal when a current of 100 pps was delivered through small electrodes. Because any physical or chemical effects of the current could be eliminated as causes of hyperthermia, the rise in skin temperature was considered to be a result of increased vascular perfusion. The results of the study demonstrate that some types of TENS cause local vasodilation. This effect may represent another mechanism by which such techniques provide pain relief, particularly in the treatment of myofascial syndromes.     

阴极经皮电刺激促进周围神经功能恢复的电生理学研究

目的:研究经皮电刺激对大鼠坐骨神经损伤后的神经电生理学的影响,探讨电刺激促进周围神经功能恢复的有效性。方法:手术横断大鼠坐骨神经后行显微外科神经吻合术并进行经皮电刺激,采用电生理学方法观察电刺激对周围神经再生的影响,并与对照组进行比较。结果:电刺激组受损坐骨神经的潜伏期(0.58±0.33ms)较对照组(2.27±0.88ms)缩短,差异有显著意义。结论:经皮电刺激可能具有促进受损周围神经再生和传导功能恢复的作用。     

Long-term peripheral nerve stimulation for painful nerve injuries

BACKGROUND: Although peripheral nerve stimulation (PNS) has been used in the treatment of pain since 1965, only a few follow-up studies have been published. The aim of the present retrospective study was to carefully assess the long-term efficacy and safety of PNS in the treatment of painful nerve injuries. METHODS: Patients suffering from intractable pain due to peripheral nerve injuries underwent PNS after careful selection. Long-term results were evaluated based upon patients' reports of pain intensity on a visual analog scale (VAS) and their consumption of analgesics. Two categories of results were chosen: good, referring to 50% or more relief of pain with abstinence from analgesic medications; and poor, with less than 50% improvement. RESULTS: Of 154 referred patients, 46 (26 women and 20 men) were found suitable for PNS. Four etiologic factors were identified, the most common being nerve lesion following an operation in the region of the hip or knee. Other etiologies included entrapment neuropathy, pain following nerve graft, and painful neuropathy following a traumatic injection. The follow-up period was 3-16 years. Of the 46 patients who underwent surgery, the results were classified as good in 36 (78%) patients and as poor in 10 (22%) patients. Overall, pain intensity dropped from a VAS of 69 +/- 12 before surgery to 24 +/- 28 postoperatively (P < 0.001). CONCLUSIONS: PNS can produce good pain relief in the majority of carefully selected patients suffering from isolated painful neuropathies.     

经皮神经电刺激在硼替佐米相关周围神经病变患者中的应用效果

目的 探讨经皮神经电刺激在硼替佐米相关周围神经病变患者中应用效果。方法 选取2018年1月-2022年3月收治的62例硼替佐米相关周围神经病变患者,将其随机分为对照组30例,观察组32例,对照组行常规治疗及护理;观察组在对照组的基础上加用经皮神经电刺激治疗。结果 观察组生活自理能力好于对照组(t=19.790,P<0.001),治疗神经传导速度快于对照组(P<0.001),疼痛情况轻于对照组(t=8.824,P<0.001),跌倒风险评分低于对照组(t=28.488,P<0.001)。结论 经皮神经电刺激应用于硼替佐米相关周围神经病变患者中,能减轻患者体征症状,改善其血液循环,使其运动能力和感觉恢复良好,在临床上可以推广应用。     

Cardiac pacemaker inhibition by transcutaneous electrical nerve stimulation

The use of transcutaneous electrical nerve stimulation (TENS) has increased in recent years for the management of chronic pain. One of its few contraindications is the presence of a cardiac pacemaker. Clinicians have recommended that cardiac monitoring be performed for a short interrupted period during the first application of TENS to ensure safety. We present two patients who were given trials of TENS for different chronic pain complaints. In both cases, electrocardiograms during the TENS trial did not reveal cardiac pacemaker dysfunction, but extended cardiac monitoring with the Holter monitor showed interference with pacemaker function. The abnormalities did not recur after reprogramming the sensitivity of the pacemakers. We suggest the use of extended cardiac monitoring for patients with cardiac pacemakers during the prolonged use of TENS to ensure safety and to determine any need for reprogramming of the pacemakers. Patients with cardiac pacemakers should not be excluded from the use of TENS, but careful evaluation and extended cardiac monitoring should be performed.