Hypoalgesic Effects of Transcutaneous Electrical Nerve Stimulation Combined With Joint Manipulation: A Randomized Clinical Trial

ObjectiveThe objective of this study was to compare the hypoalgesic effects of isolated or combined use of transcutaneous electrical nerve stimulation (TENS) and cervical joint manipulation (JM) in asymptomatic participants.MethodsOne hundred and forty-four healthy participants aged 18 to 30 years old were randomly assigned to 1 of 4 groups (n = 36 per group): active TENS + active JM, active TENS + placebo JM, placebo TENS + active JM, and placebo TENS + placebo JM. Active or placebo TENS was applied to the dominant forearm. JM was applied to the C6-7 segments. The pressure pain threshold was measured pre- and postintervention and after 20 minutes on the forearm and tibialis anterior of the dominant side.ResultsSegmental hypoalgesia was greater in the group active TENS + active JM compared with active TENS + placebo JM (P = .002), placebo TENS + active JM (P < .0001), and placebo TENS + placebo JM (P < .0001). For the extrasegmental hypoalgesia, active TENS + active JM had greater hypoalgesic effect compared with active TENS + placebo JM (P = .033), placebo TENS + active JM (P = .002), and placebo TENS + placebo JM (P < .0001).ConclusionTENS and JM produced hypoalgesia when used alone and, when the treatments were combined, a higher segmental and extrasegmental hypoalgesic effect was obtained in asymptomatic participants.     

The Effect of Transcutaneous Electrical Nerve Stimulation on Pain During Venous Cannulation

BackgroundThe venous cannulation procedure was widely used in many clinical procedures; however, it is associated with pain or discomfort.ObjectivesThe purpose of this study was to investigate whether transcutaneous electrical nerve stimulation (TENS) could reduce pain during cannulation of vein.MethodsOne hundred patients were allocated randomly to 2 groups. In the active TENS group, TENS was delivered via 2 electrodes on the venous cannulation site (radial side of the wrist of dominant forearm) 20 minutes before venous cannulation, and the control group received placebo (no current) TENS. Venous cannulation with a 22-gauge cannula was performed. During venous cannulation, the pain intensity (0 = no pain, 10 = worst pain imaginable) was measured. Any side effects during study periods were recorded.ResultsThe incidence of pain during venous cannulation was similar between the 2 groups. However, pain intensity was significantly lower in the active TENS group than placebo group (P < 0.01). There was no significant difference in the side effects such as erythema and itching between the groups.ConclusionsTENS may be a suitable option for reducing the pain intensity during venous cannulation. ClinicalTrials.gov identifier: NCT01607463.     

针刺联合经皮神经电刺激治疗肝豆状核变性吞咽困难的临床研究

目的探讨肝豆状核变性患者吞咽困难的有效治疗方案。方法将60例肝豆状核变性合并吞咽困难患者分为3组:A组(针刺+经皮神经电刺激+吞咽功能训练),B组(针刺+吞咽功能训练),C组(经皮神经电刺激+吞咽功能训练),1个疗程15d,共治疗2个疗程。应用洼田饮水试验及标准化床边吞咽功能检查表(SSA)进行疗效评价。结果第1个疗程后A组疗效明显优于B组、C组,A组的两种评分差值明显高于B组、C组(P0.01)。第2个疗程后3组之间饮水试验及SSA评分无显著性差异(P0.05)。结论针刺联合经皮神经电刺激和吞咽功能训练综合治疗能够有效改善肝豆状核变性患者的吞咽功能。     

Effect of Transcutaneous Electrical Nerve Stimulation on Postoperative Pain and Patient Satisfaction

Background and AimsThis study was conducted to investigate the effect of transcutaneous electrical nerve stimulation on postoperative pain, changes in patients’ vital signs, and patient satisfaction after inguinal herniorrhaphy.DesignThis study used a randomized controlled design.SettingA state hospital in the west of Turkey.Participants/SubjectsThe study was conducted on 52 patients who had inguinal herniorrhaphy between January and July 2015.MethodsPatients were randomly divided into two groups (intervention and control). Intervention group patients received transcutaneous electrical nerve stimulation postoperatively five times for 30 minutes each. Electrodes in control group patients were placed, but the device was not started. At each transcutaneous electrical nerve stimulation session, the patients’ vital signs and pain severity were recorded. A satisfaction scale was administered before discharge to assess patient satisfaction with nursing care.ResultsPain scores of patients in the intervention group were lower than those in the control group (p < .05). No differences were found in pre–and post–transcutaneous electrical nerve stimulation in the vital signs. Satisfaction scores were higher in the intervention group than control group (p < .05).ConclusionsAfter inguinal herniorrhaphy, transcutaneous electrical nerve stimulation reduced postoperative pain without a negative impact on vital signs and increased patient satisfaction with nursing care.     

Effect of Transcutaneous Electrical Nerve Stimulation on Spasticity in Adults With Stroke: A Systematic Review and Meta-analysis

Objectives

(1) To determine the effect of transcutaneous electrical nerve stimulation (TENS) on poststroke spasticity. (2) To determine the effect of different parameters (intensity, frequency, duration) of TENS on spasticity reduction in adults with stroke. (3) To determine the influence of time since stroke on the effectiveness of TENS on spasticity.

Effects of Transcutaneous Electrical Nerve Stimulation on Mastectomy Pain,Patient Satisfaction,and Patient Outcomes

PurposeMastectomy is one of the most painful surgical procedures. Postoperative pain guidelines recommend transcutaneous electrical nerve stimulation (TENS) as a reliable non-pharmacological analgesic method. The aim of this study was to investigate the effects of TENS on postoperative pain and outcomes in patients undergoing modified radical mastectomy (MRM).DesignA single-center, single-blind, prospective, randomized-controlled study.MethodsThis single-center, single-blind, randomized-controlled study included a total of 80 patients who underwent MRM at general surgery clinic of a tertiary center were included. The pain management of the patient outcomes were evaluated using the Turkish Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R-TR).FindingsThe pain levels of the intervention group were lower than the control group. There were significant improvements in the patient outcomes such as mobilization, position, sleep, anxiety, and fear in the intervention group.ConclusionsOur study results suggest that TENS reduces MRM pain. Thus, TENS can be recommended as a useful analgesic method in MRM.     

穴位经皮电刺激的止痛作用

本文报告40例疼痛病人(其中腰腿痛24例、肩颈痛7例和其他疼痛9例)使用TENS的止痛效果。采用双相脉冲波形,频率3～15Hz,脉宽0.1～1.0ms。按经络学说选用4个治疗穴位,以耐受量刺激强度,治疗15分钟。目测类比评定(0～100分):治疗后平均降低36分(治疗前为67.6分),经t检验,P<0.0005,有非常显著性差异。百分对比评定(0/100%):治疗后平均疼痛减轻51.5%,4例疼痛完全消失,1例无效。治疗后疼痛减轻60%、50%和30%以上者,分别为35%、67.5%和90%。痛觉阈和感觉阈测定:治疗后痛觉阈和感觉阈分别增高2.1mA和1.3mA(N=22),两者均P<0.0005,有非常显著性差异,痛觉阈增高比感觉阈较为显著。止痛持续时间:治疗后24小时追踪14例,疼痛减轻持续2、5、10和24小时以上者,分别为93%、64%、57%和14%左右。结合文献简要地讨论了针刺、电针和神经电刺激的止痛机制。     

Quantification of the Effects of Transcutaneous Electrical Nerve Stimulation With Functional Magnetic Resonance Imaging: A Double-Blind Randomized Placebo-Controlled Study

Kara M, Özçakar L, Gökçay D, Özçelik E, Yörübulut M, Güneri S, Kaymak B, Ak?nc? A, Çetin A. Quantification of the effects of transcutaneous electrical nerve stimulation with functional magnetic resonance imaging: a double-blind randomized placebo-controlled study.

Objective

To evaluate the effects of transcutaneous electric nerve stimulation (TENS) by using functional magnetic resonance imaging (fMRI) in patients with carpal tunnel syndrome (CTS).

Design

Randomized controlled trial.

Settings

University medical center and an outpatient imaging center.

Participants

Female patients with CTS (n=20) were randomized into 2 groups receiving either TENS (n=10) or sham TENS (n=10). In both groups, an initial baseline fMRI session was performed via stimulating digits 2, 5, and 3 in turn, 1 scan run for each. TENS versus sham TENS treatment was given, and a repeat imaging was performed starting 20 minutes after the treatment as follows: second finger on the 20th minute, fifth finger on the 25th minute (ulnar nerve innervated control finger), and third finger on the 30th min.

Interventions

Not applicable.

Main Outcome Measure

Differences in fMRI activation between the 2 groups were evaluated.

Results

Our results demonstrated that 20 to 25 minutes after TENS treatment—but not in the sham TENS group—a significant fMRI signal decrease for digit 2 (post-TENS vs baseline) was observed in the secondary somatosensory regions, ipsilateral primary motor cortex (M1), contralateral supplementary motor cortex (SMA), contralateral parahippocampal gyrus, contralateral lingual gyrus, and bilateral superior temporal gyrus. Measurements on the 25th to 30th minutes for digit 5 were similar between the groups, with presence of activities in areas other than generally activated regions because of painful stimuli. Thirty to 35 minutes after TENS treatment, a significant fMRI signal decrease for digit 3 was detected in the contralateral M1 and contralateral SMA only in the TENS group.

Conclusions

Our findings showed that TENS treatment significantly decreased the pain-related cortical activations caused by stimulation of the median nerve-innervated fingers up to 35 minutes after treatment.     

A Review of the Effects of Transcutaneous Electrical Nerve Stimulation upon the RIII Nociceptive Reflex

Abstract

Transcutaneous electrical nerve stimulation (TENS) is a popular modality for the management of pain, despite a lack of consensus regarding the optimal analgesic stimulation parameters. As a result, throughout the last four decades TENS has been the subject of extensive laboratory-based studies. The current review focuses upon one specific outcome measure, namely the RIII reflex. This reflex has been described as a good physiological correlate of nociceptive pain. Previous studies that have examined the effects of TENS upon the RIII nociceptive reflex have used a diversity of methodologies and provided equivocal results. This paper outlines the work to date, highlights the clinical implications of this work as well as possible reasons for the equivocal results and suggests areas for future investigations.     

Efficacy of Sensory Transcutaneous Electrical Nerve Stimulation on Perceived Pain and Gait Patterns in Individuals With Experimental Knee Pain

Objectives

To examine the effect of experimental knee pain on perceived knee pain and gait patterns and to examine the efficacy of transcutaneous electrical nerve stimulation (TENS) on perceived knee pain and pain-induced knee gait mechanics.

Immediate Effects of Transcutaneous Electrical Nerve Stimulation on Pain and Physical Performance in Individuals With Preradiographic Knee Osteoarthritis: A Randomized Controlled Trial

Objective

To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on knee pain and comprehensive physical function in preradiographic knee osteoarthritis.

Transcutaneous Electrical Nerve Stimulation Reduces Acute Low Back Pain during Emergency Transport

Background: Patients with acute low back pain may require emergency transport because of pain and immobilization. Transcutaneous electrical nerve stimulation (TENS) is a nonpharmaceutical therapy for patients with low back pain. Objective: To evaluate the efficacy of paramedic‐administered TENS in patients with acute low back pain during emergency transport. Methods: This was a prospective, randomized study involving 74 patients transported to hospital. The patients were randomly assigned to two groups: group 1 (n= 36) was treated with true TENS, while group 2 (n= 36) was treated with sham TENS. The authors recorded pain and anxiety as the main outcome variables using a visual analog scale (VAS). Results: The authors recorded a significant (p < 0.01) pain reduction (mean ± standard deviation) during transport in group 1 (79.2 ± 6.5 mm VAS to 48.9 ± 8.2 mm VAS), whereas pain scores remained unchanged in group 2 (75.9 ± 16.4 mm VAS and 77.1 ± 11.2 mm VAS). Similarly, the scores for anxiety were significantly reduced (p < 0.01) in group 1 (81.7 ± 7.9 mm VAS to 69.2 ± 12.1 mm VAS) after treatment. No significant change was noted (84.5 ± 5.8 mm VAS and 83.5 ± 8.9 mm VAS, respectively) in group 2. Conclusions: TENS was found to be effective and rapid in reducing pain during emergency transport of patients with acute low back pain and should be considered due to its ease of use and lack of side effects in the study population.     

经皮电神经刺激治疗中电极位置对改善截肢后幻肢痛的不同影响

目的观察经皮电神经刺激(TENS)不同电极放置治疗截肢后幻肢痛的疗效。方法截肢后幻肢痛患者60例,分为治疗组和对照组各30例,治疗组电极置于对侧肢体相当于幻肢痛的部位,对照组电极置于残端部位。结果治疗2个疗程后,治疗组总有效率为93.3%,总显效率为76.7%,优于对照组(P<0.05)。结论经皮电神经刺激治疗电极放置部位对疗效有影响。     

Transcutaneous Electrical Nerve Stimulation for Phantom Pain and Stump Pain in Adult Amputees

Abstract Following amputation, 50% to 90% of individuals experience phantom and/or stump pain. Transcutaneous electrical nerve stimulation (TENS) may prove to be a useful adjunct analgesic intervention, although a recent systematic review was unable to judge effectiveness owing to lack of quality evidence. The aim of this pilot study was to gather data on the effect of TENS on phantom pain and stump pain at rest and on movement. Ten individuals with a transtibial amputation and persistent moderate‐to‐severe phantom and/or stump pain were recruited. Inclusion criteria was a baseline pain score of ≥3 using 0 to 10 numerical rating scale (NRS). TENS was applied for 60 minutes to generate a strong but comfortable TENS sensation at the site of stump pain or projected into the site of phantom pain. Outcomes at rest and on movement before and during TENS at 30 minutes and 60 minutes were changes in the intensities of pain, nonpainful phantom sensation, and prosthesis embodiment. Mean (SD) pain intensity scores were reduced by 1.8 (1.6) at rest (P < 0.05) and 3.9 (1.9) on movement (P < 0.05) after 60 minutes of TENS. For five participants, it was possible to project TENS sensation into the phantom limb by placing the electrodes over transected afferent nerves. Nonpainful phantom sensations and prosthesis embodiment remained unchanged. This study has demonstrated that TENS has potential for reducing phantom pain and stump pain at rest and on movement. Projecting TENS sensation into the phantom limb might facilitate perceptual embodiment of prosthetic limbs. The findings support the delivery of a feasibility trial.     

The Effect of Transcutaneous Electrical Nerve Stimulation for Pain Relief During Extracorporeal Shock-Wave Lithotripsy Procedure

The purpose of this study was to investigate the effect of transcutaneous electrical nerve stimulation (TENS) for pain relief during extracorporeal shock-wave lithotripsy (ESWL) procedure. An experimental study with repeated measures design was used in this study. Fifty patients aged 20-65 years receiving ESWL treatment were used for this convenience sample. Two applications were used for each patient: one involving administration of TENS instrument for ESWL treatment and the other without TENS. For effective stimulation, 2 stimulator electrodes were placed paravertebrally at L1 and 2 near the lithotripter shock tube before ESWL. Blood pressure, heart rate, pain intensity, analgesic use, and side effects were measured every 10 minutes during the procedure and after the end of ESWL. Results showed that TENS application decreased patients’ intensity of pain and amount of analgesic requests and, related to that, decreased the incidence of side effects and increased patients’ satisfaction during ESWL. TENS application is recommended as a pain-relieving technique during ESWL.     

Efficiency of Neuromuscular Electrical Stimulation and Transcutaneous Nerve Stimulation on Hemiplegic Shoulder Pain: A Randomized Controlled Trial

Objective

To compare the efficacy of neuromuscular electrical stimulation (NMES) and transcutaneous nerve stimulation (TENS) on hemiplegic shoulder pain (HSP).

Feasibility Study of Transcutaneous Electrical Nerve Stimulation (TENS) for Cancer Bone Pain

This multicenter study assessed the feasibility of conducting a phase III trial of transcutaneous electrical nerve stimulation (TENS) in patients with cancer bone pain recruited from palliative care services. Eligible patients received active and placebo TENS for 1 hour at site of pain in a randomized crossover design; median interval between applications 3 days. Responses assessed at 30 and 60 minutes included numerical and verbal ratings of pain at rest and on movement, and pain relief. Recruitment, tolerability, adverse events, and effectiveness of blinding were also evaluated. Twenty-four patients were randomised and 19 completed both applications. The intervention was well tolerated. Five patients withdrew: 3 due to deteriorating performance status, and 2 due to increased pain (1 each following active and placebo TENS). Confidence interval estimation around the differences in outcomes between active and placebo TENS suggests that TENS has the potential to decrease pain on movement more than pain on rest. Nine patients did not consider that a placebo was used; the remaining 10 correctly identified placebo TENS. Feasibility studies are important in palliative care prior to undertaking clinical trials. Our findings suggest that further work is required on recruitment strategies and refining the control arm before evaluating TENS in cancer bone pain.PerspectiveCancer bone pain is common and severe, and partly mediated by hyperexcitability. Animal studies suggest that Transcutaneous Electrical Nerve Stimulation can reduce hyperalgesia. This study examined the feasibility of evaluating TENS in patients with cancer bone pain in order to optimize methods before a phase III trial.     

Headache and Cervical Spine Disorders: Classification and Treatment with Transcutaneous Electrical Nerve Stimulation

SYNOPSIS
A clearer definition of the relationship between headache and disorders of the cervical spine appearsnecessary not only for classification purposes but also for a more rational approach to the management ofsuch conditions. The classification proposed here would distinguish headaches etiologically related to cervicalspine disorders from those in which these disorders might represent just one of several triggering orcomplicating factors. The first group includes cervicogenic headache, occipital neuralgia, auriculotemporalneuralgia, cervicalgia and cervicobrachialgia; the second group includes muscle-contraction headache andmixed headache. Treatment with transcutaneous electrical nerve stimulation (TENS) was applied in 10 patientswith cervicogenic headache, 15 patients with occipital neuralgia, and 35 patients with muscle-contraction ormixed headache. Good results, i.e. HI improvement >60% in 70–80% of cases, were obtained in all three groupsof patients, with no significant differences between them.